Abstract Details

Title Long Term Botulinum Toxin Treatment of Cervical Dystonia: A Systematic Literature Review of the Prospective Efficacy and Safety Trials

Topic Movement Disorders

Presentation(s) P02 - (-)

Poster/Presentation
Number 072

Objective

Background BACKGROUND: Botulinum toxins are often utilized in the treatment of patients with CD. Although CD is a life-long disabling disorder, there is a paucity of prospectively collected data on long-term use of botulinum toxins.

Design/Methods DESIGN/METHODS: Reports were identified by searches conducted on MEDLINE between January 1985 and August 2012 and references contained within relevant articles. The search terms "torticollis AND botulinum toxin", "cervical dystonia AND botulinum toxin", "onabotulinumtoxinA", "abobotulinumtoxinA", "incobotulinumtoxinA", and "rimabotulinumtoxinB" were used. Papers were included if they were published in English, prospective and had 3 injections with follow-up periods.

Results RESULTS: Seventeen studies were included. The majority were open-label with one double-blind trial (utilizing incobotulinumtoxinA 120U vs. 240U). The studies with the longest follow-up periods (up to 7 years) were conducted with rimabotulinumtoxinB. The majority of studies had a criterion that subjects return to baseline symptoms prior to being eligible to receive their next injection. Many of the studies also had minimum treatment intervals which were varied (range 2-to-12 weeks). Dosing usually started with a fixed dose and then could be increased/decreased based upon patient need, with the exception of a few fixed dose studies. Botulinum toxin in multiple dose treatment was effective across all studies and in terms of safety results were consistent with short-term, single dose treatment. Treatment intervals were not consistently reported. The most frequently reported adverse events were dysphagia, muscle weakness, injection site pain and dry mouth.

Conclusions CONCLUSIONS: Botulinum toxin has demonstrated efficacy and safety in long-term multiple dose trials in subjects with CD. The criteria for reinjection almost always included a "return to baseline symptoms." A prospective study allowing for individualized dosing and treatment intervals is warranted.

Authors/Disclosures
Virgilio Gerald H. Evidente, MD, FAAN (Movement Disorders Center of Arizona) PRESENTER	Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Revance. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Evidente has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurocrine. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amneal. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Evidente has received research support from CND. The institution of Dr. Evidente has received research support from Aeon. The institution of Dr. Evidente has received research support from Bukwang Pharmaceuticals. The institution of Dr. Evidente has received research support from Jazz Pharmaceuticals. The institution of Dr. Evidente has received research support from Scion Neurostim. The institution of Dr. Evidente has received research support from Theravance Biopharma. Dr. Evidente has received research support from Cerevance. Dr. Evidente has received research support from Ipsen.
Eric J. Pappert, MD (Neurology Associates)	No disclosure on file
Weining Robieson, PhD (AbbVie)	Dr. Robieson has received personal compensation for serving as an employee of AbbVie. Dr. Robieson has received stock or an ownership interest from AbbVie.

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