AUTHOR=Contarino Maria Fiorella , Van Den Dool Joost , Balash Yacov , Bhatia Kailash , Giladi Nir , Koelman Johannes H. , Lokkegaard Annemette , Marti Maria J. , Postma Miranda , Relja Maja , Skorvanek Matej , Speelman Johannes D. , Zoons Evelien , Ferreira Joaquim J. , Vidailhet Marie , Albanese Alberto , Tijssen Marina A. J. TITLE=Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin JOURNAL=Frontiers in Neurology VOLUME=8 YEAR=2017 URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00035 DOI=10.3389/fneur.2017.00035 ISSN=1664-2295 ABSTRACT=

Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.