Objective: To provide unique data on the common patterns of muscles selected for injection and the time course of benefit and weakness for BoNT injections in a real-life setting outside a clinical trial. The study also analyses the clinical evolution of isolated focal and segmental dystonia over a long-term follow-up.

Background: Botulinum neurotoxin (BoNT) treatment is the standard of care for patients with focal dystonia. However, the success of the treatment largely depends on the proper selection of muscles to be injected. Despite the high prevalence of focal dystonia, there are only a few studies on BoNT in dystonia from India.

Method: We present a retrospective study of the clinical presentation and evolution of isolated focal and segmental dystonia in adults treated with BoNT injection from January 2002 to Jan 2022. The self-reported benefit and adverse effects were also analysed. The study included patients with a clinical diagnosis of isolated focal or segmental dystonia at presentation and underwent BoNT injection treatment at least twice. Questionnaires from 578 patients were selected for final analysis.

Results: Cervical dystonia was the most common type of focal dystonia (45.5%). Dystonia spread to other regions in 81(14%) patients, and blepharospasm(27%) was observed to have a higher risk of spreading to other parts. Ten patients(1.7%) developed parkinsonism.  In addition, the presence of sensory trick, and absence of tremor were found to be predictors of good outcome with BoNT.

Conclusion: This study provides unique data on the evolution of dystonia, course of benefit and weakness for BoNT injections in the real-life setting, outside of a clinical trial. The results of this study can be used for patient education to set expectations for response to BoNT treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-presentation-and-evolution-of-isolated-focal-and-segmental-dystonia-in-adults-20-years-experience-from-a-botulinum-toxin-clinic/