Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study

Harald Hefter; Isabelle Schomaecker; Max Schomaecker; Beyza Ürer; Raphaela Brauns; Dietmar Rosenthal; Philipp Albrecht; Sara Samadzadeh

doi:10.3390/toxins15070431

Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study

Toxins (Basel). 2023 Jun 30;15(7):431. doi: 10.3390/toxins15070431.

Authors

Harald Hefter¹, Isabelle Schomaecker¹, Max Schomaecker¹, Beyza Ürer¹, Raphaela Brauns¹, Dietmar Rosenthal¹, Philipp Albrecht^{1

2}, Sara Samadzadeh^{1

3

4

5}

Affiliations

¹ Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
² Department of Neurology, Maria Hilf Clinics, 41063 Moenchengladbach, Germany.
³ Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, 13125 Berlin, Germany.
⁴ Department of Regional Health Research and Molecular Medicine, University of Southern Denmark, 5230 Odense, Denmark.
⁵ Department of Neurology, Slagelse Hospital, 4200 Slagelse, Denmark.

Abstract

Aim of the study: To compare the course of severity of cervical dystonia (CD) before and after long-term botulinum toxin (BoNT) therapy to detect indicators for a good or poor clinical outcome.

Patients and methods: A total of 74 outpatients with idiopathic CD who were continuously treated with BoNT and who had received at least three injections were consecutively recruited. Patients had to draw the course of severity of CD from the onset of symptoms until the onset of BoNT therapy (CoDB graph), and from the onset of BoNT therapy until the day of recruitment (CoDA graph) when they received their last BoNT injection. Mean duration of treatment was 9.6 years. Three main types of CoDB and four main types of CoDA graphs could be distinguished. The demographic and treatment-related data of the patients were extracted from the patients' charts.

Results: The best outcome was observed in those patients who had experienced a clear, rapid response in the beginning. These patients had been treated with the lowest doses and with a low number of BoNT preparation switches. The worst outcome was observed in those 17 patients who had drawn a good initial improvement, followed by a secondary worsening. These secondary nonresponders had been treated with the highest initial and actual doses and with frequent BoNT preparation switches. A total of 12 patients were primary nonresponders and did not experience any improvement at all. No relation between the CoDB and CoDA graphs could be detected. Primary and secondary nonresponses were observed for all three CoDB types. The use of initial high doses as a relevant risk factor for the later development of a secondary nonresponse was confirmed.

Conclusions: Patients' drawings of their course of disease severity helps to easily detect "difficult to treat" primary and secondary nonresponders to BoNT on the one hand, but also to detect "golden responders" on the other hand.

Keywords: CoD graphs; botulinum toxin therapy; cervical dystonia; course of disease (CoD); long-term treatment; primary treatment failure; secondary treatment failure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Botulinum Toxins, Type A*
Humans
Injections
Neuromuscular Agents*
Pilot Projects
Torticollis* / diagnosis
Torticollis* / drug therapy
Treatment Outcome

Substances

Botulinum Toxins, Type A
Neuromuscular Agents

Grants and funding

This work has been supported by a restricted grant from the private Inge Diesbach-Stiftung to H.H. This funding did not influence the design or performance of the present study.