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Dose per muscle in cervical dystonia: pooled data from seven movement disorder centres
, 2, 3, 4, 5, 6, 1, 7
Affiliations- Parkinson-Klinik Ortenau, Wolfach, Germany
- Dept. of Neurology, Municipal Hospital in Poznań, Poland, Poznań, Poland
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate medical education and research, JLN Marg, New Delhi, India
- Movement Disorder Clinic, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
- Service de Neurologie et Pathologie du Mouvement, CHRU de Lille, Lille, France
- Department of Neuromuscular diseases and Department of Anatomy. CHRU Besançon, University of Franche-Comté, Besancon, France
- Department of Neurological-Psychiatric Nursing, Medical University of Gdańsk, Dpt. of Neurology, St. Adalbert Hospital, Gdańsk, Poland
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Abstract
Aim of study. Botulinum neurotoxin type A (BoNT/A) injections are the established treatment in cervical dystonia (CD). But clinical practice regarding the choice of muscles into which injections are made varies between centres. Until now, there have been no dose-per-muscle recommendations based on ‘searching the dose’ clinical trial data.
Clinical rationale for study. We therefore examined the dosages under real world conditions at seven international movement disorders centres, using an identical clinical approach.
Results. We examined 305 patients with CD (55.6 ± 13.2 years, 204 female). The most commonly injected muscles were the splenius capitis (84.9%), sternocleidomastoid (80.3%), trapezius (59.7%), levator scapulae (49.8%), semispinalis capitis (39%), and obliquus capitis inferior (36.7%). The mean total dose per treatment session with aboBoNT/A was 652.5 (SD = 285.5), with onaBoNT/A it was 159.5 (SD = 62.4), and with incoBoNT/A it was 173.4 (SD = 99.2) units. The doses injected into each muscle in the ona- or incoBoNT/A groups were between 19.7 and 48.2 units, with the highest dose for the splenius capitis with 49.2 ± 26.0 units. The doses in the aboBoNT/A group were between 69.6 and 146.4 units, and the highest dose being injected into the splenius capitis (139.6 ± 80.7 units).
Conclusions and clinical implications. In clinical trials the doses per muscle are based on an arbitrary decision. In our study, the doses were lower than in other studies, which may be due to the number of muscles per session, the use of ultrasound guidance (and therefore more precise injections), as well as the use of the Col-Cap concept. Our results exemplify everyday practice, and may help as the basis for recommendations and further investigations.
Abstract
Aim of study. Botulinum neurotoxin type A (BoNT/A) injections are the established treatment in cervical dystonia (CD). But clinical practice regarding the choice of muscles into which injections are made varies between centres. Until now, there have been no dose-per-muscle recommendations based on ‘searching the dose’ clinical trial data.
Clinical rationale for study. We therefore examined the dosages under real world conditions at seven international movement disorders centres, using an identical clinical approach.
Results. We examined 305 patients with CD (55.6 ± 13.2 years, 204 female). The most commonly injected muscles were the splenius capitis (84.9%), sternocleidomastoid (80.3%), trapezius (59.7%), levator scapulae (49.8%), semispinalis capitis (39%), and obliquus capitis inferior (36.7%). The mean total dose per treatment session with aboBoNT/A was 652.5 (SD = 285.5), with onaBoNT/A it was 159.5 (SD = 62.4), and with incoBoNT/A it was 173.4 (SD = 99.2) units. The doses injected into each muscle in the ona- or incoBoNT/A groups were between 19.7 and 48.2 units, with the highest dose for the splenius capitis with 49.2 ± 26.0 units. The doses in the aboBoNT/A group were between 69.6 and 146.4 units, and the highest dose being injected into the splenius capitis (139.6 ± 80.7 units).
Conclusions and clinical implications. In clinical trials the doses per muscle are based on an arbitrary decision. In our study, the doses were lower than in other studies, which may be due to the number of muscles per session, the use of ultrasound guidance (and therefore more precise injections), as well as the use of the Col-Cap concept. Our results exemplify everyday practice, and may help as the basis for recommendations and further investigations.
Keywords
torticollis, cervical dystonia, Col-Cap concept, botulinum toxin, sternocleidomastoideus muscle, splenius capitis muscle
About this articleTitle
Dose per muscle in cervical dystonia: pooled data from seven movement disorder centres
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
174-178
Published online
2021-01-20
Page views
1833
Article views/downloads
1600
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2021;55(2):174-178.
Keywords
torticollis
cervical dystonia
Col-Cap concept
botulinum toxin
sternocleidomastoideus muscle
splenius capitis muscle
Authors
Wolfgang H. Jost
Artur Drużdż
Sanjay Pandey
Bo Biering-Sørensen
Alexandre Kreisler
Laurent Tatu
Christian F. Altmann
Jarosław Sławek
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