Objective: To review the factors associated with patient satisfaction of routine care with BoNT-A injections for CD in a “real world” clinical setting.

Background: Cervical Dystonia (CD) is a chronic condition with significant impact on quality of life. Botulinum Toxin A (BoNT A) is the mainstay of symptomatic treatment typically injected into affected muscles every 3-4 months. The efficacy and safety of BoNT-A has been well established for CD but in clinical practice the individual injection schemes vary substantially.

Method: Patients with primary Cervical Dystonia attending a specialist botulinum toxin clinic were evaluated over a 10-year period (2008-2018). At each clinic visit, patients were asked to complete a questionnaire with a visual analogue score between 0 and 100 to rate their response from the previous injection. Outcomes were then recorded as static measurements of the time to reach 50% improvement and 75% improvement. The association between patient factors and outcome were assessed using Fisher exact test and standard t test.

Results: Data was recorded for 135 patients attending for 1665 injections over a 10-year period. Overall, 84% of patients achieved 50% improvement (n=114) and 73% (n=99) achieved 75% improvement. The median time to 75% improvement was 9 months (range 1-77months). The median time to 50% improvement (if achieved) was 3 months (range: 1-74months). There was no statistically significant association between gender, presence or absence of head tremor, toxin preparation or head posture with either the likelihood of achieving 50% improvement or the time to achieve 50% improvement.

A sensory trick was reported in 82% (n=111). The patients who did not have a sensory trick were significantly more likely to have reported a preceding trauma (62% vs 18%, p=0.05). There was a significant association between the absence of a sensory trick and not achieving 50% clinical improvement.

Conclusion: In this study, BoNT-A was again shown to overall be safe and effective for CD. Some patients continued to report improving responses after 9 months although most had maximised their response within that time. In the absence of a sensory trick, patients were more likely to report a preceding trauma and less likely to respond to BoNT-A therapy. Other factors did not show a clear association.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-10-year-service-evaluation-of-a-cervical-dystonia-botulinum-toxin-a-clinic-factors-associated-with-a-patient-satisfaction/