Dystonia, cervical

Indications Blepharospasm, hemifacial spasm, spasmodic torticollis, sialorrhea, hyperhidrosis, strabismus, oromandibular dystonia, cervical dystonia, spasmodic dysphonia. Cosmetic application for wrinkles... 

Botulinum neurotoxins are widely used as therapeutic agents to cause reduction or paralysis of skeletal muscle contraction. They are used to treat cervical dystonia, which causes regional involuntary muscle spasms often associated with pain. Moreover, they are used in strabism, blepharospasm, hemifacial spasm, and... 

Cervical dystonia (CD) (Botox only) For the treatment of CD in adults to decrease the severity of abnormal head position and neck pain associated with CD. Glabellar lines (Botox Cosmetic only) For the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator or procerus muscle activity in adult patients 65 years of age or younger. 

Botox (Toxin) Muscle relaxation activity, cervical dystonia Botulinum sp. 

Costa J, Borges A, Espirito-Santo C, et al. Botulinum toxin type A versus botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev. 2005 CD004314. 

Dressier D, Bigalke H. Botulinum toxin type B de novo therapy of cervical dystonia. Frequency of antibody induced therapy failure. J Neurol. 2005 252 904-907. 

Truong D, Duane DD, Jankovic J, et al. Efficacy and safety of botulinum type A toxin (Dysport) in cervical dystonia results of the first US randomized, doubleblind, placebo-controlled study. Mov Disord. 2005 20 783-791. 

Jahn R, Lang T, Siidhof TC (2003) Membrane fusion. Cell 112 519-33 Jankovic J (2006) Botulinum toxin therapy for cervical dystonia. Neurotox Res 9 145-8 Jankovic J, Schwartz K (1995) Response and immunoresistance to botulinum toxin injections. Neurology 45 1743-6... 

Lew MF, Adornato BT, Duane DD, Dykstra DD, Factor SA et al. (1997) Botulinum toxin type B a double-blind, placebo-controlled, safety and efficacy study in cervical dystonia. Neurology 49 701-7... 

A report found that even small doses of Risperdal (average dose of 1.7 mg/day) produced or worsened acute extrapyramidal reactions in one-third of an elderly population suffering from dementia (Baker, 1996). Among 41 patients, 6 developed new parkinsonism, 5 had a worsening of previous parkinsonism, one developed cervical dystonia, and one developed neuroleptic malignant syndrome while also taking Tegretol and Mellaril. 

Cervical dystonia to reduce the severity of abnormal head position and neck pain C. botulinum... 

The differential diagnosis includes idiopathic torsion dystonia, parkinsonism, idiopathic torticollis, Huntington s disease, Wilson s disease, and Meige s syndrome (blepharospasm, oromandibular dystonia). A retrospective evaluation of the records of patients with idiopathic cervical dystonias (n = 82) and tardive cervical dystonias (n = 20) has been performed, in a search for clinical features that could help separate these closely related disorders (332). Despite the overall similarity, the presence of a dystonic head tremor was strongly suggestive of the idiopathic form, which was present in 42% and did not occur at all in the tardive group. A family history of dystonia (10%) was also exclusive to the idiopathic group. 

Molho ES, Feustel PJ, Factor SA. Clinical comparison of tardive and idiopathic cervical dystonia. Mov Disord 1998 13(3) 486-9. 

Olanzapine has fewer extrapyramidal effects than typical neuroleptic drugs such as haloperidol (SEDA-24, 66). Even some cases of tardive dystonia have been successfully managed with atypical neuroleptic drugs. The anti-dystonic efficacy of olanzapine has been studied in an open video-blinded study in four patients with tardive cervical dystonia after several years of neuroleptic drug treatment (35). There was moderate to marked improvement in dystonia in all of them, and no serious adverse effects at the maximum dosage reached (7.5 mg/day). 

Dystonia, rudely translated, means badly functioning muscle tone as is seen in many movement disorders. Cervical dystonia, also known as spasmodic torticollis, is a focal—that is, it occurs in one place—dystonia characterized by neck muscles contracting involuntarily, causing abnormal movements and posture of the head and neck. (Adapted from http //www.dystonia-foundation.org/defined/cervical.asp)... 

Botulinum toxin-B Myobloc (Elan) Cervical dystonia... 

Botulinum toxin-A Botox cosmetic (Allergen) Strabismus blepharospasm glabellar lines cervical dystonia axillary hyperidrosis... 

Biological products were developed traditionally, before recombinant proteins, as extracts or derivatives of the actual protein from the human body or nature. This approach continues today and Table 15 lists 18 such products, mostly blood derivatives for therapeutic use. Albumin is obtained for cardiovascular volume conditions. A fish protein is harvested for osteoporosis. Igs extracted from blood are available for immunodeficiency conditions, viral infections (hepatitis-B and vaccinia), hemolytic anemia in newborns, and idiopathic thrombocytopenic purpurea. Antihemophilic products are still derived from blood. An antiglobulin is produced for kidney transplant rejection. A collagen product and two botulinum toxin products are used for various facial wrinkle problems and cervical dystonia. A bacterial antigen is formulated to enhance immunity to treat a cancer. 

Ansved T, Odergren T, Borg K. Muscle fiber atrophy in leg muscles after botulinum toxin type A treatment of cervical dystonia. Neurology 1997 48(5) 1440-2. 

Botulinum toxin type B interferes with neurotransmitter release by cleaving synaptic vesicle-associated membrane protein. It is indicated in reduction of severity of abnormal head position and neck pain in adult patients with cervical dystonia. 

Dystonia Blepharospasm Cervical dystonia Spasmodic dysphonia Otomandibular dystonia Focal hand dystonia Limb dystonia... 

Nervous system A randomised, double-blind, crossover study of 12 healthy adults with risperidone demonstrated significant dose-dependent effects on balance control. This effect was observed at low doses with no clinically detectable extrapyramidal symptoms [249 -]. Pisa syndrome is a dystonia affecting cervical and lumbar musculature that has been reported with risperidone, paliperidone and chlorpromazine. A case is presented of a 31-year-old male with MS and FDD who developed Pisa syndrome after chronic risperidone treatment showed improvement with lurasidone, but recurrence with chlorpromazine [250 ]. Another case in a 23-year-old female with history of seizure due to periventricular focal nodular heterotopia occurring 12 months after risperidone treatment she was eventually managed on olanzapine and baclofen PSI ]. A case of persistent Parkinsonism in an 84-year-old male after 5 months of risperidone (2 mg per day) is reported [252 ]. Other dystonic phenomena reported with risperidone include dislocation of the temporomandibular joint [253 ]. 

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