Botulinum toxin injections during the COVID-19 epidemic: A retrospective chart review

BACKGROUND AND AIM: Clinical services were severely affected globally during the COVID-19 pandemic. This study aimed to characterize the clinical experience of using botulinum toxin (BTX) injections during the COVID-19 pandemic. Method(s): This is a retrospective chart review of patients who received BTX injections from April 2019 to January 2022. Result(s): A total of 105 patients received an BTX injections, out of which 76 (72.4%) were men. The mean age of the patients was 47.9 +/- 15.1 years. The most common indication for receiving BTX injections was dystonia (n = 79;75.2%), followed by hemifacial spasm (n = 22;21%) and miscellaneous movement disorders (n = 4;3.8%). Focal dystonia (n = 45;57%) was the most frequent form of dystonia, followed by segmental dystonia (n = 24;30%). The percentage of generalized dystonia and hemidystonia was 12% and 1%, respectively. Cervical dystonia (44.4%), blepharospasm (17.8%), and writer's cramp (15.6%) were the most frequent forms of focal dystonia. The miscellaneous group included four patients (3.8%) with trigeminal neuralgia, Holmes tremor, dystonic tics, and hemimasticatory spasm. The mean ages of patients in the dystonia, hemifacial spasm, and the miscellaneous groups were 47.7 +/- 14.9 years, 49.2 +/- 14.0 years, and 44.2 +/- 26.0 years, respectively. The mean BTX dose was 131.6 +/- 104.1 U. The mean BTX doses for the dystonia group, hemifacial spasm, and the miscellaneous group were 158.7 +/- 105.3 U, 40.1 +/- 11.3 U, and 100.0 +/- 70.7 U, respectively. Conclusion(s): Most patients in our cohort had dystonia, followed by hemifacial spasm. Among the patients with dystonia, most had focal dystonia, with cervical dystonia being the most common movement disorder. The data obtained in our study is important to increase awareness of the effectiveness of BTX injections in patients with chronic disorders.Copyright © 2023 Annals of Movement Disorders.

Acute cervical dystonia following the BNT162b2 mRNA COVID-19 vaccine.

The coronavirus disease of 2019 (COVID-19) pandemic is caused by a novel coronavirus SARS-Cov-2. Four major vaccine types are being used to fight against this deadly pandemic and save precious human lives. All types of vaccines have been associated with a risk of neurological complications ranging from mild to severe. Cervical dystonia occurring after a COVID-19 vaccine was not previously reported in the literature. In this article, we describe a case of acute cervical dystonia occurring after the first dose of the BNT162b2 COVID-19 vaccine. We attribute the occurrence of cervical dystonia to the vaccine due to the temporal relationship. This report adds to the literature a possible rare side effect of a COVID-19 vaccine and contributes to the limited literature on potential neurological side effects of mRNA-based vaccines. The likely mechanism is autoimmune. Further research is needed to probe and study the exact mechanism.

Pilot Feasibility Study of a Multi-View Vision Based Scoring Method for Cervical Dystonia.

Abnormal movement of the head and neck is a typical symptom of Cervical Dystonia (CD). Accurate scoring on the severity scale is of great significance for treatment planning. The traditional scoring method is to use a protractor or contact sensors to calculate the angle of the movement, but this method is time-consuming, and it will interfere with the movement of the patient. In the recent outbreak of the coronavirus disease, the need for remote diagnosis and treatment of CD has become extremely urgent for clinical practice. To solve these problems, we propose a multi-view vision based CD severity scale scoring method, which detects the keypoint positions of the patient from the frontal and lateral images, and finally scores the severity scale by calculating head and neck motion angles. We compared the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) subscale scores calculated by our vision based method with the scores calculated by a neurologist trained in dyskinesia. An analysis of the correlation coefficient was then conducted. Intra-class correlation (ICC)(3,1) was used to measure absolute accuracy. Our multi-view vision based CD severity scale scoring method demonstrated sufficient validity and reliability. This low-cost and contactless method provides a new potential tool for remote diagnosis and treatment of CD.

The Impact of SARS-CoV-2 Pandemic Lockdown on a Botulinum Toxin Outpatient Clinic in Germany.

Botulinum neurotoxin type A (BoNT/A) injections have to be administered repeatedly to achieve a rather stable, high level of improvement. This study aimed to take a look at changes in the daily routine of a BoNT/A outpatient clinic due to the SARS-CoV-2 pandemic lockdown, analyze the impact of SARS-CoV-2-induced re-injection delay on outcomes in patients with cervical dystonia (CD) (n = 36) and four other disease entities (n = 58), and study the influence of covariables, including previous injections and doses. For the present observational study, the first 100 patients who were scheduled to have an appointment between April 20 and May 18 during the partial lockdown and also had been treated regularly before the lockdown were recruited. Clinical and demographical characteristics and treatment-related data from the previous visits were extracted from charts. Time delay, symptom severity assessment, and TSUI score (if applicable) were gathered at the first coronavirus pandemic lockdown emergency visit for each patient. Of the 94 patients who could come to the clinic, 48 reported a delay and 44 reported worsening during the delay. Delays ranged from 1 to 63 days, the mean delay was 23 days, and the mean worsening was 26% compared to the previous visit. A significant correlation was found between the duration of the delay and the patient's rating of worsening (PwP). In CD patients, the physician´s rating of CD worsening by the TSUI score (ATUSI-PTSUI) was significantly correlated with general worsening (DwP) and the TSUI at the last visit (PTSUI). A small delay of a few weeks led to a similar worsening of symptoms in CD and all other disease entities and to relapse on a higher level of severity. This relapse can only be compensated by continuous treatment up to at least 1 year until patients reach the same level of treatment efficacy as that before the SARS-CoV-2 pandemic.