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. 2023 Jan;270(1):340-347.
doi: 10.1007/s00415-022-11343-0. Epub 2022 Sep 6.

Efficacy and safety of long-term botulinum toxin treatment for acquired cervical dystonia: a 25-year follow-up

Martina Petracca  1 , Maria Rita Lo Monaco  2 , Tamara Ialongo  1 , Enrico Di Stasio  3   4 , Maria Luana Cerbarano  1 , Loredana Maggi  4 , Alessandro De Biase  5 , Giulia Di Lazzaro  1   6   7 , Paolo Calabresi  1   7 , Anna Rita Bentivoglio  1   7
Affiliations

Efficacy and safety of long-term botulinum toxin treatment for acquired cervical dystonia: a 25-year follow-up

Martina Petracca et al. J Neurol. 2023 Jan.

Abstract

Botulinum toxin A (BoNT/A) is the first-line treatment for idiopathic cervical dystonia (ICD) and is widely used in the clinical setting. To date, scanty data are available on the effectiveness of BoNT in treating acquired cervical dystonia (ACD). Here we present a long-term follow-up of ACD patients treated with BoNT/A that focused on safety and efficacy. The study included subjects who had received at least six treatments of three commercially available BoNT/A drugs [abobotulinumtoxinA (A/Abo), incobotulinumtoxinA (A/Inco) and onabotulinumtoxinA (A/Ona)]. Safety and efficacy were assessed based on patients' self-reports regarding adverse effects (AE), duration of improvement of dystonia and/or pain relief. Global clinical improvement was measured on a six-point scale. 23 patients with ACD were administered 739 treatments (A/Abo in 235, A/Inco in 72, A/Ona in 432) with a mean number of treatments of 31 ± 20 (range 6-76) and duration of 10 ± 6 weeks (range 2-25). The mean dose was 737 ± 292 U for A/Abo, 138 ± 108 U for A/Inco and 158 ± 80 U for A/Ona. The average benefit duration was 89 ± 26 (A/Abo), 88 ± 30 days (A/Inco), and 99 ± 55 days (A/Ona) (p = 0.011); global clinical improvement for all sessions was 4 ± 1. ANOVA one-way analysis indicated that A/Ona had the best profile in terms of duration (p < 0.05), whereas A/Abo had the best pain relief effect (p = 0.002). Side effects were reported in 9% of treatments (67/739), with ten treatments (1%) complicated by two side effects. Most side effects were rated mild to moderate; severe side effects occurred following three treatments with the three different BoNT; two required medical intervention. No allergic reactions were reported. Even after 25 years of repeated treatments, all serotypes of BoNT demonstrate positive effects in treating ACD with long-lasting efficacy and safety.

Keywords: Acquired cervical dystonia; Botulinum toxin A; Efficacy; Long-term outcome; Safety.

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Conflict of interest statement

ARB has organized workshops, is a member of advisory boards and has received unrestricted educational grants from Allergan, Ipsen and Merz. The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Mean duration of maximum clinical improvement overtime. In sky-blue: maximum benefit duration; in red: number of patients
See this image and copyright information in PMC

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