A randomized study of botulinum toxin versus botulinum toxin plus physical therapy for treatment of cervical dystonia

被引:18
作者
Hu, Wei [1 ]
Rundle-Gonzalez, Valerie [1 ]
Kulkarni, Shankar J. [2 ]
Martinez-Ramirez, Daniel [1 ]
Almeida, Leonardo [1 ]
Okun, Michael S. [1 ]
Shukla, Aparna Wagle [1 ]
机构
[1] Univ Florida, Dept Neurol, Ctr Movement Disorders & Neurorestorat, Gainesville, FL USA
[2] Univ Florida, Shands Rehabil Serv, Gainesville, FL USA
基金
美国国家卫生研究院;
关键词
Botulinum toxin; Dystonia; Physical therapy; Cervical dystonia; PLASTICITY;
D O I
10.1016/j.parkreldis.2019.02.035
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Physical therapy (PT) for cervical dystonia is not well studied, and the underlying physiological effects are not known. Methods: We enrolled 26 subjects comprising of 16 cervical dystonia and 10 healthy controls for normative physiological data. We randomized cervical dystonia patients who reported suboptimal benefits on botulinum toxin (BoNT) injections to BoNT alone (BoNT arm) or BoNT plus PT (PT-BoNT arm). PT-BoNT arm received manual PT on the injection day followed by six weeks of home-exercise program. Home-exercise program comprised of stretching, range-of-motion and isometric exercises. The primary outcome was change from baseline in Toronto Western spasmodic torticollis rating scale (TWSTRS) that was recorded six weeks after exercise program. TWSTRS was video evaluated by blinded raters. We probed sensorimotor plasticity with transcranial magnetic stimulation (TMS) using a paired associative stimulation (PAS) paradigm. Results: TWSTRS score improved (severity 31%, p = 0.002; pain 28%, p = 0.01) and PAS plasticity decreased (p = 0.01) in PT-BoNT arm compared to BoNT arm. PAS values for PT-BoNT arm were found to approach values of healthy control values. Change in PAS measure correlated significantly with TWSTRS change (severity, r = 0.56, p = 0.04; pain, r = 0.61, p = 0.03. TWSTRS disability score only approached significance (p = 0.14) when comparing the two treatment arms. Conclusion: PT is a potential adjunct in patients with cervical dystonia who report suboptimal benefits with BoNT therapy. PT related benefits in cervical dystonia are likely mediated through modulation of sensorimotor plasticity.
引用
收藏
页码:195 / 198
页数:4
相关论文
共 16 条
[1]   Progressive resistance exercise training and changes in resting-state functional connectivity of the caudate in persons with multiple sclerosis and severe fatigue: A proof-of-concept study [J].
Akbar, Nadine ;
Sandroff, Brian M. ;
Wylie, Glenn R. ;
Strober, Lauren B. ;
Smith, Angela ;
Goverover, Yael ;
Motl, Robert W. ;
DeLuca, John ;
Genova, Helen .
NEUROPSYCHOLOGICAL REHABILITATION, 2020, 30 (01) :54-66
[2]   Phenomenology and classification of dystonia: A consensus update [J].
Albanese, Alberto ;
Bhatia, Kailash ;
Bressman, Susan B. ;
DeLong, Mahlon R. ;
Fahn, Stanley ;
Fung, Victor S. C. ;
Hallett, Mark ;
Jankovic, Joseph ;
Jinnah, Hyder A. ;
Klein, Christine ;
Lang, Anthony E. ;
Mink, Jonathan W. ;
Teller, Jan K. .
MOVEMENT DISORDERS, 2013, 28 (07) :863-873
[3]  
[Anonymous], 2005, J APPL PHYSL, V99, P1558
[4]   Impact of cervical dystonia on quality of life [J].
Camfield, L ;
Ben-Shlomo, Y ;
Warner, TT .
MOVEMENT DISORDERS, 2002, 17 (04) :838-841
[5]   Unmet Needs in the Management of Cervical Dystonia [J].
Contarino, Maria Fiorella ;
Smit, Marenka ;
van den Dool, Joost ;
Volkmann, Jens ;
Tijssen, Marina A. J. .
FRONTIERS IN NEUROLOGY, 2016, 7
[6]   A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia [J].
Counsell, Carl ;
Sinclair, Hazel ;
Fowlie, Jillian ;
Tyrrell, Elaine ;
Derry, Natalie ;
Meager, Peter ;
Norrie, John ;
Grosset, Donald .
PARKINSONISM & RELATED DISORDERS, 2016, 23 :72-79
[7]   Botulinum Toxin Injections Reduce Associative Plasticity in Patients with Primary Dystonia [J].
Kojovic, Maja ;
Caronni, Antonio ;
Bologna, Matteo ;
Rothwell, John C. ;
Bhatia, Kailash P. ;
Edwards, Mark J. .
MOVEMENT DISORDERS, 2011, 26 (07) :1282-1289
[8]   Mediation analysis [J].
MacKinnon, David P. ;
Fairchild, Amanda J. ;
Fritz, Matthew S. .
ANNUAL REVIEW OF PSYCHOLOGY, 2007, 58 :593-614
[9]   Working capacity and cervical dystonia [J].
Martikainen, Kirsti K. ;
Luukkaala, Tiina H. ;
Marttila, Reijo J. .
PARKINSONISM & RELATED DISORDERS, 2010, 16 (03) :215-217
[10]   Comparable Botulinum Toxin Outcomes between Primary and Secondary Blepharospasm: A Retrospective Analysis [J].
Martinez-Ramirez, Daniel ;
Giugni, Juan C. ;
Hastings, Erin ;
Shukla, Aparna Wagle ;
Malaty, Irene A. ;
Okun, Michael S. ;
Rodriguez, Ramon L. .
TREMOR AND OTHER HYPERKINETIC MOVEMENTS, 2014, 4