Botulinum toxin type A therapy for cervical dystonia.

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Background

Analysis 1.2. Comparison 1 Botulinum toxin type B vs Placebo, Outcome 2 Overall cervical dystonia improvement as assessed with TWSTRS: change from baseline to week 4-Doses subgroup analysis.. .. .. .. .. . Analysis 1.3. Comparison 1 Botulinum toxin type B vs Placebo, Outcome 3 Overall cervical dystonia improvement as assessed with TWSTRS: change from baseline to week 4-BtA-responsive vs BtA-non-responsive subgroup analysis. Analysis 1.4. Comparison 1 Botulinum toxin type B vs Placebo, Outcome 4

The available evidence suggests that BtA injections provide more objective and subjective benefit than trihexyphenidyl to patients with cervical dystonia. We could not draw any conclusions about other anticholinergic drugs. Future trials should explore the role of anticholinergic drugs in patients that do not get benefit with BtA.

Editorial group: Cochrane Movement Disorders Group. Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 11, 2020.

BackgroundThis is an update of a Cochrane Review, first published in 2005.Hemifacial spasm (HFS) is characterised by unilateral, involuntary contractions of the muscles innervated by the facial nerve. It is a chronic disorder, and spontaneous recovery is very rare. The two treatments routinely available are microvascular decompression and intramuscular injections with botulinum toxin type A (BtA). ObjectivesTo compare the e icacy, safety, and tolerability of BtA versus placebo in people with HFS. Search methodsWe searched CENTRAL, MEDLINE, Embase, reference lists of articles, and conference proceedings in July 2020. We ran the electronic database search, with no language restrictions, in July 2020. Selection criteriaDouble-blind, parallel, randomised, placebo-controlled trials (RCTs) of BtA versus placebo in adults with HFS. Data collection and analysisTwo review authors independently assessed records. We planned to select included studies, extract data using a paper pro forma, and evaluate the risk of bias. We resolved disagreements by consensus, or by consulting a third review author. We planned to perform metaanalyses. The primary e icacy outcome was HFS-specific improvement. The primary safety outcome was the proportion of participants with any adverse event. Main resultsWe found no parallel-group randomised controlled trials comparing BtA and placebo in HFS.

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