This protocol targets a specific sub-population: patients with primary cranial dystonia in whom oromandibular involvement is absent. This distinction defines a well-characterised clinical scenario with a distinct first-line therapeutic pathway.
Primary cranial dystonia, with oromandibular dystonia specifically excluded. The presentation and anatomical distribution shape the recommended treatment approach, which differs from generalised or other focal dystonias.
First-line management in this setting centres on a targeted injection-based therapy. An alternative injection agent is specified within the protocol for cases where the first-line option is not suitable. Full agent selection, sequencing, and clinical decision criteria are detailed in the complete protocol.
Botulinum toxin (BoNT) type A is the first-line treatment for primary cranial (excluding oromandibular) or cervical dystonia; it is also effective on writing dystonia.
BoNT/A (or type B if there is resistance to type A) can be regarded as first-line treatment for primary cranial (excluding oromandibular) or cervical dystonia (level A).
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