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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<br><br>Which of the following treatments is most likely to be effective in this patient?
Explanation
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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.<br><br>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.<br><br>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.
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Reference
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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.
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Option 1
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Is Correct (Option 1):
Trihexyphenidyl
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Option 2
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Is Correct (Option 2):
Botulinum toxin
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Option 3
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Is Correct (Option 3):
Levodopa
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Option 4
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Is Correct (Option 4):
Tetrabenazine
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