Background

The aim of study was to demonstrate that the first three injections of botulinum neurotoxin type A (BoNT/A) appear to be less effective in botulinum toxin naïve patients with idiopathic cervical dystonia (CD) with mild symptoms and low severity scores (TSUI-scores) at onset of BoNT/A-therapy compared to patients with full-blown CD and high initial TSUI-scores.

Methods

In 337 patients with CD who started BoNT/A-therapy in the BoNT-outpatient clinic of the university hospital in Düsseldorf during the last 12 years, demographical and treatment-related data as well as outcome measures (TSUI-scores) of the first four visits were extracted from the treatment ACCESS data bank.

Results

Distribution of the severity of CD scored using the TSUI-score significantly changed with the first three injections. In patients with a high baseline severity (TSUI-score > 10), mean TSUI-score continuously decreased (p < 0.001), whereas in patients with a low initial severity (TSUI-score < 6), mean TSUI-score increased (p < 0.001) during the first three injection cycles. Individual responses varied between 100% improvement, no response at all, and even worsening. Improvement of CD at the end of an injection cycle was observed in less than 25% in the mildly affected patients, but in more than 80% in the more severely affected patients.

Conclusion

Clinical response to the first three BoNT/A-injections in severely affected de novo CD-patients is different from the response to BoNT/A in mildly affected de novo CD-patients. This has implications for further scientific studies and the patient management of mildly affected de novo patients with cervical dystonia.

中文翻译：

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初始严重程度对后期结果的影响：对一大群未接受过肉毒杆菌毒素的特发性颈肌张力障碍患者进行回顾性分析。

背景

研究的目的是证明，前三次注射 A 型肉毒杆菌神经毒素 (BoNT/A) 似乎对未接受肉毒杆菌毒素治疗、症状轻微、严重程度评分较低（TSUI 评分）的特发性颈肌肌张力障碍 (CD) 患者效果较差）在 BoNT/A 治疗开始时与完全 CD 和高初始 TSUI 评分的患者相比。

方法

在过去 12 年中，在杜塞尔多夫大学医院的 BoNT 门诊诊所开始接受 BoNT/A 治疗的 337 名 CD 患者中，前 4 名患者的人口统计和治疗相关数据以及结果测量（TSUI 评分）访问次数是从治疗 ACCESS 数据库中提取的。

结果

使用 TSUI 评分评分的 CD 严重程度分布在前 3 次注射中发生显着变化。在基线严重程度较高的患者 (TSUI 分数 > 10) 中，平均 TSUI 分数持续下降 ( p < 0.001)，而在初始严重程度较低的患者 (TSUI 分数 < 6) 中，平均 TSUI 分数增加 ( p  < 0.001)  < 0.001) 在前三个注射周期内。个人反应各不相同，有 100% 改善、完全没有反应、甚至恶化。在注射周期结束时，观察到轻度受影响患者的 CD 改善率不到 25%，但在受影响更严重的患者中，改善率超过 80%。

结论

严重受影响的新发 CD 患者对前三次 BoNT/A 注射的临床反应与轻度受影响的新发 CD 患者对 BoNT/A 的反应不同。这对进一步的科学研究和对患有轻度颈肌张力障碍的新发患者的患者管理具有重要意义。