Benefits, Safety, and Adjunct Modality Prevalences of Long-Term Botulinum Toxin Injections for Cervical Dystonia and Myofascial Neck Pain: A Retrospective Cohort Study
Bibliographic record
Abstract
Dion Diep,1 Jasmine Ko,2 John Lan,3 Kinga T Koprowicz,3 Gordon Ko3,4 1MD Program, University of Toronto, Toronto, ON, Canada; 2Department of Kinesiology, McMaster University, Hamilton, ON, Canada; 3Canadian Centre of Integrative Medicine, Toronto, ON, Canada; 4Division of Physical Medicine & Rehabilitation, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaCorrespondence: Gordon KoClinical Adjunct Lecturer, Division of Physical Medicine & Rehabilitation, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, CanadaTel +1416-480-4342Fax +1416-480-6885Email drgordko@rogers.comIntroduction: There is a paucity of long-term treatment benefit and safety data of botulinum toxin A (BTX-A) for cervical dystonia (CD) and myofascial neck pain syndrome (MPS). Additionally, the prevalence of adjunct modality uses during this period is unknown despite evolving practices.Objective: To assess and compare treatment benefit, safety, and adjunct modality prevalences of long-term BTX-A injections between CD and MPS patients.Design: Retrospective cohort study.Setting: Private practice tertiary care clinics in Toronto.Patients: Convenience sample of 37 (52.9%) CD and 33 (47.1%) MPS patients treated for a mean±SD duration of 7.2± 4.3 and 8.3± 4.7 years, respectively.Interventions: BTX-A injections administered at least once yearly, for a duration longer than 1 year.Main Outcome Measures: Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS) for disability and pain, Patient Global Impression of Change (PGIC) score, time to peak effect, duration of total response, adverse effects, and prevalence of adjunct modalities.Results: CD patients experienced improvements in TWSTRS disability (17.57± 6.79 to 9.81± 4.35, p< 0.001) and pain (14.61± 3.08 to 9.05± 3.49, p< 0.001) scores as well as PGIC score (52.00%± 23.60% to 64.80%± 23.60%, p=0.007). MPS patients experienced improvements in TWSTRS disability (15.86± 7.70 to 10.07± 7.01, p=0.01) and pain (15.25± 4.09 to 10.85± 4.49, p=0.01) scores. In both cohorts, there were no changes in time to peak effect and duration of total response. Adverse effects were minimal and self-limiting. Prevalences of adjunct modalities used by CD versus MPS patients were 28.13% versus 50.00% for anesthetic procedures, 23.08% versus 15.38% for image-guidance, 65.71% versus 56.25% for pectoralis minor injections, and 47.06% versus 53.13% for cannabis-use.Conclusion: There were demonstrated and comparable treatment benefit, safety, and adjunct modality prevalences. Our study is the first to demonstrate that long-term BTX-A injections for MPS, although commonly used off-label, can be effective and safe.Keywords: botulinum toxin, cervical dystonia, myofascial pain syndrome
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".