Botulinum Toxin in the Treatment of Cervical Dystonia: Evidence-Based Review

Hammoud, Nadia; Jankovic, Joseph

doi:10.3389/dyst.2022.10655

Cited by 5 publications

(3 citation statements)

References 120 publications

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“…Dysphagia is a common complication of anterocollis, and this can be worsened with anterior neck muscle BoNT injections, particularly with bilateral injections; hence, it is crucial to start with low doses of BoNT in these instances. The usefulness of BoNT in the treatment of CD has been demonstrated in numerous trials ( Hammoud and Jankovic, 2022 ). In one study of 144 patients with CD and 24 due to parkinsonism, the duration of benefit, dosage of BoNT, and occurrence of dysphagia after BoNT were similar in patients with CD and associated parkinsonism vs. CD without parkinsonism ( Patterson et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Use of botulinum toxin in the management of dystonia in Parkinson’s disease

Anandan,

Jankovic

2024

Front. Neurosci.

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Botulinum toxin is one of the most potent neurotoxins, but when injected into an overactive muscle, it can transiently alleviate an involuntary movement, such as dystonia. The primary aim of this article is to provide a comprehensive review of the various forms of dystonia observed in patients with Parkinson’s disease who can benefit from a therapeutic trial of botulinum toxin. Although most of these indications are not supported by randomized controlled clinical trials and, therefore, not approved by the Food and Drug Administration, there are many open-label trials supporting a large body of empirical experience testifying to the benefits of botulinum toxin treatment in these conditions.

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Section: Discussionmentioning

confidence: 99%

Use of botulinum toxin in the management of dystonia in Parkinson’s disease

Anandan,

Jankovic

2024

Front. Neurosci.

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“…All of them were responders to the BoNT injection therapy. However, after several years of repeated BoNT injections, they decided to terminate their injection therapy for various reasons [15,23]. Their last BoNT injection was received within a time frame of 165 to 1239 days (5.5-41.3 months) before the day of the experiment.…”

Section: Participantsmentioning

confidence: 99%

“…The reasons vary and may include a change of provider, the short duration of effect, symptom improvement through other treatment options, and many more. For dystonic musicians in particular, an adaptation of their repertoire, the shift from a solo to a teaching career, the high treatment cost, the alternative available treatment options such as sensorimotor retraining, and an insufficient response/benefit of the injection therapy are reasons why they decide to terminate their BoNT treatment [15,23]. Therefore, besides adding to the limited findings on human subjects, the current study attempted to objectively assess muscular atrophy and weakness via ultrasonography and finger strength assessments [24] in dystonic musicians who have terminated their BoNT treatment therapy.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Muscular Atrophy and Weakness Following Cessation of Botulinum Toxin Type A Injections in the Flexor Digitorum Muscle of Musicians with Focal Hand Dystonia

Ioannou

Hodde-Chriske

Altenmüller

2023

Toxins

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The present study assessed muscular atrophy and weakness of the flexor digitorum superficialis (FDS) and profundus (FDP) muscle as possible long-term side effects of botulinum toxin (BoNT) injections in hand dystonia patients after the termination of their treatment. For the assessment of both parameters, a group of 12 musicians diagnosed with focal hand dystonia was compared with a group of 12 healthy matched musicians. The minimum and maximum times since the last injection across patients were 0.5 to 3.5 years, respectively. The thickness and strength of the FDS and FDP were assessed via ultrasonography and a strength measurement device. Group differences were estimated through the calculation of the symmetry index between the dominant and non-dominant hand. The results revealed that compared to the control group, thickness and flexion strength of the injected FDS and FDP were decreased by 10.6% ± 5.3% (95% CI) and 12.5% ± 6.4% (95% CI), respectively, in the patient group. The amount of weakness and atrophy was predicted significantly by the total amount of BoNT injected throughout the entire treatment period. In contrast, the time after the last injection did not predict the amount of strength and muscle mass recovery after the cessation of the treatment. The current study revealed that even up to 3.5 years after the termination of BoNT injections, long-term side effects such as weakness and atrophy can still be observed. We suggest that the total BoNT dose should remain as small as possible to reduce long-lasting side effects to the minimum. Although side effects differ significantly among patients, a potential full recovery of atrophy and weakness after the cessation of BoNT treatment might be observed after periods longer than 3.5 years.

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Focused Ultrasound Pallidothalamic Tractotomy in Cervical Dystonia: A Pilot Study

Horisawa,

Saito,

Qian

et al. 2024

Movement Disorders

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BackgroundNo clinical trials have been reported on the use of focused ultrasound (FUS) for treating cervical dystonia.ObjectiveWe aimed to confirm the efficacy and safety of FUS pallidothalamic tractotomy for cervical dystonia.MethodsThis was a prospective, open‐label, non‐controlled pilot study. The primary outcome was defined as a change in the score for the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) from baseline to 6 months after FUS pallidothalamic tractotomy. The secondary outcomes included a change in the neck scale for the Burke‐Fahn‐Marsden Dystonia Rating Scale (BFMDRS), mood scales including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Apathy Evaluating Scale (AES), and adverse events. Patients were assessed for TWSTRS, BFMDRS, and adverse events at baseline, 1 week, 1 month, 3 months, and 6 months after treatment. BDI, BAI, and AES were assessed at baseline and 6 months after treatment.ResultsTen patients were enrolled in this study. The mean age of onset of dystonia was 51.6 ± 10.2 years. The TWSTRS at 6 months (29.9 ± 16.0, range: 3–55) was significantly improved by 43.4% (P < 0.001) from baseline. The BFMDRS‐Neck scales at 6 months (4.2 ± 2.8) were significantly improved by 38.2% (P < 0.001) from baseline. The BDI, BAI, and AES at 6 months were improved by 23.2%, 10.9%, and 30.3%, respectively from baseline. Reduced hand dexterity in three patients and weight gain in two patients were confirmed at the last evaluation.ConclusionThis study suggests that FUS pallidothalamic tractotomy may be an effective treatment option for patients with cervical dystonia. © 2024 International Parkinson and Movement Disorder Society.

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Botulinum Toxin in the Treatment of Cervical Dystonia: Evidence-Based Review

Cited by 5 publications

References 120 publications

Use of botulinum toxin in the management of dystonia in Parkinson’s disease

Use of botulinum toxin in the management of dystonia in Parkinson’s disease

Long-Term Muscular Atrophy and Weakness Following Cessation of Botulinum Toxin Type A Injections in the Flexor Digitorum Muscle of Musicians with Focal Hand Dystonia

Focused Ultrasound Pallidothalamic Tractotomy in Cervical Dystonia: A Pilot Study

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