Objective: To evaluate long-term efficacy and safety of the treatment of cervical dystonia (CD) with abobotulinumtoxinA in daily life routine in an outpatient clinic for movement disorders.

Background: Symptomatic treatment with botulinum toxin A (BoNT-A) is the evidence based first-line therapy of cervical dystonia. Treatment data over a very long time are available.

Method: We conducted a retrospective analysis of the treatment data of all CD patients who had been treated at least three times consecutively with abobotulinumtoxinA in our outpatient clinic between May 1989 and December 2016. In order to examine a representative cohort, we included not only patients with focal CD, but also patients with CD as part of a segmental, multifocal or generalized dystonia. For the same reason, the cohort was heterogeneous concerning the etiology of dystonia.

Results: The mean observation time was 11.0 years with a maximum of 27 years. We analyzed 6660 treatment sessions of 209 patients. The mean dose was 663 mouse units with a moderate increase in the first years succeeded by a stable level over the following years. Injection intervals were quite stable from the beginning. The reported effect duration was longer in one´s 5th year of treatment (11.0 weeks) than in the 1st year (10.6). The occurrence of at least one undesired effect was reported by the patients after 15 % of all treatment sessions with a decrease in frequency over the years. The most frequent side effects were mild dysphagia (in 6 % of all sessions), muscle weakness (2 %) and pain (2 %). 48 % of all patients were still on treatment in our outpatient clinic in December 2016. Reasons for discontinuation of therapy were change to another nearby physician, age, other diseases, spontaneous improvement of symptoms, switch to another BoNT-A product (altogether 46 % of cases of discontinuation), side effects (6 %), primary (5 %) or possible secondary (16 %) treatment failure and unknown reasons (26 %). Extensor-digitorum-brevis-tests conducted in 5 patients did prove a secondary treatment failure in 2 patients. Both showed BoNT-A antibodies.

Conclusion: Real life data on the long-term treatment of CD with abobotulinumtoxinA confirm its safety and efficacy. The results are helpful for counselling patients who seek treatment for their disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-treatment-of-cervical-dystonia-with-abobotulinumtoxina/