Objective: We present a series of patients with Parkinson’s disease (PD) who developed cervical dystonia (CD) and were managed with botulinum toxin therapy. We report the outcomes of their recurrent injections treatment.

Background: Dystonia in Parkinson’s disease, mostly affecting hands or feet, is commonly related to motor fluctuations associated with dopaminergic therapy. Focal or segmental dystonia in other areas, including in the cervical region, can also occur in PD patients, but usually it does not respond to oral medications [1, 2]. Denervation with botulinum toxins is a recommended first line therapy for idiopathic cervical dystonia (CD), but evaluation of its efficacy in secondary CD associated with PD is rarely reported.

Method: Case series with assessment of duration of the benefits of botulinum toxin injections, improvement of neck mobility and pain using global impression of change.

Results: We included 14 PD patients with HY stage 2-4 with the age range 46 to 79 years. Predominant patterns of CD included anterocollis and laterocollis with five patients each, and four patients had a rotational pattern of torticollis. None of the patients had improvement in neck symptoms based on their on or off status. Every subject reported the onset of cervical dystonia at least five years since the initial onset of PD. The toxin doses for the treatment of CD ranged from 80 U to 500U of either onabotulinumtoxinA (eight patients) or incobotulinumtoxinA (six patients), and the minimal duration of the therapy was 24 months. Six patients also received toxin therapy for other forms of dystonia, one blepharospasm and five for lower extremity dystonia. Twelve of 14 treated patients experienced benefits in treated CD with improvement ranging from 6 to 12 weeks, mostly related to better pain control and neck mobility. Four patients were categorized as mildly improved and eight as moderately improved. Two patients with anterocollis have experienced only pain improvement for about four weeks but opted to continue with the therapy. Adverse effects included mild and transient neck weakness, especially in two patients with anterocollis.

Conclusion: Similarly to the established benefits of botulinum toxin therapy for idiopathic CD, patients with PD complicated by secondary CD also benefit from botulinum toxin chemodenervation.

References: 1. Tolosa E, Compta Y. Dystonia in Parkinson’s disease. J Neurol. 2006 Dec;253 Suppl 7:VII7-13.
2. Thiel MF, Altman CF, Jost WH. Cervical dystonia in Parkinson’s Disease: frequency of occurrence and subtypes. Neurol Neurochir Pol. 2022;56(4):379-380.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/efficacy-of-botulinum-toxin-treatment-for-cervical-dystonia-associated-with-parkinsons-disease-a-case-series/