Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Department of Neurology, Maria Hilf Clinics, 41063 Moenchengladbach, Germany.
Toxins (Basel). 2023 Jun 30;15(7):431. doi: 10.3390/toxins15070431.
To compare the course of severity of cervical dystonia (CD) before and after long-term botulinum toxin (BoNT) therapy to detect indicators for a good or poor clinical outcome.
A total of 74 outpatients with idiopathic CD who were continuously treated with BoNT and who had received at least three injections were consecutively recruited. Patients had to draw the course of severity of CD from the onset of symptoms until the onset of BoNT therapy (CoDB graph), and from the onset of BoNT therapy until the day of recruitment (CoDA graph) when they received their last BoNT injection. Mean duration of treatment was 9.6 years. Three main types of CoDB and four main types of CoDA graphs could be distinguished. The demographic and treatment-related data of the patients were extracted from the patients' charts.
The best outcome was observed in those patients who had experienced a clear, rapid response in the beginning. These patients had been treated with the lowest doses and with a low number of BoNT preparation switches. The worst outcome was observed in those 17 patients who had drawn a good initial improvement, followed by a secondary worsening. These secondary nonresponders had been treated with the highest initial and actual doses and with frequent BoNT preparation switches. A total of 12 patients were primary nonresponders and did not experience any improvement at all. No relation between the CoDB and CoDA graphs could be detected. Primary and secondary nonresponses were observed for all three CoDB types. The use of initial high doses as a relevant risk factor for the later development of a secondary nonresponse was confirmed.
Patients' drawings of their course of disease severity helps to easily detect "difficult to treat" primary and secondary nonresponders to BoNT on the one hand, but also to detect "golden responders" on the other hand.
比较长期肉毒毒素（BoNT）治疗前后颈肌张力障碍（CD）严重程度的变化，以寻找良好或不良临床疗效的预测指标。
共连续纳入 74 例接受 BoNT 治疗的特发性 CD 门诊患者，所有患者均至少接受过 3 次注射。患者需在开始出现症状后至开始 BoNT 治疗时（CoDB 图）和最后一次 BoNT 注射时（CoDA 图）描绘 CD 严重程度的变化。平均治疗时间为 9.6 年。可区分出 3 种主要的 CoDB 类型和 4 种主要的 CoDA 类型。从患者病历中提取患者的人口统计学和治疗相关数据。
在开始时反应迅速且明显改善的患者中观察到最佳疗效。这些患者接受了最低剂量和最低次数的 BoNT 制剂更换治疗。最差的疗效见于 17 例初始改善良好但随后出现继发性恶化的患者。这些继发性无应答者接受了最高的初始和实际剂量以及频繁的 BoNT 制剂更换治疗。有 12 例患者为原发性无应答者，根本没有任何改善。未发现 CoDB 与 CoDA 图之间存在任何关联。所有 3 种 CoDB 类型均观察到原发性和继发性无应答。最初使用高剂量被确认为继发无应答发生的相关风险因素。
患者对疾病严重程度的描述有助于在一方面容易发现对 BoNT 治疗“难以治疗”的原发性和继发性无应答者，另一方面也能发现“黄金应答者”。
