Cervical dystonia: pain relieving effects of botulinum toxin treatment

Marciniec Michał, Szczepańska-Szerej Anna, Rejdak Konrad. Cervical dystonia: pain relieving effects of botulinum toxin treatment. Journal of Education, Health and Sport. 2018;8(8):147-154. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1302493 http://ojs.ukw.edu.pl/index.php/johs/article/view/5616 https://pbn.nauka.gov.pl/sedno-webapp/works/869073 DOAJ https://doaj.org/article/32ab7c591e3842bba8223d5cebd91fb2 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2018; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.06.2018. Revised: 28.06.2018. Accepted: 01.07.2018. Cervical dystonia: pain relieving effects of botulinum toxin treatment Michał Marciniec1, Anna Szczepańska-Szerej1, Konrad Rejdak1 1Chair and Department of Neurology, Medical University of Lublin, Poland * E-mail address: lekmarciniec@gmail.com ABSTRACT Cervical dystonia (CD) is a third most common movement disorder characterized by sustained or intermittent muscle contractions causing abnormal movements and postures of head and neck. Physical, emotional, cognitive, and self-awareness aspects are also affected, so CD is currently considered to be a “network” disorder with the involvement of multiple brain regions and cellular mechanisms. Pain occurs in 54.6% to 88.9% of patients with CD and is the most disabling non-motor symptom which strongly attributes to the quality of life deterioration. The dystonia-related pain is also the main reason patients are looking for treatment. Despite the high prevalence only small number of studies develops this issue. Botulinum toxin (BoNT) is a safe, efficacious and first choice treatment for CD. Up to 90% of patients reports an improvement in pain and motor symptoms after BoNT injections, however above mentioned effects may be partially independent due to the earlier and longer pain relief compared to muscle relaxation. The results of current studies suggest analgesic effects of BoNT are related to not only the acting in the neuromuscular junction. The central processing of nociceptive stimuli is contributed to be the main effect of BoNT analgesic therapy. To date, evidence for the association between dystonia-related pain and BoNT treatment become more significant but is still lacking. Further research is needed to investigate above correlation and issue an unambiguous high-level recommendations of analgesic therapy in CD. Keywords: Cervical Dystonia, Torticollis, Pain, Botulinum Toxins. GLOSSARY aboBoNT-A – abobotulinumtoxinA, AEs – adverse effects, BoNT – botulinum neurotoxin, CD – cervical dystonia, DBS – deep brain stimulation, EMG – electromyography, incoBoNT-A – incobotulinumtoxinA, onaBoNT-A – onabotulinumtoxinA, PNRS – pain numeric rating scale, RCTs – randomized controlled trials, rimaBoNT-B – rimabotulinumtoxinB, TWSTRS – Toronto Western Spasmodic Torticollis Rating Scale, VAS – visual analog scale