Objective: This systematic review aimed to determine the barriers to satisfaction and facilitators that could improve satisfaction with BoNT therapy for people with CD.

Background: Cervical dystonia (CD) is an isolated, focal, idiopathic dystonia affecting the neck and upper back. CD is usually treated by botulinum toxin (BoNT) injections into the dystonic muscles, however about 20% of people will discontinue BoNT therapy.

Method: A database search for journal articles investigating satisfaction with BoNT treatment in CD identified seven qualitative studies and one randomised controlled trial. Results were grouped into “direct” and “indirect” barriers and facilitators.

Results: The most reported direct barrier to satisfaction with BoNT in people with CD was treatment non-response, reported by up to 66% of participants. Other direct barriers to satisfaction with BoNT therapy in this population included negative side effects, early wearing-off of treatment effect and inexperience of the treating physician. Indirect barriers to satisfaction with BoNT therapy included limited access to treatment (including prohibitive cost) and personal choice. Direct facilitators of satisfaction with BoNT in people with CD included relief of symptoms and flexible re-treatment intervals. Indirect facilitators included easy access to treatment and affordability of injections.

Conclusion: Despite BoNT having a discontinuation rate of only 20%, it appears a much greater proportion of people with CD are dissatisfied with this treatment. As BoNT is currently the main treatment offered to people with CD, efforts to improve treatment response rates, reduce side effects and make treatment more flexible and readily available should be adopted to improve the quality of life for people with CD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-barriers-and-facilitators-to-satisfaction-with-botulinum-neurotoxin-treatment-in-people-with-cervical-dystonia-a-systematic-review/