Objective: This study aims to compare the effectiveness of botulinum toxin injections versus oral medications in the symptomatic management of cervical dystonia , evaluating their impact on symptom severity, functional outcomes, and quality of life across multiple centers.

Background: CD is a chronic neurological disorder characterized by involuntary contractions of neck muscles, leading to abnormal head postures and significant disability. Treatment options include botulinum toxin injections, which target affected muscles, and anticholinergics, muscle relaxants, and dopaminergic agents. While BoNT is considered the gold standard, oral medications widely used due to accessibility and cost considerations. A comparative analysis of their effectiveness is essential.

Method: A multi-center, prospective, observational study was conducted across five neurology clinics. Patients with primary cervical dystonia were divided into 2 groups: those receiving BoNT injections and oral medications. Clinical outcomes were assessed using the Toronto Western Spasmodic Torticollis Rating Scale at baseline, 4 weeks, and 12 weeks. Secondary outcomes included patient-reported pain levels, functional disability, and quality of life measured using the SF-36 questionnaire. Statistical analysis was performed using ANOVA and logistic regression models.

Results: A total of 256 patients (BoNT: 136, Oral medications: 120) were included. At 12 weeks, BoNT-treated patients showed a significant reduction in TWSTRS scores (mean decrease: 42%) compared to the oral medication group (mean decrease: 18%, p < 0.001). Pain reduction was greater in the BoNT group (55% vs. 23%, p < 0.01). Functional disability and quality of life improved significantly in the BoNT group, with 78% reporting moderate to significant relief compared to 39% in the oral medication group. Adverse effects were more common in the oral medication group, with sedation and dry mouth being predominant, whereas BoNT-related side effects were mild and transient.

Conclusion: BoNT injections demonstrate superior efficacy in reducing symptom severity, pain, and disability in cervical dystonia compared to oral medications. While oral medications remain an alternative for patients with contraindications to BoNT, their lower effectiveness and higher side effect profile suggest that BoNT should be the preferred first-line treatment.

Baseline Characteristics of Study Participants

Table 2: Clinical Outcomes at 12 Weeks

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparative-effectiveness-of-botulinum-toxin-vs-oral-medications-in-the-management-of-cervical-dystonia-a-multi-center-study/