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Evolution of dose and response to botulinum toxin A in cervical dystonia: a multicenter study

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Abstract

Botulinum neurotoxin (BoNT) is an effective treatment for cervical dystonia (CD). Long-term changes of several variables, including the dose of BoNT, in these patients is largely unknown. We reviewed the clinical charts of 275 patients with CD treated with BoNT type A (BoNT-A) for at least 5 years since 1989 at ten tertiary centers. The mean dose of BoNT-A per session during the first 5 years of treatment was calculated and the appearance of resistance was noted. The dose of BoNT-A for the whole group showed a significant trend to increase over time (year 1: 180 ± 65 U; year 5: 203 ± 63 U; ANOVA:p < 0.0001). However, when we studied the evolution of the dose of BoNT-A for those patients (n = 49) first injected after 2000 (introduction of current BOTOX preparation in our country), there was no significant increase in dose (year 1: 181.8 ± 75 U; year 5: 181.7 ± 75 U; ANOVAp: ns). A total of 19 patients became secondary nonresponders; all but one of these patients began BoNT-A treatment before 2000. In summary, there is a statistically significant increase of mean dose of BoNT-A per session over time, and this could be explained by the appearance of secondary nonresponders. On the other hand, those patients initially treated after 2000 did not show any statistically significant increase in dose for 5 years. This could be explained by better experience and techniques, fewer immunogenic problems with the current BoNT-A, and also less variability of the dose per vial.

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Conflict of interest

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Author information

Authors and Affiliations

  1. Department of Neurology, Fundación Jiménez Díaz, Madrid, Spain

    Pedro J. Garcia Ruiz

  2. Department of Neurology, Hospital Ramón y Cajal, 28034, Madrid, Spain

    Juan Carlos Martínez Castrillo

  3. Department of Neurology, Hospital Universitario La Fé, Valencia, Spain

    Juan A. Burguera

  4. Department of Neurology, Hospital Clinico Universitario, Malaga, Spain

    Victor Campos

  5. Department of Neurology, Hospital Clínico de Santiago, Santiago de Compostela, Santiago, Spain

    Alfonso Castro

  6. Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain

    Esther Cancho & Jose Chacón

  7. Department of Neurology, Hospital Valle de Hebrón, Barcelona, Spain

    Jaime Hernández Vara & Francesc Miquel

  8. Department of Neurology, Hospital Clínico Universitario, Saragossa, Spain

    Javier Lopez del Val & Elena Lopez Garcia

  9. Department of Neurology, Hospital de Mataró, Barcelona, Spain

    Pilar Sanz

  10. Department of Neurology, Fundación Hospital Alcorcón, Madrid, Spain

    Lydia Vela

Authors
  1. Pedro J. Garcia Ruiz
  2. Juan Carlos Martínez Castrillo
  3. Juan A. Burguera
  4. Victor Campos
  5. Alfonso Castro
  6. Esther Cancho
  7. Jose Chacón
  8. Jaime Hernández Vara
  9. Javier Lopez del Val
  10. Elena Lopez Garcia
  11. Francesc Miquel
  12. Pilar Sanz
  13. Lydia Vela

Corresponding author

Correspondence toJuan Carlos Martínez Castrillo.

Additional information

P. J. Garcia Ruiz and J. C. Martínez Castrillo contributed equally to this work.

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Garcia Ruiz, P.J., Martínez Castrillo, J.C., Burguera, J.A.et al. Evolution of dose and response to botulinum toxin A in cervical dystonia: a multicenter study.J Neurol258, 1055–1057 (2011). https://doi.org/10.1007/s00415-010-5880-1

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