Evolución a largo plazo de la dosis de toxina botulínica en las distonías laríngea y cervical / Long term evolution of the doses of botulinum toxin used in laryngeal and cervical distonias

Introduction. Dystonia is a neurological condition characterised by involuntary movements that give rise to abnormal postures. Different strategies have been used in the treatment of focal dystonias, but the most widely accepted at the present time involves the use of botulinum toxin type A (BTA) injections. Yet, despite its widespread use, the ideal dosages for long-term treatment are still not known with precision. Aims. The purpose of this study is to report on our experience with long-term BTA therapy in laryngeal (LD) and in cervical dystonia (CD). Patients and methods. We reviewed the data concerning the dosages of BTA injected in 10 patients with LD who received treatment in our centre over a period of eight years. We also analysed the data regarding the doses of BTA injected over an eight-year period in 17 patients with CD. The data were analysed using an ANOVA for paired data. Results. No significant differences were found in the highest dosages of BTA needed for the treatment of LD throughout the progression of the disease (p = 0.84). These data contrast with those obtained from the analysis of the treatment of CD, which do show a gradual increase in the dose of toxin that is required (p < 0.0001). Conclusions. These findings suggest that the long-term response to treatment is different in the two conditions (AU)

Introducción. La distonía es una entidad neurológica caracterizada por movimientos involuntarios que ocasionan posturas anómalas. En el tratamiento de las distonías focales se han utilizado diferentes estrategias, pero la más aceptada en la actualidad es la inyección de toxina botulínica de tipo A (TBA). Sin embargo, a pesar de su uso extendido, no se conoce con precisión cuáles son las dosis idóneas para el tratamiento a largo plazo. Objetivo. Mostrar nuestra experiencia en el tratamiento a largo plazo con TBA en la distonía laríngea (DL) y en la cervical (DC). Pacientes y métodos. Revisamos los datos correspondientes a las dosis de TBA inyectadas a 10 pacientes con DL tratados en nuestro centro durante ocho años, y analizamos los datos correspondientes a la dosis de toxina botulínica inyectada durante ocho años a 17 pacientes con DC. Analizamos los datos con el estadístico ANOVA para datos apareados. Resultados. No encontramos diferencias significativas en las dosis máximas autorizadas de TBA necesaria para el tratamiento de la DL a lo largo de la evolución de la enfermedad (p = 0,84). Estos datos contrastan con los obtenidos al analizar el tratamiento de la DC, en la que sí se observa un aumento gradual de la dosis necesaria de toxina (p < 0,0001). Conclusión. Estos hallazgos hacen pensar en una diferente respuesta a largo plazo al tratamiento en ambas entidades (AU)

[Long-term evolution of the doses of Botulinum toxin used in laryngeal and cervical dystonias]. / Evolución a largo plazo de la dosis de toxina botulínica en las distonías laringea y cervical

INTRODUCTION: Dystonia is a neurological condition characterised by involuntary movements that give rise to abnormal postures. Different strategies have been used in the treatment of focal dystonias, but the most widely accepted at the present time involves the use of botulinum toxin type A (BTA) injections. Yet, despite its widespread use, the ideal dosages for long-term treatment are still not known with precision. AIMS: The purpose of this study is to report on our experience with long-term BTA therapy in laryngeal (LD) and in cervical dystonia (CD). PATIENTS AND METHODS: We reviewed the data concerning the dosages of BTA injected in 10 patients with LD who received treatment in our centre over a period of eight years. We also analysed the data regarding the doses of BTA injected over an eight-year period in 17 patients with CD. The data were analysed using an ANOVA for paired data. RESULTS: No significant differences were found in the highest dosages of BTA needed for the treatment of LD throughout the progression of the disease (p=0.84). These data contrast with those obtained from the analysis of the treatment of CD, which do show a gradual increase in the dose of toxin that is required (p<0.0001). CONCLUSIONS: These findings suggest that the long-term response to treatment is different in the two conditions.