Cervical dystonia (CD) is a painful condition where the neck muscles contract involuntarily causing the head to twist or turn into an uncomfortable position. CD is a central nervous system disorder. It is primarily associated with involuntary muscle contractions around the neck, leading to repetitive or constant neck movements causing bizarre head postures. This disability and the resulting pain hinder the activities of daily living, social participation, and quality of life causing stigmatization.

Botox therapy for cervical dystonia
Botox has emerged as the first-line treatment for cervical dystonia. In this treatment, botulinum neurotoxin is injected to the dystonic neck muscles. This therapy has demonstrated success in safety and efficiency in several randomized controlled trials. Botox treatment has shown a reduction in symptoms of cervical dystonia. This therapy is found to be far superior from pharmacological treatment with anticholinergic drugs.

However, the neurotoxin effect is only temporary. Hence, repeated injections are necessary within a period of 8 to 16 weeks. The effect of the toxin builds up over the first four weeks. This is a reason why patients experience fluctuating severity of symptoms of cervical dystonia. Furthermore, the patients may see variable benefit from the following repeated injections as the treatment is skill-based. The benefit of the injection is limited to the application of the appropriate dosage into the appropriate depth of the neck muscles.

Limitations of Botox treatment for cervical dystonia
Some notable studies reveal that 60% of the patients subject to Botox treatment for cervical dystonia have shown satisfactory results. Some of the limitations of the treatment are:

• The effect of this treatment diminishes sooner than the expected time duration of twelve weeks or more in half the number of patients.
• Limited results of Botox therapy can be seen when tremors or jerky movements appear; in such cases, a number of muscles are involved together — this blocks a target-oriented injection.
• Botox treatment may cause some adverse effects such as neck weakness, dysphagia, dry mouth, or dysphonia.
• When Botox therapy is used for chronic treatment, it causes antibodies to develop in up to 5% of patients.
• Despite these limitations and the discomfort associated with repeated Botox injections, many patients adhere to this therapy, because of a potential lack of information about alternative therapies.

Botox versus Deep Brain Stimulation (DBS)
Botox as the first-line treatment for cervical dystonia, may not be successful in controlling the symptoms in a certain group of patients. Deep brain stimulation is a surgical therapy for movement disorders, which requires implantation of stimulating electrodes connected to a pacemaker device. So far, DBS is considered in cases where Botox does not give the expected results. Treatment effects of DBS are strong as it completely disables the symptoms. However, a DBS surgery carries a risk of permanent morbidity and mortality resulting from intracranial hemorrhage. But researchers are working to remove the limitations of DBS so that its benefits can be experienced in the initial stages of cervical dystonia rather than administering DBS therapy toward the end.