Background Botulinum toxin (BoNT) is an effective first-line treatment for cervical dystonia. However, secondary non responsiveness to BoNT treatment remains a key reason for a discontinuation rate of 20%.
In 2016 the British Neurotoxin Network (BNN) published recommendations for the management of cervical dystonia patients with poor response to BoNT treatment.
Aims To compare management of patients with secondary non responsiveness in two regional neuroscience centres with the BNN guidelines.
Methods We retrospectively analysed 68 patients with cervical dystonia who met criteria for secondary non responsiveness to BoNT-A treatment.
Results Suboptimal response to BoNT-A was recorded in 37 patients (54%), whilst 31 (46%) had no therapeutic response.
In the ‘suboptimal response’ group, 21 (57%) had a subsequent good therapeutic response with adjustment of dose, muscle selection and injection technique and continued BoNT-A treatment. Of the remainder, 6 (38%) were switched to BoNT-B and 7 (44%) were referred for Deep Brain Stimulation surgery.
In the ‘no response’ group 6 patients (19%) had a good therapeutic response with adjustments of dose, muscle selection and injection technique and continued BoNT-A treatment. In this group 22 patients (71%) were assessed for BoNT-A resistance, which was confirmed in 8 (36%).
Conclusion Our audit shows the importance of careful assessment of patients with cervical dystonia presenting with secondary non-reponsiveness to BoNT-A therapy. The BNN recommendations provide a useful framework for improving dystonia treatment.
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