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Management of secondary poor response to botulinum toxin in cervical dystonia: a multicenter audit


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Tucker, H, Osei-Poku, F, Ashton, D, Lally, R, Jesuthasan, A, Latorre, A, Bhatia, KP, Alty, JE ORCID: 0000-0002-5456-8676 and Kobylecki, C 2021 , 'Management of secondary poor response to botulinum toxin in cervical dystonia: a multicenter audit' , Movement Disorders Clinical Practice, vol. 8, no. 4 , pp. 541-545 , doi: 10.1002/mdc3.13181.

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BackgroundBotulinum toxin A (BoNT‐A) is an effective treatment for cervical dystonia. Nevertheless, up to 30% to 40% patients discontinue treatment, often because of poor response. The British Neurotoxin Network (BNN) recently published guidelines on the management of poor response to BoNT‐A in cervical dystonia, but adherence to these guidelines has not yet been assessed.ObjectivesTo assess adherence to and usefulness of BNN guidelines in clinical practice.MethodsWe undertook a retrospective medical notes audit of adherence to the BNN guidelines in 3 United Kingdom tertiary neurosciences centers.ResultsOf 76 patients identified with poor response, 42 (55%) had a suboptimal response and, following BNN recommendations, 25 of them (60%) responded to adjustments in BoNT dose, muscle selection or injection technique. Of the remaining 34 (45%) patients with no BoNT response, 20 (59%) were tested for immune resistance, 8 (40%) of whom showed resistance. Fourteen (18%) of all patients were switched to BoNT‐B, and 27 (36%) were referred for deep brain stimulation surgery. In those not immune to BoNT‐A, clinical improvement was seen in 5 (41%) after adjusting their dose and injection technique.ConclusionOur audit shows that optimizing BoNT dose or injection strategy largely led to improvements in those with suboptimal response and in those reporting no response without resistance. It would be helpful to standardize investigations of potential resistance in those with no therapeutic response.

Item Type: Article
Authors/Creators:Tucker, H and Osei-Poku, F and Ashton, D and Lally, R and Jesuthasan, A and Latorre, A and Bhatia, KP and Alty, JE and Kobylecki, C
Keywords: dystonia, botulinum toxin, neurology, management, clinical
Journal or Publication Title: Movement Disorders Clinical Practice
Publisher: John Wiley & Sons, Inc.
ISSN: 2330-1619
DOI / ID Number: 10.1002/mdc3.13181
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© 2021 The Authors. This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, (, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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