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. 2022 Aug 5:13:927573.
doi: 10.3389/fneur.2022.927573. eCollection 2022.

Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis

Alfonso E Martinez-Nunez  1 , Christos Sidiropoulos  2 , Julia Wall  1 , Jason Schwalb  3 , Ellen Air  3 , Peter LeWitt  1   4 , Bisena Bulica  1 , Patricia Kaminski  1 , Neepa Patel  5
Affiliations

Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis

Alfonso E Martinez-Nunez et al. Front Neurol. .

Abstract

Background: There is limited information on optimization of symptomatic management of cervical dystonia (CD) after implantation of pallidal deep brain stimulation (DBS).

Objectives: To describe the long-term, "real-world" management of CD patients after DBS implantation and the role of reintroduction of pharmacologic and botulinum toxin (BoNT) therapy.

Methods: A retrospective analysis of patients with focal cervical or segmental craniocervical dystonia implanted with DBS was conducted.

Results: Nine patients were identified with a mean follow-up of 41.7 ± 15.7 months. All patients continued adjuvant oral medication(s) to optimize symptom control post-operatively. Three stopped BoNT and four reduced BoNT dose by an average of 22%. All patients remained on at least one medication used to treat dystonia post-operatively.

Conclusion: Optimal symptom control was achieved with DBS combined with either BoNT and/or medication. We suggest utilization of adjuvant therapies such as BoNT and/or medications if DBS monotherapy does not achieve optimal symptom control.

Keywords: botulinum toxin; cervical dystonia; deep brain stimulation; long-term follow up; medical therapy.

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Conflict of interest statement

Author CS has served on the Scientific Advisory Board of Abbvie, Acorda and Boston Scientific, has served as a consultant for Medtronic and Global Kinetics, and received research grants from Abbvie, Biohaven, and Michigan State University. Author JS receives honoraria from BCBSM for his role as a co-Director of MSSIC, research funding from Medtronic, SetPoint and Neuros, and compensation from NPA for his role on the Steering Committee for RAD-PD. Author EA is a consultant for Stryker, Inc and Functional Neuromodulation, Ltd. Author PL has served as a consultant or investigator in clinical trials sponsored by Acorda Therapeutics, Amneal, Appello, Axovant, Aptynix, Biogen, Biotie, Bukwang Pharmaceuticals, Cavion, Cerevel, Denali Therapeutics, F. Hoffmann LaRoche, Impax Laboratories Inc., Impel Neuropharma, Ipsen, Kyowa Kirin Hakko, Lundbeck A/S, The Michael J. Fox Foundation for Parkinson's Research, Neurocrine Biosciences, Pharma 2B, Mitsubishi Tanabe Neuropharma, Neurocrine Biosciences, NeuroDerm Ltd, Noven, Parkinson Study Group, Prexton Therapeutics, Revance, US WorldMeds, Saccadous, Sun Pharma, and Supernus, Revance Therapeutics, Saccadous, Supernus, and US WorldMeds. He has received speaker honoraria from Acorda Therapeutics, Britannia, the American Academy of Neurology, The International Parkinson's Disease and Movement Disorders Society, Kyowa Kirin Hakko, Neurocrine Biosciences, Pallidan Labs, US WorldMeds, and the World Parkinson Congress. He is compensated for services as editor-in-chief of Clinical Neuropharmacology and serves without compensation on the editorial boards of Journal of Neural Transmission, Translational Neurodegeneration, and Journal of Parkinson's Disease. Author BB has received honoraria as a consultant to Lundbeck and as a speaker for Neurocrine Biosciences. Author NP has received honoraria as a consultant to Acorda Pharmaceuticals, Revance Pharmaceutical and Abbott Laboratories, and as a speaker for Teva Pharmaceuticals. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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