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Efficacy of botulinum toxin in treatment of spasmodic dysphonia
ARTICLE IN PRESS 34
Abstracts Toxins 2008 / Toxicon 51 (2008) 1–54
100. Comorbidity in focal dystonia and effect of botulinum toxin treatment Sebastian Paus a, Jennifer Gross a, Martina Moll-Mu¨ller a, Frank Hentschel a, Bettina Wabbels b, Thomas Klockgether a, Michael Abele a a b
Department of Neurology, University of Bonn, Bonn, Germany Department of Opthalmology, University of Bonn, Bonn, Germany
Objectives: (1) To evaluate prevalence and risk factors of sleep disorders, sexual dysfunction and autonomic failure in idiopathic cervical dystonia (CD) and blepharospasm (BL). (2) To analyze the impact of botulinum toxin (BoNT) treatment on comorbidity in focal dystonia (FD). Background: The approach to movement disorder change, and non-motor comorbidity was shown to considerably impair quality of life in degenerative diseases. In contrast, there are no data on the prevalence of sleep disorders, sexual dysfunction or autonomic failure in non-degenerative movement disorders such as CD and BL, although depression and pain are well-known complications in FD. Methods: Standardized interviews, clinical examinations, autonomic testing, and self-rating forms in 221 patients with idiopathic FD (111 CD, 110 BL). Results: Impaired sleep quality was found in 45% of CD and in 46% of BL patients. Of 80 CD patients tested, 46% had autonomic failure. Sexual dysfunction became apparent in 35% of 82 patients. Depression was found in 25% of CD and 30% of BL patients. Conclusions: Beyond pain and depression, patients with FD frequently suffer from non-motor symptoms. Interestingly, results in CD and BL patients are similar, pointing to intrinsic mechanisms of sleep and sexual disturbances. In our series, BoNT treatment ameliorated non-motor symptoms only marginally, underlining the necessity of a multimodal treatment concept in FD. Keyword: Comorbidity sleep sexual autonomic disorder 10.1016/j.toxicon.2008.04.102
101. Efficacy of botulinum toxin in treatment of spasmodic dysphonia Igor Petrovic a, Marina Svetel a, Milan Vasic b, Vladimir Kostic a a b
Institute of Neurology, Belgrade, Serbia and Montenegro City Hospital Zvezdara, ORL department, Belgrade, Serbia and Montenegro
Spasmodic dysphonia (SD) is disabling speech disturbance caused by involuntary contractions of the vocal folds. Surgical treatment and oral medication provide unsatisfactory results. The first choice treatment is represented by local injections of botulinum toxin that provide improvement in up to 80% of the patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in a series of patients with SD followed at our center. We treated 10 patients with adductor SD. After diagnostic procedures, botulinum toxin was applied either unilaterally or bilaterally in the vocal folds, in doses of 12–16 units each. Voice and speech analysis was performed prior and after treatment using a structured scale for voice and speech
abnormalities occurring in SD. The majority of patients experienced both subjective and objective improvement. Quality of life improvement was rated as highly significant (t ¼ 3.562; p ¼ 0.006). Functional voice improvement was facilitated by speech therapy and psychotherapy. Speech therapy included structured vocal techniques to reduce the degree of vocal tension and rapid changes in voice power and pitch. Currently, there is no standardized procedure for a comprehensive treatment of SD that requires a multidisciplinary approach. Keywords: Spasmodic dysphonia; Botulinum toxin 10.1016/j.toxicon.2008.04.103
102. Treatment of blepharospasm with Dysports in the Siberian District Medical Center of Roszdrav Dmitry Pokhabov, Vladislav Abramov Movement Disorders Group of Department of Neurology, Krasnoyarsks State Med. Academy; YCH FSI ‘‘SOMC Roszdrava’’, Krasnoyarsk, Russia
Botilinum toxin (Dysports) has been used for many years in our center. We review here our series of patients with blepharospasm. Eighteen patients had blepharospasm, 15 had blepharospasm associated with oromandibular dystonia. They were aged 59.673.4 years, had a mean disease duration of 3.871.6 years and did not respond to oral medication. Dystonia intensity was estimated by Fahn’s dystonia scale. The baseline score in the blepharospasm group was 6.1470.95 points, with a botulinum toxin dose ranging from 140 to 220 Dysports U. The baseline score in the group with blepharospasm and oromandibular dystonia was 14.271.08 points, with a boulinum toxin dose ranging from 300 to 700 Dysports U. Between-injection interval was 16–38 weeks (on average 19.673.2). The main side effect was a light ptosis lasting for 5–20 days. The delay of clinical efficacy was 1–7 days (average, 4.672.4)and the duration of maximal efficacy was 6–22 weeks (average, 13.474.5). General effect lasted 16–42 weeks (21.674.2). After treatment, the mean score for the isolated blepharospasm group was 1.3370.10 (po0.05), the mean score in the blepharospasm and oromandibular dystonia group was 7.071.23 (po0.05). With repeated treatment, dystonia did not recur to the initial level, and the doses of Dysports could be reduced for repeated injections. In cases who showed significant improvement, it became possible to increase spacing between treatments. Keywords: Oromandibula dystonia; Blepharospasm 10.1016/j.toxicon.2008.04.104
103. Treatment of cervical dystonia with Dysports in the Siberian District Medical Center of Roszdrav Dmitry Pokhabov, Vladislav Abramov Movement Disorders Group of the Department of Neurology, Krasnoyarsks State Med. Academy; YCH FSI SOMC Roszdrava, Krasnoyarsk, Russia
Botilinum toxin (Dysports) has been used for many years in our center. We review here our series of 45 patients with cervical dystonia (CD). The patients were
Abstracts Toxins 2008 / Toxicon 51 (2008) 1–54
100. Comorbidity in focal dystonia and effect of botulinum toxin treatment Sebastian Paus a, Jennifer Gross a, Martina Moll-Mu¨ller a, Frank Hentschel a, Bettina Wabbels b, Thomas Klockgether a, Michael Abele a a b
Department of Neurology, University of Bonn, Bonn, Germany Department of Opthalmology, University of Bonn, Bonn, Germany
Objectives: (1) To evaluate prevalence and risk factors of sleep disorders, sexual dysfunction and autonomic failure in idiopathic cervical dystonia (CD) and blepharospasm (BL). (2) To analyze the impact of botulinum toxin (BoNT) treatment on comorbidity in focal dystonia (FD). Background: The approach to movement disorder change, and non-motor comorbidity was shown to considerably impair quality of life in degenerative diseases. In contrast, there are no data on the prevalence of sleep disorders, sexual dysfunction or autonomic failure in non-degenerative movement disorders such as CD and BL, although depression and pain are well-known complications in FD. Methods: Standardized interviews, clinical examinations, autonomic testing, and self-rating forms in 221 patients with idiopathic FD (111 CD, 110 BL). Results: Impaired sleep quality was found in 45% of CD and in 46% of BL patients. Of 80 CD patients tested, 46% had autonomic failure. Sexual dysfunction became apparent in 35% of 82 patients. Depression was found in 25% of CD and 30% of BL patients. Conclusions: Beyond pain and depression, patients with FD frequently suffer from non-motor symptoms. Interestingly, results in CD and BL patients are similar, pointing to intrinsic mechanisms of sleep and sexual disturbances. In our series, BoNT treatment ameliorated non-motor symptoms only marginally, underlining the necessity of a multimodal treatment concept in FD. Keyword: Comorbidity sleep sexual autonomic disorder 10.1016/j.toxicon.2008.04.102
101. Efficacy of botulinum toxin in treatment of spasmodic dysphonia Igor Petrovic a, Marina Svetel a, Milan Vasic b, Vladimir Kostic a a b
Institute of Neurology, Belgrade, Serbia and Montenegro City Hospital Zvezdara, ORL department, Belgrade, Serbia and Montenegro
Spasmodic dysphonia (SD) is disabling speech disturbance caused by involuntary contractions of the vocal folds. Surgical treatment and oral medication provide unsatisfactory results. The first choice treatment is represented by local injections of botulinum toxin that provide improvement in up to 80% of the patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in a series of patients with SD followed at our center. We treated 10 patients with adductor SD. After diagnostic procedures, botulinum toxin was applied either unilaterally or bilaterally in the vocal folds, in doses of 12–16 units each. Voice and speech analysis was performed prior and after treatment using a structured scale for voice and speech
abnormalities occurring in SD. The majority of patients experienced both subjective and objective improvement. Quality of life improvement was rated as highly significant (t ¼ 3.562; p ¼ 0.006). Functional voice improvement was facilitated by speech therapy and psychotherapy. Speech therapy included structured vocal techniques to reduce the degree of vocal tension and rapid changes in voice power and pitch. Currently, there is no standardized procedure for a comprehensive treatment of SD that requires a multidisciplinary approach. Keywords: Spasmodic dysphonia; Botulinum toxin 10.1016/j.toxicon.2008.04.103
102. Treatment of blepharospasm with Dysports in the Siberian District Medical Center of Roszdrav Dmitry Pokhabov, Vladislav Abramov Movement Disorders Group of Department of Neurology, Krasnoyarsks State Med. Academy; YCH FSI ‘‘SOMC Roszdrava’’, Krasnoyarsk, Russia
Botilinum toxin (Dysports) has been used for many years in our center. We review here our series of patients with blepharospasm. Eighteen patients had blepharospasm, 15 had blepharospasm associated with oromandibular dystonia. They were aged 59.673.4 years, had a mean disease duration of 3.871.6 years and did not respond to oral medication. Dystonia intensity was estimated by Fahn’s dystonia scale. The baseline score in the blepharospasm group was 6.1470.95 points, with a botulinum toxin dose ranging from 140 to 220 Dysports U. The baseline score in the group with blepharospasm and oromandibular dystonia was 14.271.08 points, with a boulinum toxin dose ranging from 300 to 700 Dysports U. Between-injection interval was 16–38 weeks (on average 19.673.2). The main side effect was a light ptosis lasting for 5–20 days. The delay of clinical efficacy was 1–7 days (average, 4.672.4)and the duration of maximal efficacy was 6–22 weeks (average, 13.474.5). General effect lasted 16–42 weeks (21.674.2). After treatment, the mean score for the isolated blepharospasm group was 1.3370.10 (po0.05), the mean score in the blepharospasm and oromandibular dystonia group was 7.071.23 (po0.05). With repeated treatment, dystonia did not recur to the initial level, and the doses of Dysports could be reduced for repeated injections. In cases who showed significant improvement, it became possible to increase spacing between treatments. Keywords: Oromandibula dystonia; Blepharospasm 10.1016/j.toxicon.2008.04.104
103. Treatment of cervical dystonia with Dysports in the Siberian District Medical Center of Roszdrav Dmitry Pokhabov, Vladislav Abramov Movement Disorders Group of the Department of Neurology, Krasnoyarsks State Med. Academy; YCH FSI SOMC Roszdrava, Krasnoyarsk, Russia
Botilinum toxin (Dysports) has been used for many years in our center. We review here our series of 45 patients with cervical dystonia (CD). The patients were