Objective: The primary outcome was the relationship between BoNT dosage and DBS surgery in each muscle. A secondary analysis of BoNT dosages through different muscle segments was performed.
Background: Deep Brain Stimulation (DBS) is a recognized treatment for different dystonia subtypes and is recommended after failure of botulinum toxin (BoNT) and other oral medications. However, there are only a few reports comparing the overall impact of surgical treatment in BoNT protocols. This retrospective multicenter chart-review study analyzed pre-and postoperative botulinum toxin protocols in dystonic patients who underwent DBS surgery. Comparative analyses of BoNT treatment before and after surgery were provided.
Method: This was a retrospective study with prospective data collection. The data were collected by reviewing charts at different centers: Hospital das Clínicas da Universidade de São Paulo; Hospital Universitário Cajuru; University Health Network, Toronto Western Hospital; Neurológico de Curitiba; and Hospital Universiário Clementino Fraga Filho. The study included 23 patients diagnosed with generalized dystonia who underwent DBS and received BoNT injections before surgery and at least 1 year after surgery.
Results: The baseline patient characteristics are summarized in Table 1.
As shown in Table 2, the median total dose (median) of BoNT in the preoperative period was 800U (N=23). After surgery, the medians were: 6 months (N=17) 600U; 12 months (N=21) 640U; current dose (N=20) 700U (p=0,05). At the end of the study period, there was a 12,5% reduction in median dosage.
The mean differences between baseline and post-surgery dosages (6 months, 12 months, and current dose) were 293.4, 292.6, and 295.2, respectively. There were no significant differences between the post-surgery doses (p>0.999; Table 3).
We analyzed five muscles individually: the splenius capitis, paravertebral, sternocleidomastoid, semispinalis, and trapezius. There was significant difference in BoNT doses in splenius capitis and paravertebral, as shown in Figure 1 and 2.
Conclusion: In conclusion, despite the limitations, we observed a significant reduction in BoTN doses after DBS surgery. This suggests that these treatments may have a combined effect. In addition, certain body segments (axial muscles, for instance) may have a greater response after DBS.
Further prospective studies could improve our understanding of the role of BoNT combined with DBS in the management of generalized dystonia.
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To cite this abstract in AMA style:
J. Souza, A. Falcone, R. Barbosa, M. Soares, R. Munhoz, M. Farah, T. Capato, S. Casagrande, M. Cordellini, G. Micheli, J. Limongi, E. Barbosa, C. Listik, R. Cury. Botulinum Toxin and Deep Brain Stimulation in Dystonia [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/botulinum-toxin-and-deep-brain-stimulation-in-dystonia/. Accessed October 6, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-and-deep-brain-stimulation-in-dystonia/