Cumulative effect of botulinum toxin therapy on motor impairment severity in cervical dystonia patients

Ciljevi istraživanja: cilj ovog istraživanja bio je utvrditi utjecaj dužine liječenja, latencije između dviju aplikacija, ukupne prosječne doze, učestalosti primjene botulinum toksina, dužine trajanja simptoma cervikalne distonije, dobi i spola na poboljšanje motoričkih simptoma i bolnosti kod oboljelih od cervikalne distonije. Ustroj studije: presječna s povijesnim podatcima. Ispitanici i metode: U istraživanju je sudjelovao 41 pacijent s dijagnosticiranom cervikalnom distonijom. Bolesnici su liječeni u KBC-u Osijek u Ambulanti za botulinum toksin. Za istraži vanje je korišten upitnik konstruiran za potrebe ovog istraživanja, a za procjenu težine motori čkih simptoma korištena je modificirana Tsui skala na početku liječenja, te zadnja procijenjen a Tsui skala tijekom perioda liječenja. Također, za subjektivnu pacijentovu procjenu utjecaja t erapije na poboljšanje boli i motoričkih simptoma korišten je kratki upitnik “Patients Global I mpression of Change – Improvement scale”. Rezultati: uočili smo značajan utjecaj većeg ukupnog broja aplikacija, veće ukupne prosječne doze te veće ukupne dužine perioda liječenja primjenom BoNT-a na subjektivnu procjenu poboljšanja bolnosti. Nismo uočili utjecaj broja aplikacija, prosječne doze i veće učestalosti primjene BoNT-a, latencije između dviju aplikacija, veće ukupne dužine perioda liječenja, veće dužine trajanja simptoma, dobi i spola na poboljšanje motoričkih simptoma (niti na subjektivnu, niti na objektivnu procjenu). Također nismo uočili utjecaj učestalosti primjene BoNT-a, ukupne dužinu trajanja simptoma, doba i spola na subjektivnu procjenu bolnosti. Zaključak: Povećanje ukupnog broj aplikacija, ukupne prosječne doze BoNT-a te ukupne dužine perioda liječenja ima bolji učinak na bolnost kod bolesnika sa cervikalnom distonijom.Objectives: The objective of this research was to determine the effect of total length of treatment period, latency between two separate applications, total average dose, frequency of application of botulinum toxin, as well as duration of symptoms, age and sex on the severity of motor symptoms and pain in patients with cervical dystonia. Study design: cross-sectional with historical data Participants and methods: The research included 41 patients diagnosed with cervical dystonia. The patients were treated in the Neurology Clinic of Clinical Hospital Centre in Osijek. As a research tool there was used a questionnaire designed for this research. For the evaluation of severity of motor symptoms, the modified Tsui scale was used, assessed during the first and during the last recorded visit to the clinic. Also, a short questionnaire “Patients Global Impression of Change – Improvement scale” was used for the assessment of patient`s subjective evaluation of effects of the therapy onto the perceived pain and motor symptoms. Results: It was found out, that larger total number of applications, larger total average doses and longer total duration of treatment period have a significant effect onto the patients’ subjective assessment of pain improvement. The effect of number of applications, average dose and larger frequency of BoNT application, as well as the effect of age, sex, longer total duration of treatment period, longer duration of symptoms and longer latency between two separate applications onto the motor symptoms improvement (both subjective and objective assessment) was found not to be significant. Also, we did not find a significant effect of frequency of application, total duration of symptoms, age and sex onto the subjective assessment of pain. Conclusion: Both larger total number of applications and the larger average BoNT doses as well as the total length of treatment have a better effect on pain improvement in patients with cervical dystonia