Intervention Review

Botulinum toxin type A versus anticholinergics for cervical dystonia

  1. João Costa1,*,
  2. Cláudia C Espírito-Santo1,
  3. Ana A Borges1,
  4. Peter Moore2,
  5. Joaquim Ferreira1,
  6. Miguel M Coelho1,
  7. Cristina Sampaio1

Editorial Group: Cochrane Movement Disorders Group

Published Online: 24 JAN 2005

Assessed as up-to-date: 7 OCT 2004

DOI: 10.1002/14651858.CD004312.pub2


How to Cite

Costa J, Espírito-Santo CC, Borges AA, Moore P, Ferreira J, Coelho MM, Sampaio C. Botulinum toxin type A versus anticholinergics for cervical dystonia. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004312. DOI: 10.1002/14651858.CD004312.pub2.

Author Information

  1. 1

    Faculdade de Medicina de Lisboa, Laboratório de Farmacologia Clínica e Terapêutica, Lisboa, Portugal

  2. 2

    NHS Trust, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK

*João Costa, Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina de Lisboa, Av. Prof. Egas Moniz, Lisboa, 1649-028, Portugal. joaoncosta@sapo.pt.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Cervical dystonia is the most common form of focal dystonia. It is characterized by involuntary posturing of the head and frequently is associated with neck pain. Disability and social withdrawal are common. Most cases are idiopathic and generally cervical dystonia is a life-long disorder. Botulinum toxin Type A (BtA) is now the first line therapy. Before BtA, anticholinergics were the most widely accepted treatment, so it is important to understand how these two treatments compare.

Objectives

To compare the clinical efficacy and safety of BtA versus anticholinergic drugs in the treatment of cervical dystonia.

Search methods

We searched the Cochrane Movement Disorders Group trials register (June 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2003), MEDLINE 1977 to June 2003), EMBASE (1977 to June 2003) and reference lists of articles. We also contacted manufacturers and researchers in the field.

Selection criteria

Randomised studies comparing BtA versus any anticholinergic drug for the treatment of cervical dystonia.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials.

Main results

We found only one trial suitable for inclusion and accordingly no meta-analysis was performed. It compared BtA versus trihexyphenidyl in 66 patients with cervical dystonia. Although this was a relatively small trial with short duration, the results can probably be generalized for the population, since the trial appears to be unbiased and produced clear clinically significant results. The results favoured BtA, and the difference was similar in size to that obtained in a systematic review comparing BtA with placebo. BtA was better tolerated.

Authors' conclusions

The available evidence suggests that BtA injections provide more objective and subjective benefit than trihexyphenidyl to patients with cervical dystonia. We could not draw any conclusions about other anticholinergic drugs. Future trials should explore the role of anticholinergic drugs in patients that do not get benefit with BtA.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

BtA injections provide more objective and subjective benefit than trihexyphenidyl to patients with cervical dystonia.

Cervical dystonia is characterized by involuntary posturing of the head and frequently is associated with neck pain. Disability and social withdrawal are common. Botulinum toxin Type A (BtA) is now the first line therapy but previously anticholinergics were the most widely accepted treatment. This review demonstrated that BtA injections are better than trihexyphenidyl, reduce involuntary muscular movements and tremor, reduce pain, and have fewer adverse effects as measured by objective scales and subjectively by patients.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

A型肉毒桿菌毒素與抗膽鹼藥物對頸部肌張力異常的比較

頸部肌張力異常是最常見的局部肌張力異常。它的特點是非自主性的頭部擺位,經常合併有頸部疼痛。失能和社會性退縮是常見的。大多數病例是不明原因的而且一般頸部肌張力障礙是一種終身疾病。A型肉毒桿菌毒素(BtA)是目前第一線治療方式。在BtA之前,抗膽鹼藥物是最被廣泛接受的治療,所以重要的是了解如何比較這兩者。

目標

要比較BtA與抗膽鹼藥物在治療頸部肌張力異常的臨床療效和安全性。

搜尋策略

我們搜尋了the Cochrane Movement Disorders Group trials register (June 2003), the Cochrane Central Register of Controlled Trials(The Cochrane Library Issue 2, 2003), MEDLINE 1977 to June 2003), EMBASE (1977to June 2003)和文章的參考文獻目錄.我們也連絡了製造商和在這個領域的研究員.

選擇標準

比較BtA和任何抗膽鹼藥物在治療頸部肌張力異常的隨機試驗.

資料收集與分析

2名審查員獨立評估試驗品質和提取數據。研究作者被聯繫以獲得更多信息。從試驗中收集不良反應的資訊。

主要結論

我們只找到1個適合加入的試驗,因此沒有進行綜合分析。它比較BtA與trihexyphenidyl在66個有頸肌張力異常的病人.雖然這是一個相對較小和短期的試驗,其結果也許可以推廣為一般族群,由於這個試驗是沒有偏差的而且產生了有明顯臨床意義的結果。其結果對BtA有利,差異的大小類似於從比較BtA和安慰劑的系統性回顧獲得的結果。BtA的耐受性較好。

作者結論

現有的證據暗示,BtA注射在有頸部肌張力異常的患者比trihexyphenidyl 提供更多客觀和主觀的好處。我們不能作出任何結論對其他抗膽鹼藥物。今後的試驗應探討抗膽鹼藥物的角色在沒有從BtA得到好處的病人。

翻譯人

本摘要由新光醫院李建欣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

BtA注射在有頸部肌張力異常的患者比trihexyphenidyl 提供更多客觀和主觀的好處。頸部肌張力異常的特點是非自主性的頭部擺位和經常合併有頸部疼痛。失能和社會性退縮是常見的。A型肉毒桿菌毒素(BtA)是目前第一線治療,但以前抗膽鹼藥物是最廣為接受的治療方式。這項回顧顯示BtA注射優於trihexyphenidyl,可以減少非自主性肌肉運動和顫動,減輕疼痛,並減少副作用,不管是以客觀的衡量方式或病人的主觀感受。