Comprehensive diagnosis of cervical dystonia and the efficacy of long-term (three-year) botulinum therapy

Abstract

Cervical dystonia (CD) is common in outpatient practice but in many cases is diagnosed at late stages. The efficacy of long-term botulinum therapy (BT) in CD has been poorly studied.Objective: to analyse the typical practice of treating patients with CD and the efficacy of long-term BT therapy (three years).Material and methods. Sixty-three patients (43 women and 20 men) diagnosed with CD (mean age 51 [42; 63] years) participated in the study. We performed an analysis of typical practice of managing patients with CD before starting BT. The mean duration of disease at the time of referral was 6 [4; 10] years. Patients received repeated injections of BT at 10–20 week intervals; BT was administered under electromyographic control and ultrasound navigation. The severity of CD was assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWRSTW), quality of life using the EuroQol-5D questionnaire (EQ-5D) questionnaire, and anxiety level using the Generalized Anxiety Disorder Questionnaire scale-7, GAD-7). Patients' condition was assessed at baseline, 1 month after BT, and after 3 years against the background of regular BT. The severity of the disease before BT was 36.71±3.6 points. The control group consisted of 46 healthy subjects (39 women and 7 men, mean age 53.8±12.3 years).Results. The diagnosis of CD was made on average 2.3±1.1 years after the onset of the first symptoms, BT was started on average 5±2.6 years after diagnosis. At the first visit to the physician, CD was detected in only 32% of cases. In the CD group there was an increase in the severity of anxiety up to 9.93±4.7 points (in the control group – 4.28±3.5 points; p≤0.05) and a decrease in quality of life down to 62.53±12.1 points (in the control group – 86.38±6.4 points; p≤0.05). One month after BT, a significant decrease in the severity of the disease was observed – from 36.7±13.6 to 13.3±10.8 points (p≤0.05). After three years of regular BT the severity of the disease decreased to 12.7±10.5 points (p≤0.05), the level of anxiety decreased to 5.2±3.7 points (p≤0.05), the patients' quality of life increased up to 77.93±8.4 points (p≤0.05).Conclusion. CD is still underdiagnosed in practice, and BT is not prescribed until several years after the onset of the disease. Regular and longterm use of BT not only reduces the severity of CD, but also reduces the severity of anxiety disorders and improves patients' quality of life.