neurologic disorders
Cervical Dystonia
Drugs
Injections of botulinum toxin type A or B into the dystonic muscles can reduce painful spasms for 1 to 4 months in about 70% of patients, restoring a more neutral position of the head. However, in a few cases, when the toxin is repeatedly injected, it becomes less effective because neutralizing antibodies against the toxin develop. Oral drugs can usually relieve pain, but they suppress dystonic movements in only about 25 to 33% of patients. These drugs include Anticholinergic drugs, such astrihexyphenidyl5 mg once a day up to 10 to 15 mg orally in 2 or 3 doses (eg, 5 mg orally 2 or 3 times a day), but adverse effects possibly limiting their use Benzodiazepines (particularlyclonazepam0.5 mg orally 2 times a day) Baclofen10 to 20 mg orally 3 times a day Carbamazepine100 to 200 mg orally 3 times a day All drugs should be started in low doses (eg,trihexyphenidyl2 to 2.5 mg orally once a day). Doses should be increased until symptoms are controlled or intolerable adverse effects (particularly likely in older patients) develop. In older patients,trihexyphenidylcan be started at 1 mg orally once a day. 