Abstract

Botulinumtoxin injection (BoNT) into affected muscles is effective to improve motor symptoms of cervical dystonia (CD) by reducing muscle contraction and involuntary dystonic movement and posturing. However, the understanding of the effect on health-related quality of life (HR-QoL) and patient referral under HR-QoL aspects is incomplete. In this open-label clinical prospective observational study, we characterized the outcomes in CD (n = 159) from botulinumtoxin on both generic HR-QoL (EuroQol; EQ-5D-5L) and disease-specific HR-QoL [craniocervical dystonia questionnaire (CDQ-24)]. Additionally, we characterized motor and non-motor signs of dystonia including motor symptom improvement, depressive symptoms, pain, and sleep quality. We assessed patients at the end of a regular 3-month period from last injection (Timepoint1) and 4 weeks after the re-injection of BoNT (Timepoint2). We aimed to define outcomes on both generic and disease-specific HR-QoL and to evaluate predictors of therapeutic outcome in terms of stepwise multiple regression models. Patients with CD showed a robust improvement of both generic and disease-specific HR-QoL. Furthermore, motor and non-motor signs improved. Multiple regression analyses revealed that EQ-5D-5L and “satisfaction with health” (Fragen zur Lebenszufriedenheit-G) at Timepoint1 predicted treatment response on generic HR-QoL outcome (R2 = 0.284; P = 0.019). Similarly, CDQ-24 and Beck’s Depression inventory at Timepoint1 predicted the treatment response on disease-specific HR-QoL (R2 = 0.253; P = 0.026). Our study underscores both generic and disease-specific HR-QoL improvements in CD, and provides useful predictors on HR-QoL outcomes.

Highlights

  • Health-related quality of life (HR-QoL) is impaired in cervical dystonia (CD) when compared with the healthy control population [1,2,3,4,5]

  • Longitudinal surveys may help to identify meaningful predictors, when approximating the potential effect of botulinumtoxin injection (BoNT) on HR-QoL outcomes in patients with CD. In this open-label clinical prospective observational study, we address this need by characterizing outcomes on both generic and disease-specific HR-QoL from repetitive BoNTs in a cohort of 159 CD patients

  • Cervical dystonia patients showed improved generic HR-QoL in both EQ-5D-5L (P = 0.017) and EQ-VAS (P < 0.001) at Timepoint2 compared with Timepoint1

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Summary

Introduction

Health-related quality of life (HR-QoL) is impaired in cervical dystonia (CD) when compared with the healthy control population [1,2,3,4,5]. Pain is a predominant feature in up to 75% of the patients with CD [12] and impacts HR-QoL Such conclusions should be substantiated on larger studies and patient samples [13,14,15]. This implies the need for additional insight and inclusion of larger and comprehensive data sets including assessments of motor and non-motor signs. In this sense, clinical studies on HR-QoL outcomes became a mainstay for therapy referral in wide fields of movement disorders, including dystonia and Parkinson’s disease [16,17,18]. Longitudinal surveys may help to identify meaningful predictors, when approximating the potential effect of BoNT on HR-QoL outcomes in patients with CD

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