Objective: The purpose of this project is to determine if outside influences or stressors have an effect on the therapeutic benefit of botulinum toxin injections used for treatment of dystonia.

Background: Patients occasionally report that the therapeutic effect of botulinum toxin injections were less than expected or not as robust as previously experienced. When this occurs, many practitioners increase the dose or change the type of toxin used. A question is raised as to whether these changes are needed routinely or if identifying outside factors which may have impacted the effect of the toxin and addressing those factors will lead to improved outcomes.

Methods: We conducted a chart review of more than 971 patient injection visits. For almost three years, a routine component of patient visits for toxin injections in our movement disorders clinic included a history form which asked patients to report the outcome of the treatment received in their preceding visit. In addition, patients were asked if they had experienced any new medical problems or life stressors (an "event") since their last visit.

Results: Of the 971 patient visits collected, 146 (15%) were associated with an event;.194 patients were represented, with 83 (43%) describing an event during at least one visit. Events described ranged from patient diagnosis of cancer to incarceration of relatives. A mixed model method was used to assess the relationship between visits with events and the patients’ perceived treatment effect. This method takes into account the varying number of visits a patient may have had and that the visits may be correlated to each other within a patient. The average treatment effect was significantly lower for the visits with an event when compared to the visits without an event (2.62, s.e. 0.09 vs 3.24, s.e. 0.06, p < 0.001).

Conclusions: When patients experience a reduced benefit from botulinum toxin injections, clinicians have often responded by increasing the amount of toxin injected or changing the toxin used. This study suggests that analyzing the experiences of a patient between injections can help determine if any changes are needed. Illness or stressful events appear to play a significant role in the effect of botulinum toxin injections. Recognition of these events will give clinicians needed information regarding the best treatment strategies and lead to improved outcomes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-outside-influences-on-the-therapeutic-benefits-of-botulinum-toxin-injections/