Stephen Gollomp, MD Department of Neurology The Lankenau Hospital Thomas Jefferson University Wynnewood, PA The most common focal dystonia, cervical dystonia is characterized by involuntary contractions in agonist and antagonist muscles of the neck. The resulting tilting and turning decreases range of motion in the neck, is usually painful, and can place a significant psychosocial burden on the patient. The precise etiology of cervical dystonia is often not known. Genetic factors likely play a role in many patients and some research suggests that trauma may contribute to triggering dystonia in susceptible individuals. Historically, treatment for cervical dystonia was limited to surgery and/or systemic medications, including anticholinergics, benzodiazepines, and antispasticity agents. First-line therapy now usually involves injections of botulinum toxin, a paralyzing agent that can be injected directly into overactive neck muscles.Botulinum toxin therapy has been recommended by the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology as safe and effective for the treatment of cervical dystonia based on numerous randomized controlled trials.