Botulinum toxin assessment, intervention and aftercare for cervical dystonia and other causes of hypertonia of the neck: international consensus statement

Eur J Neurol. 2010 Aug:17 Suppl 2:94-108. doi: 10.1111/j.1468-1331.2010.03130.x.


Dystonia in the neck region can be safely and effectively reduced with injections of Botulinum neurotoxin-A and B. People with idiopathic cervical dystonia have been studied the most. Benefits following injection include increased range of movement at the neck for head turning, decreased pain, and increased functional capacity (Class I evidence, level A recommendation). The evidence for efficacy and safety in patients with secondary dystonia in the neck is unclear based on the lack of rigorous research conducted in this heterogeneous population (level U recommendation). Psychometrically sound assessments and outcome measures exist to guide decision-making (Class I evidence, level A recommendation). Much less is known about the effectiveness of therapy to augment the effects of the injection (Class IV, level U recommendation). More research is needed to answer questions about safety and efficacy in secondary spastic neck dystonia, effective adjunctive therapy, dosing and favourable injection techniques.

Publication types

  • Consensus Development Conference
  • Practice Guideline

MeSH terms

  • Botulinum Toxins / administration & dosage*
  • Botulinum Toxins / adverse effects
  • Drug Monitoring / methods*
  • Humans
  • Internationality
  • Muscle Hypertonia / drug therapy*
  • Muscle Hypertonia / physiopathology
  • Neck Muscles / drug effects*
  • Neck Muscles / innervation
  • Neck Muscles / physiopathology
  • Neuromuscular Agents / administration & dosage*
  • Neuromuscular Agents / adverse effects
  • Outcome Assessment, Health Care / methods
  • Physical Therapy Modalities / standards
  • Randomized Controlled Trials as Topic
  • Risk Assessment / standards
  • Torticollis / drug therapy*
  • Torticollis / physiopathology


  • Neuromuscular Agents
  • Botulinum Toxins