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

ACCREDITATION EXPIRED: May 19, 2025

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

Agenda

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.

Accreditation

ACCME Activity #202522667

ACCREDITATION FOR THIS COURSE HAS EXPIRED. YOU MAY VIEW THE PROGRAM, BUT CME / CE IS NO LONGER AVAILABLE AND NO CERTIFICATE WILL BE ISSUED.

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.

Instructions

  • 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

PC
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
MAC
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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