Tsui Score Research Articles

Phenol block for cervical dystonia: effects and side effects

Takeuchi N, Chuma T, Mano Y. Phenol block for cervical dystonia: effects and side effects. Arch Phys Med Rehabil 2004;85:1117-20. Objective To report on the effectiveness and side effects of 2% phenol block in patients with cervical dystonia (CD). Design Case series. Setting A rehabilitation department at a university medical center in Japan. Participants Sixteen patients (11 men, 5 women; mean age ± standard deviation, 43.4±11.2y) with CD. The cause of the CD was unknown, and all cases were refractory to the oral medication and rehabilitation therapy. Intervention Two percent phenol blocks guided by electromyography. Main outcome measures A blind analysis by neurologists of the Tsui score before and after 2 weeks of treatment with phenol block. Side effects were evaluated by another neurologist and patient report. Results There was significant ( P=.0002) improvement in neck movement and position, based on a reduced Tsui score, after the phenol block. However, 4 patients had a complication of sensory disturbance of the transverse cutaneous nerve of the neck area. The sensory disturbances decreased gradually and disappeared within 3 months, whereas the effects of the phenol block continued. Conclusions Phenol block can reduce the impact of CD that is refractory to therapy.

Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia

Objectives: Botulinum toxin type A is a potent neuromuscular paralyzing agent used in various disorders including cervical dystonia. Two preparations of botulinum toxin are now commercially available ( Dysport and...

Riluzole therapy in cervical dystonia.

We conducted a 6-week open-label pilot study with blinded video rating of riluzole (50 mg twice a day) in six patients with cervical dystonia (CD) refractory to botulinum toxin A and oral pharmacological treatment. The Tsui rating scale served as primary efficacy measure and improved significantly under riluzole (P = 0.002). In three of six patients, the Tsui score improved by more than 30% with a greater 50% reduction in the head tremor/jerk subscore of the Tsui scale. These data suggest that riluzole may be helpful in a subgroup of patients with disabling CD refractory to other therapies.

Social phobia in spasmodic torticollis

OBJECTIVESTo study the prevalence of psychiatric comorbidity assessed by the use of a structured clinical interview in a large, representative sample of patients with spasmodic torticollis (ST) and to test...

A double blind, randomised, parallel group study to investigate the dose equivalence of Dysport® and Botox®in the treatment of cervical dystonia

OBJECTIVEThis study was designed to establish whether a ratio of three units of Dysport® is equivalent to one unit of Botox® for the treatment of cervical dystonia.METHODSPatients with predominantly rotational...

What is the optimal dose of botulinum toxin A in the treatment of cervical dystonia? Results of a double blind, placebo controlled, dose ranging study using Dysport®

OBJECTIVESBotulinum toxin injections have become a first line therapeutic approach in cervical dystonia. Nevertheless, published dosing schedules, responder rates, and frequency of adverse events vary widely. The present prospective multicentre...

Muscle activity changes in spasmodic torticollis after botulinum toxin treatment

We assessed electromyographic (EMG) activity in neck muscles before and after botulinum toxin injections in 28 patients with spasmodic torticollis (ST) to investigate possible changes in muscle activation after treatment. A six-channel EMG with surface electrodes was used to record activity of sternocleiodomastoid, trapezius and splenius capitis bilaterally. Objective benefit (>25% reduction in Tsui's score) occurred in 22 patients (78%). Of the 168 muscles studied before botulinum toxin injections, 90 presented EMG activity. Sixty-eight of these muscles were injected and a decrease in EMG activity occurred in 44 (65%) of them. A decrease in EMG activity was also detected in 15 (68%) of those which were not injected. On the other hand, 70 of the 78 muscles without pre-botulinum toxin EMG activity were not injected. However, after treatment, EMG activity increased in 37 (52%) of these muscles. These changes involved 18 patients and occurred without concomitant change in the main direction of head deviation despite the improvement observed in most cases. These results suggest that in ST head turning results from an abnormal central motor program which results in non-specific neck muscle activation.

Efficacy of botulinum toxin for cervical dystonia. A comparison of methods for evaluation

Twenty patients with cervical dystonia were treated during one year with repeated intramuscular injections of botulinum toxin. The outcome was evaluated comparing subjective global rating with relative changes in degree of pain on the Visual analogue scale (VAS), degree of dysfunction due to dystonia, and quality of life according to the Nottingham health profile (NHP). Objective measurement of dystonic position and movement ability was performed using a goniometer, semiquantitatively noted as scores according to Fahn and Tsui. Before treatment, the degree of impaired life quality on the NHP did not correlate with the Tsui score of dystonic posture, but significantly with the Fahn score (p < 0.01) which also includes data on pain. Significant improvement after treatment was seen for all parameters (p < 0.05). Global subjective rating correlated significantly with improved posture according to the Tsui score (p < 0.05), but not with reduced pain or degree of dysfunction. The results suggest that the efficacy of botulinum toxin in cervical dystonia is best evaluated using a combination of the VAS for pain and the Tsui score for dystonic posture and movement ability.

Efficacy of botulinum toxin for cervical dystonia. A comparison of methods for evaluation

Twenty patients with cervical dystonia were treated during one year with repeated intramuscular injections of botulinum toxin. The outcome was evaluated comparing subjective global rating with relative changes in degree of pain on the Visual analogue scale (VAS), degree of dysfunction due to dystonia, and quality of life according to the Nottingham health profile (NHP). Objective measurement of dystonic position and movement ability was performed using a goniometer, semiquantitatively noted as scores according to Fahn and Tsui. Before treatment, the degree of impaired life quality on the NHP did not correlate with the Tsui score of dystonic posture, but significantly with the Fahn score (p < 0.01) which also includes data on pain. Significant improvement after treatment was seen for all parameters (p < 0.05). Global subjective rating correlated significantly with improved posture according to the Tsui score (p < 0.05), but not with reduced pain or degree of dysfunction. The results suggest that the efficacy of botulinum toxin in cervical dystonia is best evaluated using a combination of the VAS for pain and the Tsui score for dystonic posture and movement ability.