Trinchillo Assunta, Cuomo Nunzia, Habetswallner Francesco, Esposito Marcello
Neuroscience and Cell Biology Institute, Neuromodulation and Motor Control Section, St. George's University of London, London, UK.
Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II", University, Naples, Italy.
J Neural Transm (Vienna). 2025 Feb;132(2):253-256. doi: 10.1007/s00702-024-02848-1. Epub 2024 Oct 14.
Cervical dystonia (CD) patterns may change with Botulinum toxin (BoNT) treatment.
To evaluate the time within those changes usually occur, the most predisposed phenotypes and predisposing factors.
We divided idiopathic CD patients into two groups- change YES and NO, collecting general clinical and demographic variables. We also evaluated duration of BoNT treatment, Tsui total scores and subscores - assessed at T0 - before BoNT start - and at T1- time to chenge in the YES group or last visit in the NO group. The risk of pattern change was assessed by Kaplan Meyer curves and Cox regression analysis. Finally, Multivariate linear regressions were employed to assess if Tsui severity correlated with the change.
Among 100 patients (60 women), 37 experienced a phenotype switch, mostly in the first five years of BoNT treatment, YES and NO groups were comparable. Multivariate Cox Regression revealed the presence of laterocollis or rotatocollis at T0 as predictors of switch (respectively P = 0.01, HR = 3.5; P = 0.03, HR = 1.5). Multivariate linear regressions revealed that high Tsui subscores for the tilt and low Tsui total scores were risk factors for the change of pattern (respectively P = 0.002, OR = 6; P = 0.03, OR = 0.8).
Latero and Rotatocollis are the CD phenotypes most predisposed to change. CD characterized by neck tilt are more likely to change phenotype following treatment. Dystonias with a low degree of severity are more predisposed to switch. Both, the different degree of muscle activation and BoNT mechanism of action, may impact on that phenomenon.
肉毒杆菌毒素（BoNT）治疗可能会改变颈部肌张力障碍（CD）的模式。
评估这些变化通常发生的时间、最易发生变化的表型及诱发因素。
我们将特发性CD患者分为两组——变化组（是）和非变化组，收集一般临床和人口统计学变量。我们还评估了BoNT治疗的持续时间、徐氏总分及分项评分——在T0（BoNT开始治疗前）和T1（变化组发生变化的时间或非变化组的最后一次就诊时间）进行评估。通过Kaplan - Meyer曲线和Cox回归分析评估模式变化的风险。最后，采用多元线性回归评估徐氏严重程度是否与变化相关。
在100例患者（60名女性）中，37例出现了表型转换，大多发生在BoNT治疗的前五年，变化组和非变化组具有可比性。多变量Cox回归显示，T0时存在侧方痉挛或旋转痉挛是转换的预测因素（分别为P = 0.01，HR = 3.5；P = 0.03，HR = 1.5）。多元线性回归显示，倾斜的高徐氏分项评分和低徐氏总分是模式变化的危险因素（分别为P = 0.002，OR = 6；P = 0.03，OR = 0.8）。
侧方痉挛和旋转痉挛是最易发生变化的CD表型。以颈部倾斜为特征的CD在治疗后更有可能改变表型。严重程度较低的肌张力障碍更容易发生转换。肌肉激活程度的不同和BoNT的作用机制都可能影响这一现象。
