Benefits, Safety, and Adjunct Modality Prevalences of Long-Term Botulinum Toxin Injections for Cervical Dystonia and Myofascial Neck Pain: A Retrospective Cohort Study

Dion Diep,1 Jasmine Ko,2 John Lan,3 Kinga T Koprowicz,3 Gordon Ko3,4 1MD Program, University of Toronto, Toronto, ON, Canada; 2Department of Kinesiology, McMaster University, Hamilton, ON, Canada; 3Canadian Centre of Integrative Medicine, Toronto, ON, Canada; 4Division of Physical Medicine & Rehabilitation, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaCorrespondence: Gordon KoClinical Adjunct Lecturer, Division of Physical Medicine & Rehabilitation, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, CanadaTel +1416-480-4342Fax +1416-480-6885Email drgordko@rogers.comIntroduction: There is a paucity of long-term treatment benefit and safety data of botulinum toxin A (BTX-A) for cervical dystonia (CD) and myofascial neck pain syndrome (MPS). Additionally, the prevalence of adjunct modality uses during this period is unknown despite evolving practices.Objective: To assess and compare treatment benefit, safety, and adjunct modality prevalences of long-term BTX-A injections between CD and MPS patients.Design: Retrospective cohort study.Setting: Private practice tertiary care clinics in Toronto.Patients: Convenience sample of 37 (52.9%) CD and 33 (47.1%) MPS patients treated for a mean±SD duration of 7.2± 4.3 and 8.3± 4.7 years, respectively.Interventions: BTX-A injections administered at least once yearly, for a duration longer than 1 year.Main Outcome Measures: Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS) for disability and pain, Patient Global Impression of Change (PGIC) score, time to peak effect, duration of total response, adverse effects, and prevalence of adjunct modalities.Results: CD patients experienced improvements in TWSTRS disability (17.57± 6.79 to 9.81± 4.35, p< 0.001) and pain (14.61± 3.08 to 9.05± 3.49, p< 0.001) scores as well as PGIC score (52.00%± 23.60% to 64.80%± 23.60%, p=0.0