ABSTRACT

Objectives

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.

Methods

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.

Results

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.

Conclusion

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.

中文翻译：

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颈肌张力障碍：使患者对肉毒杆菌毒素长期治疗满意的因素。

摘要

目标

肉毒杆菌毒素 (BoNT) 是治疗颈肌张力障碍 (CD) 的有效一线药物。尽管普遍具有良好的治疗效果，但大约 20-40% 的 CD 患者的肌张力障碍症状没有达到可接受的缓解。本研究的目的是确定长期 BoNT 治疗 CD 患者满意度低的因素。

方法

在这项病例对照研究中，接受 BoNT 肌内注射治疗长达 24 年的 CD 患者由两名独立评估员以三个经过验证的量表进行评估：用于测量疼痛的 TWSTRS、Tsui 和 VAS。从病史中获得有关接受的 BoNT 剂量和治疗持续时间的数据。与治疗开始相比，所有参与者都以 0-3 的等级对他们的长期治疗满意度进行评分。

结果

研究由 58 名参与者完成，他们接受了 9.0 ± 6.3 年的 BoNT 治疗，并接受了 19 个注射周期的中位数。20.7% 的参与者报告无/低治疗满意度。与中等/良好的治疗满意度相比，无/低 BoNT 疗效的 CD 患者颈痛发生率增加（p = .018），疼痛的平均 VAS 评分增加（p = .037），并有更高的口下颌肌张力障碍共存（p =.018）。此外，较差的治疗满意度与较短的治疗周期之间的时间间隔、Tsui 总分、TWSTRS 总分以及 TWSTRS 分量表：严重程度、残疾和疼痛的得分提高相关。

结论

颈痛和口下颌肌张力障碍的共存降低了 CD 患者的长期治疗满意度。Tsui 和 TWSTRS 分量表的较高分数与较差的主观 BoNT 治疗反应相关。