Cervical dystonia: factors deteriorating patient satisfaction of long-term treatment with botulinum toxin

ABSTRACT

Objectives

Botulinum toxin (BoNT) is an effective first-line treatment for cervical dystonia (CD). Despite generally good therapeutic efficacy, approximately 20–40% of CD patients do not achieve acceptable relief of the dystonic symptoms. The aim of this study was to identify factors of low patient satisfaction of long-term BoNT therapy for CD.

Methods

In this case-control study CD patients treated with BoNT intramuscular injections for up to 24 years were assessed by two independent assessors in three validated scales: TWSTRS, Tsui and VAS for pain measurement. Data on received BoNT doses and treatment duration were obtained from medical history. All of participants rated their long-term treatment satisfaction compared to the therapy onset on a 0–3 scale.

Results

Study was completed by 58 participants who were treated with BoNT for 9.0 ± 6.3 years and received a median of 19 injection cycles. None/low therapy satisfaction was reported by 20.7% of participants. Compared to moderate/good treatment satisfaction, CD patients with none/low BoNT efficacy had increased incidence of cervical pain (p =.018), enhanced mean VAS score for pain (p =.037) and had higher coexistence of oromandibular dystonia (p =.018). In addition, worse treatment satisfaction correlated with shorter time intervals between treatment cycles, enhanced scores of Tsui total, TWSTRS total, as well as TWSTRS subscales: severity, disability and pain.

Conclusion

Cervical pain and coexistence of oromandibular dystonia deteriorated long-term treatment satisfaction in CD patients. Higher scores of Tsui and TWSTRS subscales were correlated with worse subjective BoNT treatment response.

KEYWORDS:

• Cervical dystonia
• botulinum toxin
• treatment failure
• pain

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Michał Marciniec

Michał Marciniec is a doctoral student in the Department of Neurology at the Medical University of Lublin. His current research interests involve cerebrovascular diseases and the medical use of botulinum toxin in the treatment of focal dystonias.

Anna Szczepańska-Szerej

Anna Szczepańska-Szerej is an assistant professor in the Department of Neurology at the Medical University of Lublin. Her researches have mainly focused on cerebrovascular diseases and medical use of botulinum toxin.

Konrad Rejdak

Konrad Rejdak is a professor in the Department of Neurology at the Medical University of Lublin. His researches have mainly focused on multiple sclerosis, myasthenia gravis and neurodegenerative disorders.