Cervical dystonia: factors deteriorating patient satisfaction of long-term treatment with botulinum toxin

To assess the long-term efficacy and morbidity of radiofrequency volumetric tissue reduction (RFVTR) of the soft palate for snoring, we examined the medical records of 39 patients who received this treatment at an academic medical center. Telephone interviews were conducted with the patients to evaluate the long-term subjective efficacy and sequelae. The average follow-up was 14 months (range, 3 to 26 months). Twenty-eight patients (72%) responded to treatment, defined as a 4-point decrease on a 10-point scale. The self-reported snoring score decreased an average of 52% (8.8 ± 1.9 to 4.2 ± 2.9). Sixty-seven percent of the patients were satisfied. The response to treatment did not always correlate with patient satisfaction. The snoring relapse rate was 11% among responders. No significant differences were identified between responders and nonresponders. No significant complications or long-term sequelae were observed. We conclude that RFVTR of the palate is a relatively safe and effective long-term treatment for snoring. Defining realistic pretreatment expectations is important in maximizing patient satisfaction.

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How satisfied are cervical dystonia patients after 3 years of botulinum toxin type A treatment? Results from a prospective, long-term observational study

Journal of Neurology ◽

10.1007/s00415-019-09527-2 ◽

2019 ◽

Vol 266 (12) ◽

pp. 3038-3046 ◽

Cited By ~ 8

Author(s):

Carlo Colosimo ◽

◽

David Charles ◽

Vijay P. Misra ◽

Pascal Maisonobe ◽

...

Keyword(s):

Patient Satisfaction ◽

Botulinum Toxin ◽

Observational Study ◽

Cervical Dystonia ◽

Treatment Cycle ◽

Symptom Control ◽

Type A ◽

Peak Effect ◽

End Of Treatment

Abstract Background Patients with cervical dystonia (CD) typically require regular injections of botulinum toxin to maintain symptomatic control. We aimed to document long-term patient satisfaction with CD symptom control in a large cohort of patients treated in routine practice. Methods This was a prospective, international, observational study (NCT01753349) following the course of adult CD treated with botulinum neurotoxin type A (BoNT-A) over 3 years. A comprehensive clinical assessment status was performed at each injection visit and subjects reported satisfaction in two ways: satisfaction with symptom control at peak effect and at the end of treatment cycle. Results Subject satisfaction remained relatively stable from the first to the last injection visit. At 3 years, 89.9% of subjects reported satisfaction with symptom control at peak effect and 55.6% reported satisfaction with symptom control at end of treatment cycle. By contrast, objective ratings of CD severity showed an overall reduction over 3 years. Mean ± SD Toronto Western Spasmodic Rating Scale (TWSTRS) Total scores (clinician assessed at end of treatment cycle) decreased from 31.59 ± 13.04 at baseline to 24.49 ± 12.43 at 3 years (mean ± SD reduction from baseline of − 6.97 ± 11.56 points). Tsui scale scores also showed gradual improvement; the percent of subjects with a tremor component score of 4 reduced from 12.4% at baseline to 8.1% at 3 years. Conclusions Despite objective clinical improvements over 3 years, subject satisfaction with symptom control remained relatively constant, indicating that factors other than symptom control also play a role in patient satisfaction.

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VAIKŲ, SERGANČIŲ CEREBRINIU PARALYŽIUMI, ILGALAIKIO GYDYMO BOTULINO TOKSINU POVEIKIS ČIURNOS SĄNARIO JUDESIO AMPLITUDEI IR VAIKŲ MOBILUMUI

Sveikatos mokslai ◽

10.5200/sm-hs.2015.010 ◽

2015 ◽

Vol 25 (1) ◽

pp. 58-65

Author(s):

Laima Mikulėnaitė ◽

Jovita Petrulytė ◽

Anastasija Žernakova

Keyword(s):

Cerebral Palsy ◽

Botulinum Toxin ◽

Ankle Joint ◽

Movement Disorders ◽

Treatment Time ◽

Term Treatment ◽

Clinical Syndrome ◽

Functional Movement ◽

Long Term Treatment

Introduction. Spasticity – the basic and the most common clinical syndrome of cerebral palsy. Most of the time child’s functional and movement disorders depend on this. Botulinum toxin is a drug that relaxes muscles by blocking the release of acetylcholine (ACH) in neuro muscular connection and reduces level of spasticity. The short-term effect of BTX has been proven in scientific literature and it is well known. The effect of treatment with BTX –A in a long-term remains insufficiently studied. Purpose. To evaluate the effect on changes in child’s with cerebral palsy conditions of ankle and child’s mobility over the long time (over 1 year) in the treatment with BTX-A. Method. 98 children with cerebral palsy were treated. The main indication for the treatment of BTX- A was a dynamic ankle joint contracture, resulting in functional status or movement disorders. Condition of all children were evaluated 1 month before starting the treatment with BTX; prior to each injection; within 1 – 2 months after the beginning of treatment with Dysport and after 4 months while planning further treatment with botulinum toxin. The passive ROM of child’s ankle joint was assessed with goniometer measuring the ankle of dorsiflexion while stretching the child’s knee. The functional movement of the child was assessed using the GMFM -88 scale. Results. The average age of children after first BTX-A injection was 33.29 ± 16.235 months. The majority of children (n = 45) were mobile belonging to I - II level at the GMFCS and partly mobile belonging to level III (n = 35). The number of injections of BTX –A ranged from 2 to 8 times per child. The data suggest that despite long-term treatment with BTX –A and physical therapy with the increase of child’s age the contracture of the ankle joint forms. In all cases the only criteria which are statistically significant is time. It means that passive changes in ankle joint dorsiflexion depend on its treatment time. Assessment of child’s functional movement with GMFM -88 scale showed that with each injection of BTX –A the functional movement of a child is enhanced. The highest improvement in motion has been established after the sixth injection of botulinum toxin. Conclusion. Treatment with BTX-A doesn’t have an impact on increase of passive amplitude of ankle and it doesn‘t affect the formation of contractures. Functional movements of a child improvement depend on treatment time: the best result was reached after sixth injection of BTX.

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