Question

An 18-year-old woman is evaluated for a 2-year history of repetitive fast movements of the neck that tilt the head to the right side. She reports that these movements are preceded by a feeling of discomfort in the right shoulder and that if she concentrates and taps the right foot immediately after this sensory cue, she usually can avoid the neck movements. She is a senior in high school and says she has not been able to use this method successfully in the classroom, especially during examinations, when she often experiences a cluster of movements that exhaust and distract her. Her mother notes that before onset of the neck symptoms, the patient used to roll her eyes and clear her throat frequently. She has obsessive-compulsive disorder treated with sertraline. On physical examination, vital signs are normal. During the examination, the patient displays rapid tilting movements of the head followed by rolling of the head and shoulder; these movements repeat several times in a stereotyped manner. The patient can suppress these movements on request. Which of the following is the most appropriate treatment? A. Botulinum toxin injection B. Clonidine administration C. Cognitive behavioral therapy D. Haloperidol administration

Answer 1

Botulinum toxin injection is the most appropriate treatment for this patient with cervical dystonia. Thus option A is the correct option.

Step-by-step explanation:

The most appropriate treatment for this patient is botulinum toxin injection (option A). The patient's symptoms are consistent with cervical dystonia, a neurological disorder characterized by involuntary muscle contractions of the neck that cause abnormal head movements and positioning. Botulinum toxin injections are often used as a first-line treatment for cervical dystonia and can help reduce abnormal movements and associated pain. Other treatment options, such as clonidine, cognitive behavioral therapy, and haloperidol, are not typically used as primary treatment for cervical dystonia.