CD is the most common type of focal dystonia encountered in neurological practice.¹

In patients with CD, painful and involuntary patterned postures of intermittent spasms of the neck muscles cause the head to rotate, tilt or move away from its normal position or posture.^2,3

To help select the correct muscles for treatment, subtypes of CD have been proposed based on the anatomic organisation and action of dystonia of the main cervical muscles.^3,4 Torticollis, the most common form of CD, can induce rotation in the head but primarily involves muscles at the C2-C7 level.^2–4

Classical definitions of CD subtypes

Figure adapted from Jost WH, et al. 2015.⁴

CD has a considerable impact on patients’ quality of life, affecting employment, independence and psychological health.^5,6

BoNT has become the treatment of choice for CD.^3,4 An international survey among patients with CD treated with BoNT-A highlighted the common problem of symptom recurrence between injections and the significant impact that re-emerging symptoms have on their lives, including the ability to work.⁷

Symptom recurrence between BoNT-A injections has considerable impact on patient quality of life*⁷

Proportion of patients surveyed on each BoNT-A product: 44% onabotulinumtoxinA, 25% Dysport^®, 24% incobotulinumtoxinA, 7% did not know⁷

Patient symptom journey:

Figure adapted from Comella C, et al. 2021.⁷

^*As reported by patients.^7
†119 out of 209 patients surveyed were working and responded to the question: How does the reappearance of your CD pre-existing symptoms between two sessions of BoNT-A injections affect your work?⁷

References:

1. Abogunrin S, et al. Clinicoecon Outcomes Res. 2015;7:441–449.
2. Gonzales-Usigli HA. Cervical dystonia. In: MSD Manuals Professional Version. Cervical Dystonia – Neurologic Disorders – MSD Manual Professional Edition (msdmanuals.com). (Accessed: September 2025).
3. Reichel G. Basal Ganglia. 2011;1:5–12.
4. Jost WH and Tatu L. Mov Disord Clin Pract. 2015;2:224–226.
5. Mollho ES, et al. Mov Disord. 2009;24:1384–1387.
6. Comella and Bhatia K. J Neurol. 2015;262:837–848.
7. Comella C, et al. J Neurol. 2021;268(3):903–912.

Abbreviations:

BoNT, botulinum neurotoxin; BoNT-A, botulinum toxin type A; C2, second cervical vertebra; CD, cervical dystonia.

For further information, please refer to the Prescribing Information or the Summary of Product Characteristics.