■宫颈肌张力障碍(CD)引起头部的不自主运动和姿势,脖子,和肩膀,以及包括疼痛在内的非运动症状,心情,和睡眠功能障碍,影响生活质量。CD的一线治疗是肉毒神经毒素(BoNT)注射。
■CD的临床表现和诊断,以及BoNT在治疗环境中的位置,首先审查。接下来,解释了BoNT产品可用制剂的作用机理和药理学差异。对可用的BoNT制剂的运动和非运动功效和安全性的证据基础进行了审查。关注作为患者满意度驱动因素的受益持续时间。BoNT疗效的实际决定因素进行了综述,包括肌肉选择,精确的肌肉注射,与反应不良或恶化有关的因素,和免疫原性。
■BoNT代表了CD治疗的显着进步。更准确的诊断,肌肉选择和瞄准,和给药可以改善现有BoNT制剂的结果。进一步完善BoNT效力,行动的持续时间,安全,和免疫原性将有助于减少未满足的需求在规模和持续时间的好处。DBS和MRI引导聚焦超声的其他验证可能会扩展毒素无应答患者的选择。
UNASSIGNED: Cervical dystonia (CD) causes involuntary movements and postures of the head, neck, and shoulders, as well as nonmotor symptoms including pain, mood, and sleep dysfunction, and impacts quality of life. The first-line treatment for CD is botulinum neurotoxin (BoNT) injections.
UNASSIGNED: The clinical presentation and diagnosis of CD, as well as where BoNT resides in the treatment landscape, is reviewed first. Next, the mechanism of action and the pharmacological differences in the available preparations of BoNT products are explained. The evidence base for motor and nonmotor efficacy and safety of the available BoNT formulations is reviewed, with attention to duration of benefit as a driver of patient satisfaction. Practical determinants of BoNT efficacy are reviewed including muscle selection, accurate muscle injection, factors related to poor or deteriorating response, and immunogenicity.
UNASSIGNED: BoNT represents a significant advancement in the treatment of CD. More accurate diagnosis, muscle selection and targeting, and dosing can improve outcomes with existing BoNT formulations. Further refinement of BoNT potency, duration of action, safety, and immunogenicity will help reduce unmet needs in the magnitude and duration of benefit. Additional validation of DBS and MRI-guided focused ultrasound may expand options for patients with toxin nonresponse.