Botulinum toxin versus trihexyphenidyl in cervical dystonia

Brans, J. W. M.; Lindeboom, Robert; Snoek, J. W.; Zwarts, M.J.; Weerden, T.W. van; Brunt, Ehrout R.; Hilten, J.J. van; Kamp, Wim van der; Prins, Maria; Speelman, J. D.

doi:10.1212/wnl.46.4.1066

Cited by 173 publications

(77 citation statements)

References 12 publications

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“…In this small group of patients, 35% of the 19 patients with a predominantly dystonic clinical picture experienced decrease of dystonia severity. Apomorphine, bromocriptine in high doses (18- [77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94] . Some recent experimental studies have focused on the effect of antimuscarinic therapy in dystonia.…”

Section: Treatmentmentioning

confidence: 99%

Understanding dystonia: diagnostic issues and how to overcome them

Camargos

Cardoso

2016

Arq. Neuro-Psiquiatr.

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The diagnosis and treatment of dystonia are challenging. This is likely due to gaps in the complete understanding of its pathophysiology, lack of animal models for translational studies, absence of a consistent pathological substrate and highly variable phenotypes and genotypes. The aim of this review article is to provide an overview of the clinical, neurophysiological and genetic features of dystonia that can help in the identification of this movement disorder, as well as in the differential diagnosis of the main forms of genetic dystonia. The variation of penetrance, age of onset, and topographic distribution of the disease in carriers of the same genetic mutation indicates that other factors -either genetic or environmental -might be involved in the development of symptoms. The growing knowledge of cell dysfunction in mutants may give insights into more effective therapeutic targets.Keywords: dystonia; apoptosis. RESUMOO diagnóstico e o tratamento da distonia podem ser desafiadores. Isso se dá provavelmente a pouca compreensão da fisiopatologia, a falta de modelos animais para estudos translacionais, ausência de um substrato patológico consistente e genótipo e fenótipo altamente variáveis. O objetivo deste artigo de revisão é fornecer uma visão geral dos aspectos clínicos, neurofisiológicos e genéticos de distonia que podem ajudar na identificação deste distúrbio do movimento, bem como no diagnóstico diferencial das principais formas de distonia hereditária. Há uma ênfase particular na nova definição e classificação da Internacional das Distonias, bem como as recentes descobertas dos mecanismos moleculares subjacentes em algumas formas de distonia primária. A variação de penetrância, idade de início, e distribuição topográfica da doença em portadores da mesma mutação genética indica que outros fatores -genéticos ou ambientais podem estar envolvidos no desenvolvimento dos sintomas. O conhecimento crescente sobre a disfunção celular em mutantes pode gerar insights sobre alvos terapêuticos mais eficazes.Palavras-chave: distonia; apoptose

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Section: Treatmentmentioning

confidence: 99%

Understanding dystonia: diagnostic issues and how to overcome them

Camargos

Cardoso

2016

Arq. Neuro-Psiquiatr.

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“…"s much as 40% of patients reported improvement with trihexyphenidyl [18,19]. However, these medications are often of limited beneit due to systemic side efects.…”

Section: Treatment Of Cervical Dystoniamentioning

confidence: 99%

“…"oNT has been approved for use in many countries and remains the treatment of choice for CD [8,18,26,27]. Recent studies also provided level " evidence supporting for the treatment of CD [28].…”

Section: Treatment Of Cervical Dystoniamentioning

confidence: 99%

How Effective and Safe is Botulinum Toxin Therapy in Cervical Dystonia: The Current Stand

Jamora¹,

Piano²

2016

Botulinum Toxin Therapy Manual for Dystonia and Spasticity

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Cervical dystonia (CD) is the most common focal dystonia that is characterized by involuntary contraction of cervical muscles causing abnormal head movements and postures. The treatment for CD was previously limited to oral medications, however, with consequent systemic side efects. In recent years, botulinum toxin ("oNT) has demonstrated eicacy in several studies and thus has received level " recommendation from both the "merican "cademy of Neurology and the European Federation of Neurological Sciences in the treatment of dystonia. In many countries, it is the irst-line treatment for CD. There are four types of toxin approved for the use in CD, three type " [Onabotulinumtoxin" (Ona"oNT"), "bobotulinumtoxin" ("bo"oNT"), and Incobotulinumtoxin " (Inco"oNT")] and one type " [Rimabotulinumtoxin" (Rima-"oNT")]. Proper selection of afected muscles and dose of toxin are important parameters in successfully providing symptomatic treatment. Good response rate is deined as improvement of more than 25 % from baseline using the Toronto Western Torticollis Rating Scale. The most common side efect of chemodenervation with "oNT for CD is dysphagia.

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“…1,2 Since the mid-1980s, botulinum toxin type A has been the primary treatment for this disorder, improving head position and associated pain. 3,4 In a randomized, controlled trial, 5 botulinum toxin type A was found to produce greater improvement in head position with fewer AEs than the anticholinergic trihexyphenidyl hydrochloride in patients with cervical dystonia. In 2000, a botulinum neurotoxin product based on the B serotype that also significantly improves the symptoms of cervical dystonia was introduced in many European countries and the United States.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Acceptable tolerability has been reported with the A and B serotypes in the treatment of cervical dystonia. [3][4][5][6][7] However, according to a MEDLINE search (key terms, botulinum toxin type A, botulinum toxin type B, cervical dystonia, torticollis, comparison, BOTOX ,* and MYOBLOC , † a growing amount of research and experience suggests that the specific AE profiles of these 2 preparations differ somewhat, 8 although no published, controlled studies have directly compared these botulinum neurotoxins in the treatment of cervical dystonia. In particular, xerostomia, or dry mouth, is one of the most common AEs with type B in the treatment of cervical dystonia, occurring in 17 of 39 patients (43.6%) treated with 10,000 U in a double-blind trial 6 and in 21 of 24 patients (87.5%) treated with a mean of 11,310 U in an open-label trial.…”

Section: Introductionmentioning

confidence: 99%

Severity and impact of xerostomia in patients treated with botulinum toxin type b for cervical dystonia: Observations on the quality of life of patients with xerostomia

Hogan

Charles

Watts³

et al. 2004

Current Therapeutic Research

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Background: Although dry mouth (xerostomia) has been reported with botulinum toxin type B used as treatment for cervical dystonia, the impact of this adverse effect (AE) on patients' activities of daily living (ADLs) has not been assessed.Objective: The aim of this study was to examine the severity, duration, and impact of xerostomia in patients with cervical dystonia who reported this AE in routine clinical practice following treatment with botulinum toxin type B.Methods: In this uncontrolled study, investigators at 5 study centers across the United States retrospectively identified patients who were diagnosed with cervical dystonia and had received Ն1 treatment with botulinum toxin type B injection and who had reported xerostomia, based on patients' charts. These patients were mailed a survey that included questions about their treatment history, disease severity, and xerostomia (severity, onset, duration, change with subsequent injections, and effects on dental and oral health), as well as an 8-item Patient Benefit Questionnaire (PBQ), which was designed to assess the impact of xerostomia symptoms on patients' ADLs.Results: A total of 45 patients received a mean of 2.91 injections with botulinum toxin type B (mean dose per injection, 11,958 U), with a total of 131 injections. The mean severity of patient-rated xerostomia following the first injection of botulinum toxin type B was 3.88 on a scale of 1 (mild) to 5 (severe), and this rating did not change for patients who received subsequent injections (mean, 3.76). Following a typical injection of botulinum toxin type B, xerostomia Accepted for publication January 20, 2004. Reproduction in whole or part is not permitted.0011-393X/04/$19.00 began a mean (SD) of 4.82 (3.32) days later and persisted for a mean (SD) duration of 5.56 (3.57) weeks. The overall mean score on the 10-point PBQ prior to botulinum toxin treatment was 8.89, which decreased to 5.42 following botulinum toxin type B injection (lower scores indicate more severe xerostomia). C U R R E N T T H E R A P E U T I C R E S E A R C H ாV Conclusions:This study of patients with cervical dystonia suggests that patients who experience xerostomia following treatment with botulinum toxin type B injection, on average, rate their symptoms as moderate to severe and exhibit reduced scores on the PBQ-a questionnaire on which lower scores indicate greater negative impact of xerostomia on patients' ADLs. (Curr Ther Res Clin Exp.

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Botulinum toxin versus trihexyphenidyl in cervical dystonia

Abstract: BTA is significantly more effective in the treatment of ICD, with less adverse effects.

Cited by 173 publications

References 12 publications

Understanding dystonia: diagnostic issues and how to overcome them

Understanding dystonia: diagnostic issues and how to overcome them

How Effective and Safe is Botulinum Toxin Therapy in Cervical Dystonia: The Current Stand

Severity and impact of xerostomia in patients treated with botulinum toxin type b for cervical dystonia: Observations on the quality of life of patients with xerostomia

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