Vol 54, No 3 (2020)
Invited Editorial
Published online: 2020-06-30
Botulinum toxin for cervical dystonia: addressing treatment failure and improving outcomes
Abstract
Introduction. Cervical dystonia is a form of focal dystonia characterised by tilting and turning of the head and neck. This can cause significant disability in affected patients. Botulinum toxin injections are the mainstay of therapy. However, approximately 30% of patients discontinue treatment.
Clinical reflections. Tyślerowicz et al. have provided a comprehensive review of the factors contributing to treatment failure. Such factors include appropriate identification of dystonia patterns, accurate injection of muscles, and addressing non-motor features of cervical dystonia.
Clinical implications. A systematic approach is needed to identify and address the potentially modifiable factors that contribute
to treatment failure.
References
- Albanese A, Bhatia K, Bressman SB, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013; 28(7): 863–873.
- Brans JW, Lindeboom R, Snoek JW, et al. Botulinum toxin versus trihexyphenidyl in cervical dystonia: a prospective, randomized, double-blind controlled trial. Neurology. 1996; 46(4): 1066–1072.
- Greene P, Kang U, Fahn S, et al. Double-blind, placebo-controlled trial of botulinum toxin injections for the treatment of spasmodic torticollis. Neurology. 1990; 40(8): 1213–1218.
- Jinnah HA, Comella CL, Perlmutter J, et al. Dystonia Coalition Investigators. Longitudinal studies of botulinum toxin in cervical dystonia: Why do patients discontinue therapy? Toxicon. 2018; 147: 89–95.
- Tyślerowicz M, Kiedrzyńska W, Adamkiewicz B, et al. Cervical dystonia - improving the effectiveness of botulinum toxin therapy. Neurol Neurochir Pol. 2020 [Epub ahead of print].
- Szejko N, Jakubczyk A, Dunalska A, et al. Dystonic tics in patients with Gilles de la Tourette syndrome. Neurol Neurochir Pol. 2019; 53(5): 335–340.
- Tipton PW. Searching for tics. Neurol Neurochir Pol. 2019; 53(5): 315–316.
- Yoon WT. Comparison of dystonia between Parkinson's disease and atypical parkinsonism: The clinical usefulness of dystonia distribution and characteristics in the differential diagnosis of parkinsonism. Neurol Neurochir Pol. 2018; 52(1): 48–53.
- Jost WH, Biering-Sørensen Bo, Drużdż A, et al. Preferred muscles in cervical dystonia. Neurol Neurochir Pol. 2020 [Epub ahead of print].
- Finsterer J, Maeztu C, Revuelta GJ, et al. Collum-caput (COL-CAP) concept for conceptual anterocollis, anterocaput, and forward sagittal shift. J Neurol Sci. 2015; 355(1-2): 37–43.
- Speelman JD, Brans JW. Cervical dystonia and botulinum treatment: is electromyographic guidance necessary? Mov Disord. 1995; 10(6): 802.
- Van Gerpen JA, Matsumoto JY, Ahlskog JE, et al. Utility of an EMG mapping study in treating cervical dystonia. Muscle Nerve. 2000; 23(11): 1752–1756, doi: 10.1002/1097-4598(200011)23:11<1752::aid-mus12>3.0.co;2-u.
- Brashear A, Bergan K, Wojcieszek J, et al. Patients' perception of stopping or continuing treatment of cervical dystonia with botulinum toxin type A. Mov Disord. 2000; 15(1): 150–153, doi: 10.1002/1531-8257(200001)15:1<150::aid-mds1024>3.0.co;2-x.
- 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.
- Fabbrini G, Berardelli I, Moretti G, et al. Psychiatric disorders in adult-onset focal dystonia: a case-control study. Mov Disord. 2010; 25(4): 459–465.
- Ben-Shlomo Y, Camfield L, Warner T, et al. ESDE collaborative group. What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry. 2002; 72(5): 608–614.
- Slawek J, Friedman A, Potulska A, 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.
- Berardelli I, Ferrazzano G, Pasquini M, et al. Clinical course of psychiatric disorders in patients with cervical dystonia. Psychiatry Res. 2015; 229(1-2): 583–585.
