Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia

KARLI, HAMDI NECDET; Zarifoglu, Mehmet; ÖZBEK, Sevda Erer; yurtogullari, sukran; OCAKOGLU, Gokhan

Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia

Sevda Erer ÖZBEK, (Uludağ Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Bursa, Türkiye)

Necdet KARLI, (Uludağ Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Bursa, Türkiye)

Şükran YURTOĞULLARI, (Uludağ Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Bursa, Türkiye)

Mehmet ZARİFOĞLU, (Uludağ Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Bursa, Türkiye)

GÖKHAN OCAKOĞLU (Uludağ Üniversitesi, Tıp Fakültesi, Biyoistatistik Anabilim Dalı, Bursa, Türkiye)

Journal of Neurological Sciences (Turkish)

0 0

Yıl: 2015 Cilt: 32 Sayı: 3 Sayfa Aralığı: 566 - 574 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia

Öz:

Amaç: Servikal distonili (SD) hastaların %70'inde ağrı semptomu tabloya eşlik etmektedir.Ağrının eşlikci olmasında altta yatan patogenez halen daha tam olarak bilinmemektedir.Çalışmamızda, Botulinum toksin (BoNT) tedavisi uygulanan SD'li hastalarda, eşlik edenağrının tipleri, klinik özelliklerin tanımlanması, tedavi öncesi ve sonrası, elektrik stimulasyonyöntemiyle, ağrı eşiğinin değerlendirilmesi amaçlanmıştır.Metod: Çalışmaya SD tanısı almış BoNT tedavisi gören 35 hasta alınmıştır. Hastalara, BoNTtedavi öncesi ve sonrası ağrı değerlendirme skalası, birleşik distoni değerlendirme skalası(BDDS) uygulandı. EMG eşliğinde distonik kaslardan, distonik aktivite olmayan komşu veyakontralateral kastan ve referans kabul ettiğimiz uzak lokalizasyonlu normal kastan elektrik stimulasyonu ile elde edilen ağrı eşiği değerleri kayıt edildi ve BoNT tedavi öncesi ve sonrasıtüm veriler karşılaştırıldı.Bulgular: Tedavi öncesi ve sonrası distonik kaslardan elde edilen ağrı eşiği değerlerindefarklılık saptanmadı. BoNT tedavisi alan ağrılı ve ağrısız distoni hastalarında tedavi sonrası,cinsiyet ve VAS grupları arasında ağrı eşiği değerleri bakımından farklılık gözlenmezken,BDDS (süre ve şiddet) skorlarında anlamlı azalma olduğu görüldü.Sonuç: Botulinum toksin tedavi öncesi ve sonrası distonik kaslardan elde edilen ağrı eşiğideğerlerinde değişkenlik olmamasınin nedeni, santral sensitizasyonun gelişmediği, ağrıdadüzelmenin distonik kas kontraksiyonlarındaki azalmaya sekonder gelişebileceğinidüşündürmektedir.

Anahtar Kelime:

Konular: Nörolojik Bilimler

Botulinum Toksin Tedavisinin, Primer Servikal Distonili Hastalarda, Ağrının Klinik Özelliklerine ve Ağrı Eşiği Üzerine Etkilerinin Değerlendirmesi

Öz:

Objective: In 70% of patients with cervical dystonia (CD), the clinical presentation includesthe symptom of pain. In this study, we aimed to define the types and clinical characteristics ofthe pain and to investigate whether this pain is a result of central sensitization by evaluatingpre- and post-botulinum toxin (BoNT) treatment pain threshold values using electricalstimulation.Methods: The study enrolled a total of 35 patients with CD who received BoNT therapy. Thepatients were evaluated using the pain evaluation scale and Unified Dystonia Rating scale(UDRS) before and after BoNT therapy. The pain threshold values obtained from dystonicmuscles, the contiguous or contralateral muscle without dystonic activity and a normalreference muscle with distant localization were recorded through electrical stimulation withEMG guidance, and all values obtained before and after BoNT therapy were compared.Results: No difference was found between the pain threshold values obtained from dystonicmuscles before and after treatment. While no difference was observed across genders or VASgroups in terms of pain threshold values, the UDRS (duration and motor severity factor)scores showed significant decreases after treatment with BoNT in patients with painfuldystonia and in patients with painless dystonia.Conclusions: The absence of a difference in pre- and post- BoNT treatment pain thresholdvalues in dystonic muscles might be explained by the absence of central sensitization. Painrelief in dystonic patients might occur secondary to decreases in dystonic muscle contractions.

Anahtar Kelime:

Konular: Nörolojik Bilimler

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Blackie JD, Lees AJ. Botulinum toxin treatment in sp asmodic torticollis. J Neurol Neurosurg Psychiatry. 1990; 53:640643.
2. Chan J, Brin MF, Fahn S. Idiop athic cervical dystonia: clinical characteristics. Mov Disord 1991;6:119-126.
3. Clayp ool D W, Duane DD, Ilstrup DM, Melton LJ. Ep idemiology and outcome of cervical dystonia (sp asmodic torticollis) in Rochester, Minnesota. Mov Disord. 1995 ;10(5) :608-614.
4. Colhado OC, Boeing M, Ortega LB. Botulinum toxin in p ain treatment.Rev Bras Anestesiol. 2009;59(3) :366-381.
5. Cui M, Khanij ou S, Rubino J, et al. Subcutaneous administration of botulinum toxin A reduces f ormalin-induced p ain. Pain 2004;107:125133.
6. Diener HC, Dodick D W, Aurora SK, et al. OnabotulinumtoxinA f or treatment of chronic migraine: Results f rom the double-blind, randomized, p lacebo-controlled p hase of the PREEMPT 2 trial. Cep halalgia. 2010;30:804- 814.
7. Dodick D W, Turkel CC, DeGryse RE, et al. OnabotulinumtoxinA f or treatment of chronic migraine: Pooled results f rom the double-blind, randomized, p lacebo-controlled p hases of the PREEMPT clinical p rogram. Headache. 2010;50:921-936.
8. Ep idemiologic study of Dystonia in Europ e (ESDE) Collaborative Group . Sex-related inf luences on the f requency and age of onset of onset of p rimary dystonia. Neurology 1999;53:1871-1873.
9. Ep idemiological Study of Dystonia in Europ e (ESDE) Collaborative Group . A p revalence study of p rimary dystonia in eight Europ ean countries. J Neurol 2000;247:787-792.
10. Haussermann P, Marczoch S, Klinger C, Landgrebe M, Conrad B, Ceballos-Baumann A. Long-term f ollow-up of cervical dystonia p atients treated with botulinum toxin A. Mov Disord 2004;19:303-308.
11. Jankovic J. Treatment of cervical dystonia with botulinum toxin. Mov. Disord 2004; ( Supp l 8) :109-115.
12. Jankovic J, Tsui J, Bergeron C. Prevalence of cervical dystonia and sp asmodic torticollis in the United States general p op ulation. Parkinsonism Relat Disord 2007;13: 411-416.
13. Jankovic J, Leder S, Warner D, Schwartz K. Cervical dystonia: clinical f indings and associated movement disorders. Neurology 1991;41(7) :1088-1091.
14. Karadaş O, Öztürk B, Zincir S, Tok F, Çelik C, Odabası Z. Servikoj enik Baş Ağrılı Hastalarda Botulinum Toksin Tip A Tedavisi İle Anksiyete ve Dep resyon Düzeylerinin Değerlendirilmesi. Bulletin of Clinical Psychop harmacology 2011; 21: 232-236.
15. Kim C, McCall WD Jr, Kim YK, Chung J W Eff ect of botulinum toxin on p ressure p ain threshold and EMG p ower sp ectrum of masseter muscle during sustained f atiguing contraction. Am J Phys Med Rehabil. 2010;89 (9) :736-743.
16. Kutvonen O, Dastidar P, Nurmikko T. Pain in sp asmodic torticollis. Pain 1997;69 279286.
17. Lorentz IT, Subramaniam SS, Yiannikas C. Treatment of idiop athic torticollis with botulinum toxin A: a double-blind study on twenty-three p atients. Mov Disord. 1991; 6:145150.
18. Nutt JG, Muenter MD, Aronson A, Kurland LT, Melton 3rd LJ. Ep idemiology of f ocal and generalized dystonia in Rochester, Minnesota. Mov Disord 1988;3:188-194.
19. Ondo WG, Gollomp S, Galvez-Jimenez N. A Pilot Study of Botulinum Toxin A f or Headache in Cervical Dystonia Headache 2005;45:1073- 1077.
20. Skogseid IM, Kerty E. The course of cervical dystonia and p atient satisf action with long-term botulinum toxin A treatment. Europ ean J Neurol 2005;12:163-170.
21. Truong D, Duane DD, Jankovic J, Singer C, Seeberger LC, Comella CL, et al. Eff icacy and saf ety of botulinum typ e A toxin (Dysp ort) in cervical dystonia: results of the f irst US randomized, double-blind, p lacebocontrolled study. Mov Disord 2005;20:783-791.
22. Tinazzi M, Valeriani M, Squintani G, Corrà F, Recchia S, Def azio G, Berardelli A. Nocicep tive p athway f unction is normal in cervical dystonia: a study using laser-evoked p otentials. J Neurol. 2012 Oct;259(10) :2060- 2066.
23. Winner PK, Sadowsky CH, Martinez WC, Zuniga JA, Poulette A. Concurrent OnabotulinumtoxinA treatment of cervical dystonia and concomitant migraine. Concurrent OnabotulinumtoxinA Treatment of Cervical Dystonia and Concomitant Migraine. Headache. 2012;52(8) :1219-1225.

APA	ÖZBEK S, KARLI H, yurtogullari s, Zarifoglu M, OCAKOGLU G (2015). Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. , 566 - 574.
Chicago	ÖZBEK Sevda Erer,KARLI HAMDI NECDET,yurtogullari sukran,Zarifoglu Mehmet,OCAKOGLU Gokhan Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. (2015): 566 - 574.
MLA	ÖZBEK Sevda Erer,KARLI HAMDI NECDET,yurtogullari sukran,Zarifoglu Mehmet,OCAKOGLU Gokhan Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. , 2015, ss.566 - 574.
AMA	ÖZBEK S,KARLI H,yurtogullari s,Zarifoglu M,OCAKOGLU G Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. . 2015; 566 - 574.
Vancouver	ÖZBEK S,KARLI H,yurtogullari s,Zarifoglu M,OCAKOGLU G Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. . 2015; 566 - 574.
IEEE	ÖZBEK S,KARLI H,yurtogullari s,Zarifoglu M,OCAKOGLU G "Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia." , ss.566 - 574, 2015.
ISNAD	ÖZBEK, Sevda Erer vd. "Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia". (2015), 566-574.

APA	ÖZBEK S, KARLI H, yurtogullari s, Zarifoglu M, OCAKOGLU G (2015). Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. Journal of Neurological Sciences (Turkish), 32(3), 566 - 574.
Chicago	ÖZBEK Sevda Erer,KARLI HAMDI NECDET,yurtogullari sukran,Zarifoglu Mehmet,OCAKOGLU Gokhan Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. Journal of Neurological Sciences (Turkish) 32, no.3 (2015): 566 - 574.
MLA	ÖZBEK Sevda Erer,KARLI HAMDI NECDET,yurtogullari sukran,Zarifoglu Mehmet,OCAKOGLU Gokhan Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. Journal of Neurological Sciences (Turkish), vol.32, no.3, 2015, ss.566 - 574.
AMA	ÖZBEK S,KARLI H,yurtogullari s,Zarifoglu M,OCAKOGLU G Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. Journal of Neurological Sciences (Turkish). 2015; 32(3): 566 - 574.
Vancouver	ÖZBEK S,KARLI H,yurtogullari s,Zarifoglu M,OCAKOGLU G Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia. Journal of Neurological Sciences (Turkish). 2015; 32(3): 566 - 574.
IEEE	ÖZBEK S,KARLI H,yurtogullari s,Zarifoglu M,OCAKOGLU G "Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia." Journal of Neurological Sciences (Turkish), 32, ss.566 - 574, 2015.
ISNAD	ÖZBEK, Sevda Erer vd. "Evaluation of the Effects of Botulinum Toxin Therapy on the Clinical Characteristics of Pain and Pain Threshold Value in Patients With Primary Cervical Dystonia". Journal of Neurological Sciences (Turkish) 32/3 (2015), 566-574.