title: Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin.
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.
authors.affiliation: Department of Neurology, Haga Teaching Hospital, The Hague, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.
authors.forename: Maria Fiorella
authors.initials: MF
authors.lastname: Contarino
authors.affiliation: Department of Neurology AB 51, University Medical Centre Groningen, Groningen, Netherlands; ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Van Den Dool
authors.affiliation: Movement Disorders Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yacov
authors.initials: Y
authors.lastname: Balash
authors.affiliation: Sobell Department, Institute of Neurology, National Hospital for Neurology, University College London , London , UK.
authors.forename: Kailash
authors.initials: K
authors.lastname: Bhatia
authors.affiliation: Movement Disorders Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
authors.affiliation: Department of Neurology/Clinical Neurophysiology, Academic Medical Center , Amsterdam , Netherlands.
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Koelman
authors.affiliation: Department of Neurology, Copenhagen University Hospital Bispebjerg , Copenhagen , Denmark.
authors.forename: Annemette
authors.initials: A
authors.lastname: Lokkegaard
authors.affiliation: Department of Neurology, Hospital Clinic i Universitari, Institut D'Investigacio Biomedica August Pi i Sunyer (IDIBAPS), CIBERNED , Barcelona , Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Marti
authors.affiliation: Department of Neurology/Clinical Neurophysiology, Academic Medical Center , Amsterdam , Netherlands.
authors.forename: Miranda
authors.initials: M
authors.lastname: Postma
authors.affiliation: Movement Disorders Center, Department of Neurology, Clinical Medical Center School of Medicine, Zagreb University , Zagreb , Croatia.
authors.forename: Maja
authors.initials: M
authors.lastname: Relja
authors.affiliation: Department of Neurology, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia.
authors.forename: Matej
authors.initials: M
authors.lastname: Skorvanek
authors.affiliation: Department of Neurology/Clinical Neurophysiology, Academic Medical Center , Amsterdam , Netherlands.
authors.forename: Johannes D
authors.initials: JD
authors.lastname: Speelman
authors.affiliation: Department of Neurology/Clinical Neurophysiology, Academic Medical Center , Amsterdam , Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Zoons
authors.affiliation: Clinical Pharmacology Unit, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon , Lisbon , Portugal.
authors.forename: Joaquim J
authors.initials: JJ
authors.lastname: Ferreira
authors.affiliation: Sorbonne University, UPMC Paris-6, Paris, France; Brain and Spine Institute - ICM, Centre for Neuroimaging Research - CENIR, UPMC UMR 1127, Paris, France; INSERM U 1127, Paris, France; CNRS UMR 7225, Team Control of Normal and Abnormal Movement, Paris, France; Department of Neurology, Salpêtriere Hospital, AP-HP, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Vidailhet
authors.affiliation: Department of Neurology, Humanitas Research Hospital, Milano, Italy; Department of Neurology, Università Cattolica del Sacro Cuore, Milano, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.affiliation: Department of Neurology AB 51, University Medical Centre Groningen , Groningen , Netherlands.
authors.forename: Marina A J
authors.initials: MA
authors.lastname: Tijssen
keywords: botulinum toxin; cervical dystonia; efficacy; recommendations; side effects; treatment strategy