Complications
Incidence of degenerative spine disease is uncertain. One group found 14 of 34 patients with cervical dystonia had clear degenerative changes, associated with the degree and direction of the torticollis.[76]
Myelopathy or radiculopathy has been reported, but this is uncommon in either generalized or cervical dystonia.
Degenerative changes may be detected on spinal radiographs, but if myelopathy is suspected, spinal magnetic resonance imaging is indicated.
Loss of benefit from botulinum toxin following an initially beneficial response may signal the development of neutralizing antibodies that inhibit therapeutic response. In one meta-analysis, neutralizing antibodies were present in around 20% of patients who had been treated with botulinum toxin.[79]
Although absolute data are lacking, the incidence of contractures is presumed to be greater with longer duration of disease.
Contractures may be suspected by the presence of a palpable enlarged tendon across a joint but may be difficult to distinguish from extreme dystonia or spasticity. Electromyography may be helpful.[77]
Regular physical therapy, bracing, and stretching may reduce contractures, but no formal clinical trials have been carried out.[78]
Use of this content is subject to our disclaimer