Abstract
Objective:Botulinum Toxin (BTX) has become a widely used treatment in several dystonic conditions, but the evidence for its efficacy has largely come from open trials and expert opinion. This systematic review examined the efficacy and safety of BTX in the treatment of Focal Hand Dystonia (FHD) in Randomized Controlled Trials (RCTs).Methods:We searched Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, SPORT Discus, SCOPUS, Web of Science, PEDro, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) for randomized, placebo-controlled trials on the use of BTX for FHD.Results:Of 1,116 publications retrieved from the databases searched, three publications were included. The evidence identified pertains to focal task-specific hand dystonias. Sixty-nine participants were involved in the three RCTs with a mean duration of symptoms of 7.5 years. Participants were assessed using a combination of self-reported and functional performance outcome measures following injections of BTX subtype A (BTX-A) or placebo. The Oxford Quality Scale was used to assess the included studies, and the three studies each scored 3/5 or above. The included studies reported no adverse events with BTX-A use, other than muscle weakness and pain at the injection sites.Conclusion:The number of participants included in these three trials is too small to draw dependable conclusions about the efficacy and safety of BTX-A for FHD. There is currently not enough evidence to recommend the routine use of BTX-A for FHD.
Highlights
Dystonia is a disabling neurological syndrome that can produce involuntary, sustained or spasmodic movements and abnormal postures [1, 2]
Two of the studies were limited to participants who had been diagnosed with Writer’s Cramp (WC), and overall the majority (94%) of the participants had WC
Significant mean change in velocity from baseline to 2 weeks for Botulinum Toxin (BTX)-A was recorded for horizontal movement (0.17 cm/sec, p < 0.05); for vertical movement (0.9 cm/sec, p < 0.01); and for descending movement (0.39 cm/sec, p < 0.05)
Summary
Dystonia is a disabling neurological syndrome that can produce involuntary, sustained or spasmodic movements and abnormal postures [1, 2]. The pathophysiology of dystonia is complex and it seems likely that dysfunction in the basal ganglia or linked central pathways leads to abnormal motor output from the central nervous system. Complex movements, such as writing or playing the piano, can be affected. The Open Neurology Journal, 2019, Volume 13 33 motor control while performing a specific skilled repetitive hand action (e.g. musician’s dystonia, writer's cramp). Such movements require exquisite motor control with excitatory and inhibitory signals controlling appropriate muscle contractions whilst simultaneously relaxing surrounding muscles. This “surround inhibition” is abnormal in patients with dystonia with both agonist and antagonist muscles in a limb segment cocontracting [3]
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