Objective: To evaluate the long-term therapeutic effect of Botulinum neurotoxin type A (BoNT-A) in cervical dystonia.

Background: Cervical dystonia is the most common adult-onset focal dystonia. BoNT-A injections is the most effective and widely recommended first line treatment for cervical dystonia. It usually impacts quality of life and often presents with a chronic, progressive course. BoNT-A is the first-line treatment for CD, effectively reducing symptoms. Optimizing dosing and response variability remains a key clinical focus.

Method: We conducted an open administration of Botulinum neurotoxin type A (BoNT-A) in consecutive subjects with cervical dystonia in a movement disorders clinic in El Salvador. Follow-up visits occurred between 2004 and 2023. The subjects were prospectively evaluated by medical observation and video recordings by a movement disorder specialist.

Results: Out of 56 subjects with cervical dystonia (CD), 36 met the inclusion criteria. 63.8% of the subjects were female (23) and 36.1% were male (13). The mean age of onset for CD was 59.4 (19-87) years and average delay in diagnosis was 7.3 (1-22) years. Idiopathic CD was the most common form (61.1%), followed by drug-induced (33.3%). Haloperidol was the most common neuroleptic associated with drug-induced CD, followed by Cinnarizine (Table 1). Subjects received an average dose of BoNT-A of 245.7 units (90-400), with and average of 10 application cycles (3-33). Mean score of subjective global improvement was 90.5%, with a maximum duration of therapeutic effect of 4.3 months (3-7) (Table-2).

Conclusion: Botulinum neurotoxin type A had a good therapeutic response in subjects with cervical dystonia, with sustained effectiveness overtime.

Table 1

Table 2

References: 1. Rodrigues FB, et al. Botulinum toxin type A therapy for cervical dystonia. Cochrane Database Syst Rev. 2020 Nov 12;11(11):CD003633. doi: 10.1002/14651858.CD003633.pub4. PMID: 33180963; PMCID: PMC8106615.

2. Comella C,et al . Patient perspectives on the therapeutic profile of botulinum neurotoxin type A in cervical dystonia. J Neurol. 2021 Mar;268(3):903-912. doi: 10.1007/s00415-020-10217-7. Epub 2020 Sep 16. Erratum in: J Neurol. 2021 Mar;268(3):913. doi: 10.1007/s00415-020-10255-1. PMID: 32939574; PMCID: PMC7914227.

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