We thank the Brain Foundation for this 2009 research grant award, which will further our clinical studies in the area of cervical dystonia, or involuntary abnormal posturing or tremor of the neck. As recently as the 1970s, CD was thought to have a psychological basis of hysteria, but in the past 3 decades the neurophysiological basis has been identified, and treatment with botulinum toxin injections into selected neck muscles has been adopted as standard practice. The clinical problem is in choosing which of the more than 30 different paired neck muscles to inject. With current selection methods (muscle hypertrophy on palpation, neck positioning, EMG assessment), we are only 60-75% effective in getting the treatment to the ideal muscles, and this limits treatment efficacy. This research will examine novel techniques we have recently developed to improve target muscle identification, using MRI scanning (for muscle enlargement) and specialised movement analysis (for neck deviation and tremor). We will look at treatment naïve patients, and follow their response to standard injection treatment. The overall aim of the research is to improve the efficacy of botulinum toxin treatment by better target muscle selection, and also to gain a better understanding of the basis of CD and the way in which botulinum toxin may exert its effects. My co-investigators are Dr Noel Lythgo (University of Melbourne) and Professor Malcolm Horne (Florey Neuroscience Institutes).