Objective: To evaluate outcomes following Botulinum toxin (BoNT) treatment for head and neck dystonia in a tertiary multidisciplinary clinic, characterise adverse effects and identify treatment patterns.

Background: Head and neck dystonias are chronic movement disorders characterised by involuntary movements and postures (1,2). These conditions can significantly impact quality of life. BoNT is established therapy for focal cervical dystonia (3), but longitudinal real-world data for other head and neck dystonias in multidisciplinary services is limited.

Method: Retrospective service evaluation of patients receiving BoNT injections in a tertiary Neurology–ENT dystonia clinic. Injection characteristics were analysed at three timepoints (first, penultimate and most recent treatments). Outcomes included patient-reported benefit, injection characteristics and adverse effects. Patients were categorised into oromandibular dystonia (OMD), laryngeal dystonia and ‘other’ dystonias.

Results: Twenty-two patients included (mean age 62.4 years; 54.5% female): OMD (n=9), laryngeal dystonia (n=8) and other dystonias (n=5). Median follow-up was 2 years (IQR 1–7; 0–15) with 10 visits (2–54). Patients were typically treated at three-monthly intervals, with benefit reported within several days and peaking at 1–2 weeks. In OMD, injection strategies broadened from masseter injections to increased pterygoid targeting (2/9) with bilateral pterygoid strategies increasing from 1/9 to 4/9 patients. Dose increases occurred in masseter, anterior digastric and lateral pterygoid muscles.

In laryngeal dystonia, thyroarytenoid injections were used in 5/8 patients. Treatment evolved through TA dose titration, plus the addition of false vocal cord injections in two cases. Adverse effects included temporary dysphonia (n=2) and dysphagia (n=1).

Conclusion: BoNT treatment provided consistent patient-reported benefit with low adverse-effect rates. OMD management evolved towards broader muscle targeting, whereas laryngeal dystonia treatment remained relatively standardised. These findings support multidisciplinary longitudinal review to optimise care for head and neck dystonias and inform service planning.

References: 1. Rosales RL, Cuffe L, Regnault B, Trosch RM. Pain in cervical dystonia: mechanisms, assessment and treatment. Expert Rev Neurother. 2021.
2. Charous S, Comella C. Dystonias of the head and neck: an overview. Ear Nose Throat J. 2011.
3. Rodrigues FB, Duarte GS, Marques RE, et al. Botulinum toxin type A therapy for cervical dystonia. Cochrane Database Syst Rev. 2020.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-treatment-patterns-and-outcomes-in-head-and-neck-dystonia-experience-from-a-tertiary-multidisciplinary-clinical-service/