Quiz Form

Question Date: 29/06/2023

Question: A 35-year-old man presents for evaluation of head tremor. The tremor started 3 months ago and is associated with neck discomfort. He is not taking any medication and has no family history of a movement disorder. On examination, he has evidence of dystonic posturing of his neck with associated tremor, which worsens when his head is turned away from the direction of the dystonia Which of the following treatments is most likely to be effective in this patient?

Options:

Trihexyphenidyl
Botulinum toxin
Levodopa
Tetrabenazine

Correct Answer: Botulinum toxin

Explaination: This patient is experiencing focal dystonia involving neck muscles, known as cervical dystonia. Evidence suggests that botulinum toxin injections should be used as first-line therapy for focal dystonia. Treatment is generally administered every 3 months. Levodopa-responsive dystonia usually manifests in childhood and predominantly affects the limbs; however, adult onset has been described, justifying a trial with levodopa also in adult-onset lower limb dystonia. Baclofen, tetrabenazine, and trihexyphenidyl are all somewhat effective at treating dystonia but are generally used in the management of generalized dystonia and have dose-limiting side effects.

Reference: Morgante F, Klein C. Dystonia. Continuum (Minneap Minn). 2013 Oct;19(5 Movement Disorders):1225-41. doi: 10.1212/01.CON.0000436154.08791.67. PMID: 24092288.