Does botulinum toxin type A treatment influence non-motor symptoms in cervical dystonia patients? A systematic review
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Abstract
The effect of botulinum toxin A (BoNTA) on non-motor symptoms (NMS) in patients with cervical dystonia remains an area of significant clinical interest, given the profound impact of these symptoms on patients’ quality of life. While the therapeutic efficacy of BoNTA in alleviating motor symptoms of cervical dystonia is well established, its impact on NMS such as depression, anxiety disorder, and sleep disturbance requires further investigation.
This systematic review synthesizes the latest evidence on the effects of BoNTA on these selected non-motor symptoms.
A comprehensive search of the PubMed, Web of Science, and Scopus databases identified 266 articles, of which eight studies met our strict inclusion criteria. Pre- and post-intervention changes in depression, anxiety, and sleep disturbance were assessed in a total of 280 adult patients with cervical dystonia treated with BoNTA.
The results indicate that BoNTA has a positive effect on depressive symptoms, with most studies showing a statistically significant improvement after treatment. Similarly, studies are reporting significant reductions in anxiety scores following BoNTA treatment. However, the effects of this treatment method on sleep disturbances were less conclusive, with none of the reviewed studies showing significant improvements in sleep quality or daytime sleepiness.
The results highlight the potential of BoNTA to positively influence non-motor symptoms, particularly depression and anxiety, in patients with cervical dystonia, although its effects on sleep remain unclear. These findings underscore the need for further research to fully understand the mechanisms underlying the non-motor effects of BoNTA and to develop comprehensive treatment strategies.
Keywords: cervical dystonianon-motor symptomsdepressionanxietysleepbotulinum toxin type ABoNTquality of life
References
- Albanese A, Bhatia K, Bressman SB, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013; 28(7): 863–873.
- Kuyper DJ, Parra V, Aerts S, et al. Nonmotor manifestations of dystonia: a systematic review. Mov Disord. 2011; 26(7): 1206–1217.
- Ray S, Pal PK, Yadav R. Non-Motor Symptoms in Cervical Dystonia: A Review. Ann Indian Acad Neurol. 2020; 23(4): 449–457.
- Yilmaz HN, Bilen S. Evaluation of non-motor symptoms in cervical dystonia, hemifacial spasm, and blepharospasm patients and their correlation with motor symptoms. Neurol Sci. 2023; 44(11): 4077–4086.
- Yang J, Shao Na, Song W, et al. Nonmotor symptoms in primary adult-onset cervical dystonia and blepharospasm. Brain Behav. 2017; 7(2): e00592.
- Albanese A, Bhatia KP, Cardoso F, et al. Isolated Cervical Dystonia: Diagnosis and Classification. Mov Disord. 2023; 38(8): 1367–1378.
- Costanzo M, Belvisi D, Berardelli I, et al. Effect of Botulinum Toxin on Non-Motor Symptoms in Cervical Dystonia. Toxins (Basel). 2021; 13(9).
- Tyślerowicz M, Kiedrzyńska W, Adamkiewicz B, et al. Cervical dystonia - improving the effectiveness of botulinum toxin therapy. Neurol Neurochir Pol. 2020; 54(3): 232–242.
- Albanese A, Wissel J, Jost WH, et al. Pain Reduction in Cervical Dystonia Following Treatment with IncobotulinumtoxinA: A Pooled Analysis. Toxins (Basel). 2023; 15(5).
- Rosales RL, Cuffe L, Regnault B, et al. Pain in cervical dystonia: mechanisms, assessment and treatment. Expert Rev Neurother. 2021; 21(10): 1125–1134.
- Ceylan D, Erer S, Zarifoğlu M, et al. Evaluation of anxiety and depression scales and quality of LIFE in cervical dystonia patients on botulinum toxin therapy and their relatives. Neurol Sci. 2019; 40(4): 725–731.
- Sławek J, Jost WH. Botulinum neurotoxin in cervical dystonia revisited - recent advances and unanswered questions. Neurol Neurochir Pol. 2021; 55(2): 125–132.
- Sugar D, Patel R, Comella C, et al. The effect of botulinum toxin on anxiety in cervical dystonia: A prospective, observational study. Parkinsonism Relat Disord. 2023; 114: 105792.
- Eichenseer SR, Stebbins GT, Comella CL. Beyond a motor disorder: a prospective evaluation of sleep quality in cervical dystonia. Parkinsonism Relat Disord. 2014; 20(4): 405–408.
- Müller J, Kemmler G, Wissel J, et al. Austrian Botulinum Toxin and Dystonia Study Group. The impact of blepharospasm and cervical dystonia on health-related quality of life and depression. J Neurol. 2002; 249(7): 842–846.
- Sławek J, et al. Factors affecting the health-related quality of life of patients with cervical dystonia and the impact of botulinum toxin type A injections. Funct Neurol. 2007; 22(2): 95–100.
- Karakulova Y, Loginova NV. Efficacy of Botulinum Therapy in Correcting the Level of Pain Syndrome and Quality of Life in Patients with Cervical Dystonia. Neuroscience and Behavioral Physiology. 2019; 49(2): 271–274.
- Dec-Ćwiek M, Sawczyńska K, Porębska K, et al. KinesioTaping: impact on non-motor symptoms in cervical dystonia patients treated with botulinum toxin injection. Neurol Neurochir Pol. 2024; 58(1): 127–133.
- Tinazzi M, Fiorio M, Fiaschi A, et al. Sensory functions in dystonia: insights from behavioral studies. Mov Disord. 2009; 24(10): 1427–1436.
- Nevrlý M, Hluštík P, Hok P, et al. Changes in sensorimotor network activation after botulinum toxin type A injections in patients with cervical dystonia: a functional MRI study. Exp Brain Res. 2018; 236(10): 2627–2637.
- Stamelou M, Edwards MJ, Hallett M, et al. The non-motor syndrome of primary dystonia: clinical and pathophysiological implications. Brain. 2012; 135(Pt 6): 1668–1681.
- Bailey GA, Martin E, Peall KJ. Cognitive and Neuropsychiatric Impairment in Dystonia. Curr Neurol Neurosci Rep. 2022; 22(11): 699–708.
- Medina Escobar A, Pringsheim T, Goodarzi Z, et al. The prevalence of depression in adult onset idiopathic dystonia: Systematic review and metaanalysis. Neurosci Biobehav Rev. 2021; 125: 221–230.
- Rafee S, Al-Hinai M, Douglas G, et al. Mood symptoms in cervical dystonia: Relationship with motor symptoms and quality of life. Clin Park Relat Disord. 2023; 8: 100186.
- da Silva-Júnior FP, Dos Santos Alves CO, Silva SM, et al. High prevalence of self-reported non-motor symptoms and lack of correlation with motor severity in adult patients with idiopathic isolated dystonia. Neurol Sci. 2022; 43(2): 1061–1065.
- Bailey GA, Rawlings A, Torabi F, et al. Longitudinal analysis of the relationship between motor and psychiatric symptoms in idiopathic dystonia. Eur J Neurol. 2022; 29(12): 3513–3527.
- Li Y, Liu T, Luo W. Botulinum Neurotoxin Therapy for Depression: Therapeutic Mechanisms and Future Perspective. Front Psychiatry. 2021; 12: 584416.
- Han V, Skorvanek M, Smit M, et al. Prevalence of non-motor symptoms and their association with quality of life in cervical dystonia. Acta Neurol Scand. 2020; 142(6): 613–622.
- Jahanshahi M. Neuropsychological and Neuropsychiatric Features of Idiopathic and DYT1 Dystonia and the Impact of Medical and Surgical treatment. Arch Clin Neuropsychol. 2017; 32(7): 888–905.
- Monaghan R, Cogley C, Burke T, et al. Non-motor features of cervical dystonia: Cognition, social cognition, psychological distress and quality of life. Clin Park Relat Disord. 2021; 4: 100084.
- Comella CL, Jankovic J, Truong DD, et al. U.S. XEOMIN Cervical Dystonia Study Group. Efficacy and safety of incobotulinumtoxinA (NT 201, XEOMIN®, botulinum neurotoxin type A, without accessory proteins) in patients with cervical dystonia. J Neurol Sci. 2011; 308(1-2): 103–109.
- Dressler D, Altenmüller E, Krauss JK. Treatment of Dystonia. Cambridge University Press, Cambridge 2018.
- Jankovic J, Adler CH, Charles D, et al. Primary results from the cervical dystonia patient registry for observation of onabotulinumtoxina efficacy (CD PROBE). J Neurol Sci. 2015; 349(1-2): 84–93.
- Novaretti N, Cunha AL, Bezerra TC, et al. The Prevalence and Correlation of Non-motor Symptoms in Adult Patients with Idiopathic Focal or Segmental Dystonia. Tremor Other Hyperkinet Mov (N Y). 2019; 9: 596.
