Refractory cervical dystonia, unresolve issue and therapeutic challenge: Follow-up of a case with surgical denervation combined with conservative treatments

Abstract

Cervical dystonia is the most common focal dystonia affecting adults. It frequently causes postural control problems, neck pain and spasm attacks of the cervical musculature. One of the surgical options available is selective cervical denervation. We report the case of a 32-year-old patient with cervical dystonia refractory to conservative treatment and an injection of botulinum toxin A, which was finally completed by bilateral selective cervical denervation, with considerable regression of cervical spasm at 16 months post-operatively.

The clinical presentation of cervical dystonia includes abnormal movements or postural changes of the head, neck and shoulders caused by involuntary contractions of the cervical muscles. When the spasmodic attacks are recurrent, they can cause real handicaps for the patient. The causes of the disease and its pathophysiological mechanism are still poorly understood. There are a number of treatment options, including pharmacological therapy and surgery in cases of therapeutic failure. Repeated intramuscular injections of botulinum toxin are the first-line treatment. Some conservative measures such as physiotherapy are also used, although there is little literature on these approaches.

Selective peripheral denervation is currently the main surgical treatment for refractory cervical dystonia. A combination of conservative treatment with BT-A injection and denervation appears to be an effective treatment option.