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CERVICAL DYSTONIA: IT'S A PAIN IN THE NECK!

Cervical dystonia (CD) affects thousands of people every year.

CD, also called spasmodic torticollis, is a neurological movement disorder that causes the muscles in your neck to contract (tighten) involuntarily.

This muscle tightening can cause you to hold your head and neck in painful, abnormal positions.

These painful, abnormal head positions can cause discomfort and challenges in your everyday life.1

The four most common head positions associated with CD

CD symptoms include:

  • Abnormal and painful turning of head and neck2
  • Increasing neck muscle tightness or spasms2
  • Neck pain3
  • Uncomfortable pulling in the neck2
  • Tremors of the head and neck4
  • Limited range of motion4

Pain is a common complaint of most patients with CD

of patients with CD reported neck pain as a common symptom5
Of those patients, nearly 7 out of 10 said the pain was moderate or severe6
CD pain may interfere with your work and social life1,5,7,8

What causes CD?

Normally, your brain sends chemical signals to your head and neck muscles to keep their movements smooth and controlled. In patients with CD, these signals work improperly. When acetylcholine, one of the chemical signals, is released at above-normal amounts, it causes muscles to be tense and overactive.

In some cases of CD, causes can be linked to neck, head and shoulder injuries, and certain drugs.2

While the exact cause is not clear, research is still being conducted to explore the factors that can contribute to CD.

References:

  1. 1. Camfield L, Ben-Shlomo Y, Warner TT, and the Epidemiological Study of Dystonia in Europe Collaborative Group Impact of cervical dystonia on quality of life. Mov Disord. 2002;17:838–841.
  2. 2. DMRF website: https://www.dystonia-foundation.org/what-is-dystonia/forms-of-dystonia/focal-dystonias/cervical-dystonia/more-on-cervical-dystonia.
  3. 3. Costa J, Espirito-Santo C, Borges A, et al. Botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004315.
  4. 4. Jankovic J. Dystonias, choreas, athetosis, and ballism. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. Philadelphia, PA: Saunders; 2004:2312–2314.
  5. 5. Lew MF. Botulinum toxin type B: an effective treatment for alleviating pain associated with cervical dystonia. J Back Musculoskel Rehab. 2002;16:3–9.
  6. 6. Chan J, Brin MF, Fahn S. Idiopathic cervical dystonia: clinical characteristics. Mov Disord. 1991;6:119–126.
  7. 7. Van Zandijcke M. Cervical dystonia (spasmodic torticollis). Some aspects of natural history. Acta Neurol Belg. 1995;95:210–215.
  8. 8. Ben-Shlomo Y, Camfield L, Warner T. What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry. 2002;72:608–614.

INDICATION

MYOBLOC® (rimabotulinumtoxinB) Injection is indicated for the treatment of adults with cervical dystonia to reduce the severity of abnormal head position and neck pain associated with cervical dystonia.

IMPORTANT SAFETY INFORMATION FOR MYOBLOC

WARNING: DISTANT SPREAD OF TOXIN EFFECT

Postmarketing reports indicate that the effects of MYOBLOC and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children and adults, and in approved indications, cases of spread of effect have occurred at doses comparable to those used to treat cervical dystonia and at lower doses [see Warnings and Precautions].

MYOBLOC is contraindicated in patients with a known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation.

MYOBLOC is contraindicated for use in patients with infection at the proposed injection site(s).

The potency Units of MYOBLOC are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of MYOBLOC cannot be compared to or converted into units of any other botulinum toxin products assessed with any other specific assay method.

Treatment with MYOBLOC and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection that are involved in breathing or swallowing. When distant effects occur, additional respiratory muscles may be involved.

Deaths as a complication of severe dysphagia have been reported after treatment with botulinum toxin. Dysphagia may persist for several months and require use of a feeding tube to maintain adequate nutrition and hydration. Aspiration may result from severe dysphagia and is a particular risk when treating patients in whom swallowing or respiratory function is already compromised.

Treatment of cervical dystonia with botulinum toxins may weaken neck muscles that serve as accessory muscles of ventilation. This may result in a critical loss of breathing capacity in patients with respiratory disorders who may have become dependent upon these accessory muscles. There have been postmarketing reports of serious breathing difficulties, including respiratory failure, in cervical dystonia patients. Patients treated with botulinum toxin may require immediate medical attention should they develop problems with swallowing, speech or respiratory disorders. These reactions can occur within hours to weeks after injection with botulinum toxin.

Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junctional disorders (e.g., myasthenia gravis or Lambert-Eaton syndrome) should be monitored particularly closely when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects including severe dysphagia and respiratory compromise from typical doses of MYOBLOC.

This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) also is considered extremely remote. No cases of transmission of viral diseases or CJD have ever been identified for albumin.

Only 9 subjects without a prior history of tolerating injections of type A botulinum toxin have been studied. Treatment of botulinum toxin naïve patients should be initiated at lower doses of MYOBLOC.

Co-administration of MYOBLOC and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like compounds) should only be performed with caution as the effect of the toxin may be potentiated.

The effect of administering different botulinum neurotoxin serotypes at the same time or within less than 4 months of each other is unknown. However, neuromuscular paralysis may be potentiated by co-administration or overlapping administration of different botulinum toxin serotypes.

It is not known whether MYOBLOC can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. MYOBLOC should be given to a pregnant woman only if clearly needed.

The most commonly reported adverse events associated with MYOBLOC treatment in all studies were dry mouth, dysphagia, dyspepsia, and injection site pain. Dry mouth and dysphagia were the adverse reactions most frequently resulting in discontinuation of treatment. There was an increased incidence of dysphagia with increased dose in the sternocleidomastoid muscle. The incidence of dry mouth showed some dose-related increase with doses injected into the splenius capitis, trapezius and sternocleidomastoid muscles.

To report SUSPECTED ADVERSE REACTIONS or product complaints, contact US WorldMeds at 1-888-461-2255, Option 2. You may also report SUSPECTED ADVERSE REACTIONS to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please see the full Prescribing Information, including Boxed WARNING and Medication Guide.