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Mejia-Vergara AJ, Méndez Cardona L, Flórez Rocha DA, Rozo N, Rincón López JV. Translation, adaptation, and cross-cultural validation of the CDQ-24 scale in patients with primary blepharospasm under botulinum toxin treatment, pilot test. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024:S2173-5794(24)00103-8. [PMID: 38878820 DOI: 10.1016/j.oftale.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/06/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Benign essential blepharospasm (BEB) is the most common adult-onset focal facial dystonia and its treatment of choice is periodic application of botulinum toxin (BtA). It has a higher incidence in middle and late adulthood, especially in women between 40 and 60 years of age. OBJECTIVE To carry out the translation and cross-cultural adaptation of the CDQ24 questionnaire in its Spanish version in patients diagnosed with BEB who have been treated with BtA in an ophthalmologic center in Bogotá - Colombia. MATERIALS AND METHODS Pilot test of validation study and adaptation of a scale assembled in a prospective cohort of the CDQ24 instrument to Spanish in adult patients with primary blepharospasm treated with botulinum toxin in Bogota, Colombia. RESULTS We obtained a sample of 26 patients to whom the instrument was applied after translation and retranslation of the original document, composed of 19 (73%) women with a median age of 64.5 years; the average time to answer the survey was 4.93 min. The internal consistency of the scale evaluated by Cronbach's Alpha had a total score of 0.78. Criterion validity between the CDQ24 scale and the WHOQOL-BREF quality of life scale was determined by determining correlation between the Emotional Well-Being and Phsychological domains of both scales. CONCLUSIONS The translation and cross-cultural adaptation of the CDQ-24 scale into Spanish allowed the applicability of the instrument to the Spanish-speaking population during the pilot test, which allows us to continue the relevant studies in the study population.
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Affiliation(s)
- A J Mejia-Vergara
- Centro Oftalmológico Oftalmosanitas, Bogotá, Colombia; Departamento de Oftalmología, Facultad de Medicina, Fundación Universitaria Sanitas, Bogotá, Colombia; Departamento de Oftalmología, Facultad de Medicina. University of Florida, Gainesville, Florida, USA
| | - L Méndez Cardona
- Departamento de Oftalmología, Facultad de Medicina, Fundación Universitaria Sanitas, Bogotá, Colombia.
| | - D A Flórez Rocha
- Departamento de Oftalmología, Facultad de Medicina, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - N Rozo
- Unidad de Investigación, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - J V Rincón López
- Unidad de Investigación, Fundación Universitaria Sanitas, Bogotá, Colombia; Visión Colombia, Grupo de Investigación, Fundación Universitaria Sanitas, Bogotá, Colombia
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Junker J, Hall J, Berman BD, Vidailhet M, Roze E, Bäumer T, Malaty IA, Shukla AW, Jankovic J, Reich SG, Espay AJ, Duque KR, Patel N, Perlmutter JS, Jinnah HA, Brandt V, Brüggemann N. Longitudinal predictors of health-related quality of life in isolated dystonia. J Neurol 2024; 271:852-863. [PMID: 37839041 PMCID: PMC10827910 DOI: 10.1007/s00415-023-12022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To determine longitudinal predictors of health-related quality of life (HR-QoL) in an international multicenter cohort of patients with isolated dystonia. METHODS Out of 603 dystonia patients prospectively enrolled in the Natural History Dystonia Coalition study, 155 were assessed three times within 2 years for HR-QoL, symptoms of depression, generalized anxiety disorder (GAD), and social anxiety disorder (SAD), as well as dystonia severity and dystonic tremor. In addition, the impact of botulinum neurotoxin (BoNT) injections on HR-QoL was evaluated after 1 year. RESULTS Depressive symptoms at baseline predicted lower HR-QoL on all subscales after 2 years (all p ≤ 0.001). Higher GAD scores at baseline predicted lower HR-QoL related to general health, pain and emotional well-being, whereas higher SAD scores predicted higher pain-related QoL after 2 years (all p ≤ 0.006). Dystonia severity at baseline predicted social functioning (p = 0.002). Neither dystonic tremor, age, or sex predicted HR-QoL at 2 years. Two latent categories were revealed across the three-time points: Category 1 with higher total HR-QoL scores (mean HR-QoL = 74.4% ± 16.1), susceptible to symptoms of depression and SAD, and Category 2 with lower total HR-QoL scores (mean HR-QoL = 45.5% ± 17.6), susceptible to symptoms of GAD. HR-QoL improved over the course of 1 year irrespective of the use of BoNT. CONCLUSION The longitudinal impact of psychiatric symptoms on HR-QoL emphasizes the importance of incorporating mental health treatment, in particular also the therapy of anxiety disorders, into treatment regimens for dystonia.
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Affiliation(s)
- Johanna Junker
- Department of Neurology, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, SH, Germany
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - James Hall
- Southampton Education School, University of Southampton, Southampton, UK
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Marie Vidailhet
- Departement de Neurologie, AP-HP, Hopital de La Pitie-Salpetriere, Paris, France
- Institut du Cerveau_ Paris Brain Institute-ICM, INSERM 1127, CNRS 7225, Sorbonne Université, Paris, France
| | - Emmanuel Roze
- Departement de Neurologie, AP-HP, Hopital de La Pitie-Salpetriere, Paris, France
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurologic Disorders, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurologic Disorders, University of Florida, Gainesville, FL, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Stephen G Reich
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Kevin R Duque
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Neepa Patel
- RUSH Parkinson's Disease and Movement Disorders Center, Department of Neurological Science, RUSH University Medical Center Chicago, Chicago, IL, USA
| | - Joel S Perlmutter
- Departments of Neurology, Radiology and Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
| | - H A Jinnah
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Valerie Brandt
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK
| | - Norbert Brüggemann
- Department of Neurology, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, SH, Germany.
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany.
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Hefter H, Schomaecker I, Schomaecker M, Ürer B, Brauns R, Rosenthal D, Albrecht P, Samadzadeh S. Lessons about Botulinum Toxin A Therapy from Cervical Dystonia Patients Drawing the Course of Disease: A Pilot Study. Toxins (Basel) 2023; 15:431. [PMID: 37505701 PMCID: PMC10467134 DOI: 10.3390/toxins15070431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
AIM OF THE STUDY To compare the course of severity of cervical dystonia (CD) before and after long-term botulinum toxin (BoNT) therapy to detect indicators for a good or poor clinical outcome. PATIENTS AND METHODS A total of 74 outpatients with idiopathic CD who were continuously treated with BoNT and who had received at least three injections were consecutively recruited. Patients had to draw the course of severity of CD from the onset of symptoms until the onset of BoNT therapy (CoDB graph), and from the onset of BoNT therapy until the day of recruitment (CoDA graph) when they received their last BoNT injection. Mean duration of treatment was 9.6 years. Three main types of CoDB and four main types of CoDA graphs could be distinguished. The demographic and treatment-related data of the patients were extracted from the patients' charts. RESULTS The best outcome was observed in those patients who had experienced a clear, rapid response in the beginning. These patients had been treated with the lowest doses and with a low number of BoNT preparation switches. The worst outcome was observed in those 17 patients who had drawn a good initial improvement, followed by a secondary worsening. These secondary nonresponders had been treated with the highest initial and actual doses and with frequent BoNT preparation switches. A total of 12 patients were primary nonresponders and did not experience any improvement at all. No relation between the CoDB and CoDA graphs could be detected. Primary and secondary nonresponses were observed for all three CoDB types. The use of initial high doses as a relevant risk factor for the later development of a secondary nonresponse was confirmed. CONCLUSIONS Patients' drawings of their course of disease severity helps to easily detect "difficult to treat" primary and secondary nonresponders to BoNT on the one hand, but also to detect "golden responders" on the other hand.
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Affiliation(s)
- Harald Hefter
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany (P.A.); (S.S.)
| | - Isabelle Schomaecker
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany (P.A.); (S.S.)
| | - Max Schomaecker
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany (P.A.); (S.S.)
| | - Beyza Ürer
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany (P.A.); (S.S.)
| | - Raphaela Brauns
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany (P.A.); (S.S.)
| | - Dietmar Rosenthal
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany (P.A.); (S.S.)
| | - Philipp Albrecht
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany (P.A.); (S.S.)
- Department of Neurology, Maria Hilf Clinics, 41063 Moenchengladbach, Germany
| | - Sara Samadzadeh
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany (P.A.); (S.S.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, 13125 Berlin, Germany
- Department of Regional Health Research and Molecular Medicine, University of Southern Denmark, 5230 Odense, Denmark
- Department of Neurology, Slagelse Hospital, 4200 Slagelse, Denmark
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Hirunwiwatkul P, Supawatjariyakul W, Jariyakosol S, Apinyawasisuk S, Sriratanaban J, Chongpison Y, Jagota P, Aui-aree N, Witthayaweerasak J, Setthawatcharawanich S, Kitthaweesin K, Chirapapaisan N, Chaimongkoltrakul P, Laowanapiban P, Hansapinyo L, Panpitpat S, Kurathong S, Nimworaphan J, Thitiwichienlert S, Vanikieti K, Samipak N, Srimanan W, Mekhasingharak N, Chaitanuwong P. Health-related quality of life of daily-life-affected benign essential blepharospasm: Multi-center observational study. PLoS One 2023; 18:e0283111. [PMID: 36920965 PMCID: PMC10016646 DOI: 10.1371/journal.pone.0283111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE To compare Thais' health-related quality of life (HRQOL) and severity grading, efficacy and safety in daily-life-affected benign essential blepharospasm (BEB) patients at baseline and after Botulinum toxin type A (BTX-A) treatment. DESIGN Prospective-observational study. PARTICIPANTS BEB patients with Jankovic rating scale (JRS) at least 3 in both severity and frequency graded from 14 institutes nationwide were included from August 2020 to June 2021. METHODS Demographic data, HRQOL evaluated by the Thai version of EQ-5D-5L and NEI-VFQ-25 questionnaires, and severity grading score evaluated by Jankovic rating scale (JRS) at baseline, 1, and 3 months after the treatment were collected. The impact of the BTX-A injections and their complications were recorded. RESULTS 184 daily-life-affected BEB patients were enrolled; 159 patients (86.4%) had complete data with a mean age of 61.40±10.09 years. About 88.05% were female, and 10.1% were newly diagnosed. Most of the patients had bilateral involvement (96.9%) and 12.6% had history of BEB-related accident. After BTX-A treatment, HRQOL improved significantly in 4 dimensions of EQ-5D-5L, except self-care. The EQ_VAS (mean±SD) was 64.54±19.27, 75.13±15.37, 73.8±15.85 (p<0.001) and EQ-5D-5L utility score was 0.748±0.23, 0.824±0.19 and 0.807±0.19 at baseline, 1, 3 months after treatment, respectively. From NEI-VFQ-25, HRQOL also improved in all dimensions, except eye pain. The JRS improved in all patients. Self-reported minor adverse events were 22.6%, which mostly resolved within the first month. CONCLUSION Daily-life-affected BEB impacted HRQOL in most dimensions from both generic and visual-specific questionnaires. BTX-A treatment not only decreased disease severity, but also improved quality of life.
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Affiliation(s)
- Parima Hirunwiwatkul
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
- Ophthalmology Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- * E-mail:
| | - Wajamon Supawatjariyakul
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
- Ophthalmology Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Supharat Jariyakosol
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
- Ophthalmology Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Supanut Apinyawasisuk
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
- Ophthalmology Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jiruth Sriratanaban
- Faculty of Medicine, Preventive and Social Medicine Department, Chulalongkorn University, Bangkok, Thailand
| | - Yuda Chongpison
- Faculty of Medicine, Center of Excellence in Biostatistics, Research Affairs, Chulalongkorn University, Bangkok, Thailand
- The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nipat Aui-aree
- Faculty of Medicine, Department of Ophthalmology, Prince of Songkla University, Songkla, Thailand
| | | | | | - Kitthisak Kitthaweesin
- Faculty of Medicine, Department of Ophthalmology, Khon Kaen University, Khon Kaen, Thailand
| | - Niphon Chirapapaisan
- Faculty of Medicine Siriraj Hospital, Department of Ophthalmology, Mahidol University, Bangkok, Thailand
| | | | - Poramaet Laowanapiban
- Department of Ophthalmology, Mettapracharak (Wat Rai Khing) Hospital, Nakorn Pathom, Thailand
| | - Linda Hansapinyo
- Faculty of Medicine, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
| | - Suthida Panpitpat
- Department of Ophthalmology, Udon Thani Hospital, Udon Thani, Thailand
| | - Sireedhorn Kurathong
- Faculty of Medicine Vajira Hospital, Department of Ophthalmology, Navamindradhiraj University, Bangkok, Thailand
| | - Jirat Nimworaphan
- Faculty of Medicine Vajira Hospital, Department of Ophthalmology, Navamindradhiraj University, Bangkok, Thailand
| | | | - Kavin Vanikieti
- Faculty of Medicine Ramathibodi Hospital, Department of Ophthalmology, Mahidol University, Bangkok, Thailand
| | - Narong Samipak
- Department of Ophthalmology, Chakri Naruebodindra Medical Institute, Samut Prakan, Thailand
| | - Worapot Srimanan
- Department of Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand
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The Use of High Initial Doses of Botulinum Toxin Therapy for Cervical Dystonia Is a Risk Factor for Neutralizing Antibody Formation-A Monocentric Cross-Sectional Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010088. [PMID: 35056396 PMCID: PMC8779899 DOI: 10.3390/medicina58010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: The present study aims to analyze the complex patient/treating physician interaction at onset of botulinum toxin (BoNT) therapy in patients with idiopathic cervical dystonia (CD) and the influence of high initial doses on long-term outcomes. Materials and Methods: A total of 74 CD patients with well-documented courses of BoNT treatment were consecutively recruited after written informed consent. Patients had to rate the amount of improvement of CD in percent of severity of CD at onset of BoNT therapy. They had to draw the course of disease severity (CoD) of CD from the onset of symptoms until the onset of BoNT therapy and from the onset of BoNT therapy until recruitment. The remaining severity of CD was estimated by the treating physician using the TSUI score. Demographic- and treatment-related data were extracted from the charts of the patients. Seventeen patients with suspected secondary treatment failure (STF) were tested for the presence of antibodies. Results: Depending on the CoD before BoNT therapy, three patient subgroups could be distinguished: rapid onset, continuous onset and delayed onset groups. Time to BoNT therapy, increase in dose and improvement were significantly different between these three groups. In the rapid onset group, with the highest initial doses, the best improvement was reported, but the highest number of patients with an STF and with neutralizing antibodies was also observed. Conclusion: The use of high initial doses in the BoNT therapy of CD is associated with a rapid response and quick success; however, it leads to an elevated risk for the development of a secondary treatment failure and induction of neutralizing antibodies.
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Danchenko N, Johnston KM, Whalen J. The cost-effectiveness of abobotulinumtoxinA (Dysport) and onabotulinumtoxinA (Botox) for managing spasticity of the upper and lower limbs, and cervical dystonia. J Med Econ 2022; 25:919-929. [PMID: 35730362 DOI: 10.1080/13696998.2022.2092354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the costs and benefits associated with the use of abobotulinumtoxinA (aboBoNT-A) and onabotulinumtoxinA (onaBoNT-A) for lower limb spasticity in children, upper and lower limb spasticity in adults, and cervical dystonia in adults. METHODS This pharmacoeconomic analysis compared aboBoNT-A with onaBoNT-A. A decision tree model with a 1-year time horizon was conducted from a UK National Health Service (NHS) perspective using data from a variety of sources: randomized controlled trials (RCTs), network meta-analyses (NMAs), observational studies, and a physician survey investigating treatment patterns and resource utilization. Four patient populations were included: pediatric patients with lower limb spasticity (PLL), and adults with upper limb spasticity (AUL), lower limb spasticity (ALL), and cervical dystonia (CD). Outcomes included costs, quality-adjusted life years (QALYs) gained, cost per responder, and incremental cost per QALY gained. The effectiveness of each treatment was evaluated as a response to treatment. The base case assumption was that all patients in the model continued to receive botulinum toxin type A (BoNT-A) treatments at regular intervals regardless of treatment response status. Scenario analysis evaluated the impact of discontinuing BoNT-A for patients without a response to the first injection. RESULTS The model found that aboBoNT-A resulted in greater quality-of-life and lower costs compared with onaBoNT-A for the management of spasticity and CD in all included indications. Across populations, cost savings ranged from £304 to £3,963 and QALYs gained ranged from 0.010 to 0.02 over a 1-year time horizon. Results were robust to scenario analyses and were driven by the impact of treatment response on health-related quality-of-life. CONCLUSIONS AboBoNT-A was associated with higher treatment response, improved quality-of-life, and reduced costs in spasticity and CD versus onaBoNT-A. These findings could help deliver more effective and efficient healthcare in the NHS.
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Rafee S, O'Riordan S, Reilly R, Hutchinson M. We Must Talk about Sex and Focal Dystonia. Mov Disord 2021; 36:604-608. [PMID: 33503303 DOI: 10.1002/mds.28454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 01/28/2023] Open
Abstract
In a recent workshop on "Defining research priorities in dystonia,", there was absolutely no reference to sex as a factor in disease pathogenesis. In this viewpoint paper, we argue that the most distinctive aspects of adult onset isolated focal dystonia are the marked sex-related differences demonstrated by epidemiological, clinical, and laboratory studies in patients with adult onset dystonia, particularly in cervical dystonia, the most common presentation. We propose that the future focus of research should be on neurobiological mechanisms underlying the profound sexual dimorphism in this disorder. Targeting research into gamma aminobutyric acid (GABA)ergic function, which also shows similar sexual dimorphism, would be most productive in elucidating the pathogenesis of adult onset dystonia. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Sean O'Riordan
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Richard Reilly
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Bajenaru OL, Popescu-Olaru I, Dumitrescu L, Serban E, Cozma L, Raicu F, Cocos R, Popescu OB. Non-Motor Manifestations in Idiopathic Dystonia with Focal Onset - A Pilot Study. J Med Life 2020; 13:170-174. [PMID: 32742509 PMCID: PMC7378344 DOI: 10.25122/jml-2020-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent studies emphasize an increased prevalence of non-motor symptoms in idiopathic dystonia with focal onset (IDFO), but their pathophysiological relationship is not clear. We aimed to identify the prevalence of depression and neurocognitive impairment in a group of patients with idiopathic dystonia with focal onset and their impact on the patients' quality of life. This study represents a component of an ongoing research project - GENDYS. From the database of this project, we selected 48 patients 56.62+/-14.16 years old who have been examined clinically and using specific scales: Patient Health Questionnaire-9 (for depression), Montreal Cognitive Assessment - MoCA (for cognitive impairment), and a 5-degree analog scale for subjective perception of the severity of the disease. We conducted a descriptive cross-sectional study on patients with depression and cognition evaluated by the above-mentioned scales. We also performed a nested case-control analysis on 20 IDFO patients with and without at least moderate depression matched for age and gender; the cut-offs for depression were PHQ-9 score ≥10 and PHQ9 <5, for the depression group and the control group, respectively. The cut-off for MoCA was 26 points. 22 IDFO patients (46%) had depression; 54.5% of IDFO patients with depression had cognitive impairment, indicating a slight trend of increased cognitive impairment in those with depression compared to those without; the perception of the severity of disease was the greatest in patients with depression. Depression is more prevalent in patients with IDFO and is associated with a worse perception of the disease severity.
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Affiliation(s)
- Ovidiu-Lucian Bajenaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Ana Aslan" National Institute of Geriatrics and Gerontology, Bucharest, Romania
| | - Iulia Popescu-Olaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Laura Dumitrescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Elena Serban
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liviu Cozma
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Florina Raicu
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Relu Cocos
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Bogdan Popescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania.,Laboratory of Molecular Biology, "Victor Babes" National Institute of Pathology, Bucharest, Romania
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Orbicularis Oculi Morphological Alterations in Affected and Nonaffected Sides in Hemifacial Spasm. J Neuroophthalmol 2019; 40:193-197. [PMID: 31453923 DOI: 10.1097/wno.0000000000000823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the nonaffected side appears to be clinically normal in hemifacial spasm (HFS), it is not known whether this side can be considered normal regarding histopathological findings. The purpose of this study was to objectively evaluate and compare orbicularis oculi samples of patients with HFS (not previously treated with botulinum toxin) and control patients undergoing cosmetic upper eyelid blepharoplasty. METHODS Orbicularis oculi samples from 22 eyelids were evaluated. There were 7 samples from the affected and 7 samples from the nonaffected sides of patients with HFS who had not been previously treated with botulinum toxin, and 8 samples from normal control patients. Muscle samples were prepared using hematoxylin and eosin staining, and a digital image analysis software was used for objective analyses. RESULTS When compared with normal controls, endomysial and perimysial connective tissue areas were significantly increased (P = 0.015) on the affected side in HFS, suggesting that this disorder is associated with chronic alterations that lead to muscle degeneration. Cell density was significantly reduced on the affected (P = 0.028) and also on the nonaffected sides in HFS (P = 0.003) compared with normal controls. This was observed, although, clinically, there were no signs or symptoms of increased muscular contraction on the nonaffected sides in any of the patients with HFS studied. CONCLUSIONS Significant morphological differences in the orbicularis oculi muscle in patients with HFS were observed on both the affected and nonaffected sides. Our findings suggest a potential role for muscle homeostasis disturbances on both sides for patients with HFS. Affected sides in patients with HFS did, however, demonstrate muscle degeneration that was not present on the nonaffected sides.
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Moll M, Rosenthal D, Hefter H. Quality of life in long-term botulinum toxin treatment of cervical dystonia: Results of a cross sectional study. Parkinsonism Relat Disord 2018; 57:63-67. [DOI: 10.1016/j.parkreldis.2018.07.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022]
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11
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Girach A, Vinagre Aragon A, Zis P. Quality of life in idiopathic dystonia: a systematic review. J Neurol 2018; 266:2897-2906. [PMID: 30460447 PMCID: PMC6851210 DOI: 10.1007/s00415-018-9119-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/03/2018] [Accepted: 11/09/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Dystonia is characterised by sustained muscular contractions frequently producing repetitive, twisting and patterned movements. The primary aim of this systematic review was to establish how quality of life (QoL) is affected in idiopathic focal, multifocal and segmental dystonia. This review aimed to evaluate variations in QoL between different subtypes of dystonia, identify the determinants of QoL and assess the effects of different treatments on QoL. METHODOLOGY A systematic computer-based literature search was conducted using the PubMed database to search for papers on QoL in idiopathic focal, segmental, multifocal and generalized dystonia. We identified 75 studies meeting our inclusion criteria. Information was extracted regarding prevalence, demographics and response to treatment where indicated. RESULTS This review revealed QoL to be a significant yet often overlooked issue in idiopathic dystonia. Data consistently showed that dystonia has a negative effect on QoL in patients compared to healthy controls, when measured using disease-specific and generic QoL measures. The majority of studies (n = 25) involved patients with cervical dystonia, followed by benign-essential blepharospasm (n = 10). Along with the beneficial effect to the dystonia symptoms, treatment using Botulinum Toxin and Deep Brain Stimulation is also effective in improving overall QoL across the majority of subtypes. CONCLUSION The findings demonstrate that patients' QoL should routinely be assessed and monitored, as this may affect subsequent management. Further research will allow for more robust management of factors contributing to impaired QoL, aside from the physical defects found in dystonia.
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Affiliation(s)
- Ayesha Girach
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.
| | - Ana Vinagre Aragon
- Academic Department of Neurosciences, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK.,Medical School, University of Cyprus, Nicosia, Cyprus
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Weiss D, Hieber L, Sturm J, Börtlein A, Buchthal J, Dippon C, Arnold G, Wächter T. Health-related quality of life outcomes from botulinumtoxin treatment in blepharospasm. Clin Neurol Neurosurg 2018; 172:130-133. [PMID: 29990961 DOI: 10.1016/j.clineuro.2018.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/25/2018] [Accepted: 06/30/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Blepharospasm associates with impairment in generic health-related quality of life (HR-QoL). Albeit botulinum toxin is widely used to alleviate the motor symptoms of blepharospasm, its effect on generic health-related quality of life (HR-QoL) is heterogeneous. PATIENTS AND METHODS In this open-label clinical observational study, we characterized outcomes on HR-QoL in terms of the EuroQol (EQ-5D-5 L) from botulinum toxin (BoNT) injection in a prospective cohort of patients with blepharospasm (n = 55). Additionally, we characterized motor and non-motor signs of blepharospasm including motor symptom improvement, life satisfaction, depressive symptoms, pain and sleep quality. Patients were assessed at the end of a regular three-month period from last injection (Timepoint1) and four weeks after the re-injection of BoNT (Timepoint2). RESULTS There was no improvement of generic HR-QoL on group-level. Individual findings were heterogeneous, dividing patients in three groups of responders (RESP), unchanged outcomes (UNCHN), and worsening (WORSE). We identified, that these subgroups differed at Timepoint 1 with respect to EQ-5D-5 L, EQ-VAS, life satisfaction (health and movement disorders domains), Beck's Depression inventory, and sleep quality (One-way ANOVAs, P < 0.05, adjusted for multiple comparisons). In post-hoc Tuckey tests, RESP or WORSE showed distinct differences from UNCHN that might help to separate the subgroups in future. As such, RESP showed higher impairment in EQ-5D-5L, EQ-VAS, and Beck's Depression Inventory compared to UNCHN (unlike WORSE), whereas WORSE showed higher impairment in life satisfaction 'movement disorders' domain (unlike RESP). CONCLUSION Our study suggests, that several dependent non-motor, life satisfaction and generic HR-QoL measures associate to individual patient outcomes. The variables identified in this study may be validated in future studies to predict HR-QoL outcomes in patients with blepharospasm.
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Affiliation(s)
- Daniel Weiss
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany; Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany
| | - Leonhard Hieber
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany; Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany
| | - Justine Sturm
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany; Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany
| | - Axel Börtlein
- Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - Joachim Buchthal
- Neurologische Gemeinschaftspraxis am Seelberg, Stuttgart, Germany
| | - Christian Dippon
- Neurologische Gemeinschaftspraxis am Seelberg, Stuttgart, Germany
| | - Guy Arnold
- Klinik für Neurologie Sindelfingen, Krankenhaus Sindelfingen-Böblingen, Sindelfingen, Germany
| | - Tobias Wächter
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany; Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany; Abteilung für Neurologie, Reha-Zentrum Bad Gögging, Passauer Wolf, Bad Gögging, Germany.
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Kongsaengdao S, Maneeton N, Maneeton B. Long-term quality of life in cervical dystonia after treatment with abobotulinum toxin A: a 2-year prospective study. Neuropsychiatr Dis Treat 2018; 14:1119-1124. [PMID: 29731634 PMCID: PMC5927345 DOI: 10.2147/ndt.s152252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The short-term quality of life (QoL) in cervical dystonia (CD) after treating with abobotulinum toxin A (Abo-BTX A) and neubotulinum toxin A (Neu-BTX A) have been studied in Thai CD patients. However; the long-term study has not been published. OBJECTIVE The aim of the present study was to determine long-term improvement of the health-related quality of life (HRQoL) after eight injections of Abo-BTX A over 2 years in CD patients. PATIENTS AND METHODS A 2-year prospective study on the QoL of CD patients, as measured by HRQoL, before and after receiving eight injections of Abo-BTX A at 3-month intervals over a 2-year treatment period was performed. The disease-specific HRQoL was assessed before and after the treatment by using the Cervical Dystonia Impact Profile-58 (CDIP-58) questionnaire. The general HRQoL was assessed by using the Medical Outcomes 36-Item Short Form Health Survey (SF-36), while depressive disorder screening was assessed by using the Center of Epidemiologic Studies-Depression (CES-D) questionnaire. The SF-36 and CES-D questionnaire were administered before treatment and every 3 months before the next injection for a 2-year period. RESULTS A total of 20 CD patients were enrolled from January 2013 to December 2015. CDIP-58 showed a significant improvement after long-term injections of Abo-BTX A in all domains (P < 0.001). However, only vitality domain of SF-36, which assessed general HRQoL, showed a significant improvement after long-term injections (P = 0.037). There was no prevalence of depressive disorder in all patients (CES-D score <20) in this study. CONCLUSION The Abo-BTX A injections at 3-month intervals over a 2-year period improved the CDIP-58 scores, which assess disease-specific HRQoL, as well as an increased vitality domain of general HRQoL. No patient suffered from depression in this study.
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Affiliation(s)
- Subsai Kongsaengdao
- Division of Neurology, Department of Medicine, Rajavithi Hospital, Department of Medical Services, Public Health Ministry, Bangkok, Thailand.,Department of Medicine, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Weiss D, Hieber L, Sturm J, Börtlein A, Mayr I, Appy M, Kühnler B, Buchthal J, Dippon C, Arnold G, Wächter T. Botulinumtoxin Improves both Generic and Disease-Specific Quality of Life in Cervical Dystonia. Front Neurol 2017; 8:561. [PMID: 29114239 PMCID: PMC5660718 DOI: 10.3389/fneur.2017.00561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/05/2017] [Indexed: 11/16/2022] Open
Abstract
Botulinumtoxin injection (BoNT) into affected muscles is effective to improve motor symptoms of cervical dystonia (CD) by reducing muscle contraction and involuntary dystonic movement and posturing. However, the understanding of the effect on health-related quality of life (HR-QoL) and patient referral under HR-QoL aspects is incomplete. In this open-label clinical prospective observational study, we characterized the outcomes in CD (n = 159) from botulinumtoxin on both generic HR-QoL (EuroQol; EQ-5D-5L) and disease-specific HR-QoL [craniocervical dystonia questionnaire (CDQ-24)]. Additionally, we characterized motor and non-motor signs of dystonia including motor symptom improvement, depressive symptoms, pain, and sleep quality. We assessed patients at the end of a regular 3-month period from last injection (Timepoint1) and 4 weeks after the re-injection of BoNT (Timepoint2). We aimed to define outcomes on both generic and disease-specific HR-QoL and to evaluate predictors of therapeutic outcome in terms of stepwise multiple regression models. Patients with CD showed a robust improvement of both generic and disease-specific HR-QoL. Furthermore, motor and non-motor signs improved. Multiple regression analyses revealed that EQ-5D-5L and “satisfaction with health” (Fragen zur Lebenszufriedenheit-G) at Timepoint1 predicted treatment response on generic HR-QoL outcome (R2 = 0.284; P = 0.019). Similarly, CDQ-24 and Beck’s Depression inventory at Timepoint1 predicted the treatment response on disease-specific HR-QoL (R2 = 0.253; P = 0.026). Our study underscores both generic and disease-specific HR-QoL improvements in CD, and provides useful predictors on HR-QoL outcomes.
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Affiliation(s)
- Daniel Weiss
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany
| | - Leonhard Hieber
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany
| | - Justine Sturm
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany
| | - Axel Börtlein
- Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - Ingo Mayr
- Klinik für Neurologie Sindelfingen, Krankenhaus Sindelfingen-Böblingen, Sindelfingen, Germany
| | - Matthias Appy
- Berufsausübungsgemeinschaft Dres. Matthias Appy, Wolfgang Molt, Prof. Arthur Melms und Kollegen, Stuttgart, Germany
| | - Benedicta Kühnler
- Berufsausübungsgemeinschaft Dres. Matthias Appy, Wolfgang Molt, Prof. Arthur Melms und Kollegen, Stuttgart, Germany
| | - Joachim Buchthal
- Neurologische Gemeinschaftspraxis am Seelberg, Stuttgart, Germany
| | - Christian Dippon
- Neurologische Gemeinschaftspraxis am Seelberg, Stuttgart, Germany
| | - Guy Arnold
- Klinik für Neurologie Sindelfingen, Krankenhaus Sindelfingen-Böblingen, Sindelfingen, Germany
| | - Tobias Wächter
- Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurodegenerative Diseases, Centre of Neurology, University of Tübingen, Tübingen, Germany.,Abteilung für Neurologie, Reha-Zentrum Bad Gögging, Passauer Wolf, Bad Gögging, Germany
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15
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Jahanshahi M. Neuropsychological and Neuropsychiatric Features of Idiopathic and DYT1 Dystonia and the Impact of Medical and Surgical treatment. Arch Clin Neuropsychol 2017; 32:888-905. [DOI: 10.1093/arclin/acx095] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 11/14/2022] Open
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16
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Muthukumar M, Desai K, Abogunrin S, Harrower T, Gabriel S, Dinet J. Cost-effectiveness analysis of abobotulinumtoxinA for the treatment of cervical dystonia in the United Kingdom. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:211-229. [PMID: 28458568 PMCID: PMC5402907 DOI: 10.2147/ceor.s112254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cervical dystonia (CD) involves painful involuntary contraction of the neck and shoulder muscles and abnormal posture in middle-aged adults. Botulinum neurotoxin type A (BoNT-A) is effective in treating CD but little is known about its associated cost-effectiveness. OBJECTIVE To evaluate the cost-effectiveness of abobotulinumtoxinA for treating CD from the UK payer perspective. METHODS A Markov model was developed to evaluate the cost-effectiveness of abobotulinum-toxinA versus best supportive care (BSC) in CD, with a lifetime horizon and health states for response, nonresponse, secondary nonresponse, and BSC in patients with CD (mean age: 53 years; 37% male). Clinical improvement measured using Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was mapped to utility using data from a randomized trial of abobotulinumtoxinA. Health care resource use, costs, and other inputs were from the British National Formulary, Personal Social Services Research Unit, published literature, or expert opinion. Costs and outcomes were discounted at 3.5% per annum. RESULTS In the base case, the incremental lifetime quality-adjusted life-years (QALYs) gained from abobotulinumtoxinA arm versus BSC was 0.253 per patient, whereas the incremental cost was £7,160, leading to an incremental cost-effectiveness ratio (ICER) of £30,468 per QALY. One-way sensitivity analyses showed that these results were sensitive to the proportion of responders to abobotulinumtoxinA at first injection, duration between injections, the number of reinjections allowed among primary nonresponders, and any difference in baseline TWSTRS value between the BSC and abobotulinumtoxinA arms. Probabilistic sensitivity analysis showed that abobotulinumtoxinA was cost-effective 46% and 49% of times at thresholds of £20,000 and £30,000 per QALY, respectively. Scenarios are considered including vial-sharing, productivity losses, secondary response/nonresponse at subsequent injections, 5-year time horizon, and alternative reinjection intervals for BoNT-As produced ICERs ranging from cost-saving to £40,777 per QALY, versus BSC. CONCLUSION AbobotulinumtoxinA was found to be cost-effective in treating adults with CD, at acceptable willingness-to-pay thresholds in the UK.
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Affiliation(s)
| | | | | | | | | | - Jerome Dinet
- Health Economics and Outcomes Research (Global), Ipsen Pharma, Boulogne-Billancourt, France
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17
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Kongsaengdao S, Maneeton B, Maneeton N. Quality of life in cervical dystonia after treatment with botulinum toxin A: a 24-week prospective study. Neuropsychiatr Dis Treat 2017; 13:127-132. [PMID: 28138245 PMCID: PMC5237598 DOI: 10.2147/ndt.s116325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study aimed to identify possible improvements in disease-specific health-related quality of life (HRQoL) after multiple injections of botulinum toxin A over 24 weeks in Thai cervical dystonia (CD) patients. MATERIALS AND METHODS A 24-week prospective study comparing HRQoL of Thai CD patients before and after multiple injections of botulinum toxin A at 3-month intervals was performed. Disease-specific HRQoL was assessed by using the Cervical Dystonia Impact Profile-58 questionnaire (CDIP-58) and the Craniocervical Dystonia Questionnaire-24 (CDQ-24). General HRQoL was assessed by using the Medical Outcomes' 36-Item Short Form Health Survey (SF-36) and the EuroQoL 5-dimension questionnaire (EQ-5D). All the assessments were performed before and after the 24-week treatment period. RESULTS A total of 20 CD patients were enrolled in this study from April to December 2011. CDIP-58 and CDQ-24 scores, which assess disease-specific HRQoL, showed a significant improvement after 24 weeks of treatment by botulinum toxin A (P<0.001). However, EQ-5D and SF-36 scores, which assess general HRQoL, showed no significant improvement after the treatment (P>0.05). CONCLUSION CD patients' disease-specific HRQoL improved after being treated with multiple botulinum toxin A injections. However, general HRQoL was not improved.
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Affiliation(s)
- Subsai Kongsaengdao
- Division of Neurology, Department of Medicine, Rajvithi Hospital, Department of Medical Services, Public Health Ministry, Bangkok, Thailand; Department of Medicine, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
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Leplow B, Eggebrecht A, Pohl J. Treatment satisfaction with botulinum toxin: a comparison between blepharospasm and cervical dystonia. Patient Prefer Adherence 2017; 11:1555-1563. [PMID: 29066869 PMCID: PMC5605128 DOI: 10.2147/ppa.s141060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Differential effects of botulinum toxin (BoNT) treatment in cervical dystonia (CD) and blepharospasm (BSP) treatment satisfaction and emotional responses to a life with a disabling condition were investigated. Special interest was drawn to the course within a BoNT treatment cycle and the effects of subjective well-being vs perceived intensity of motor symptoms and quality of life. METHODS A questionnaire was distributed among 372 CD patients and 125 BSP patients, recruited from 13 BoNT centers throughout Germany. Items were related to dystonic symptoms, BoNT treatment responses and treatment satisfaction, quality of life, working situation, and emotional reactions to a life with dystonia. RESULTS CD patients and BSP patients were widely satisfied with BoNT treatment, but treatment satisfaction worsened significantly within the treatment cycle. Especially CD patients reported that both the dystonic symptoms and the effects of BoNT treatment were influenced by emotional factors. Despite good overall treatment effects, patients from both groups perceived marked persistence of motor symptoms, restrictions of everyday life functions, and reduced quality of life. Functional amelioration of motor symptoms and emotional well-being were only moderately correlated. About 22% of patients from both groups reported mental disorders or emotional disturbances prior to the onset of dystonia. CONCLUSION As numerous psychological factors determine perceived outcome, BoNT treatment should be further improved by patient's education strategies enhancing behavioral self-control. From the patient's perspective, individual intervals, which may avoid exacerbation between injection points, should be considered. Moreover, patients at risk, with reduced adherence and poor BoNT outcome, should be identified and addressed within psychoeducation.
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Affiliation(s)
- Bernd Leplow
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Correspondence: Bernd Leplow, Department of Psychology, Emil-Abderhalden-Str. 26–27, Martin-Luther-University Halle-Wittenberg, 06099 Halle (Saale), Germany, Tel +49 345 552 4358, Fax +49 345 552 7218, Email
| | - Anna Eggebrecht
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Johannes Pohl
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Jagota P, Kaewwilai L, Boonrod N, Singmaneesakulchai S, Boonpang K, Sringean J, Jitkritsadakul O, Petchrutchatachart S. Impact of Neu-botulinumtoxinA on the Severity and Quality of Life of Cervical Dystonia Patients. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:407. [PMID: 27536464 PMCID: PMC4975793 DOI: 10.7916/d8736r2h] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/05/2016] [Indexed: 12/30/2022]
Abstract
Background Cervical dystonia (CD) is a debilitating neurological disorder that may gravely affect a patient’s quality of life (QoL). Botulinum toxin treatment has been approved as a first-line treatment for this condition. This study aims to look at the efficacy and impact on the QoL of neu-botulinumtoxinA, a newer and cheaper botulinum toxin type A, in patients with CD. Methods This is a prospective, open-label, single-arm study. CD patients were recruited and evaluated for severity of CD using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), and for QoL using the Craniocervical Dystonia Questionnaire (CDQ-24), and the 36-item Short Form Health Survey questionnaire (SF-36) at baseline and 6 weeks after injection. Results Twenty patients were recruited. Significant improvement was shown in part 1 and total TWSTRS score and total CDQ-24 scores. Analysis of individual items of the TWSTRS scale showed significant improvement in rotation, duration of CD, and work ability. Significant improvements in the QoL were also seen in some items of the stigma, emotional wellbeing, and energy/fatigue domains of the CDQ-24 and SF-36 questionnaires. Discussion Neu-botulinumtoxinA is efficacious in treating CD symptoms and improving QoL of patients with CD. A larger, double-blinded study is needed to study the extent of improvements.
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Affiliation(s)
- Priya Jagota
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Lalita Kaewwilai
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nonglak Boonrod
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Surat Singmaneesakulchai
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Kamolwan Boonpang
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Jitkritsadakul
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sitthi Petchrutchatachart
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Comella CL, Perlmutter JS, Jinnah HA, Waliczek TA, Rosen AR, Galpern WR, Adler CA, Barbano RL, Factor SA, Goetz CG, Jankovic J, Reich SG, Rodriguez RL, Severt WL, Zurowski M, Fox SH, Stebbins GT. Clinimetric testing of the comprehensive cervical dystonia rating scale. Mov Disord 2016; 31:563-9. [PMID: 26971359 DOI: 10.1002/mds.26534] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/13/2015] [Accepted: 12/13/2015] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aim of this study was to test the clinimetric properties of the Comprehensive Cervical Dystonia Rating Scale. This is a modular scale with modifications of the Toronto Western Spasmodic Torticollis Rating Scale (composed of three subscales assessing motor severity, disability, and pain) now referred to as the revised Toronto Western Spasmodic Torticollis Scale-2; a newly developed psychiatric screening instrument; and the Cervical Dystonia Impact Profile-58 as a quality of life measure. METHODS Ten dystonia experts rated subjects with cervical dystonia using the comprehensive scale. Clinimetric techniques assessed each module of the scale for reliability, item correlation, and factor structure. RESULTS There were 208 cervical dystonia patients (73% women; age, 59 ± 10 years; duration, 15 ± 12 years). Internal consistency of the motor severity subscale was acceptable (Cronbach's alpha = 0.57). Item to total correlations showed that elimination of items with low correlations (<0.20) increased alpha to 0.71. Internal consistency estimates for the subscales for disability and pain were 0.88 and 0.95, respectively. The psychiatric screening scale had a Cronbach's alpha of 0.84 and satisfactory item to total correlations. When the subscales of the Toronto Western Spasmodic Torticollis Scale-2 were combined with the psychiatric screening scale, Cronbach's alpha was 0.88, and construct validity assessment demonstrated four rational factors: motor; disability; pain; and psychiatric disorders. The Cervical Dystonia Impact Profile-58 had an alpha of 0.98 and its construction was validated through a confirmatory factor analysis. CONCLUSIONS The modules of the Comprehensive Cervical Dystonia Rating Scale are internally consistent with a logical factor structure.
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Affiliation(s)
| | | | | | | | | | - Wendy R Galpern
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | | | | | - Stephen G Reich
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ramon L Rodriguez
- University of Florida Movement Disorders Center, Gainesville, Florida, USA
| | | | - Mateusz Zurowski
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Susan H Fox
- University of Toronto, University Health Network, Toronto, Ontario, Canada
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21
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Tilden D, Guarnieri C. Cost-Effectiveness of Incobotulinumtoxin-A with Flexible Treatment Intervals Compared to Onabotulinumtoxin-A in the Management of Blepharospasm and Cervical Dystonia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:145-152. [PMID: 27021747 DOI: 10.1016/j.jval.2015.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Incobotulinumtoxin-A (Xeomin(®), Merz Pharmaceuticals, Sydney, New South Wales) is a formulation of botulinum neurotoxin type A that is free of complexing proteins. OBJECTIVE To assess the cost-effectiveness of incobotulinumtoxin-A administered with flexible treatment intervals compared to onabotulinumtoxin-A (Botox(®), Sydney, New South Wales) in blepharospasm and cervical dystonia from the perspective of Australian health care providers. METHODS A Markov state transition model was developed to perform a cost-utility analysis to compare the cost and health benefits of incobotulinumtoxin-A to that of onabotulinumtoxin-A. The cost-utility analysis compared incobotulinumtoxin-A treatment, given at minimum intervals of 6 weeks and maximum intervals of 20 weeks, with onabotulinumtoxin-A treatment, given at minimum intervals of 12 weeks and maximum intervals of 20 weeks. The Markov model consisted of three health states and followed patients in weekly cycles for 5 years. Only direct health care costs associated with the acquisition and administration of type A botulinum neurotoxins were included. Utility values were derived from a prospective, open-labeled cohort study. The primary outcome measure was the incremental cost per quality-adjusted life-year. Univariate and probabilistic sensitivity analyses were conducted. RESULTS Incobotulinumtoxin-A was cost-effective compared to onabotulinumtoxin-A in both blepharospasm and cervical dystonia, with an incremental cost/quality-adjusted life-year gained of A$ 25,588 and A$ 23,794, respectively. CONCLUSIONS Incobotulinumtoxin-A administered at flexible treatment intervals determined by the needs of the patient was found to be a cost-effective treatment option when compared to the administration of onabotulinumtoxin-A in the Australian health care system. The option to administer incobotulinumtoxin-A according to the needs of the patient resulted in patients experiencing symptoms for a fewer number of weeks compared to onabotulinumtoxin-A given at minimum 12-week intervals.
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Affiliation(s)
- Dominic Tilden
- Thema Consulting Pty Ltd., Pyrmont, New South Wales, Australia
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Abogunrin S, Brand S, Desai K, Dinet J, Gabriel S, Harrower T. AbobotulinumtoxinA in the management of cervical dystonia in the United Kingdom: a budget impact analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:441-9. [PMID: 26392782 PMCID: PMC4573201 DOI: 10.2147/ceor.s86355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cervical dystonia (CD) can be effectively managed by a combination of botulinum neurotoxin A (BoNT-A) and conventional therapy (skeletal muscle relaxants and rehabilitative therapy), but the costs of different interventions in the UK vary. METHODS A budget impact model was developed from the UK payer perspective with a 5-year time horizon to evaluate the effects of changing market shares of abobotulinumtoxinA, onabotulinumtoxinA, and incobotulinumtoxinA, and best supportive care from the UK payer perspective. Epidemiological and resource use data were retrieved from the published literature and clinical expert opinion. Deterministic sensitivity analyses were performed to determine the parameters most influential on the budgetary findings under base case assumptions. RESULTS Under base case assumptions, an increased uptake of abobotulinumtoxinA showed an accumulated savings of £2,250,992 by year 5. Treatment per patient per year with onabotulinumtoxinA and incobotulinumtoxinA costs more when compared to treatment with abobotulinumtoxinA. One-way sensitivity analyses showed that the prevalence of CD, dose per injection of each of the BoNT-As, and time to reinjection of incobotulinumtoxinA and abobotulinumtoxinA influenced the base case findings most. CONCLUSION There is potential for cost savings associated with the greater use of abobotulinumtoxinA rather than other BoNT-A treatments, permitting more patients to benefit more from effective BoNT-A treatment with a fixed budget.
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Affiliation(s)
| | - Sarah Brand
- Health Economics, Evidera, Bethesda, MD, USA
| | | | - Jerome Dinet
- Health Economics and Outcomes Research (Global), France
| | - Sylvie Gabriel
- Global Market Access and Pricing, Ipsen Pharma, Boulogne-Billancourt, France
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Kazerooni R, Broadhead C. Cost-utility analysis of botulinum toxin type A products for the treatment of cervical dystonia. Am J Health Syst Pharm 2015; 72:301-7. [DOI: 10.2146/ajhp140276] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Quality of life in patients with craniocervical dystonia: Italian validation of the "Cervical Dystonia Impact Profile (CDIP-58)" and the "Craniocervical Dystonia Questionnaire (CDQ-24)". Neurol Sci 2014; 35:1053-8. [PMID: 24477322 DOI: 10.1007/s10072-014-1642-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
Dystonia is a disabling and disfiguring disorder that can often affect many aspects of patients' daily lives, and lower their self-esteem. To date, quality of life (QoL) has been assessed in dystonic patients using generic measures that do not address the specific problems of this diagnostic group. Recently, two disease-specific scales "The Cervical Dystonia Impact Profile (CDIP-58)" and the "Craniocervical Dystonia Questionnaire (CDQ-24)" were validated for measuring QoL in craniocervical dystonia patients. No disease-specific scales for QoL for dystonic patients are currently available in Italian. The aim of our study was to produce and validate the Italian version of the CDIP-58 and CDQ-24. We obtained the Italian version of CDQ-24 and CDIP-58 with a back-translation design. Both scales were applied to a population of 94 craniocervical dystonia patients along with the Short Form 36 health-survey questionnaire (SF-36), both before and 4 weeks after botulinum toxin therapy. A group of 65 controls matched for sex, age and comorbidity underwent the SF-36. Internal consistency was satisfactory for all subscales. Both the CDIP-58 and CDQ-24 showed moderate to high correlations with similar items of the SF-36. Sensitivity to change was confirmed by highly significant improvements in all CDQ-24 subscales and by moderate improvements in three out of eight CDIP-58 subscales and total score. This is the first Italian study on QoL in dystonia patients. We validated the Italian version of two disease-specific questionnaires to evaluate QoL in craniocervical dystonia patients. These scales could be useful for both clinical practice and clinical trials.
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Leplow B, Böttcher M, Schönfeld R. [Botulinum toxin therapy for spasmodic torticollis: medical and non-medical adjunct treatment]. DER NERVENARZT 2013; 84:493-7. [PMID: 23371379 DOI: 10.1007/s00115-012-3708-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spasmodic torticollis patients were investigated with respect to the number of adjunct treatments used before and after the introduction of botulinum toxin therapy (Btx). The study was designed in a similar way to an earlier investigation by Birner et al. (Nervenarzt 70:903-908, 1999). MATERIAL AND METHODS A total of 247 patients with idiopathic spasmodic torticollis were assessed at three time points for the diagnosis: before 1988 (n = 63), between 1989 and 1998 (n = 107) and after 1999 (n = 77). RESULTS Independent of the year of diagnosis patients underwent a mean of 14.3 different treatments. In addition to Btx most of the patients were subjected to massage, physiotherapy, medication and a large number of non-medical treatments including praying. No associations to clinical or personal variables were found. Those patients with emotional disorders prior to onset of dystonia displayed a higher rate of medical and non-medical treatments in addition to Btx. CONCLUSIONS The results confirmed those found by Birner et al.. In order to enhance compliance patients should undergo psychoeducation with respect to illness behaviour and specific history taking with respect to emotional disorders prior to dystonia.
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Affiliation(s)
- B Leplow
- Institut für Psychologie, Martin-Luther-Universität zu Halle-Wittenberg, Brandbergweg 23, 06120 Halle/Saale, Deutschland.
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The cost-effectiveness of periodic safety update reports for biologicals in Europe. Clin Pharmacol Ther 2013; 93:433-42. [PMID: 23549148 DOI: 10.1038/clpt.2013.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We analyzed the cost-effectiveness of all Periodic Safety Update Reports (PSURs) submitted for biologicals in Europe from 1995 to 2009 by comparing two regulatory scenarios: full regulation (PSUR reporting) and limited regulation (no PSUR reporting, but all other parts of the pharmacovigilance framework remain in place). During this period, PSUR reporting resulted in the detection of 2 out of a total of 24 urgent safety issues for biologicals: (i) distant spread of botulinum toxin and (ii) edema/fluid collection associated with off-label use of dibotermin-alfa. We used Markov-chain life tables to calculate costs and health effects of PSURs. The incremental cost-effectiveness ratio (ICER) of full regulation (PSUR reporting) vs. limited regulation (no PSUR reporting) for the base-case scenario was \[euro]342,110 per quality-adjusted life year (QALY) gained. It is possible to assess the cost-effectiveness of regulatory requirements using the same methods as those used in assessing the cost-effectiveness of medical interventions.
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Queiroz MR, Chien HF, Barbosa ER. Quality of life in individuals with cervical dystonia before botulinum toxin injection in a Brazilian tertiary care hospital. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 69:900-4. [PMID: 22297876 DOI: 10.1590/s0004-282x2011000700010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 06/17/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate quality of life (QoL) in a Brazilian population of individuals with cervical dystonia (CD) without effect of botulinum toxin (BTx) or with only residual effect of BTx, and identify possible physical and social aspects that affect their QoL. METHOD Sixty five out of sixty seven consecutive patients with CD were assessed with two instruments: Short-form Health Survey with 36 questions (SF-36) and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). RESULTS Severity of CD (TWSTRS) correlated moderately with two SF-36 subscale: role-physical (r= -0.42) and body pain (r= -0.43). Women also scored worse in two subscale of SF-36: vitality (p<0.05) and mental-health (p<0.005). CONCLUSION Severity of CD and gender (female) were the main factors related to a worse QoL perception. These findings may help health professionals to predict which characteristics could lead to worse QoL, and therefore, better target their interventions to lessen the burden caused by CD.
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Affiliation(s)
- Mariana Ribeiro Queiroz
- Movement Disorders Clinic of the Division of Neurology, Hospital das Clínicas, University of São Paulo, School of Medicine, Brazil.
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Abstract
BACKGROUND AND PURPOSE Hemifacial spasm (HFS), a movement disorder manifested by unilateral spasms of the muscles innervated by the facial nerve, interferes with social life in about 90% of patients, causing social isolation and depression and having a significant impact on the quality of life. The aim of the study was to assess factors affecting the quality of life in patients with HFS in respect of influence of the severity of depression symptoms and botulinum toxin type A (BTX-A) therapy. MATERIAL AND METHODS Eighty-five out of 129 patients included in the HFS database of the Movement Disorders Outpatient Clinic, Department of Neurology, University Hospital, Cracow who fulfilled the inclusion criteria and had no exclusion criteria (suffering from concomitant movement disorders, other severe chronic diseases or cognitive impairment) were studied. Demographic and clinical data (age at onset, disease duration and accompanying symptoms) were collected. Severity of HFS was assessed by the five-point clinical scale and seven-point Clinical Global Impression scale. Quality of life was assessed with the HFS-36 questionnaire and severity of depressive symptoms was evaluated with the Beck Depression Inventory. HFS-36 was performed twice, before BTX-A injection and two weeks later. RESULTS The mean global score of HFS-36 was 47 ± 31 (maximum: 140 pts). Decreased HFS-36 score resulted from divergent deterioration in all subscales included in the questionnaire. Independent risk factors of deterioration in HFS-36 were increased severity of HFS and depressive symptoms as well as accompanying trismus. The HFS-36 score depended on the number and type of accompanying symptoms as well. Botulinum toxin type A therapy led to a significant improvement of HFS-36, particularly high in patients with multiple (> 4) HFS-related symptoms. CONCLUSIONS The HFS-36 score depends mostly on severity of HFS, depressive symptoms and occurrence of accompanying trismus. It improves after BTX-A treatment.
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Zoons E, Dijkgraaf MGW, Dijk JM, van Schaik IN, Tijssen MA. Botulinum toxin as treatment for focal dystonia: a systematic review of the pharmaco-therapeutic and pharmaco-economic value. J Neurol 2012; 259:2519-26. [PMID: 22552527 PMCID: PMC3506193 DOI: 10.1007/s00415-012-6510-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
Focal dystonia is a common, invalidating neurologic condition characterized by involuntary, sustained muscle contractions causing twisting movements and abnormal postures in one body part. Currently, botulinum toxin is the treatment of first choice. We performed a systematic review towards the pharmaco-therapeutic and pharmaco-economic value of botulinum toxin as treatment for focal dystonia, which yielded the following results. Botulinum toxin is the most effective treatment for reducing dystonic symptoms measured with dystonia-specific and general questionnaires, and pain in patients with focal dystonia. Seventy-one percent of patients with cervical dystonia had a reduction in neck pain compared to 12 % in placebo groups. Adverse events occur in 58 % of patients during treatment with botulinum toxin compared to 46 % treated with placebo. Especially dry mouth, neck weakness, dysphagia, and voice changes are common. Adverse events are usually mild and self-limiting. Health-related quality of life, measured with the SF-36 is 20-50 points lower in patients with focal dystonia compared to controls and the effect of botulinum toxin on health-related quality of life is unclear. Botulinum toxin treatment is expensive because the drug itself is expensive. Yearly costs for treating a patient with focal dystonia with botulinum toxin range from EUR 347 to EUR 3,633 and the gain in QALYs with BTX treatment is small. Focal dystonia impairs the productivity and the ability to work. At start of botulinum toxin treatment only 47-50 % was working. Botulinum toxin partly improves this. Overall, we conclude that botulinum toxin is an expensive drug with good effects. From a societal perspective, the costs may well weigh up to the regained quality of life. However, the available literature concerning costs, health-related quality of life and labor participation is very limited. An extensive cost-effectiveness study should be performed incorporating all these aspects.
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Affiliation(s)
- E Zoons
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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Colosimo C, Tiple D, Berardelli A. Efficacy and Safety of Long-term Botulinum Toxin Treatment in Craniocervical Dystonia: A Systematic Review. Neurotox Res 2012; 22:265-73. [DOI: 10.1007/s12640-012-9314-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/09/2012] [Accepted: 01/31/2012] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Dystonia must be accurately diagnosed so that treatment can be administered promptly. However, dystonia is a complex disorder, with variable presentation, which can delay diagnosis. METHODS Data were gathered by questionnaire from 866 patients with dystonia or hemifacial spasm (HFS) treated in 14 movement disorders centres in Canada injecting botulinum toxin, to better understand the path to diagnosis, wait times and obstacles to treatment. RESULTS Most participants were female (64.1%), mean age was 58 years, and patients consulted an average of 3.2 physicians before receiving a dystonia or HFS diagnosis. Many patients (34%) received other diagnoses before referral to a movement disorders clinic, most commonly "stress" (42.7%). A variety of treatments were often received without a diagnosis. The mean lag time between symptom onset and diagnosis was 5.4 years. After the decision to use botulinum toxin, patients waited a mean of 3.1 months before treatment. The most common diagnoses were cervical dystonia (51.6% of patients), HFS (20.0%) and blepharospasm (9.8%). CONCLUSIONS Survey results show that diagnosis of dystonias or of HFS, and therefore, access to treatment, is delayed. An educational program for primary care physicians may be helpful to decrease the time to diagnosis and referral to a specialist centre for treatment.
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Jankovic J, Adler CH, Charles PD, Comella C, Stacy M, Schwartz M, Sutch SM, Brin MF, Papapetropoulos S. Rationale and design of a prospective study: Cervical Dystonia Patient Registry for Observation of OnaBotulinumtoxinA Efficacy (CD PROBE). BMC Neurol 2011; 11:140. [PMID: 22054223 PMCID: PMC3220636 DOI: 10.1186/1471-2377-11-140] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/04/2011] [Indexed: 12/31/2022] Open
Abstract
Background A registry of patients with cervical dystonia (Cervical Dystonia Patient Registry for Observation of onaBotulinumtoxinA Efficacy [CD PROBE]) was initiated to capture data regarding physician practices and patient outcomes with onabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA, USA). Methods and baseline demographics from an interim analysis are provided. Methods/Design This is a prospective, multicenter, clinical registry in the United States enrolling subjects with cervical dystonia (CD) who are toxin naïve and/or new to the physicians' practices, or who had been in a clinical trial but received their last injection ≥ 16 weeks prior to enrollment. Subjects are followed over 3 injection cycles of onabotulinumtoxinA, with assessments at time of injection and 4-6 weeks later. Information on physician's practice, patient demographics, CD disease history, duration of treatment intervals and neurotoxin dose, dilution, use of electromyography, and muscles injected are collected. Outcomes are assessed by physicians and subjects using various questionnaires. Discussion This ongoing registry includes 609 subjects with the following baseline data: 75.9% female, 93.6% Caucasian, mean age 57.6 ± 14.3, age at symptom onset 48.3 ± 16.2, and time to diagnosis 5.4 ± 8.6 years, with an additional 1.0 ± 3.5 years before treatment. Of those employed at the time of diagnosis, 36.6% stopped working as a result of CD. CD PROBE, the largest clinical registry of CD treatment, will provide useful data on current treatment practices with onabotulinumtoxinA, potentially leading to refinements for optimization of outcomes. Trial registration NCT00836017
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Affiliation(s)
- Joseph Jankovic
- Baylor College of Medicine, Department of Neurology, Houston, TX, USA.
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Merz R, Deakin J, Hawthorne M. Oromandibular dystonia questionnaire (OMDQ-25): a valid and reliable instrument for measuring health-related quality of life. Clin Otolaryngol 2010; 35:390-6. [DOI: 10.1111/j.1749-4486.2010.02194.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Colosimo C, Suppa A, Fabbrini G, Bologna M, Berardelli A. Craniocervical dystonia: clinical and pathophysiological features. Eur J Neurol 2010; 17 Suppl 1:15-21. [PMID: 20590803 DOI: 10.1111/j.1468-1331.2010.03045.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Blepharospasm, oromandibular, lingual, laryngeal and cervical dystonia are common forms of adult-onset dystonia. Each condition may appear in isolation or manifest along with other forms of craniocervical dystonia. Although the various craniocervical dystonias typically present with involuntary muscle spasms causing abnormal postures, they differ for some clinical features. Neurophysiologic and neuroimaging studies have shown a number of motor and sensory abnormalities at cortical and subcortical levels, probably reflecting a dysfunction in the basal ganglia-thalamo-cortical circuits. The best treatment for craniocervical dystonia is botulinum toxin injected into the overactive muscles.
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Affiliation(s)
- C Colosimo
- Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy
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Zhang SS, Fang DF, Hu XH, Burgunder JM, Chen XP, Zhang YW, Shang HF. Clinical feature and DYT1 mutation screening in primary dystonia patients from South-West China. Eur J Neurol 2010; 17:846-51. [PMID: 20113340 DOI: 10.1111/j.1468-1331.2009.02944.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clinical presentation and DYT1 status amongst Chinese patients with primary dystonia have not been well studied. METHODS One hundred and twenty patients with primary dystonia from South-West China were studied in a prospective survey for 3.5 years. Severity and the resulting disability were assessed using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS). Health related quality of life (HRQL) was measured through the 36-item short-form (SF-36). The Hospital Anxiety and Depression Scale (HADS) was utilized to identify and quantify depression and anxiety. Mutations in the DYT1 exon 5 were screened by direct sequencing. RESULTS Cervical dystonia was found to be the most frequent form of focal dystonia and was discovered to occur at an early age. Pain and tremor were the common associated symptoms. Family history was positive in 19.5% of the cases, with a trend of earlier onset. Depression (14.5%) and anxiety (6.6%) were the main HRQL impairments. Multiple linear regression analysis suggested that gender, depression, anxiety and functional disability were amongst the principal determinants of lower HRQL. Only one instance of DYT1 GAG deletion (1.4%) was detected in 71 patients. CONCLUSION Our data on a cohort of Chinese patients show some difference from descriptions in other ethnic groups. This includes an earlier age of onset, a lower incidence of depression and female serving as a predictor factor of a HRQL. Similar to other cohorts, DYT1 gene mutations are rare.
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Affiliation(s)
- S-S Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Martikainen KK, Luukkaala TH, Marttila RJ. Working capacity and cervical dystonia. Parkinsonism Relat Disord 2009; 16:215-7. [PMID: 19660976 DOI: 10.1016/j.parkreldis.2009.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 06/28/2009] [Accepted: 07/15/2009] [Indexed: 11/26/2022]
Abstract
The objective of this questionnaire study was to assess the effect of cervical dystonia on patients' working capacity. Of the 303 working-aged members of the Finnish Dystonia Association (N = 433) who participated in the study 247 (82%) had cervical dystonia. Their median age was 50 years, the median duration of CD symptoms was 12.3 years. Most (78%) subjects were on botulinum toxin treatment. Ninety-seven (39%) had retired because of CD at a median age of 48 years; 96 (39%) of the subjects were working: 87 full-time and 9 part-time. The remaining participants were on sick leave, unemployed, studying or retired of other reasons. Retirement occurred more than ten years earlier compared with the general Finnish population. All possibilities to help CD patients to continue longer in work should be considered early.
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Affiliation(s)
- Kirsti K Martikainen
- The Finnish Parkinson Association and Foundation, PO Box 905, FIN-20101 Turku, Finland.
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Judd RA, Digre KB, Warner JEA, Schulman SF, Katz BJ. Shedding Light on Blepharospasm: A Patient–Researcher Partnership Approach to Assessment of Photophobia and Impact on Activities of Daily Living. Neuroophthalmology 2009. [DOI: 10.1080/01658100701247646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mohammadi B, Buhr N, Bigalke H, Krampfl K, Dengler R, Kollewe K. A long-term follow-up of botulinum toxin A in cervical dystonia. Neurol Res 2009; 31:463-6. [PMID: 19278576 DOI: 10.1179/174313209x405137] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Cervical dystonia (CD) is the most common form of adult-onset focal dystonia, and botulinum toxin A (BoNT-A) has become the first-line treatment for this condition. METHODS In this work, we present data of 207 CD patients treated with BoNT-A for 6.7 +/- 3.5 years. One hundred and sixty-three patients were treated with Dysport (mean dose, 389 +/- 144 U) and 44 with Botox (mean dose, 145 +/- 44 U). RESULTS The mean clinical benefit, based on a 0-3 scale (0=no effect, 1=slight, 2=moderate and 3=marked improvement) was similar for Dysport (2.5 +/- 0.3) and Botox (2.2 +/- 0.4). Adverse events were mild and similar for both products. Fewer than 2% of the patients developed neutralizing antibodies. DISCUSSION These data confirm the efficacy and safety of BoNT-A treatment in CD over an extended period of up to 14 years.
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Affiliation(s)
- B Mohammadi
- Department of Neurology and Clinical Neurophysiology, Hannover Medical School, Hannover, Germany.
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Pekmezovic T, Svetel M, Ivanovic N, Dragasevic N, Petrovic I, Tepavcevic DK, Kostic VS. Quality of life in patients with focal dystonia. Clin Neurol Neurosurg 2009; 111:161-4. [DOI: 10.1016/j.clineuro.2008.09.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 09/16/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
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Camargo CHF, Teive HAG, Becker N, Baran MHH, Scola RH, Werneck LC. Cervical dystonia: clinical and therapeutic features in 85 patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:15-21. [PMID: 18392407 DOI: 10.1590/s0004-282x2008000100005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 12/22/2007] [Indexed: 11/21/2022]
Abstract
We studied patients with cervical dystonia (CD) to determine clinical features and response to botulinum toxin A (BoNT/A). Patients were submitted to clinical, laboratory and neuroimaging evaluation. BoNT/A was injected locally in 81 patients using electromyographic guidance. Four patients who had had previous treatment were considered to be in remission. The average ages at onset of focal dystonia and segmental dystonia were greater than for generalized dystonia (p<0.0003). The severity of the abnormal head-neck movements were more severe among the patients with generalized dystonia (p<0.001). Pain in the cervical area was noted in 59 patients. It was not possible to determine the etiology of the disease in 62.3% of patients. Tardive dystonia was the most common secondary etiology. A major improvement in the motor symptoms of CD and pain was observed in patients following treatment with BoNT/A. The tardive dystonia subgroup did not respond to the treatment. Dysphagia was observed in 2.35% of the patients.
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Affiliation(s)
- Carlos Henrique F Camargo
- Neurology Service, Department of Clinical Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
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Jankovic J, Kenney C, Grafe S, Goertelmeyer R, Comes G. Relationship between various clinical outcome assessments in patients with blepharospasm. Mov Disord 2008; 24:407-13. [DOI: 10.1002/mds.22368] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Brin MF, Comella CL, Jankovic J, Lai F, Naumann M. Long-term treatment with botulinum toxin type A in cervical dystonia has low immunogenicity by mouse protection assay. Mov Disord 2008; 23:1353-60. [PMID: 18546321 DOI: 10.1002/mds.22157] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To evaluate the immunogenicity of botulinum toxin type A (BoNTA; BOTOX) in cervical dystonia (CD). Subjects diagnosed with CD for > or =1 year and previously naïve to BoNTs were treated with BoNTA in a prospective, open-label, multicenter study. Serum samples were analyzed for BoNTA neutralizing antibodies using the Mouse Protection Assay (MPA). Clinical resistance was assessed with a test injection of 20 U BoNTA placed unilaterally into the frontalis (Frontalis Antibody Test; FTAT) or corrugator muscle (Unilateral Brow Injection; UBI). Efficacy was assessed and adverse events were recorded. Of 326 subjects enrolled, 251 (77%) completed the study. Subjects received a median of 9 BoNTA treatments (mean dose per session ranged from 148.4 to 213.0 U over a mean of 2.5 years [range: 3.2 months-4.2 years]). Only 4 of 326 subjects (1.2%) tested positive for antibodies in the MPA; three of these subjects stopped responding clinically to BoNTA (of whom one also showed clinical resistance in the FTAT) and one continued to respond. Consistent improvements in the signs/symptoms of CD were noted. The most frequent treatment-related adverse events were mild to moderate weakness, dysphagia, neck pain, and injection-site pain. The current formulation of BoNTA rarely causes neutralizing antibody formation in CD subjects treated < or =4 years.
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Affiliation(s)
- Mitchell F Brin
- Allergan, Inc., Global Drug Development, Irvine, California, USA
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Affiliation(s)
- Geoffrey Sheean
- Neuromuscular Program, University of California at San Diego, San Diego, CA 92103, USA.
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Health-related quality of life in segmental dystonia is improved by bilateral pallidal stimulation. J Neurol 2008; 255:178-82. [DOI: 10.1007/s00415-008-0614-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 03/20/2007] [Accepted: 03/28/2007] [Indexed: 10/22/2022]
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Chapman MA, Barron R, Tanis DC, Gill CE, Charles PD. Comparison of botulinum neurotoxin preparations for the treatment of cervical dystonia. Clin Ther 2007; 29:1325-37. [PMID: 17825685 DOI: 10.1016/j.clinthera.2007.07.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Comparative studies of botulinum neurotoxin preparations to date have generally examined 2 preparations at prespecified dose ratios in relatively homogeneous groups of patients under controlled study conditions. It is unclear whether the differences in adverse-event rates that have been noted under these controlled conditions can be generalized to the broader population of cervical dystonia patients, who are treated with a wider range of doses in a variety of settings. OBJECTIVE We conducted a systematic review and analysis of the published literature to compare rates of dysphagia and dry mouth in studies of botulinum neurotoxin products. METHODS We searched the MEDLINE, EMBASE, Biosis, SciSearch, JICST (Japan Science and Technology Center), and Pascal databases from 1985 through 2006 using the terms cervical dystonia, spasmodic torticollis, and botulinum toxin for original English-language studies of Botox, Dysport, or Myobloc in the treatment of cervical dystonia (or spasmodic torticollis) that documented adverse events by treatment or patient. Studies that involved patients with various types of dystonias or movement disorders were included as long as adverse events were reported separately for those with cervical dystonia. Rates of dysphagia with the original preparation of Botox were considered separately from those with the current preparation of Botox. RESULTS Seventy published articles were included in the analysis (30 Botox, 24 Dysport, 3 Botox + Dysport, 11 Myobloc, 2 Botox + Myobloc). Mean total doses per treatment ranged from 60 to 374 U for Botox, 125 to 1200 U for Dysport, and 579 to 19,853 U for Myobloc. Botox was associated with a significantly lower rate of dysphagia than Dysport, with mean dysphagia rates of 10.5% for original Botox, 8.9% for current Botox, and 26.8% for Dysport (both, P < 0.05). Myobloc was associated with dry mouth (3.2%-90.0%) in 9 of 13 studies, but this adverse event was not reported in a sufficient number of studies of botulinum toxin type A preparations (Botox, n = 2; Dysport, n = 6) to permit statistical comparison. In the weighted analysis, the duration of effect differed between botulinum neurotoxin products (current Botox > Myobloc > original Botox > Dysport; all, P < 0.001), but only 43 (61.4%) of the 70 studies reported duration, and the definitions varied. CONCLUSION The results of this analysis indicate differences in adverse-event rates between botulinum neurotoxin preparations, suggesting that use of these products should be based on their individual dosing, efficacy, and safety profiles.
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Skogseid IM, Malt UF, Røislien J, Kerty E. Determinants and status of quality of life after long-term botulinum toxin therapy for cervical dystonia. Eur J Neurol 2007; 14:1129-37. [PMID: 17708754 DOI: 10.1111/j.1468-1331.2007.01922.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess health-related quality of life (HRQoL), using the Short Form Health Survey-36 (SF-36), in 70 cervical dystonia (CD) patients after long-term botulinum toxin (BTX) treatment (median 5.5 years), and to identify factors determining reduced HRQoL. We used combined patient-and physician-based measures to assess both CD severity [Toronto Western Spasmodic Torticollis Rating Scale, (TWSTRS)] and effect of long-term BTX treatment, and the Hospital Anxiety and Depression Scale (HAD) and General Health Questionnaire-30 to assess psychological distress. Mean SF-36 domain scores of the CD patients were reduced by <1 SD compared with age- and gender-matched population samples. High TWSTRS total scores and high HAD-depression (HAD-D) scores were the main factors associated with reduced scores in the physical and mental SF-36 domains, respectively. Patients evaluated to have a 'good effect' of long-term BTX treatment (n = 47), had significantly lower median TWSTRS total score, and a 3x lower frequency of high HAD-D scores, than those evaluated to an 'unsatisfactory effect' (n = 23). In conclusion, most CD patients enjoy a good HRQoL after long-term BTX therapy. Reduced HRQoL was associated with more severe disease and/or depressive symptoms.
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Affiliation(s)
- I M Skogseid
- Faculty of Medicine, University of Oslo, Norway.
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Yoon SJ, Ho J, Kang HY, Lee SH, Kim KI, Shin WG, Oh JM. Low-Dose Botulinum Toxin Type A for the Treatment of Refractory Piriformis Syndrome. Pharmacotherapy 2007; 27:657-65. [PMID: 17461700 DOI: 10.1592/phco.27.5.657] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To evaluate the efficacy of a single, low-dose injection of botulinum toxin type A in relieving pain in Korean patients with piriformis syndrome resistant to conventional therapy, and to assess the drug's influence on these patients' quality of life. DESIGN Prospective, single-site, open-label trial. SETTING Rehabilitation medicine clinic in Seoul, Korea. PATIENTS Twenty-nine patients with a confirmed diagnosis of chronic piriformis syndrome and 82 age- and sex-matched healthy subjects were enrolled from April 1, 2003-February 28, 2004. Intervention. In 20 of the patients, botulinum toxin type A 150 U was injected using computed tomographic guidance into the affected unilateral piriformis muscle. The other nine patients served as active controls and received an injection of dexamethasone 5 mg and 1% lidocaine. The healthy subjects did not receive any injection. MEASUREMENTS AND MAIN RESULTS The patients' pain at baseline and at 4, 8, and 12 weeks after treatment was rated by using a numeric rating scale. Health-related quality of life was assessed by using the validated Korean version of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) at baseline and at 4 weeks of treatment. Healthy subjects also completed the SF-36 at baseline. Pain intensity scores were significantly lower at 4, 8, and 12 weeks after treatment than at baseline (p<0.0001). Baseline scores from the SF-36 subscales, including those for physical functioning (p<0.0001), role physical (p<0.0001), bodily pain (p<0.0001), general health (p<0.0001), vitality (p<0.0001), and social functioning (p<0.002), were significantly lower in the patients than in the healthy subjects. Four weeks after treatment, physical functioning (p=0.003), role physical (p=0.021), bodily pain (p=0.016), general health (p=0.013), vitality (p=0.031) and social functioning (p=0.035) improved significantly from baseline in the patients. However, at 4 weeks, patients in the active control group were withdrawn from the study because their pain did not improve, and continuation without further medical care was considered unethical. CONCLUSION A low dose of botulinum toxin type A relieved pain and improved quality of life in patients with refractory piriformis syndrome.
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Affiliation(s)
- Se Jin Yoon
- Department of Rehabilitation Medicine, Wooridul Spine Hospital, Seoul, Korea
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Abstract
Cervical dystonia (CD), also known as 'spasmodic torticollis', is the most common form of adult-onset focal dystonia. It is a chronic disorder for which there is no curative treatment. Proposed interventions only have a symptomatic effect that is directed at controlling the intensity of the dystonic contractions and their associated symptoms. Both serotypes of botulinum toxin (BtA and BtB) have shown efficacy for the treatment of CD, and they constitute the first-line therapy for CD. BtB constitutes the best medical treatment for secondary failures to BtA. The efficacy of all other proposed medications, including anticholinergics, should be considered unknown due to the lack of good-quality trials. This lack of evidence applies also to all physical rehabilitation treatments. Although the authors have concluded that all surgical procedures for CD should still be considered investigational, the best data supporting benefit of surgery comes from case series of selective peripheral denervation and pallidal deep brain stimulation.
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Affiliation(s)
- Joaquim J Ferreira
- Neurological Clinical Research Unit, Institute of Molecular Medicine, Lisbon School of Medicine, Centro de Estudos Egas Moniz, Faculdade de Medicina de Lisboa,1649-028 Lisboa, Portugal.
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Cano SJ, Thompson AJ, Bhatia K, Fitzpatrick R, Warner TT, Hobart JC. Evidence-based guidelines for using the Short Form 36 in cervical dystonia. Mov Disord 2007; 22:122-6. [PMID: 17115394 DOI: 10.1002/mds.21187] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We aimed to provide evidence-based guidelines for using the Short Form 36 (SF-36) as an outcome measure in cervical dystonia (CD). To do this, we tested the hypothesized relationships between items, scales, and summary measures of the SF-36 using psychometric analyses in data from a postal survey of 235 people with CD. Although the majority of subscales performed adequately, the Role Physical and Role Emotional subscales had substantial floor and/or ceiling effects. Evidence did not support computing SF-36 Physical and Mental Component Summary scores. We propose guidelines that include the recommendation that these subscale and summary scores should be reported with caution.
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Affiliation(s)
- Stefan J Cano
- Neurological Outcomes Measures Unit, Institute of Neurology, University College London, United Kingdom
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