Effects of A 3-Month Physiotherapy Intervention in Stable Cervical Dystonia As Add-On to Botulinum Toxin Therapy

Abstract

Background Treatment of choice for cervical dystonia comprises botulinum neurotoxin therapy. Whether additional physiotherapy can achieve better results is unclear. Objectives To show effects of physiotherapy as an add-on treatment to botulinum neurotoxin therapy. Methods 18 patients participated in this prospective interventional study (DRKS00006562) consisting of 2, 3-month periods. In the first period, usual botulinum toxin was applied. The second period comprised an additional multimodal physiotherapy program. Outcome measures were: range of motion, SF-36, Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), surface electromyography. Results In the comparison first phase vs. second phase patients showed significant improvements in range of motion (flexion/extension: 16.3 ± 25.4; rotation: 19.1 ± 24.6), TWSTRS (severity: 3.8 ± 3.0; disability: 1.7 ± 2.0; pain: 4.4 ± 4,1) and in mental health (SF-36: 5.9 ± 7.5); p <0.05, respectively. No significant changes were seen in the lateral flexion ROM, physical health (SF-36) and the surface electromyography. Conclusion Multimodal physiotherapy is a feasible and save additional treatment option for patients with cervical dystonia. An add-on physiotherapy program can achieve better treatment outcomes. Patients benefited especially with improved range of motion, and reduced pain and severity of symptoms.