title: Practical guidance for CD management involving treatment of botulinum toxin: a consensus statement.
abstract: Cervical dystonia is a neurological movement disorder causing abnormal posture of the head. It may be accompanied by involuntary movements which are sometimes tremulous. The condition has marked effects on patients' self-image, and adversely affects quality of life, social relationships and employment. Botulinum neurotoxin (BoNT) is the treatment of choice for CD and its efficacy and safety have been extensively studied in clinical trials. However, current guidelines do not provide enough practical information for physicians who wish to use this valuable treatment in a real-life setting. In addition, patients and physicians may have different perceptions of what successful treatment outcomes should be. Consequently, an international group of expert neurologists, experienced in BoNT treatment, met to review the literature and pool their extensive clinical experience to give practical guidance about treatment of CD with BoNT. Eight topic headings were considered: the place of BoNT within CD treatment options; patient perspectives and desires for treatment; assessment and goal setting; starting treatment with BoNT-A; follow-up sessions; management of side effects; management of non-response; switching between different BoNT products. One rapporteur took responsibility for summarising the current literature for each topic, while the consensus statements were developed by the entire expert group. These statements are presented here along with a discussion of the background information.
authors: Neurologia I Istituto Neurologico Carlo Besta, Università Cattolica del Sacro Cuore, Via G. Celoria, 11, 20133, Milan, Italy. alberto.albanese@unicatt.it.
authors: Alberto
authors: A
authors: Albanese
authors: Centre for Parkinson's Disease and Movement Disorders DINOGMI, University of Genoa Largo Daneo 3, 16132, Genoa, Italy.
authors: Giovanni
authors: G
authors: Abbruzzese
authors: Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Germany.
authors: Dirk
authors: D
authors: Dressler
authors: Section of Neurology, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 15, 205 02, Malmö, Sweden.
authors: Wojciech
authors: W
authors: Duzynski
authors: Neurological Department for Post-Stroke Patients, Moscow Federal State Hospital for Treatment and Rehabilitation Ministry of Health Russia, Moscow, Russia.
authors: Svetlana
authors: S
authors: Khatkova
authors: Neurology Service, Institut Cliníc de Neurosciències (ICN), CIBERNED, Hospital Clinic of Barcelona, Barcelona, Spain.
authors: Maria Jose
authors: MJ
authors: Marti
authors: Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.|Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Seville, Spain.
authors: Pablo
authors: P
authors: Mir
authors: Department of Biomedical Sciences, University of Padova, Via Ugo Bassi n. 58/B, 35121, Padua, Italy.
authors: Cesare
authors: C
authors: Montecucco
authors: Division of Neurology, CHU of Grenoble, Joseph Fourier University, Grenoble, France.
authors: Elena
authors: E
authors: Moro
authors: Center for Neurorehabilitation, Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria.
authors: Michaela
authors: M
authors: Pinter
authors: Referral Center for Movement Disorders, Department of Neurology, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
authors: Maja
authors: M
authors: Relja
authors: AP-HP, Hôpital de la Pitié Salpêtrière, Département de Neurologie, 75013, Paris, France.|Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France.
authors: Emmanuel
authors: E
authors: Roze
authors: Movement Disorders Unit, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Inger Marie
authors: IM
authors: Skogseid
authors: Department of Neurogenetics, Research Center of Neurology, Russian Academy of Medical Sciences, 80 Volokolamskoye shosse, Moscow, 125367, Russian Federation.
authors: Sofiya
authors: S
authors: Timerbaeva
authors: Department of Neurology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors: Charalampos
authors: C
authors: Tzoulis
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use*; D032921:Consensus; D006801:Humans; D009498:Neurotoxins / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D014103:Torticollis / Q000188:drug therapy*
chemical_list: D009498:Neurotoxins; D001905:Botulinum Toxins
keywords: Botulinum toxin type A; Botulinum toxins; Consensus development conference; Decision making; Dystonia; Torticollis