Telemedicine Follow-up for Patients With Cervical Dystonia Treated With Neurotoxin Injections

2019 ◽  
Author(s):  
Keyword(s):  
Cervical Dystonia

Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 957-963 ◽  
Author(s):  
Francesco Cacciola ◽  
Jibril Osman Farah ◽  
Paul R Eldridge ◽  
Patricia Byrne ◽  
Telekath K Varma
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Spasmodic Torticollis ◽  
Long Term Outcome ◽  
Stimulation Parameters ◽  
Deep Brain

Abstract BACKGROUND: Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/benefit ratio still need to be established. OBJECTIVE: To report our long-term outcome with bilateral GPi deep brain stimulation in cervical dystonia. METHODS: The Toronto Western Spasmodic Torticollis Rating Scale was evaluated in 10 consecutive patients preoperatively and at last follow-up. The relationship of improvement in postural severity and pain was analyzed and stimulation parameters noted and compared with those in a similar series in the literature. RESULTS: The mean (standard deviation) follow-up was 37.6 (16.9) months. Improvement in the total Toronto Western Spasmodic Torticollis Rating Scale score as evaluated at latest follow-up was 68.1% (95% confidence interval: 51.5-84.6). In 4 patients, there was dissociation between posture severity and pain improvement. Prevalently bipolar stimulation settings and high pulse widths and amplitudes led to excellent results at the expense of battery life. CONCLUSION: Improvement in all 3 subscale scores of the Toronto Western Spasmodic Torticollis Rating Scale with bilateral GPi deep brain stimulation seems to be the rule. Refinement of stimulation parameters might have a significant impact on the cost/benefit ratio of the treatment. The dissociation of improvement in posture severity and pain provides tangible evidence of the complex nature of cervical dystonia and offers interesting insight into the complex functional organization of the GPi.

scholarly journals Does the Somatosensory Temporal Discrimination Threshold Change over Time in Focal Dystonia?

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Antonella Conte ◽  
Gina Ferrazzano ◽  
Daniele Belvisi ◽  
Nicoletta Manzo ◽  
Antonio Suppa ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Cervical Dystonia ◽  
Healthy Subjects ◽  
Temporal Discrimination ◽  
Discrimination Threshold ◽  
Focal Dystonia ◽  
Inhibitory Interneurons ◽  
Follow Up Study ◽  
Over Time

Background. The somatosensory temporal discrimination threshold (STDT) is defined as the shortest interval at which an individual recognizes two stimuli as asynchronous. Some evidence suggests that STDT depends on cortical inhibitory interneurons in the basal ganglia and in primary somatosensory cortex. Several studies have reported that the STDT in patients with dystonia is abnormal. No longitudinal studies have yet investigated whether STDT values in different forms of focal dystonia change during the course of the disease.Methods. We designed a follow-up study on 25 patients with dystonia (15 with blepharospasm and 10 with cervical dystonia) who were tested twice: upon enrolment and 8 years later. STDT values from dystonic patients at the baseline were also compared with those from a group of 30 age-matched healthy subjects.Results. Our findings show that the abnormally high STDT values observed in patients with focal dystonia remained unchanged at the 8-year follow-up assessment whereas disease severity worsened.Conclusions. Our observation that STDT abnormalities in dystonia remain unmodified during the course of the disease suggests that the altered activity of inhibitory interneurons—either at cortical or at subcortical level—responsible for the increased STDT does not deteriorate as the disease progresses.

scholarly journals Botulinum toxin type A and cervical dystonia: a seven-year follow-up

2011 ◽  
Vol 69 (5) ◽  
pp. 745-750 ◽  
Author(s):  
Carlos Henrique F. Camargo ◽  
Hélio Afonso G. Teive ◽  
Nilson Becker ◽  
Renato P. Munhoz ◽  
Lineu César Werneck
Keyword(s):  
Botulinum Toxin ◽  
Cervical Dystonia ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Clinical Severity ◽  
Term Therapy ◽  
Regular Treatment

Most cases of cervical dystonia (CD) are idiopathic, and focal injections of botulinum toxin A (BoNT/A) are the treatment of choice. The objective of our study was to document the effects of long-term BoNT/A treatment in idiopathic CD patients. Fifty-eight patients with idiopathic CD were recruited from March 2001 to May 2002. Twenty-eight of the subjects were available for reassessment after seven years. During this period, all had received regular treatment with BoNT/A injections. Clinical information about patients and the severity of CD (TWSTRS and VAPS) at baseline assessment (2001-2002) and follow-up (2008-2009) was compared. Significant motor improvement was detected based on TWSTRS scale scores, which were used to analyze clinical severity (19.6±6.6 and 17.7±4.8; p<0.05). There was no improvement in the severity of cervical pain (p=0.43). In conclusion, BoNT/A was a safe and effective long-term therapy for CD.

Reliability, feasibility and satisfaction of telemedicine evaluations for cervical dystonia

2019 ◽  
Vol 26 (9) ◽  
pp. 560-567
Author(s):  
Avram Fraint ◽  
Glenn T. Stebbins ◽  
Gian Pal ◽  
Cynthia L. Comella
Keyword(s):  
Cervical Dystonia ◽  
Visual Inspection ◽  
Rating Scale ◽  
Correlation Coefficients ◽  
Summary Score ◽  
Spasmodic Torticollis ◽  
Kappa Statistics ◽  
Intra Class Correlation ◽  
Neurologic Diseases

Introduction Telemedicine is used successfully for evaluating patients with neurologic diseases, but has not been tested in cervical dystonia (CD). CD is uniquely suited for telemedicine as the scales validated to assess its severity rely only on visual inspection. The study sought to determine reliability, feasibility and satisfaction of telemedicine visits for evaluating CD. Methods Patients 18 years and older with a diagnosis of CD and scheduled for botulinum toxin (BoNT) injections were recruited, with a total of 46 enrolled. Dystonia severity was evaluated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) motor severity subscale. Three total evaluations took place: an initial telemedicine evaluation on the day prior to a scheduled BoNT injection; an in-person evaluation in clinic immediately before injections; and a follow-up telemedicine visit 4–6 weeks after injection with subsequent completion, by both participants and the clinician, of satisfaction questionnaires. Agreement between telemedicine and in-person TWSTRS data was calculated using intra-class correlation coefficients (ICC) and kappa statistics where appropriate. Feasibility was determined by the percent of patients completing all three visits, and satisfaction with telemedicine visits was determined based on answers to satisfaction questionnaires. Results There was excellent agreement between visit types for the TWSTRS motor severity summary score (κ = 0.890; 95th CI 0.713; 0.949). Only two individual TWSTRS items failed to meet the threshold for moderate agreement. Feasibility and satisfaction were high. Discussion Telemedicine is reliable and feasible in the evaluation of CD. Some CD patients would prefer telemedicine visits. Participants and the clinician were satisfied with telemedicine visits.

Unilateral pallidotomy as a potential rescue therapy for cervical dystonia after unsatisfactory selective peripheral denervation

2020 ◽  
Vol 33 (5) ◽  
pp. 658-666
Author(s):  
Yijie Lai ◽  
Peng Huang ◽  
Chencheng Zhang ◽  
Liangyun Hu ◽  
Zhengdao Deng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Rescue Therapy ◽  
Common Adverse Event ◽  
Spasmodic Torticollis ◽  
Limb Weakness ◽  
Unilateral Pallidotomy

OBJECTIVESelective peripheral denervation (SPD) is a widely accepted surgery for medically refractory cervical dystonia (CD), but when SPD has failed, the available approaches are limited. The authors investigated the results from a cohort of CD patients treated with unilateral pallidotomy after unsatisfactory SPD.METHODSThe authors retrospectively analyzed patients with primary CD who underwent unilateral pallidotomy after SPD between April 2007 and August 2019. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was used to evaluate symptom severity before surgery, 7 days postsurgery, 3 months postsurgery, and at the last follow-up. TWSTRS subscores for disability and pain and the 24-item Craniocervical Dystonia Questionnaire (CDQ-24) were used to assess quality of life.RESULTSAt a mean final follow-up of 5 years, TWSTRS severity subscores and total scores were significantly improved (n = 12, mean improvement 57.3% and 62.3%, respectively, p = 0.0022 and p = 0.0022), and 8 of 12 patients (66.7%) were characterized as responders (improvement ≥ 25%). Patients with rotation symptoms before pallidotomy showed greater improvement in TWSTRS severity subscores than those who did not (p = 0.049). The most common adverse event was mild upper-limb weakness (n = 3). Patients’ quality of life was also improved.CONCLUSIONSUnilateral pallidotomy seems to offer an effective and safe option for patients with CD who have otherwise experienced limited benefits from SPD.

scholarly journals Head tremor in patients with cervical dystonia: different outcome?

2008 ◽  
Vol 66 (4) ◽  
pp. 805-808 ◽  
Author(s):  
Clecio Godeiro-Junior ◽  
Andre C. Felicio ◽  
Patricia C. Aguiar ◽  
Vanderci Borges ◽  
Sonia M.A. Silva ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Treatment Response ◽  
Cervical Dystonia ◽  
Age At Onset ◽  
Demographic Parameters ◽  
Hand Tremor ◽  
Head Tremor ◽  
Significant Difference ◽  
Pre Treatment

OBJECTIVE: The association of cervical dystonia (CD) with other movement disorders have been already described, but data on clinical outcome regarding these patients are scant. The aim of this paper was to investigate whether patients with CD and head tremor (HT) would have a different outcome regarding to botulinum toxin type-A (BTX-A) treatment response and clinical and demographic parameters. METHOD: We retrospectively evaluated 118 medical charts of patients with CD and divided them into two groups: with (HT+) and without (HT-) head tremor. We compared the following clinical and demographic parameters: age at onset, disease duration, progression of symptoms, etiology, familial history, presence of hand tremor. We also analyzed the response to BTX-A according to Tsui score in both groups. RESULTS: The occurrence of head tremor in our sample was of 38.2%. The occurrence of postural hand tremor in the patients from the HT+ group was higher than in the HT- one (p=0.015) and if we compare BTX-A response in each group, we observe that patients with HT present a better outcome in a setting of longer follow-up. In HT+ group, Tsui score pre treatment was 10 (6-12.5) and after follow-up was 8 (5.5-10.5); p<0.001. In HT- group there was no significant difference 9 (7-12) in pre treatment and after follow-up; p=0.07. CONCLUSION: According to our data it seems that head tremor may influence the clinical outcome or treatment response with BTX-A in patients with CD.

1.254 Long-term follow-up of cervical dystonia patients treated with Botulinum toxin A

2007 ◽  
Vol 13 ◽  
pp. S66
Author(s):  
K. Kollewe ◽  
N. Buhr ◽  
K. Krampfl ◽  
R. Dengler ◽  
B. Mohammadi
Keyword(s):  
Botulinum Toxin ◽  
Cervical Dystonia ◽  
Botulinum Toxin A ◽  
Toxin A ◽  
Long Term Follow Up
Sign in / Sign up

Export Citation Format

Share Document