American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most effective treatment for focal forms of dystonia?

1. Physical therapy

2. Botulinum toxin injection

3. Deep brain stimulation

4. Oral medications

The correct answer is: Botulinum toxin injection

The most effective treatment for focal forms of dystonia is botulinum toxin injection. This form of treatment works by temporarily blocking the release of acetylcholine at the neuromuscular junction, leading to a reduction in muscle contractions that are characteristic of dystonia. Botulinum toxin has been shown to significantly improve symptoms and quality of life in patients with focal dystonia, such as cervical dystonia or blepharospasm. The targeted nature of botulinum toxin allows for precise treatment of the affected muscles, minimizing the impact on surrounding musculature and reducing side effects compared to more systemic treatments. As a result, many patients experience substantial relief and improved function following injections. Other treatments, while they may offer benefits, do not generally match the efficacy of botulinum toxin for focal dystonia. Physical therapy can be useful as an adjunctive therapy to help with movement and posture but does not address the underlying muscle spasms. Deep brain stimulation may also be an option, particularly for more generalized forms of dystonia, but involves surgical intervention and is typically considered when other treatments have failed. Oral medications can be tried, but their effectiveness tends to be less pronounced, and they may carry a higher burden of systemic side effects.