Journal of Neurology

, Volume 265, Issue 11, pp 2672–2683 | Cite as

The effect of a single botulinum toxin treatment on somatosensory processing in idiopathic isolated cervical dystonia: an observational study

  • Joke De PauwEmail author
  • Patrick Cras
  • Steven Truijen
  • Rudy Mercelis
  • Sarah Michiels
  • Wim Saeys
  • Luc Vereeck
  • Ann Hallemans
  • Willem De Hertogh
Original Communication



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.


Cervical 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.

Supplementary material

415_2018_9045_MOESM1_ESM.docx (118 kb)
Supplementary material 1 (DOCX 118 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Physical Therapy and Rehabilitation Sciences, Faculty of Medicine and Health SciencesUniversity of AntwerpWilrijkBelgium
  2. 2.Department of NeurologyAntwerp University HospitalEdegemBelgium
  3. 3.Born Bunge Institute, Faculty of Medicine and Health SciencesUniversity of AntwerpWilrijkBelgium
  4. 4.Rehabilitation Hospital RevarteEdegemBelgium
  5. 5.Multidisciplinary Motor Centre Antwerp (M2OCEAN)EdegemBelgium
  6. 6.Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpWilrijkBelgium
  7. 7.Department of OtorhinolaryngologyAntwerp University HospitalEdegemBelgium
  8. 8.Faculty of Medicine and Health SciencesCampus Drie EikenWilrijkBelgium

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