An open-label cohort study of the improvement of quality of life and pain in de novo cervical dystonia patients after injections with 500 U botulinum toxin A (Dysport)

Abstract

ObjectivesIt remains to be determined whether the benefits of botulinum toxin type A (BoNT-A) on cervical dystonia (CD) motor symptoms extend to improvements in patient's quality of life (QoL). This analysis of a large, multicentre study was conducted with the aim of investigating changes in QoL and functioning among de novo patients receiving 500 U BoNT-A (abobotulinumtoxinA; Dysport) for the treatment of the two most frequent forms of CD, predominantly torticollis and laterocollis.DesignA prospective, open-label study of Dysport (500 U; Ipsen Biopharm Ltd) administered according to a defined intramuscular injection algorithm.SettingGerman and Austrian outpatient clinics.Participants516 male and female patients (aged ≥18 years) with de novo CD. The majority of patients had torticollis (78.1%). 35 patients had concomitant depression (MedDRA-defined).Main outcome measuresChange from baseline to weeks 4 and 12 in Craniocervical Dystonia Questionnaire (CDQ-24) total and subscale scores, patient diary items (‘day-to-day capacities and activities’, ‘pain’ and ‘duration of pain’) and global assessment of pain.ResultsSignificant improvements were observed in CDQ-24 total and subscale scores at week 4 and were sustained up to week 12 (p<0.001). Changes in CDQ-24 scores did not significantly differ between the torticollis and laterocollis groups or between patients with or without depression. There were also significant reductions in patient diary item scores for activities of daily living, pain and pain duration at weeks 4 and 12 (p<0.001). Pain relief (less or no pain) was reported by 66% and 74.1% of patients at weeks 4 and 12, respectively. Changes in pain parameters demonstrated a positive relationship with change in Tsui score.ConclusionsAfter standardised open-label treatment with Dysport 500 U, improvements in QoL and pain intensity up to 12 weeks in patients with CD were observed.

Quality of life improvements in patients with cervical dystonia following treatment with a liquid formulation of abobotulinumtoxinA (Dysport®)

“…Such observations support earlier studies which have shown that other disease factors over and above dystonic severity (e.g. anxiety, depression) impact patient QoL and reinforce the idea that the ‘disease’ is more than the movement disorder. Nevertheless, it is worth noting that the association between CDIP‐58 and the TWSTRS Severity score was higher at peak effect than when assessed at baseline, indicating that symptomatic efficacy (reduction of dystonic severity) is an important contributor to the observed improvements in well‐being seen with ASI.…”

“…The significant efficacy of abobotulinumtoxinA in improving QoL in CD patients has previously been established using scales such as the Craniocervical Dystonia Questionnaire 24 and Short Form 36 . This study extends these previous findings using the comprehensive CDIP‐58 scale and shows that treatment with ASI similarly improves relevant domains of QoL in CD patients as soon as at the first cycle of treatment.…”

Ranking of Dystonia Severity by Pairwise Video Comparison

“…The highest of those correlations was with the activities‐of‐daily‐living (ADL) subscale . Similar results were replicated in a large study in >500 de novo cervical dystonia patients . Such findings can be attributed to different underlying constructs: perceived quality of life is only partially determined by motor symptom severity as has been shown in numerous studies in different movement disorders .…”

“…Such findings can be attributed to different underlying constructs: perceived quality of life is only partially determined by motor symptom severity as has been shown in numerous studies in different movement disorders . Specifically in the case of dystonia, the perceived stigma, affective symptoms, and pain have an impact in addition to the perceived effect of treatment and other sociodemographic factors . Consequently, current guidelines recommend consideration of these nonmotor aspects in the setting of treatment goals and the use of hrQoL instruments as secondary outcome measures to assess treatment efficacy .…”

Abobotulinum Toxin A in the Treatment of Chronic Low Back Pain

“…In another study, injection of 40 and 80 units of aboA into the subcutaneous tissue of 50 patients around a painful anal fissure relieved pain at Day 7 post-injection in 82% of the patients [35]. In another study [36], injection of 500 units of aboA into the neck muscles of patients with cervical dystonia resulted in alleviation of neck and shoulder pain in 66% and 76% of the subjects at Weeks 4 and 12. Ranaux et al, in a double-blind study, compared Tsui scores with Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) pain scores in 54 subjects with cervical dystonia treated with onaA and aboA.…”