Features of treatment of cervical dystonia associated with head tremor with botulinum toxin type A drugs under electro myographic control

The study was aimed to evaluate the efficacy and safety of injections of botulinum toxin typeA (BTA) in the neck muscles under electromyographic control and without it to reduce head tremor, muscle tone and dystonic postures, as well as pain in patients with cervical dystonia (CD). 49 patients with CD and dystonic head tremor who received injections of BTA were examined. 33 (67 %) patients received Dysport in an average dose of 695 (627; 762) units, 15 (31 %) patients received Xeomin in an average dose of 262 (227; 297) units and 1 (2 %) patient received 300 units of Botox. 16 (33 %) patients received injections under EMGcontrol. The level of symptoms of CD and tremor before and 4 weeks after the treatment were measured by the TWSTRS and Tsui scales. Evaluation of the treatment efficacy was carried out using the patientreported Clinical Global Improvement (CGI) scale, and the presence or absence of head tremor after injection was also recorded. The TWSTRS score decreased from 39 (36, 42) to 24 (21, 26), the TZUI score decreased from 9.8 (9, 10) to 4.9 (4, 6) in 4 weeks after injection (p <0.001). The level of tremor measured by Tsui scale decreased from 2.1 (1.7, 2.4) and 0.7 points (0,5; 0,9) (p <0.001). In 24 (49 %) cases, complete disappearance of tremor was noted in 4 weeks after injection. Complete regression of tremor was observed significantly more frequently in patients with torticollis who received injections with EMG-control in 10(71 %) cases vs. 8(32 %) without it (p <0.05). 28(57 %) patients noted moderate or significant improvement on the CGI scale. Pain decreased from 5.4 (3.9, 6.9) points to 2.4 (1.3, 3.6) (p <0.001) according to section 3 of TWSTRS scale, pain completely regressed in 15 (52 %) patients. BTA injections are highly effective and safe treatment of CD symptoms such as dystonic posture, pain and dystonic tremor. BTA injections in the neck muscles under EMGcontrol can improve outcome in patients with torticollis associated with dystonic head tremor.

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