Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
Factors influencing botulinum toxin response in cervical dystonia: a two-center GAS-based study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Lopes Sofia, Silva Margarida, Carapinha Duarte, Varanda Sara, Costa Cristina
Аннотация
BACKGROUND: Botulinum toxin (BoNT) is first-line therapy for cervical dystonia (CD), yet treatment response is heterogeneous. Patient-centered outcomes may be better captured by Goal Attainment Scaling (GAS) than by examiner-rated motor scales. We aimed to identify clinical factors influencing BoNT response in CD using GAS.
METHODS: We conducted a retrospective two-center study including adults with CD treated with BoNT between January 2011 and August 2025. Treatment response was assessed using GAS T-scores. The primary outcome was achieving GAS ≥ 50 after the first session; the secondary outcome was achieving GAS > 50 in at least one session during follow-up.
RESULTS: Eighty-seven patients were included (74.7% female; median age 68 years; median follow-up 4 years). Patients with focal cervical dystonia were significantly more likely to achieve a GAS score ≥ 50 after the first treatment session than those with non-focal forms (segmental, multifocal, or generalized dystonia; OR 5.667; 95% CI 1.853-17.326; p = 0.001). Failure to achieve a GAS score > 50 was significantly associated with the presence of other neurological disorders (OR 0.284; p = 0.020) or concomitant movement disorders (OR 0.211; p = 0.010). Ultrasound guidance was not associated with higher GAS scores.
CONCLUSION: Focal dystonia and absence of neurological comorbidities were associated with better BoNT response. Ultrasound guidance did not confer measurable benefit in this real-world cohort. GAS may support individualized treatment evaluation in CD.
METHODS: We conducted a retrospective two-center study including adults with CD treated with BoNT between January 2011 and August 2025. Treatment response was assessed using GAS T-scores. The primary outcome was achieving GAS ≥ 50 after the first session; the secondary outcome was achieving GAS > 50 in at least one session during follow-up.
RESULTS: Eighty-seven patients were included (74.7% female; median age 68 years; median follow-up 4 years). Patients with focal cervical dystonia were significantly more likely to achieve a GAS score ≥ 50 after the first treatment session than those with non-focal forms (segmental, multifocal, or generalized dystonia; OR 5.667; 95% CI 1.853-17.326; p = 0.001). Failure to achieve a GAS score > 50 was significantly associated with the presence of other neurological disorders (OR 0.284; p = 0.020) or concomitant movement disorders (OR 0.211; p = 0.010). Ultrasound guidance was not associated with higher GAS scores.
CONCLUSION: Focal dystonia and absence of neurological comorbidities were associated with better BoNT response. Ultrasound guidance did not confer measurable benefit in this real-world cohort. GAS may support individualized treatment evaluation in CD.