title: Survey of practices employed by neurologists for the definition and management of secondary non-response to botulinum toxin in cervical dystonia.
abstract: Secondary non-response (SNR) to botulinum toxin (BoNT) in cervical dystonia (CD) lacks a universal definition. We conducted a retrospective survey to develop a definition based on clinicians' practice. Fifty-seven neurologists completed a 17-item questionnaire. In defining SNR, insufficiently improved posture was considered to be more relevant (98% of physicians) than insufficiently improved pain (86%). The most frequently used diagnostic test for SNR was the frontalis test (68%); antibody testing was performed by only 13% of physicians. Three consecutive unsuccessful injection cycles were considered the most appropriate indicator of SNR (55% of physicians). Physicians reported that 5.9% (median) of patients treated in 2008 became secondary non-responders to BoNT-A. The most common strategy for SNR was optimization of physiotherapy, considered by 98% of the physicians. On the basis of our findings, SNR can be defined as insufficiently improved posture after ≥3 unsuccessful injection cycles in CD patients previously achieving satisfactory results.
authors.affiliation: Neurological Clinical Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal. joaquimjferreira@gmail.com
authors.forename: Joaquim J
authors.initials: JJ
authors.lastname: Ferreira
authors.forename: Roongroj
authors.initials: R
authors.lastname: Bhidayasiri
authors.forename: Carlo
authors.initials: C
authors.lastname: Colosimo
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Marti
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zakine
authors.forename: Pascal
authors.initials: P
authors.lastname: Maisonobe
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000009:adverse effects*; D001905:Botulinum Toxins / Q000009:adverse effects*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010820:Physicians / Q000523:psychology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014103:Torticollis / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins