Optimizing Care of Cervical Dystonia: Improving Diagnosis and Skills for Localization and Injection of Affected Muscles with Botulinum Neurotoxin

Released On
April 30, 2021

Expires On
April 30, 2022

Media Type

Completion Time
60 minutes

Neurology, Physiatry, Primary Care

Parkinson's & Movement Disorders

Scroll to the Bottom of this Information to Begin this Course

This activity is provided by Paradigm Medical Communications, LLC.

Supported by an educational grant from Allergan, Inc.

This activity is supported with in-kind contributions: Allergan, Inc. – disposable supplies (injectables).

Credit Available

  • Physicians — maximum of 1.0 AMA PRA Category 1 Credit(s)

All other healthcare professionals completing this course will be issued a statement of participation.

Target Audience

This activity has been designed for neurologists and physiatrists. It may also benefit other healthcare providers—including internists and family physicians—who often work in concert with neurologists and physiatrists and/or are interested and actively engaged in the management of patients with cervical dystonia.

Statement of Need/Program Overview

Evidence suggests that cervical dystonia is underdiagnosed and undertreated, and that when treatment with botulinum neurotoxins (BoNTs) occurs it is often suboptimal. Suboptimal treatment (poor or no response or intolerable adverse events) is a frequent cause of patient discontinuation of BoNT therapy. Limited response, primary nonresponse, secondary nonresponse, and intolerable adverse events may be attributed to insufficient understanding of the complex muscle patterns contributing to symptoms, inappropriate BoNT dosing, and lack of skills regarding use of sophisticated diagnostic and injection guidance techniques to identify and target relevant muscles. This activity was designed to facilitate optimal care of patients with cervical dystonia by neurologists and physiatrists.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Contrast the fundamental pharmacology and use of botulinum neurotoxins indicated for cervical dystonia, including mechanism of action, potency/interchangeability, adverse events, reconstitution, and issues related to dosing.
  • Outline the anatomy and pathophysiology of musculature targeted by botulinum neurotoxin as cervical dystonia treatment.
  • Apply current methods for accurate identification of muscles for targeted botulinum neurotoxin delivery in cervical dystonia, including ultrasonography- and electromyography-guided techniques.


Katharine Alter, MD

Mount Washington Pediatric Hospital
University of Maryland
Prince George’s Hospital Center
Cheverly, MD

Sherry A. Downie, PhD

Director, Clinical & Developmental Anatomy
Director, Anatomical Donation Program
Departments of Anatomy and Structural Biology and Physical Medicine and Rehabilitation
Albert Einstein College of Medicine
Bronx, NY

Yeva M. Fernandez, MD

Assistant Professor
Department of Neurology
Rutgers-Robert Wood Johnson School of Medicine
New Brunswick, NJ

Physician Accreditation Statement

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

Physician Credit Designation

Paradigm Medical Communications, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

PA Continuing Education

PAs may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

Nurse Practitioner Continuing Education

The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.

Disclosures of Conflicts of Interest

In accordance with ACCME requirements on disclosure, faculty and contributors are asked to disclose any relationships with commercial interests associated with the area of medicine featured in the activity. These relationships are described below. Any potential conflicts of interest have been resolved.

Katharine Alter, MD: No financial relationships to disclose.

Sherry A. Downie, PhD

  • Consulting Fees: Allergan, Inc.
  • Speakers Bureau: Allergan, Inc.

Yeva Fernandez, MD: No financial relationships to disclose.

Paradigm Medical Communications, LLC staff members have no financial relationships to disclose.

Independent peer reviewer, Stephen A. Nichols, MD, has the following financial relationships to disclose:

  • Contracted Research: Ipsen Biopharmaceuticals, Inc.

Resolution of Conflict of Interest

Paradigm Medical Communications, LLC has implemented a system to resolve conflicts of interest for each CME activity to help ensure content is objective, fair and balanced, independent, and aligned with the public interest. Conflicts, if any, are resolved through one or more processes. All CME content in this activity has been independently reviewed to ensure that it is free of commercial bias, scientifically rigorous, aligned with the public interest, and compliant with all regulatory guidance and the ACCME’s Standards for Commercial Support of Continuing Medical Education.

Instructions for Participation and Credit

To receive a CME certificate of participation, you should:

  1. Follow instructions to register or log in with your professional information and complete the pre-activity assessment
  2. View the online activity in its entirety
  3. Complete and submit the online posttest and evaluation. You must answer 70% of the posttest questions correctly to earn credit. You will have unlimited opportunities to successfully complete the posttest

A certificate of participation will be available for download/printing immediately following your successful completion of the posttest and evaluation.

For questions regarding CME credit, contact the Paradigm CME Department at (845) 398-5949 or cme@paradigmmc.com.

There is no fee required for participation in this activity.

Course Viewing Requirements

Hardware/Software Requirements
This certified CME activity is designed using HTML5 web components. As you navigate the video using the supplied controls, the slides will sync to the speaker.

Supported Browsers (Desktop/Mobile):
Chrome 45+, Firefox 40+, Edge, Edge Chromium, Safari 8+, Opera 31+

PDF documents
This activity may contain PDF documents. Most current browsers support viewing of PDFs natively, but you may also download a free version of Adobe Acrobat Reader here: http://get.adobe.com/reader

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA.


This CME activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by, Paradigm Medical Communications, LLC. Reasonable efforts have been taken to present educational subject matter in a balanced, unbiased fashion, and in compliance with regulatory requirements. However, each activity participant must always use his or her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

If included, signed statements of informed consent granting permission for publication have been obtained for all photographs and videos in which an individual can be identified.

As an ACCME-accredited provider, Paradigm Medical Communications, LLC’s activities must include a balanced view of therapeutic options. Use of generic names contributes to this impartiality. In this activity, tradenames are occasionally used for clarity. The use of trade names should not be viewed as an endorsement of specific products by Paradigm Medical Communications, LLC.

Technical Support: If you have any technical problems or playback issues email us at contactus@paradigmmc.com.

Contact Information
If you have any questions or comments, please email us at contactus@paradigmmc.com