Objective: To compare standard botulinum toxin (BoNT) versus physical therapy (PT) combined with BoNT in primary cervical dystonia (PCD).

Background: PCD is frequently a source of disability, depression and decreased quality of life. BoNT is the gold standard treatment for PCD. However, the response can be suboptimal in many patients. BoNT efficacy wears off between doses even in patients who have good response.

Methods: PCD subjects with suboptimal benefits on BoNT (10 weeks or lesser) were enrolled. These PCD subjects either received PT and BoNT (PT group) or BoNT alone. Toronto Western Spasmodic Torticollis Scale (TWSTRS) scores, SF-36 quality of life scores and visual analog scale (VAS) scores for pain were obtained at baseline, at peak BoNT benefits (approximately 3-6 weeks), and 12 weeks post BoNT. A PT program was initiated at baseline visit. A supervised session followed by a home exercise program was performed for six weeks. Subjects were contacted weekly to ensure compliance with the exercise program.

Results: Fifteen subjects (7 male, 8 female, mean age 64.5 ± 5.4 years, mean disease duration 14.4 ± 10.9 years) were recruited. At baseline, the mean TWSTRS disability score was 9.9 ± 5.3 (PT group) and 5.8 ± 3.3 (non-PT group), TWSTRS pain score was 8.9 ± 5.8 (PT group) and 6 ± 5.2 (non-PT group) and VAS pain score was 3.6 ± 3.1 (PT group) and 1.19 ± 1.31 (non-PT group). Repeated Measures ANOVA was used. The change in TWSTRS pain score and VAS pain score at 6 weeks peak BoNT benefits in PT group was significantly greater than non-PT group. Improvement in SF-36 physical component scale approached significance in the PT group.

Conclusions: Preliminary results suggests PT combined with BoNT has a better pain control and improves quality of life in PCD. A larger clinical trial is needed for further validation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/synergistic-effects-of-physical-therapy-and-botulinum-toxin-in-primary-cervical-dystonia/