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open access

Vol 54, No 3 (2020)
Review Article
Submitted: 2020-01-25
Accepted: 2020-03-13
Published online: 2020-04-14
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Cervical dystonia — improving the effectiveness of botulinum toxin therapy

Małgorzata Tyślerowicz1, Weronika Kiedrzyńska1, Bożena Adamkiewicz1, Wolfgang H. Jost2, Jarosław Sławek34
DOI: 10.5603/PJNNS.a2020.0021
·
Pubmed: 32285434
·
Neurol Neurochir Pol 2020;54(3):232-242.
Affiliations
  1. Department of Neurology, Copernicus Memorial Hospital in Lodz, Comprehensive Cancer Centre and Traumatology, Lodz, Poland, Poland
  2. Parkinson-Klinik Ortenau, Wolfach, Germany
  3. Department of Neurological-Psychiatric Nursing, Medical University of Gdańsk, Poland
  4. Department of Neurology, St Adalbert Hospital, “Copernicus” Ltd., Gdańsk, Poland

open access

Vol 54, No 3 (2020)
Review articles
Submitted: 2020-01-25
Accepted: 2020-03-13
Published online: 2020-04-14

Abstract

Introduction. Cervical dystonia is the most frequent form of focal dystonia. It is characterised by involuntary muscular contractions resulting in abnormal head/neck and shoulder movements and postures, which can be associated with tremor and pain. Local intramuscular injections of botulinum toxin type A (BoNT-A) is the treatment of choice, being both effective and well-tolerated. However, a considerable number (c. 30%) of patients discontinue this treatment. The aim of this review was to analyse the factors possibly responsible for treatment failures of cervical dystonia (CD), with special regard to the new classification known as the ‘Col-Cap’ concept and non-motor symptoms.

Clinical implications. Several factors analysed in this review are responsible for effective treatment: proper diagnosis of dystonia and exclusion of pseudodystonias, correct recognition of dystonia pattern and identification of new patterns according to the Col-Cap concept, muscle selection and precise injections under electromyography (EMG) and/or ultrasonography (US) guidance. Furthermore, concomitant diagnosis and treatment of non-motor symptoms such as depression, anxiety, fatigue, sleep problems, phobias and stigmatisation are crucial in obtaining the best overall effect of the treatment. Primary and secondary immunisation and non-responsiveness seem to be marginal problems nowadays due to a low potential of new BoNT-A formulations to produce neutralising antibodies.

Future directions. There is a need for new and relevant scales combining the Col-Cap concept patterns with non-motor symptoms and quality of life. There is also a lack of specific rehabilitation protocols which could enhance BoNT-A treatment results.

Abstract

Introduction. Cervical dystonia is the most frequent form of focal dystonia. It is characterised by involuntary muscular contractions resulting in abnormal head/neck and shoulder movements and postures, which can be associated with tremor and pain. Local intramuscular injections of botulinum toxin type A (BoNT-A) is the treatment of choice, being both effective and well-tolerated. However, a considerable number (c. 30%) of patients discontinue this treatment. The aim of this review was to analyse the factors possibly responsible for treatment failures of cervical dystonia (CD), with special regard to the new classification known as the ‘Col-Cap’ concept and non-motor symptoms.

Clinical implications. Several factors analysed in this review are responsible for effective treatment: proper diagnosis of dystonia and exclusion of pseudodystonias, correct recognition of dystonia pattern and identification of new patterns according to the Col-Cap concept, muscle selection and precise injections under electromyography (EMG) and/or ultrasonography (US) guidance. Furthermore, concomitant diagnosis and treatment of non-motor symptoms such as depression, anxiety, fatigue, sleep problems, phobias and stigmatisation are crucial in obtaining the best overall effect of the treatment. Primary and secondary immunisation and non-responsiveness seem to be marginal problems nowadays due to a low potential of new BoNT-A formulations to produce neutralising antibodies.

Future directions. There is a need for new and relevant scales combining the Col-Cap concept patterns with non-motor symptoms and quality of life. There is also a lack of specific rehabilitation protocols which could enhance BoNT-A treatment results.

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Keywords

cervical dystonia, Col-Cap concept, botulinum toxin, treatment failures, primary non-responsiveness, secondary non-responsiveness

About this article
Title

Cervical dystonia — improving the effectiveness of botulinum toxin therapy

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 54, No 3 (2020)

Article type

Review Article

Pages

232-242

Published online

2020-04-14

Page views

4909

Article views/downloads

5354

DOI

10.5603/PJNNS.a2020.0021

Pubmed

32285434

Bibliographic record

Neurol Neurochir Pol 2020;54(3):232-242.

Keywords

cervical dystonia
Col-Cap concept
botulinum toxin
treatment failures
primary non-responsiveness
secondary non-responsiveness

Authors

Małgorzata Tyślerowicz
Weronika Kiedrzyńska
Bożena Adamkiewicz
Wolfgang H. Jost
Jarosław Sławek

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