| Background:Cervical dystonia (Spasmodic torticollis) is the most common focal type seen in adult-onset disease, most patients manifest involuntarily paroxysmal or consistent contraction of cervical muscles, leading to the deviation of head or paroxysmal muscle spasm. Patients often feel painful in the involved muscles, and there could be sometimes tremor in the involved muscle. Currently, the exact pathophysiology of cervical dystonia is not yet understood, and it has many overlapping characteristics with other diseases, so the diagnosis and treatment of cervical dystonia is a sophisticated art in the clinical practice.Objective:In this article, we tried to combine with case series and literature review to compare the efficacy of different therapy, and hopefully our result can provide some evidence to the neurologists when they consider the treatment plan for their cervical dystonia patients in the future.Methods:From October 2013 to February 2016, we collect 18 patients with diagnosed cervical dystonia from our inpatient and outpatient service.10 of them received medical treatment,7 of them received Botox injection and 1 of them received Deep Brain Stimulation (DBS). We compared the patients’ baseline and post-treatment TWSTRS (Toronto Western Spasmodic Torticollis Rating Scale) scores and SF-36 (the Medical Outcome Study 36-items short-form health survey, Short Form-36) scores. Plus, we searched Medline via Pubmed with keywords of "cervical dystonia", "review", and we found and read 508 articles from January 1967 to February 2016. Currently there is still not a general guideline to help neurologists choose plan for their patients, and there are currently tons of therapies that might offer some help to patients with cervical dystonia, from noninvasive to invasive, but every one has its own advantages and disadvantages.Results:After analyzing all the data we collected, we concluded that for patients with disease course less than 3 months — it greatly improves symptoms (45.0%). But for patients with disease course longer than 3 months, its efficacy dramatically decreases. Overall, the symptoms improved with Botox injection in our cases up to 47.7% and the quality of life is greatly improved(P<0.05). However, Botox is not long-lasting and it requires frequent re-injection, this disadvantage may lead to resistance of Botox by specific antibodies produced due to frequent exposure. So patients might lose their response to the injection eventually. For those patients without responses to Botox injection, neurologist could consider to ask consult from neurosurgeons for surgical treatment. Nowadays, with the maturation of deep brain stimulation (DBS) skills and technique, it is more and more prevalent and gradually becomes the first-line choice in dystonia surgical treatment. It is relatively minimally invasive, with less adverse reactions and better benefit. In our data, patients’ symptoms improved 41.3% after receiving DBS and their depressive symptoms were greatly improved.Conclusions:Cervical dystonia is the most common adult-onset focal dystonia, and it has many overlapping manifestations with other disease. Currently we are still not sure about its exact pathogenesis, so we still have many obstacles in diagnosing and treating cervical dystonia. For now, most therapies focus on the relief of symptoms, but early diagnosis and treatment is very important. Besides, patient education could also enhance patient-physician relationship and their cooperation. Patients with early disease could be put on medications, but if there is no response or patient could not tolerate the side effects, Botox injection should be recommended. For patients who do not improve with Botox injection, Deep Brain Stimulation is the next choice in line. Furthermore, physical therapy is always a great add-up in any regimen because it can help patient relieve their pain. In a word, choosing a treatment plan needs to base on a patient’s specific situation and requests. |
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