Objective: To report international dosing practice for abobotulinumtoxinA (ABO) in a real-world pragmatic setting for the management of cervical dystonia (CD) with simple patterns.

Background: For the effective management of CD optimal dosing of botulinum neurotoxin-A (BoNT-A) is vital to maximise clinical efficacy and to minimise adverse effects. The sites of injection placement and dosing should be tailored to the individual patient’s presentation; however current clinical guidelines provide little consistent guidance on BoNT-A injection technique (i.e. muscle selection, dosing per muscle, use of guidance techniques).

Methods: Meta-analyses of two observational international studies (INTEREST IN CD1 & 2) and one US registry (ANCHOR-CD) were conducted on baseline data from subjects with a simple CD pattern (1 clear CD pattern only with no secondary component) who had previously received ABO.

Results: Descriptive data are presented for 369 ABO treated subjects with a simple CD pattern. The most common pattern was rotational torticollis (n=151) and the next most common pattern was laterocollis (n=27). Across both patterns, the 5 most commonly injected muscles were the splenius capitis, sternocleidomastoid, trapezius, levator scapulae and semispinalis capitis. Table 1 gives ABO dosing details for the 5 most injected muscles in simple patterns of CD (rotation/laterocollis) .

Conclusions: These data illustrate the pragmatic usage of ABO in routine clinical practice for the management of the most common simple CD patterns i.e. rotational torticollis and laterocollis. The most commonly injected muscles were those which are most easily accessible. It is unknown if these common choices are the best choices. This study describes how BoNT is currently utilised in CD, but not how BoNT should be ideally utilised in CD. Studies comparing the efficacy of different muscle selection and dosing are needed to address this important issue.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dosing-of-abobotulinumtoxina-and-muscle-selection-in-patients-with-simple-patterns-of-cervical-dystonia/