There are several treatments for<unk> , the most commonly used being botulinum toxin injections in the dystonic muscle of the neck. Other treatments include sensory trick for a mild occasional twinge, oral medications, and deep brain<unk> imulation. Combinations of these treatments have been used to control<unk> . In addition, selective surgical denervation of nerves triggering muscle contractions may offer relief from spasms and pain, and limit damage to the spine as a result of torqued posture. Spinal fibrosis (i.e., locking of spinal facets due to muscular contortion resulting in fused vertebrae) may occur rapidly. Therefore, it is important to seriously evaluate the option of surgical denervation as early as possible. This suggests that the desynchronization of the frequency range is movement related. Obtaining relief via a "sensory trick", also known as a geste antagoniste, is a common characteristic present in focal dystonias, most prevalently in cervical dystonia; however, it has also been seen in patients with blepharospasm. Sensory tricks offer only temporary and often partial relief of<unk> . 74% of patients report only partial relief of<unk>  compared to 26% reporting complete relief. The sensory trick must also be applied by the patient themselves. When the sensory trick is applied by an examiner, only 32% of patients report relief comparable to relief during self-application. Since the root of the problem is neurological, doctors have explored sensorimotor retraining activities to enable the brain to "rewire" itself and eliminate dystonic movements. Oral medications In the past, dopamine blocking agents have been used in the treatment of<unk> . Treatment was based on the theory that there is an imbalance of the neurotransmitter dopamine in the basal ganglia. These drugs have fallen out of fashion due to various serious side effects: sedation, parkinsonism, and tardive dyskinesia. Other oral medications can be used in low doses to treat early<unk> ages of<unk> . Relief from<unk>  is higher in those patients who take anticholinergic agents when compared to other oral medications. Many have reported complete management with gabapentin alone or in combination with another drug such as clonazepam. 50% of patients who use anticholinergic agents report relief, 21% of patients report relief from clonazepam, 11% of patients report relief from baclofen, and 13% from other benzodiazepines. Higher doses of these medications can be used for later<unk> ages of<unk> ; however, the frequency and severity of side effects associated with the medications are usually not tolerated. Side effects include dry mouth, cognitive disturbance, drowsiness, diplopia, glaucoma and urinary retention. Botulinum toxin Target molecules of botulinum (BoNT) and tetanus (TeNT) toxins inside the axon terminal. The most commonly used treatment for<unk>  is the use of botulinum toxin injection in the dystonic musculature. Botulinum toxin type A is most often used; it prevents the release of acetylcholine from the presynaptic axon of the motor end plate, paralyzing the dystonic muscle. By disabling the movement of the antagonist muscle, the agonist muscle is allowed to move freely. With botulinum toxin injections, patients experience relief from<unk>  for approximately 12 to 16 weeks. There are several type A preparations available worldwide; however Botox and Dysport are the only preparations approved by the U.S. Food and Drug Administration (FDA) for clinical use in the United<unk> ates. Some patients experience or develop immunoresistance to botulinum toxin type A and must use botulinum toxin type B. Approximately 4% to 17% of patients develop botulinum toxin type A antibodies. The only botulinum toxin type B accessible in the United<unk> ates is Myobloc. Treatment using botulinum toxin type B is comparable to type A, with an increased frequency of the side effect dry mouth. Common side effects include pain at the injection site (up to 28%), dysphagia due to the spread to adjacent muscles (11% to 40%), dry mouth (up to 33%), fatigue (up to 17%), and weakness of the injected or adjacent muscle (up to 56%). A Cochrane review published in 2016 reported moderate-quality evidence that a single Botulinum toxin-B treatment session could improve cervical dystonia symptoms by 10% to 20%, although with an increased risk of dry mouth and swallowing difficulties. Another Cochrane review published in 2020 for Botulinum toxin-A found similar results. Deep brain<unk> imulation Insertion of electrode during surgery Deep brain<unk> imulation to the basal ganglia and thalamus has recently been used as a successful treatment for tremors of patients with Parkinson's disease. This technique is currently, as of 2007, being trialed in patients with<unk> . Patients are subjected to<unk> imulation of the globus pallidus internus, or the subthalamic nucleus. The device is analogous to a pacemaker: an external battery is placed subcutaneously, with wires under the skin which enter the skull and a region of the brain. To<unk> imulate the globus pallidus internus, microelectrodes are placed into the globus pallidus internus bilaterally. After the surgery is performed, multiple visits are required to program the settings for the<unk> imulator. The<unk> imulation of the globus pallidus internus disrupts the abnormal discharge pattern in the globus pallidus internus, resulting in inhibition of hyperactive cortical activity. Globus pallidus internus deep brain<unk> imulation is the preferred surgical procedure, due to the lower frequency of side effects. Advantages of deep brain<unk> imulation include the reversibility of the procedure, and the ability to adjust the settings of the<unk> imulation. In one<unk> udy, patients who had developed immunoresistance to botulinum toxin underwent globus pallidus internus deep brain<unk> imulation, showing improvement by 54.4% after three to six months. There is a low rate of side effects for those who undergo deep brain<unk> imulation. The most common side effect is headache, occurring in 15% of patients, followed by infection (4.4%) and cognitive dysfunction (4%). Serious side effects are seizure (1.2%), intracerebral hemorrhage (0.6%), intraventricular hemorrhage (0.6%), and large subdural hematoma (0.3%). Physical Interventions Physical treatment options for cervical dystonia include biofeedback, mechanical braces as well as patients self-performing a geste antagoniste. Physical therapy also has an important role in managing<unk>  by providing<unk> retching and<unk> rengthening exercises to aid the patient in keeping their head in proper alignment with their body. Patients with cervical dystonia ranked physical therapy intervention second to botulinum toxin injections in overall effectiveness in reducing symptoms and patients receiving physiotherapy in conjunction with botulinum toxin injections reported enhanced effects of treatment compared to the injections alone. One<unk> udy examined patients with cervical dystonia who were treated with a physiotherapy program that included muscle<unk> retching and relaxation, balance and coordination training, and exercises for muscle<unk> rengthening and endurance. A significant reduction in pain and severity of dystonia as well as increased postural awareness and quality of life was found.
Spasmodic torticollis
Torticollis
Dysbarism
Superior oblique myokymia
Pseudostrabismus
Benign paroxysmal torticollis
Hemifacial spasm
Misophonia