Abstract
Multichannel Electromyographic Mapping to Optimize OnabotulinumtoxinA Efficacy in Cervical Dystonia
Highlights
Cervical dystonia (CD), known as spasmodic torticollis, is a focal dystonia characterized by sustained, involuntary contractions of the muscles of the neck and shoulders resulting in abnormal and painful posturing of the head, neck, and shoulders.[1]
Pain is present in up to 60% of patients, and is sometimes the most disabling feature.[2]. It is typically a life-long disease that may wax and wane in severity and represents the most common form of focal dystonia seen in neurological practice, with a prevalence of 89 per 1 million people.[3]
The Toronto Western Spasmodic Torticollis Scale (TWSTRS) is a rating scale frequently used in clinical trials to measure the impact of cervical dystonia
Summary
Cervical dystonia (CD), known as spasmodic torticollis, is a focal dystonia characterized by sustained, involuntary contractions of the muscles of the neck and shoulders resulting in abnormal and painful posturing of the head, neck, and shoulders.[1]. Botulinum toxin injections are currently established as safe and effective in the treatment of CD4 and can provide relief for up to 85% of patients.[5]. The aim of this study was to examine whether multichannel electromyogaphic mapping improved outcomes in a cohort of antibody-negative onabotulinumtoxinA non-responders by more precisely identifying which muscles were involved in the dystonia. Patients received either a multichannel electromyographic mapping study prior to the first botulinum toxin injection, which was followed by use of only a single-lead injection 16 weeks later (injected by an alternate and blinded movement disorders specialist) or vice versa. Mean percentage improvement in Total Toronto Western Spasmodic Torticollis Rating Scale was 23.5% using multichannel electromyography compared with 9% using the single-channel technique (p50.11).
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