Chair and Department of Neurology, Medical University of Lublin , Lublin, Poland.
Neurol Res. 2020 Nov;42(11):987-991. doi: 10.1080/01616412.2020.1796430. Epub 2020 Jul 22.
Botulinum toxin (BoNT) is an effective first-line treatment for cervical dystonia (CD). Despite generally good therapeutic efficacy, approximately 20-40% of CD patients do not achieve acceptable relief of the dystonic symptoms. The aim of this study was to identify factors of low patient satisfaction of long-term BoNT therapy for CD.
In this case-control study CD patients treated with BoNT intramuscular injections for up to 24 years were assessed by two independent assessors in three validated scales: TWSTRS, Tsui and VAS for pain measurement. Data on received BoNT doses and treatment duration were obtained from medical history. All of participants rated their long-term treatment satisfaction compared to the therapy onset on a 0-3 scale.
Study was completed by 58 participants who were treated with BoNT for 9.0 ± 6.3 years and received a median of 19 injection cycles. None/low therapy satisfaction was reported by 20.7% of participants. Compared to moderate/good treatment satisfaction, CD patients with none/low BoNT efficacy had increased incidence of cervical pain (p =.018), enhanced mean VAS score for pain (p =.037) and had higher coexistence of oromandibular dystonia (p =.018). In addition, worse treatment satisfaction correlated with shorter time intervals between treatment cycles, enhanced scores of Tsui total, TWSTRS total, as well as TWSTRS subscales: severity, disability and pain.
Cervical pain and coexistence of oromandibular dystonia deteriorated long-term treatment satisfaction in CD patients. Higher scores of Tsui and TWSTRS subscales were correlated with worse subjective BoNT treatment response.
肉毒毒素（BoNT）是治疗颈部肌张力障碍（CD）的有效一线治疗方法。尽管治疗效果总体良好，但仍有约 20-40%的 CD 患者未获得满意的缓解。本研究旨在确定长期 BoNT 治疗 CD 患者满意度低的因素。
在这项病例对照研究中，对接受 BoNT 肌肉内注射治疗长达 24 年的 CD 患者，由两位独立评估者通过三个经过验证的量表进行评估：TWSTRS、Tsui 和 VAS 用于疼痛测量。从病史中获取接受 BoNT 剂量和治疗持续时间的数据。所有参与者根据 0-3 分制对他们的长期治疗满意度与治疗开始时进行评分。
完成了这项研究的有 58 名参与者，他们接受 BoNT 治疗了 9.0±6.3 年，接受了中位数为 19 个注射周期。20.7%的参与者报告无/低治疗满意度。与中度/良好治疗满意度相比，无/低 BoNT 疗效的 CD 患者的颈部疼痛发生率更高（p=.018），疼痛的平均 VAS 评分更高（p=.037），口面肌张力障碍共存率更高（p=.018）。此外，治疗满意度越差与治疗周期之间的时间间隔越短、Tsui 总分、TWSTRS 总分以及 TWSTRS 子量表：严重程度、残疾和疼痛的评分越高有关。
颈部疼痛和口面肌张力障碍共存恶化了 CD 患者的长期治疗满意度。Tsui 和 TWSTRS 子量表的评分越高，与主观 BoNT 治疗反应越差有关。
