Diep Dion, Ko Jasmine, Lan John, Koprowicz Kinga T, Ko Gordon
MD Program, University of Toronto, Toronto, ON, Canada.
Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
J Pain Res. 2020 Jun 3;13:1297-1304. doi: 10.2147/JPR.S254032. eCollection 2020.
There is a paucity of long-term treatment benefit and safety data of botulinum toxin A (BTX-A) for cervical dystonia (CD) and myofascial neck pain syndrome (MPS). Additionally, the prevalence of adjunct modality uses during this period is unknown despite evolving practices.
To assess and compare treatment benefit, safety, and adjunct modality prevalences of long-term BTX-A injections between CD and MPS patients.
Retrospective cohort study.
Private practice tertiary care clinics in Toronto.
Convenience sample of 37 (52.9%) CD and 33 (47.1%) MPS patients treated for a mean±SD duration of 7.2±4.3 and 8.3±4.7 years, respectively.
BTX-A injections administered at least once yearly, for a duration longer than 1 year.
Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS) for disability and pain, Patient Global Impression of Change (PGIC) score, time to peak effect, duration of total response, adverse effects, and prevalence of adjunct modalities.
CD patients experienced improvements in TWSTRS disability (17.57±6.79 to 9.81±4.35, p<0.001) and pain (14.61±3.08 to 9.05±3.49, p<0.001) scores as well as PGIC score (52.00%±23.60% to 64.80%±23.60%, p=0.007). MPS patients experienced improvements in TWSTRS disability (15.86±7.70 to 10.07±7.01, p=0.01) and pain (15.25±4.09 to 10.85±4.49, p=0.01) scores. In both cohorts, there were no changes in time to peak effect and duration of total response. Adverse effects were minimal and self-limiting. Prevalences of adjunct modalities used by CD versus MPS patients were 28.13% versus 50.00% for anesthetic procedures, 23.08% versus 15.38% for image-guidance, 65.71% versus 56.25% for pectoralis minor injections, and 47.06% versus 53.13% for cannabis-use.
There were demonstrated and comparable treatment benefit, safety, and adjunct modality prevalences. Our study is the first to demonstrate that long-term BTX-A injections for MPS, although commonly used off-label, can be effective and safe.
关于A型肉毒毒素（BTX-A）治疗颈部肌张力障碍（CD）和肌筋膜性颈部疼痛综合征（MPS）的长期治疗益处和安全性数据较少。此外，尽管治疗方法不断演变，但在此期间辅助治疗方式的使用情况尚不清楚。
评估和比较CD患者与MPS患者长期BTX-A注射的治疗益处、安全性和辅助治疗方式的使用情况。
回顾性队列研究。
多伦多的私立三级医疗诊所。
便利样本，37例（52.9%）CD患者和33例（47.1%）MPS患者，平均治疗时间±标准差分别为7.2±4.3年和8.3±4.7年。
每年至少注射一次BTX-A，持续时间超过1年。
用于评估残疾和疼痛的多伦多西部痉挛性斜颈评定量表（TWSTRS）、患者总体印象变化（PGIC）评分、达到峰值效应的时间、总反应持续时间、不良反应以及辅助治疗方式的使用情况。
CD患者的TWSTRS残疾评分（从17.57±6.79降至9.81±4.35，p<0.001）、疼痛评分（从14.61±3.08降至9.05±3.49，p<0.001）以及PGIC评分（从52.00%±23.60%升至64.80%±23.60%，p=0.007）均有改善。MPS患者的TWSTRS残疾评分（从15.86±7.70降至10.07±7.01，p=0.01）和疼痛评分（从15.25±4.09降至10.85±4.49，p=0.01）也有改善。在两个队列中，达到峰值效应的时间和总反应持续时间均无变化。不良反应轻微且为自限性。CD患者与MPS患者使用辅助治疗方式的比例分别为：麻醉程序28.13%对50.00%，影像引导23.08%对15.38%，胸小肌注射65.71%对56.25%，使用大麻47.06%对53.13%。
BTX-A注射在治疗益处、安全性和辅助治疗方式使用情况方面具有可比性。我们的研究首次证明，长期BTX-A注射治疗MPS尽管通常为非适应证用药，但可以有效且安全。
