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CME: Straightening out our approach to the management of cervical dystonia: optimizing treatment strategies

Activity Description / Statement of Need:

In this online, self-learning activity:

Cervical dystonia is the most common focal dystonia, characterized by involuntary muscular contractions resulting in abnormal head, neck, and shoulder movements in addition to posture that can cause tremor and pain. Early-onset dystonia can begin in infancy, childhood, or adolescence, and it generally progresses from focal to generalized. Adult-onset dystonia usually affects the upper part of the body; the origin of the dystonia determines the risk of spread. Cervical dystonia may appear as torticollis, laterocollis, anterocollis, or retrocollis. It may be distinguished from nondystonic hand tremor and essential tremor by the absence of limb tremor and the manner of neck movement. However, it is more difficult to distinguish from pseudodystonias, resulting in misdiagnosis and inappropriate treatment.

Target Audience:

The following HCPs: medical neurologists; physician assistants, nurse practitioners, and pharmacists who practice in neurology; and other clinicians who commonly encounter patients with cervical dystonia. 

Commercial Support Disclosure: This program is supported by an educational grant from Merz Pharmaceuticals.

This activity is free of charge.

Release Date: May 19, 2023 -- Expiration Date: May 19, 2025

Faculty: Hwai Yin (Evelyn) Ooi, MD


Faculty introduction, disclosures 

Review of cervical dystonia 

  • Epidemiology: statistics of cervical dystonia and spasticity 
  • Health burden
  • Clinical features, presentation, diagnosis, and the risk of misdiagnosis

Treatment of cervical dystonia

  • Goals of therapy 
  • Monitoring response 
  • Review of and evidence behind treatment options
    • First-line: botulinum toxins 
      • Product comparison and contrast 
      • Initial dosing strategy 
      • Length of treatment interval 
      • Injection technique 
      • Neutralizing antibodies and adverse effect mitigation 
    • Second-line: anticholinergics, benzodiazepines, GABA agonists, dopaminergics, and anti-dopaminergics 
  • Investigational therapies
  • Treatment challenges
    • Approach to primary and secondary non-responsiveness 
    • Special populations: anticoagulation, pregnancy 
  • Patient case(s)

Summary, conclusions, and best practice recap 

Learning Objectives

By the end of the session the participant will be able to:

  • Recall the health burden of cervical dystonia.
  • Describe the diagnosis of cervical dystonia and challenges associated with it.
  • Identify the present and emerging treatment options for the management of cervical dystonia.
  • Formulate a treatment plan for a patient with cervical dystonia.


ACCME Activity #202522667

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.


ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ABIM MOC Credit Type: Medical Knowledge

Physicians: For maintenance of certification (MOC) points, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC points for this activity. By providing this data, you acknowledge that it will be shared with ACCME and the applicable certifying board. Please note: Not all activities on this site provide MOC points. If this activity does not specify that it provides MOC points in this section, then it does NOT provide MOC points. This activity provides MOC points only for ABIM.


ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 1.25 contact hours (0.125 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-23-020-H01-P. This is an Application (A)-type activity. 

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME. ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.

Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Disclosures of Faculty: Hwai Yin (Evelyn) Ooi, MD, Assistant Professor of Clinical Neurology, Weill Cornell Medicine, has received financial compensation from research grants from Biogen, Sun Pharma Advanced Research Company, Genentech, Neuroderm, Bluerock, Novo Nordisk, and Insightec.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty WILL discuss off-label uses of a commercial product.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from Merz Pharmaceuticals.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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