The effect of a single botulinum toxin treatment on somatosensory processing in idiopathic isolated cervical dystonia: an observational study
Patients with idiopathic cervical dystonia (CD) experience involuntary neck muscle contractions, abnormal head position and pain accompanied by dysfunctions in somatosensory processes such as postural control, cervical sensorimotor and perception of visual verticality. First-line treatment is injection with botulinum toxin (BoNT). It remains unclear whether this affects sensorimotor processes.
To investigate the effect of first-line care on deficiencies in somatosensory processes.
In this observational study, 24 adult patients with idiopathic CD were assessed three times over a treatment period of 12 weeks following a single treatment with BoNT. Disease severity was assessed by a disease-specific questionnaire, rating scale and the visual analogue scale. Seated postural control was assessed with posturography, cervical sensorimotor control was assessed by the joint repositioning error with an eight-camera infrared motion analysis system during a head repositioning accuracy test and perception of visual verticality was assessed with the subjective visual vertical test.
Disease symptoms significantly improved following BoNT injections and deteriorated again at 12 weeks. This improvement was not accompanied by improved postural control, cervical sensorimotor control and perception of visual verticality. A trend toward improvement was seen; however, it did not reach the level of the control population.
The peripheral and central treatment effects of BoNT have little to no effect on postural and cervical sensorimotor control in CD. Further research may explore whether sensory training or specialized exercise therapy improves somatosensory integration and everyday functioning in patients with CD.
KeywordsCervical dystonia Sensorimotor integration Proprioception Botulinum toxin
This study was performed at and with support from the Multidisciplinary Motor Centre Antwerp (M2OCEAN) that was established by means of a Hercules Grant type 2 for medium-sized research infrastructure from the Flemish Research Council (AUHA/09/006).
University Antwerp (G815).
Compliance with ethical standards
Conflicts of interest
No conflict of interest is to be reported.
- 20.Odergren T, Hjaltason H, Kaakkola S et al (1998) A double blind, randomised, parallel group study to investigate the dose equivalence of Dysport and Botox in the treatment of cervical dystonia. J Neurol Neurosurg Psychiatry 64:6–12. https://doi.org/10.1136/jnnp.64.1.6 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF). Arthritis Care Res 63:240–252. https://doi.org/10.1002/acr.20543 CrossRefGoogle Scholar
- 36.Müller G (1916) Über das Aubertsche phänomen. Z Sinnesphysiol 49:109–246Google Scholar
- 41.Prudente CN, Hess EJ, Jinnah HA (2014) Dystonia as a network disorder: what is the role of the cerebellum? Neuroscience 260:23–35. https://doi.org/10.1016/j.neuroscience.2013.11.062 CrossRefPubMedGoogle Scholar
- 46.Kafiovskf P, Streitovb H, Dufek J et al (1998) Change in lateralization of the P22/N30 cortical component of median nerve somatosensory evoked potentials in patients with cervical dystonia after successful treatment with botulinum toxin A. 108–117Google Scholar
- 54.Bove M, Fenoggio C, Tacchino a et al (2009) Interaction between vision and neck proprioception in the control of stance. Neuroscience 164:1601–1608. https://doi.org/10.1016/j.neuroscience.2009.09.053 CrossRefPubMedGoogle Scholar
- 62.Blood AJ, Tuch DS, Makris N et al (2006) White matter abnormalities in dystonia normalize after botulinum toxin treatment. Neuroreport 17:1251–1255. https://doi.org/10.1097/01.wnr.0000230500.03330.01.White CrossRefPubMedPubMedCentralGoogle Scholar
- 63.Jull G, Falla D, Treleaven J et al (2007) Retraining cervical joint position sense: the effect of two exercise regimes. J Orthop Res 404–412. https://doi.org/10.1002/jor
- 69.Defazio G, Jankovic J, Giel JL, Papapetropoulos S (2013) Descriptive epidemiology of cervical dystonia. Tremor Other Hyperkinet Mov (N Y). doi: tre-03-193-4374-2 [pii]Google Scholar
- 72.Simpson DM, Blitzer A, Brashear A et al (2008) Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 70:1699–1706. https://doi.org/10.1007/s00394-015-0841-1.A CrossRefPubMedPubMedCentralGoogle Scholar
- 73.Mordin M, Masaquel C, Abbott C, Copley-Merriman C (2014) Factors affecting the health-related quality of life of patients with cervical dystonia and impact of treatment with abobotulinumtoxinA (Dysport): results from a randomised, double-blind, placebo-controlled study. BMJ Open 4:e005150. https://doi.org/10.1136/bmjopen-2014-005150 CrossRefPubMedPubMedCentralGoogle Scholar