Hefter Harald, Samadzadeh Sara, Moll Marek
Departments of Neurology, University of Düsseldorf, Moorenstrasse, Germany.
Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Unverstät zu Berlin, Berlin, Germany.
Front Neurol. 2025 Jun 17;16:1553989. doi: 10.3389/fneur.2025.1553989. eCollection 2025.
Idiopathic cervical dystonia (CD) affects more female than male patients. This sex-based influence on the clinical manifestation of CD may also affect outcomes after long-term BoNT therapy.
To analyze the potential differential influence of sex on the efficacy of BoNT therapy, a cross-sectional study was conducted with 135 female and 85 male patients with idiopathic cervical dystonia. Demographic and treatment-related data were extracted from patient charts. The 24-item Cervical Dystonia Questionnaire (CDQ24), patients' self-assessment of CD severity (PAS), and the TSUI score were used as outcome measures. On the day of recruitment, blood samples were collected to analyze neutralizing antibody (NAB) formation using an ELISA, with confirmation by the mouse hemidiaphragm assay (MHDA) test.
Male patients had significantly ( < 0.02) lower mean age and age at symptom onset and received significantly ( < 0.02) higher BoNT doses per session. Female patients had significantly worse PAS and CDQ24 scores ( < 0.006), though the TSUI score showed no significant difference ( = 0.19). Despite receiving lower BoNT doses, female patients exhibited a significantly ( < 0.006) higher risk of NAB induction.
This reanalysis of previously published data reveals that female and male patients in this cohort were treated and responded differently to long-term BoNT therapy, a discrepancy that remained unnoticed by their treating physicians over more than 10 years of treatment.
特发性颈部肌张力障碍（CD）患者中女性多于男性。这种基于性别的因素对CD临床表现的影响可能也会影响长期肉毒毒素（BoNT）治疗后的疗效。
为分析性别对BoNT治疗疗效的潜在差异影响，对135例女性和85例男性特发性颈部肌张力障碍患者进行了一项横断面研究。从患者病历中提取人口统计学和治疗相关数据。采用24项颈部肌张力障碍问卷（CDQ24）、患者对CD严重程度的自我评估（PAS）和TSUI评分作为疗效指标。在招募当天，采集血样，采用酶联免疫吸附测定（ELISA）分析中和抗体（NAB）的形成，并通过小鼠半膈肌试验（MHDA）进行确认。
男性患者的平均年龄和症状出现时的年龄显著较低（<0.02），每次接受的BoNT剂量显著较高（<0.02）。女性患者的PAS和CDQ24评分显著更差（<0.006），尽管TSUI评分无显著差异（=0.19）。尽管接受的BoNT剂量较低，但女性患者诱导产生NAB的风险显著较高（<0.006）。
对先前发表数据的重新分析显示，该队列中的女性和男性患者在长期BoNT治疗中的治疗和反应存在差异，在超过10年的治疗过程中，他们的治疗医生并未注意到这种差异。
