Optimising effects of botulinum toxin by post-injection activity

Abstract

Recent studies indicate that increased motor activity can increase presentation of SV2-specific botulinum toxin type A (BTX-A) receptor. This might result in higher efficacy of BTX-A injected. The aim of the present study was to investigate whether post-injection activation program may increase the duration of clinical benefit in cervical dystonia (CD). A total of 27 patients (17 female and 10 male, age range 26–63 years, disease duration >2 years) who had improved significantly to BTX-A injections during the previous year were enrolled into this single-centre, single-blind, crossover study. Each patient was injected with previously used effective dose of BTX-A (100–200 U of BOTOX, Allergan). CD was assessed using validated scales for dystonia (TWSTRS, ADL) every 2 weeks. In addition, patients were asked to contact their doctor immediately when they deemed the effect of BTX-A. Only after the second BTX-A injection activation and physical therapy, with the help of a physiotherapist, were performed 15 min before and immediately after BTX-A administration (60 min daily during 2 weeks). Physical activity protocol included biofeedback training and active stretching to increase specific muscle activity. Our results showed that BTX-A was effective in improving CD symptoms during both treatment periods. But the duration of clinical improvement was significantly longer (10–15 days) when the same dose of BTX-A was administered in combination with activation physiotherapy.