Objective: To quantify the impact of sensory trick on botulinum toxin dose and treatment outcomes in cervical dystonia (CD)

Background: Sensory tricks are voluntary maneuvers that clinically dampen dystonia severity. Sensory trick and botulinum toxin efficacies are postulated to involve GABAergic pathways similarly leading to clinical improvement. The interactive impact of sensory trick on dystonia severity and toxin dose has not been quantified.

Method: Data from the date of botulinum injection from the CD PROBE study [CD Patient Registry for Observation of OnabotulinumtoxinA Efficacy] were extracted : age, sex, disease duration, time from symptom onset to diagnosis, time from diagnosis to any treatment, sensory trick efficacy (complete,  partial or absent), botulinum toxin dose, TWSTRS score, and CDIP-mood score.

One-way ANOVA analysis compared. Effects of sensory trick on disease severity [total and subscale ( motor, disability and pain)] TWSTRS scores, total injected dose, and time from symptom onset to diagnosis and any treatment were done using one-way ANOVA. Multivariate logistic and linear regression models were run with treatment dose (median split of dose) as outcome and complete sensory trick, age, disease duration, total TWSTRS and CDIP-mood as covariates. Correction for multiple comparisons were applied as appropriate.

Results: Of 1039 CD patients included, sensory trick efficacy was rated as complete in 271, partial in 476 and absent in 292 subjects. There was a graded association between sensory trick efficacy and milder symptoms (total TWSTRS 34 vs 40 vs 41.5, p <.001), severity (14.5 vs. 17.8 vs. 19, p <.001), disability (9.6 vs. 11.7 vs. 11.5, p<.001) and pain (10 vs. 10.4 vs. 11, p =.06). Those with a complete sensory trick received a lower mean toxin dose (160 vs. 177 vs. 174 units; p = 0.02). After accounting for age and disease duration, presence of a complete sensory trick was associated with a lower toxin dose by approximately 10% (p < 0.05). After accounting for confounders, absence of a complete sensory trick was associated with greater odds of requiring a higher toxin dose (OR: 1.34, p =0.05). There was no difference in time from symptom onset to diagnosis (268 vs. 263 vs. 265 weeks, p=.99) or any treatment (318 vs. 334 vs. 321 weeks, p=.88).

Conclusion: Our analysis shows that a complete sensory trick is associated with a lower dose of botulinum toxin but no difference in time to toxin treatment.

References: 1. Patel N, Hanfelt J, Marsh L, Jankovic J. Alleviating manoeuvres (sensory tricks) in cervical dystonia. Journal of neurology, neurosurgery, and psychiatry. Aug 2014;85(8):882-884.
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3. Patel N, Jankovic J, Hallett M. Sensory aspects of movement disorders. The Lancet. Neurology. Jan 2014;13(1):100-112.
4. Sarasso E, Agosta F. Sensory trick phenomenon in cervical dystonia: a functional MRI study. Apr 2020;267(4):1103-1115.
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Acknowledgement: This abstract is based on research using data from data contributors AbbVie that has been made available through Vivli, Inc. Vivli has not contributed to or approved, and is not in any way responsible for, the contents of this publication.

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