College of Psychiatric and Neurologic Pharmacists

Idiopathic dystonia and tremor disorders are movement disorders that are underrecognized or undertreated. Familiarity with the clinical features and available treatments will allow clinicians to better identify and manage patients with dystonia or tremor disorders. This session will utilize video cases as learning tools.

Idiopathic dystonia is a neurologic condition and can be focal, segmental, or generalized. However, focal cervical dystonia is more common in characterized by involuntary contractions of cervical musculature resulting and abnormal movements and postures of the head. It is often disabling and disfiguring. Although primarily a motor disorder, cervical dystonia is also characterized by derangements of sensory function. For example, pain can be present. Sensory tricks (gestes antagonistes) are interesting examples of abnormalities in sensorimotor integration. The majority of cervical dystonias are idiopathic and focal, i.e., there is no other associated clinical or neuroimaging features and they remain restricted to the neck and shoulder girdle muscles. There is no definitive diagnostic algorithm for dystonias nor is there universal agreement on the best approaches to management. Oral agents such as antimuscarinics provide modest benefit and are limited by side effects. Botulinum toxin provides significant relief and restores head and neck position. The role of various agents will be discussed.

Essential tremor is a common movement disorder of adulthood that interferes with the performance of functional and social activities. This type of tremor can be mistaken as Parkinson’s disease or dismissed as a benign condition. Additionally, patients with cervical dystonia may have coexisting signs of limb or head tremor which can make recognition between dystonic and essential tremor difficult.

Currently, the mainstays of pharmacotherapy consist of propranolol and primidone. However, various antiepileptic drugs can also be offered to provide symptomatic benefits. Thalamic deep brain stimulation is an alternative when medical therapy is inadequate. Effective therapies are available for focal dystonias and essential tremor. Thus, proper recognition and treatment are key for achieving optimal outcomes.

1. Differentiate between the clinical presentation of dystonia and tremor disorders.
2. Discuss the benefits and limitations of treatments for dystonia and tremor disorders.
3. Outline a treatment approach for dystonia and tremor disorders

Activity Dates: 04/21/2009 - 04/21/2012
ACPE Contact Hours: 1.0
ACPE Number: 0284-0000-09-012-H01-P
Nursing Credit Reminder: Note that ACPE and ACCME credit is accepted for certification renewal.

This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.

Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.

If you are a pharmacist, nurse practitioner or other healthcare professional involved in the medication therapy management of psychiatric and/or neurological patients, we invite you to participate in this online course.

This programming was supported in part by grants from Bristol-Myers Squibb, Forest Laboratories, Inc., Lilly, Schering-Plough, Cyberonics, Shire, and Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. administered by Ortho-McNeil Janssen Scientific Affairs, LLC.