Weiss Daniel, Hieber Leonhard, Sturm Justine, Börtlein Axel, Mayr Ingo, Appy Matthias, Kühnler Benedicta, Buchthal Joachim, Dippon Christian, Arnold Guy, Wächter Tobias
Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany.
Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany.
Front Neurol. 2017 Oct 24;8:561. doi: 10.3389/fneur.2017.00561. eCollection 2017.
Botulinumtoxin injection (BoNT) into affected muscles is effective to improve motor symptoms of cervical dystonia (CD) by reducing muscle contraction and involuntary dystonic movement and posturing. However, the understanding of the effect on health-related quality of life (HR-QoL) and patient referral under HR-QoL aspects is incomplete. In this open-label clinical prospective observational study, we characterized the outcomes in CD ( = 159) from botulinumtoxin on both generic HR-QoL (EuroQol; EQ-5D-5L) and disease-specific HR-QoL [craniocervical dystonia questionnaire (CDQ-24)]. Additionally, we characterized motor and non-motor signs of dystonia including motor symptom improvement, depressive symptoms, pain, and sleep quality. We assessed patients at the end of a regular 3-month period from last injection (Timepoint1) and 4 weeks after the re-injection of BoNT (Timepoint2). We aimed to define outcomes on both generic and disease-specific HR-QoL and to evaluate predictors of therapeutic outcome in terms of stepwise multiple regression models. Patients with CD showed a robust improvement of both generic and disease-specific HR-QoL. Furthermore, motor and non-motor signs improved. Multiple regression analyses revealed that EQ-5D-5L and "satisfaction with health" (Fragen zur Lebenszufriedenheit-G) at Timepoint1 predicted treatment response on generic HR-QoL outcome ( = 0.284; = 0.019). Similarly, CDQ-24 and Beck's Depression inventory at Timepoint1 predicted the treatment response on disease-specific HR-QoL ( = 0.253; = 0.026). Our study underscores both generic and disease-specific HR-QoL improvements in CD, and provides useful predictors on HR-QoL outcomes.
向受影响的肌肉注射肉毒杆菌毒素(BoNT)可通过减少肌肉收缩、非自愿性肌张力障碍运动和姿势来有效改善颈部肌张力障碍(CD)的运动症状。然而,对于其对健康相关生活质量(HR-QoL)的影响以及在HR-QoL方面的患者转诊情况的了解并不完整。在这项开放标签的临床前瞻性观察研究中,我们对159例CD患者接受肉毒杆菌毒素治疗后的一般HR-QoL(欧洲生活质量量表;EQ-5D-5L)和疾病特异性HR-QoL[颅颈肌张力障碍问卷(CDQ-24)]结果进行了特征描述。此外,我们还对肌张力障碍的运动和非运动体征进行了特征描述,包括运动症状改善、抑郁症状、疼痛和睡眠质量。我们在最后一次注射后的常规3个月期末(时间点1)以及再次注射BoNT后4周(时间点2)对患者进行了评估。我们旨在确定一般和疾病特异性HR-QoL的结果,并根据逐步多元回归模型评估治疗结果的预测因素。CD患者的一般和疾病特异性HR-QoL均有显著改善。此外,运动和非运动体征也有所改善。多元回归分析显示,时间点1的EQ-5D-5L和“对健康的满意度”(生活满意度问卷-G)预测了一般HR-QoL结果的治疗反应(r = 0.284;p = 0.019)。同样,时间点1的CDQ-24和贝克抑郁量表预测了疾病特异性HR-QoL的治疗反应(r = 0.253;p = 0.026)。我们的研究强调了CD患者在一般和疾病特异性HR-QoL方面的改善,并提供了HR-QoL结果的有用预测因素。