Botulinum Toxin Injections for Cervical Dystonia

Dystonia is the medical term used to describe abnormal and sudden muscle spasms that result in painful and repetitive movements or postures (Pana & Saggu, 2023). The addition of cervical to dystonia indicates the area affected. Cervical dystonia (CD), also known as spasmodic torticollis, is the most common type of dystonia and can be accompanied by other types of dystonia.

There are two types of CD, acquired and primary. It is more often seen in women/AFAB between 30 and 50 years old (Kilic‐Berkmen et al., 2021). Recent research has highlighted the possibility of a genetic factor in the development of CD (Siokas et al., 2018).

The most common cause of acquired CD is a traumatic head, neck, or upper spine injury. Some medications, such as anti-seizure drugs, may also cause this type of CD. However, primary CD is thought to be caused by a genetic issue and is most often seen in adults.

CD is considered to be a neurological disorder, where the muscles receive sudden and abnormal signals from the brain, causing sudden muscle spasms. However, the exact mechanism of action of CD is still being researched.

The symptoms of CD start gradually before getting worse if left untreated. Long-term untreated CD may cause permanent damage to the neck and cervical spine. The main symptom of CD is twisting of the head towards the chin, shoulder, or straight down. It may disappear on its own before returning with greater intensity. The diagnosis of CD is based primarily on the physical symptoms seen during an examination.

Children with cerebral palsy may develop CD as a secondary symptom.

The introduction of a safe and purified strain of Clostridium botulinum, the bacteria responsible for botulism food poisoning, into the body through an, or a series of, injection(s) is known as botulinum toxin injections (BTI). These bacteria create a substance that acts on the muscle receptors and prevents acetylcholine, a neurotransmitter, from binding to its receptors (Padda & Tadi, 2023).

By blocking the acetylcholine from binding to the muscle receptors, it prevents those muscles from contracting, forcing them into a state of relaxation. This is also referred to as muscle paralysis. Through this effect, strained muscles can rest and recover from any injuries that may be causing pain.

Furthermore, blocking acetylcholine from attaching to nerves reduces its ability to transmit pain signals to the brain. This leads to less overall pain as the brain doesn’t receive those signals.

BTI is a good pain management option for people with muscle- or nerve-related pain issues, especially if other treatments haven’t provided good results. It provides long-term pain relief through a minimally invasive procedure with few side effects.

The use of BTI for CD has been approved since 2000 and is considered the best treatment for this disorder (Jankovic et al., 2023). Treating CD with BTI has been shown to reduce pain, and the risk of long-term and permanent side effects of untreated CD, and improve the overall quality of life of patients. While somewhat invasive, BTI is safe and recommended as the first treatment in a CD treatment plan.