What treatment options are there for cervical dystonia?

What type of treatment will you need?
Since the exact cause of cervical dystonia is unknown, treatments are aimed at reducing the symptoms of the condition to help you to live your life as normally as possible. There are different treatments that your doctor may suggest and discuss with you and advise on which of these may be suitable for you, as follows:

ORAL MEDICINES:
Oral medicines - include drugs such as anticholinergics, benzodiazepines and GABA agonists.

COMPLEMENTARY (non-medical) CARE:
There are different types of ‘complementary or non-medical care’ that may help you.

Physiotherapy can help you to improve your posture and by working on different muscle groups, help you to increase your range of movements.

Supportive therapy and counselling may also be of benefit to assist you with any feelings of reduced self-esteem, depression and social isolation which are common feelings for cervical dystonia sufferers.

BOTULINUM TOXINS:
Botulinum toxin injections are a widely used treatment that can provide benefit in some patients.

What are botulinum toxins?
Botulinum toxins are a group of proteins produced naturally by the bacterium Clostridium botulinum. Very small doses of botulinum toxins are used as a treatment in some cervical dystonia patients when used under careful medical supervision.

How do botulinum toxins work?
Nerve endings normally produce a chemical substance called acetylcholine which cause muscles to contract. Botulinum toxins work by blocking the release of acetylcholine from the nerves in the area of muscle where they are injected, so inhibiting muscle contractions and causing the muscle to relax. The goal of treatment is to reduce the involuntary contractions and spasms of cervical dystonia, produce muscle relaxation and so help to relieve symptoms.

What will botulinum treatment involve for you?
Botulinum toxins have to be injected directly into the overactive muscles affected by the cervical dystonia; this must be done at the clinic where you are being treated. The effect of the injection will lasts for variable periods of time in different patients but is usually about 12 to 16 weeks, so you will receive injections on a regular basis – your doctor will decide how often you will need these depending on the severity of your symptoms and your response to the injection.

What can you expect after an injection?
As with any injection, you may feel some stinging or mild pain but this should not last. Any benefits of the injection and symptom improvements will be noticed within 7-14 days and will probably last for several weeks, often until the time of the next injection. However, each patient is unique and for some, it may take several injections to achieve maximum benefit; please do not become discouraged if you do not experience major improvements immediately. Your doctor will work with you to try to achieve the best results for you.

Do all botulinum toxins have the same effect?
There are several different types of botulinum toxins, each has a slightly different make up and works slightly differently, although all produce similar effects on the nerves and muscles. Your doctor will choose the toxin he considers most suitable for you.

Will you experience any side effects or adverse reactions from botulinum toxin treatment?
The most common side effects are:

Dry mouth
Dysphagia (difficulty swallowing)

Other side effects reported include:

Neck pain
Indigestion
Blurred vision
Constipation
Flu-like symptoms
Loss of strength and energy

Breathing, choking or speech difficulties, or any worsening swallowing problems following any toxin treatment may indicate toxin spread. If you experience any of these symptoms you should immediately seek medical attention.

You should make sure your doctor knows of any previous treatments you have received for your cervical dystonia, as well as any medications that you are taking.

NB The safety and efficacy of botulinum toxins in children have not been demonstrated.

For the full list of side effects, please see individual product Patient Information Leaflets.

Surgery SURGERY:
When patients are no longer responsive to other treatments, surgery may be considered. The aim of surgery is to interrupt the faulty communication between the brain and muscles that cause the involuntary muscle movements. However, as surgery is neither suitable for all patients, nor proven to be always effective, this is again something that you will need to discuss with your doctor.

How will cervical dystonia affect your life?
As has been said, this condition affects individuals differently and varies in severity, so it is not possible for your doctor to tell you exactly what to expect at the time of diagnosis. Only with time will it become more obvious how you are affected. You should be aware that some daily routine tasks may become more difficult e.g. driving, writing, but again it will depend how your condition progresses and how well you respond to treatment. If you have difficulty with some daily tasks, physiotherapy and other complementary therapies may help you to achieve relaxation and symptom relief. Again, it is important to work closely with your doctor to ensure that you receive the correct medical support for you to help you to cope with your condition.

Other support: Gaining information about the condition can make it easier for you to know what to expect from the future. Contact with other people suffering with cervical dystonia can also be helpful, either by email or telephone or even by meeting up. The European Dystonia Society can put you in touch with others (http://www.dystonia-europe.org/).