Skip to main content
SpringerLink
Log in

Botulinum Injections for Idiopathic Cervical Dystonia: a Longitudinal Study

  • Original Article
  • Published:
Neurotoxicity Research Aims and scope Submit manuscript

Abstract

Botulinum toxin (BT) injections into the cervical muscles are an effective and commonly practiced treatment approach for cervical dystonia. In this retrospective longitudinal study, we collected data from the Sheba electronic medical records on consecutive patients with idiopathic cervical dystonia (ICD), treated regularly with periodic BT injections between the years 2008–2020. All treatment visits were analyzed regarding type of toxin, dose injected, and clinical outcomes. The vast majority of patients were treated with abobotulinum toxin A. Sixty-four ICD patients (51 (79.7%) females, onset at age 45.8 ± 13.7 years) were treated over 17.1 ± 13.9 (range 3 to 49) visits per patient; BT treatment efficacy increased gradually from initial treatment sessions to visit 13, when it achieved a steady state. While the subjective report of percentage improvement and its duration were around 78.9 ± 17.1% for 2.8 ± 1.0 months, respectively, the dose of BT increased significantly over the years (p = 0.006). Side effects (SE) were not rare, and commonly recurred after subsequent sessions and were usually mild and short-lasting, with dysphagia being the most common (~17.5%), followed by neck/arm weakness (11.9%) and cervical pain (8.9%). Repeated injections of BT for ICD remain beneficial for patients over several years of therapy, and despite mild SE, patients tend to adhere to a 3–4 months interval schedule.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

BT:

Botulinum toxin

CD:

Cervical dystonia

ICD:

Idiopathic cervical dystonia

SE:

Side effects

SnR:

Secondary non-response

AB-TF:

Antibody-induced treatment failure

SMC:

Sheba Medical Center

EMR:

Electronic medical records

ABO:

Abobotulinum toxin A

ONA:

Onabotulinum toxin A

ET:

Essential tremor

TD:

Tardive dystonia

EMG:

Electromyography

GEE:

Generalized estimating equations

CVA:

Cerebrovascular accident

CP:

Cerebral palsy

AAO:

Age at onset

References

  • Bentivoglio AR, Di Stasio E, Mulas D, Cerbarano ML, Ialongo T, Laurienzo A, Petracca M (2017) Long-term abobotulinumtoxin a treatment of cervical dystonia. Neurotox Res 32(2):291–300

    Article  CAS  Google Scholar 

  • Butler JS, Beiser IM, Williams L, McGovern E, Molloy F, Lynch T, Healy DG, Moore H, Walsh R, Reilly RB, O’Riordan S, Walsh C, Hutchinson M (2015) age-related sexual dimorphism in temporal discrimination and in adult-onset dystonia suggests GABAergic mechanisms. Front Neurol 6:258

    Article  Google Scholar 

  • Dressler D, Dirnberger G (2000) Botulinum toxin therapy: risk factors for therapy failure. Mov Disord 15(Suppl. 2):51

    Google Scholar 

  • Dressler D (2004) Clinical presentation and management of antibody-induced failure of botulinum toxin therapy. Mov Disord 8:S92-100

    Article  Google Scholar 

  • Felicio AC, Godeiro-Junior C, de Carvalho AP, Borges V, Silva SM, Ferraz HB (2009) Predictable variables for short- and long-term botulinum toxin treatment response in patients with cervical dystonia. Neurol Sci 30(4):291–294

    Article  Google Scholar 

  • Finsterer J, Maeztu C, Revuelta GJ, Reichel G, Truong D (2015) Collum-caput (COL-CAP) concept for conceptual anterocollis, anterocaput, and forward sagittal shift. J Neurol Sci 355(1–2):37–43

    Article  Google Scholar 

  • Gordon MF, Brashear A, Elovic E, Kassicieh D, Marciniak C, Liu J, Turkel C, BOTOX Poststroke Spasticity Study Group (2004) Repeated dosing of botulinum toxin type A for upper limb spasticity following stroke. Neurology 63:1971–1973

    Article  CAS  Google Scholar 

  • Han V, Skorvanek M, Smit M, Turcanova Koprusakova M, Hoekstra T, van Dijk JP, Tijssen MAJ, Gdovinova Z, Reijneveld SA (2020) Prevalence of non-motor symptoms and their association with quality of life in cervical dystonia. Acta Neurol Scand 142(6):613–622

    Article  Google Scholar 

  • Hefter H, Schomaecker I, Schomaecker M, Samadzadeh S (2020) Disease progression of idiopathic cervical dystonia in spite of improvement after botulinum toxin therapy. Front Neurol 11:588395

    Article  Google Scholar 

  • Hvizdošová L, Nevrlý M, Otruba P, Hluštík P, Kaňovský P, Zapletalová J (2020) The prevalence of dystonic tremor and tremor associated with dystonia in patients with cervical dystonia. Sci Rep 10(1):1436

    Article  Google Scholar 

  • Jochim A, Meindl T, Mantel T, Zwirner S, Zech M, Castrop F, Haslinger B (2019) Treatment of cervical dystonia with abo- and onabotulinumtoxin A: long-term safety and efficacy in daily clinical practice. J Neurol 266(8):1879–1886

    Article  Google Scholar 

  • Jost WH, Schramm A, Müngersdorf M, Stenner A, Schwingenschuh P, Maisonobe P, Koch M, Haslinger B (2019) Effectiveness of botulinum neurotoxin type A injections in naïve and previously-treated patients suffering from Torti- or Laterocollis or -caput: Results from a German-Austrian open-label prospective post-marketing surveillance study. J Neurol Sci 399:44–50

    Article  CAS  Google Scholar 

  • Kessler KR, Skutta M, Benecke R (1999) Long-term treatment of cervical dystonia with botulinum toxin A: efficacy, safety, and antibody frequency. German Dystonia Study Group. J Neurol 246(4):265–274

    CAS  Google Scholar 

  • LaHue SC, Albers K, Goldman S, Lo RY, Gu Z, Leimpeter A, Fross R, Comyns K, Marras C, de Kleijn A, Smit R, Katz M, Ozelius LJ, Bressman S, Saunders-Pullman R, Comella C, Klingman J, Nelson LM, Van Den Eeden SK, Tanner CM (2020) Cervical dystonia incidence and diagnostic delay in a multiethnic population. Mov Disord 35(3):450–456

    Article  Google Scholar 

  • Mejia NI, Vuong KD, Jankovic J (2005) Longterm botulinum toxin efficacy, safety, and immunogenicity. Mov Disord 20:592–597

    Article  Google Scholar 

  • Misra VP, Ehler E, Zakine B, Maisonobe P, Simonetta-Moreau M, Interest In CD Group (2012) Factors influencing response to Botulinum toxin type A in patients with idiopathic cervical dystonia: results from an international observational study. BMJ Open 2(3):e000881

    Article  Google Scholar 

  • Norris SA, Jinnah HA, Espay AJ, Klein C, Brüggemann N, Barbano RL, Malaty IA, Rodriguez RL, Vidailhet M, Roze E, Reich SG, Berman BD, LeDoux MS, Richardson SP, Agarwal P, Mari Z, Ondo WG, Shih LC, Fox SH, Berardelli A, Testa CM, Cheng FC, Truong D, Nahab FB, Xie T, Hallett M, Rosen AR, Wright LJ, Perlmutter JS (2016) Clinical and demographic characteristics related to onset site and spread of cervical dystonia. Mov Disord 31(12):1874–1882

    Article  Google Scholar 

  • Ortiz RM, Scheperjans F, Mertsalmi T, Pekkonen E (2019) Comorbidity and retirement in cervical dystonia. J Neurol 266(9):2216–2223

    Article  Google Scholar 

  • Reichel G, Stenner A, Jahn A (2009) The phenomenology of cervical dystonia. Fortschr Neurol Psychiatr 77(5):272–277

    Article  CAS  Google Scholar 

  • Simpson LL (1981) The origin, structure, and pharmacologic activity of botulinum toxin. Pharmacol Rev 33:155–188

    CAS  PubMed  Google Scholar 

  • Tinazzi M, Squintani GM, Bhatia KP, Segatti A, Donato F, Valeriani M, Erro R (2019) Pain in cervical dystonia: evidence of abnormal inhibitory control. Parkinsonism Relat Disord 65:252–255

    Article  Google Scholar 

  • Tinazzi M, Erro R, Mascia MM, Esposito M, Ercoli T, Ferrazzano G, Di Biasio F, Pellicciari R, Eleopra R, Bono F, Bertolasi L, Barone P, Scaglione CLM, Pisani A, Altavista MC, Cotelli MS, Ceravolo R, Cossu G, Zibetti M, Moja MC, Girlanda P, Maderna L, Albanese A, Petracca M, Magistrelli L, Misceo S, Minafra B, Romano M, Squintani GM, Modugno N, Aguggia M, Cassano D, Castagna A, Morgante F, Berardelli A, Defazio G (2020) Demographic and clinical determinants of neck pain in idiopathic cervical dystonia. J Neural Transm (Vienna) 127:1435–1439

    Article  Google Scholar 

  • Tomic S, Petkovic I, Pucic T, Resan B, Juric S, Rotim T (2016) Cervical dystonia and quality of life. Acta Neurol Belg 116(4):589–592

    Article  Google Scholar 

  • Truong D, Brodsky M, Lew M, Brashear A, Jankovic J, Molho E, Orlova O, Timerbaeva S (2010) Long-term efficacy and safety of botulinum toxin type A (Dysport) in cervical dystonia. Parkinsonism Relat Disord 16(5):316–323

    Article  Google Scholar 

  • Wöllner J, Weise D, Leplow B (2021) Subjective versus objective symptom intensities ratings in cervical dystonia and hemifacial spasm across a botulinum neurotoxin cycle. Brain Behav e02023

Download references

Author information

Authors and Affiliations

  1. Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Ramat-Gan, Israel

    Gilad Yahalom, Tsvia Fay-Karmon, Vered Livneh, Simon Israeli-Korn, Lilach Ephraty & Sharon Hassin-Baer

  2. Movement Disorders Clinic and Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel

    Gilad Yahalom

  3. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Sharon Hassin-Baer

Authors
  1. Gilad Yahalom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsvia Fay-Karmon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vered Livneh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Simon Israeli-Korn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lilach Ephraty
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sharon Hassin-Baer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, G.Y., S.H.B.; Methodology, G.Y.; Software: G.Y.; Validation, G.Y., S.H.B. Formal analysis, G.Y.; Investigation, G.Y., T.F.K., V.L., S.I.K., L.E., S.H.B.; Resources, G.Y., T.F.K., V.L., S.I.K., L.E., S.H.B.; Data Curation, G.Y..; Writing—Original Draft Preparation, G.Y..; Writing—Review and Editing, G.Y., S.I.K., S.H.B.; Visualization, none.; Supervision, S.H.B..; Project Administration, S.H.B.; Funding Acquisition—none.

Corresponding author

Correspondence to Gilad Yahalom.

Ethics declarations

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Sheba Medical Center (protocol code 7080–20, date of approval 11.06.2020).

Informed Consent

Since this study is a retrospective one, the requirement for informed consent contingent on a de-identified analysis of the study database was waived.

Conflict of Interest

Prof. Sharon Hassin-Baer, Dr. Simon Israeli-Korn, and Dr. Gilad Yahalom received consultancy fees from Abbvie Biopharmaceuticals Inc. and Medison Pharma. No other disclosures were reported.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yahalom, G., Fay-Karmon, T., Livneh, V. et al. Botulinum Injections for Idiopathic Cervical Dystonia: a Longitudinal Study. Neurotox Res 39, 1352–1359 (2021). https://doi.org/10.1007/s12640-021-00378-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12640-021-00378-2

Keywords

Search

Navigation