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Cervical Dystonia Refractory to Botulinum Toxin Responding to Radiofrequency Ablation: A Case Report

Authors Dey S, Ghosh S

Received 15 July 2020

Accepted for publication 18 August 2020

Published 18 September 2020 Volume 2020:13 Pages 2313—2316


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael A Überall

Saugat Dey, Sayantani Ghosh

Benefis Health System, Great Falls, MT, USA

Correspondence: Saugat Dey
Pain Management Center, Dartmouth-Hitchcock Medical Center, 7 Timberwood Drive, Apt 230, Lebanon, NH 03766, USA
Tel +1 267 736 0286

Abstract: A 62-year-old male diagnosed with cervical dystonia (CD) and chronic right-sided neck pain presented to the Pain Clinic after his pain and CD symptoms failed to resolve with botulinum toxin therapy. During clinical examination, right C3-C4 and C4-C5 facet arthropathy was suspected. After two sets of diagnostic right cervical, C3, C4, and C5 medial branch blocks provided > 80% pain relief; cervical radiofrequency ablation (CRFA) was performed. Post CRFA, the patient was followed for 12 months. Till the last follow-up, he was not only experiencing 90% pain relief, but also had significant improvement in his CD symptoms to the point that he no longer needed botulinum toxin and other CD-related therapy. This report suggests that large-scale research is required to postulate whether CD patients, whose symptoms are refractory to botulinum toxin, should be routinely screened for cervical facet arthropathy. This is the first reported case of improvement in CD symptoms with CRFA. This effect could be explained by the fact that certain deep cervical muscles, which are affected in CD, are innervated by medial branch nerves.

Keywords: cervical dystonia, radiofrequency ablation, botulinum toxin, neck pain, medial branch nerves, deep neck muscles

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