Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study
Aim of the study: 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. Patients and Methods: A total of 74 outpatients with idiopathic CD who were continuously treated with BoNT...
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| Format: | Article |
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MDPI AG
2023-06-01
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| Series: | Toxins |
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| Online Access: | https://www.mdpi.com/2072-6651/15/7/431 |
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| author | Harald Hefter Isabelle Schomaecker Max Schomaecker Beyza Ürer Raphaela Brauns Dietmar Rosenthal Philipp Albrecht Sara Samadzadeh |
| author_facet | Harald Hefter Isabelle Schomaecker Max Schomaecker Beyza Ürer Raphaela Brauns Dietmar Rosenthal Philipp Albrecht Sara Samadzadeh |
| author_sort | Harald Hefter |
| collection | DOAJ |
| description | Aim of the study: 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. Patients and Methods: 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. Results: 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. Conclusions: 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. |
| first_indexed | 2024-03-11T00:35:27Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2072-6651 |
| language | English |
| last_indexed | 2024-03-11T00:35:27Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Toxins |
| spelling | doaj.art-ac5117376ed74a759b8ebdae781061ec2023-11-18T21:38:06ZengMDPI AGToxins2072-66512023-06-0115743110.3390/toxins15070431Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot StudyHarald Hefter0Isabelle Schomaecker1Max Schomaecker2Beyza Ürer3Raphaela Brauns4Dietmar Rosenthal5Philipp Albrecht6Sara Samadzadeh7Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, GermanyDepartment of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, GermanyDepartment of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, GermanyDepartment of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, GermanyDepartment of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, GermanyDepartment of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, GermanyDepartment of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, GermanyDepartment of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, GermanyAim of the study: 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. Patients and Methods: 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. Results: 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. Conclusions: 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.https://www.mdpi.com/2072-6651/15/7/431cervical dystoniacourse of disease (CoD)CoD graphsbotulinum toxin therapylong-term treatmentsecondary treatment failure |
| spellingShingle | Harald Hefter Isabelle Schomaecker Max Schomaecker Beyza Ürer Raphaela Brauns Dietmar Rosenthal Philipp Albrecht Sara Samadzadeh Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study Toxins cervical dystonia course of disease (CoD) CoD graphs botulinum toxin therapy long-term treatment secondary treatment failure |
| title | Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study |
| title_full | Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study |
| title_fullStr | Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study |
| title_full_unstemmed | Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study |
| title_short | Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study |
| title_sort | lessons about botulinum toxin a therapy from cervical dystonia patients drawing the course of disease a pilot study |
| topic | cervical dystonia course of disease (CoD) CoD graphs botulinum toxin therapy long-term treatment secondary treatment failure |
| url | https://www.mdpi.com/2072-6651/15/7/431 |
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