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CME: Breaking the hold: avoiding missteps and optimizing management in the identification and treatment of cervical dystonia

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, inappropriate treatment, and treatment delay.

Target Audience:

HCPs including but not limited to: medical neurologists; physician assistants, nurse practitioners, nurses, 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: January 14, 2026 -- Expiration Date: January 14, 2028

Faculty: Hwai Yin (Evelyn) Ooi, MD

Agenda

Faculty introduction, disclosures

Review of cervical dystonia

  • Epidemiology: statistics of cervical dystonia
  • 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
        • Dosing considerations
        • Length of treatment interval
        • Injection technique
        • Neutralizing antibodies and adverse effect mitigation
        • Special considerations – anticoagulation, pregnancy
    • Second-line: anticholinergics, benzodiazepines, GABA agonists, dopaminergics, anti-dopaminergics, VMAT2 inhibitors
    • Deep brain stimulation
  • Treatment challenges and solutions
      • Young-onset cases, the role of the levodopa trial, and dopa-responsive dystonia
      • Approach to primary and secondary non-responsiveness
  • Patient case

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Recognize the clinical and societal burden associated with cervical dystonia.
  • Explain current diagnostic approaches and barriers to timely diagnosis of cervical dystonia.
  • Summarize available therapeutic options for managing cervical dystonia.
  • Develop a patient-centered treatment strategy for cervical dystonia based on current evidence.

Accreditation

ACCME Activity #203368584

ScientiaCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Pharmacists

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 1.25 contact hours  of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-26-009-H01-P. This is an Application (A)-type activity. 

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurses: This activity is designated for up to 1.25 AMA PRA Category 1 Credit(s)™, and the American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 Credit(s)™ to meet the continuing education renewal requirements of nursing re-certification for APRNs and RN specialty. Some state nursing boards accept AMA PRA Category 1 Credit(s)™ for re-licensure requirements, some do not. Check your state board of nursing's CE requirements before applying credit from this course to your re-licensure.

Physician Assistants: The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credit™ assigned by organizations accredited by the ACCME as satisfying Category 1 CME for National Commission on Certification of Physician Assistants (NCCPA) national certification maintenance. This activity is designated for up to 1.25 AMA PRA Category 1 Credit(s)™.

Nurse Practitioners: The American Academy of Nurse Practitioners Certification Board (AANPCB) states that continuing education providers accredited by the ACCME may provide acceptable, accredited Advanced Practice Provider content. This activity is designated for up to 1.25 AMA PRA Category 1 Credit(s)™.


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 Blue Rock, MeiraGTX, Novo Nordisk, Biogen, Genentech, UCB, Cerevance, Biohaven, and Vima Therapeutics for research/clinical trial support.

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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