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Cervical Dystonia

Cervical dystonia, also called spasmodic torticollis, is a chronic, often painful neurological disorder. Cervical dystonia is a type of movement disorder – conditions that are characterized by loss of control over one or more parts of the body – which is estimated to affect approximately 125,000 people in the United States1, yet awareness of the condition is extremely limited.

Risk Factors and Symptoms

Cervical dystonia is characterized by involuntary contractions of the neck muscles that cause twisting, repetitive movements, or abnormal postures of the head. These muscle contractions hinder normal movement and can cause severe, chronic neck pain. The mean age of symptom onset in patients with cervical dystonia is approximately 41 years – although it may occur in all ages – and women are twice as likely to be affected as men.2 The symptoms of cervical dystonia usually develop gradually over a period of time, with the severity of symptoms leveling off after five years.3 These symptoms can include painful contractions of the neck muscles that force the head to move forward (anterocollis), backward (retrocollis), sideways (laterocollis), or to twist to the left or right (torticollis). The neck spasms experienced by patients with this disorder may be constant or intermittent. This excessive muscle activity is often painful.

Treatment

Cervical dystonia is treated by various medical experts, including neurologists and movement disorder specialists, otolaryngologists (ear, nose and throat specialists), and physiatrists (doctors specializing in physical rehabilitation). While there is no cure for cervical dystonia, there are a number of treatment options that can help relieve the excessive muscle spasms of the neck and shoulder muscles and the associated neck pain. Injection of therapeutic doses of BOTOX®(onabotulinumtoxinA) neurotoxin into the neck and shoulder muscles is a commonly chosen treatment and is considered a first-line therapy for cervical dystonia4 in adults to treat the abnormal head position and neck pain that happens with cervical dystonia. The effect is temporary and the treatment can be readministered approximately every three months depending on the individual patient. In severe cases, surgeries in which either the nerve to the contracting muscle is cut or a section of the muscle itself is removed are recommended in patients who do not respond to less invasive therapy.

Finally, physical therapy is generally recommended in all patients with cervical dystonia to help ease the severity of contractions. Stretching exercises and neck braces have been shown to ease the severity of contractions and are recommended in addition to medication and/or other therapies.

Indications

BOTOX® is a prescription medicine that is injected into muscles and used:

  • to treat increased muscle stiffness in elbow, wrist, and finger muscles with upper limb spasticity in people 18 years and older.
  • to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in people 16 years and older.
  • to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (blepharospasm) in people 12 years and older.

BOTOX® is also injected into the skin to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough in people 18 years and older.

It is not known whether BOTOX® is safe or effective for other types of muscle spasms or for severe sweating anywhere other than your armpits.

IMPORTANT SAFETY INFORMATION

BOTOX® may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX®:

  • Problems swallowing, speaking, or breathing, due to weakening of associated muscles,can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months.
  • Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice (dysphonia), trouble saying words clearly (dysarthria), loss of bladder control, trouble breathing, trouble swallowing.

There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat severe underarm sweating, blepharospasm, or strabismus.

The dose of BOTOX® is not the same as, or comparable to, another botulinum toxin product.

Serious and/or immediate allergic reactions have been reported. These reactions include itchy rash, swelling, and shortness of breath. Tell your doctor or get medical help right away if you experience any such symptoms, further injection of BOTOX® should be discontinued.

Do not take BOTOX® if you: are allergic to any of the ingredients in BOTOX® (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® or Dysport®; have a skin infection at the planned injection site.

Tell your doctor about all your muscle or nerve conditions such as amyotrophic lateral sclerosis [ALS or Lou Gehrig’s disease], myasthenia gravis or Lambert-Eaton syndrome as you may be at increased risk of serious side effects including severe dysphagia (difficulty swallowing) and respiratory compromise (difficulty breathing) from typical doses of BOTOX®.

Tell your doctor about all your medical conditions, including if you have: plans to have surgery; had surgery on your face; weakness of forehead muscles, such as trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (It is not known if BOTOX® can harm your unborn baby); are breast-feeding or plan to breastfeed (It is not known if BOTOX® passes into breast milk).

Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins and herbal products.

BOTOX® may cause loss of strength or general muscle weakness, or vision problems. If this happens, do not drive a car, operate machinery, or do other dangerous activities.

Other side effects of BOTOX® include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes.

For more information refer to the Medication Guide or talk with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see BOTOX® full Product Information, including Medication Guide.



  1. Spasmodic Torticollis (ST) Dystonia Web site. Accessed March 2, 2009. Available at: http://www.spasmodictorticollis.org/newsroom_QASheet.cfm

  2. Jankovic, J; Dystonia: Etiology, Clinical Features, and Treatment, 2004: Chapter 13, Page 159

  3. Pathak, M; The Spasmodic Torticollis Handbook, 2003

  4. Jankovic J. Treatment of Cervical Dystonia With Botulinum Toxin. 2004;19(Suppl 8): pp S109-S115 Movement Disorders 2004;19: pp S109-S115