Cervical dystonia is a neurological movement disorder characterized by abnormal movements and postures of the neck [
]. Standard practice treatment is botulinum toxin A injections repeated every 3 months. While this treatment is effective the benefits commonly do not last the entire treatment cycle [
- Albanese A.
- Bhatia K.
- Bressman S.B.
- et al.
Phenomenology and classification of dystonia: a consensus update.
Mov Disord. 2013; 28: 863-873
- Hefter H.
- Benecke R.
- Erbguth F.
- Jost W.
- Reichel G.
- Wissel J.
An open-label cohort study of the improvement of quality of life and pain in de novo cervical dystonia patients after injections with 500 U botulinum toxin A (Dysport).
BMJ Open. 2013; 3
3]. Direct current stimulation (DCS) is a form of non-invasive brain stimulation that can influence excitability of the cerebellum and primary motor cortex (M1), both implicated in the pathophysiology of cervical dystonia [
- Truong D.
- Brodsky M.
- Lew M.
- et al.
Long-term efficacy and safety of botulinum toxin type A (Dysport) in cervical dystonia.
Parkinsonism Relat Disord. 2010; 16: 316-323
]. It is possible that DCS to cerebellum and M1 might augment the effect of botulinum toxin injections. This idea was tested for proof of concept in a single case of a 47 year old female musician with a 14 year history of cervical dystonia. The participant had been forced into retirement from her professional career as a bassoonist in 2003 by dystonia. Her primary neck torsion at the time of the study was left rotation. Botulinum toxin injection history included 3 monthly treatments over 14 years, apart from a three year remission between 2007 and 2010. The study was approved by the local ethics committee. The participant was enrolled just prior to her usual botulinum toxin injection appointment with her neurologist. Before the appointment she underwent baseline assessments of cortical neurophysiology using transcranial magnetic stimulation (TMS) and quality of life by the self-reported Cervical Dystonia Questionnaire (CDQ-24) [
- Bradnam L.
- Barry C.
The role of the trigeminal sensory nuclear complex in the pathophysiology of craniocervical dystonia.
J Neurosci. 2013; 33: 18358-18367
] and Cervical Dystonia Impact Profile (CDIP-58) [
- Muller J.
- Wissel J.
- Kemmler G.
- et al.
Craniocervical dystonia questionnaire (CDQ-24): development and validation of a disease-specific quality of life instrument.
J Neurol Neurosurg Psychiatry. 2004; 75: 749-753
]. Dystonia severity was assessed by the consulting neurologist using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) [
- Cano S.J.
- Hobart J.C.
- Edwards M.
- et al.
CDIP-58 can measure the impact of botulinum toxin treatment in cervical dystonia.
Neurology. 2006; 67: 2230-2232
] at the time of the injections (left splenius capitus (50 units), left levator scapulae (2 × 50 units), left upper trapezius (62.5 units) and right sternocleideomastoid (2 × 50 units)). Beginning one week after the injections, the participant attended the laboratory of an investigator (LB) for DCS twice per week until the next botulinum toxin injection appointment 12 weeks later. Outcome measures were repeated at 4, 8 and 12 weeks after the injections, apart from the TWSTRS which was assessed by the same neurologist during the second botulinum toxin injection appointment of the study period.
- Consky E.
- Lang A.
Clinical assessments of patients with cervical dystonia.
in: Jankovic J.H.M. Therapy with botulinum toxin. Marcel Dekker Inc, New York1994
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- Phenomenology and classification of dystonia: a consensus update.Mov Disord. 2013; 28: 863-873
- An open-label cohort study of the improvement of quality of life and pain in de novo cervical dystonia patients after injections with 500 U botulinum toxin A (Dysport).BMJ Open. 2013; 3
- Long-term efficacy and safety of botulinum toxin type A (Dysport) in cervical dystonia.Parkinsonism Relat Disord. 2010; 16: 316-323
- The role of the trigeminal sensory nuclear complex in the pathophysiology of craniocervical dystonia.J Neurosci. 2013; 33: 18358-18367
- Craniocervical dystonia questionnaire (CDQ-24): development and validation of a disease-specific quality of life instrument.J Neurol Neurosurg Psychiatry. 2004; 75: 749-753
- CDIP-58 can measure the impact of botulinum toxin treatment in cervical dystonia.Neurology. 2006; 67: 2230-2232
- Clinical assessments of patients with cervical dystonia.in: Jankovic J.H.M. Therapy with botulinum toxin. Marcel Dekker Inc, New York1994
- Modulation of cerebellar excitability by polarity-specific noninvasive direct current stimulation.J Neurosci. 2009; 29: 9115-9122
- Shaping the optimal repetition interval for cathodal transcranial direct current stimulation (tDCS).J Neurophysiol. 2010; 103: 1735-1740
- Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.J Physiol. 2000; 527 Pt 3: 633-639
- Priming sensorimotor cortex to enhance task-specific training after subcortical stroke.Clin Neurophysiol. 2014; 125: 1451-1458
- Combined statistical analysis method assessing fast versus slow movement training in a patient with cerebellar stroke: a single-case study.Phys Ther. 2013; 93: 649-660
Published online: October 07, 2014
Accepted: September 10, 2014
Received in revised form: September 8, 2014
Received: August 29, 2014
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.