Influence of botulinum toxin on torticollis spasmodicus and psychical health after middle-term botulinum toxin treatment

Objectives: The aim of this study was to examine the effect of intramuscular botulinum toxin type a injections on clinical severity of torticollis spasmodicus and psychical health of patients after some time of botulinum toxin pre-treatment. Furthermore, we looked at influence of duration of disease and botulinum toxin therapy on dystonia severity and psychical distress.

Methods: 22 patients with torticollis spasmodicus already pre-treated for some time with botulinum toxin type a were included. Severity of torticollis was assessed with the ‘TWSTRS-Scale’, psychical distress was evaluated with the questionnaires ‘Die Befindlichkeitsskala’ and ‘Die Symptom-Checkliste 90-R (SCL-90-R)’. Two ratings were made at consecutive botulinum toxin injections (3 months time gap), in between we saw the patients in the therapeutic effect of botulinum toxin (4 to 6 weeks after the first botulinum toxin injection). Wilcoxon test was used to compare the results at injection with the results in the therapeutic effect of botulinum toxin.

Results: Mean duration of botulinum toxin therapy was 44,8 months. Botulinum toxin injections significantly improved the total severity score of the TWSTRS scale in the total sample (p=0,023) and in the subgroup of 7 patients with disease duration ≤5 years (p=0,043). Investigations of mental-health aspects showed that the global severity index (GSI) of the SCL-90-R was higher than reported for healthy individuals (mean 54,76±13,08). This was also observed in the ‘Befindlichkeitsskala’ (mean 58,66±9,12). 22,73 percent of our patients showed considerable psychical distress (GSI >60). There was no change of GSI within one therapeutic cycle of botulinum toxin application (p=0,983).

Conclusions: Also after some time of treatment, botulinum toxin has to be considered as an effective therapeutic strategy of torticollis with a pronounced profit for patients with short disease duration. The sample feels in mean little more emotional stress than healthy individuals, but about one quarter of the collective shows distinct psychical distress. Torticollis as chronic somatic illness is probably one influence factor for the degree of psychical burden. But also the reservoir of pre-existing coping strategies and the subjective dealing with illness may play a role. This may be the reason why there was no evidence for an undulant change of the psychical situation parallel to the therapeutic effect of botulinum toxin within one therapy cycle.