Comprehensive diagnosis of cervical dystonia and the efficacy of long-term (three-year) botulinum therapy
Bibliographic record
Abstract
Cervical dystonia (CD) is common in outpatient practice but in many cases is diagnosed at late stages. The efficacy of long-term botulinum therapy (BT) in CD has been poorly studied. Objective: to analyse the typical practice of treating patients with CD and the efficacy of long-term BT therapy (three years). Material and methods . Sixty-three patients (43 women and 20 men) diagnosed with CD (mean age 51 [42; 63] years) participated in the study. We performed an analysis of typical practice of managing patients with CD before starting BT. The mean duration of disease at the time of referral was 6 [4; 10] years. Patients received repeated injections of BT at 10–20 week intervals; BT was administered under electromyographic control and ultrasound navigation. The severity of CD was assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWRSTW), quality of life using the EuroQol-5D questionnaire (EQ-5D) questionnaire, and anxiety level using the Generalized Anxiety Disorder Questionnaire scale-7, GAD-7). Patients' condition was assessed at baseline, 1 month after BT, and after 3 years against the background of regular BT. The severity of the disease before BT was 36.71±3.6 points. The control group consisted of 46 healthy subjects (39 women and 7 men, mean age 53.8±12.3 years). Results. The diagnosis of CD was made on average 2.3±1.1 years after the onset of the first symptoms, BT was started on average 5±2.6 years after diagnosis. At the first visit to the physician, CD was detected in only 32% of cases. In the CD group there was an increase in the severity of anxiety up to 9.93±4.7 points (in the control group – 4.28±3.5 points; p≤0.05) and a decrease in quality of life down to 62.53±12.1 points (in the control group – 86.38±6.4 points; p≤0.05). One month after BT, a significant decrease in the severity of the disease was observed – from 36.7±13.6 to 13.3±10.8 points (p≤0.05). After three years of regular BT the severity of the disease decreased to 12.7±10.5 points (p≤0.05), the level of anxiety decreased to 5.2±3.7 points (p≤0.05), the patients' quality of life increased up to 77.93±8.4 points (p≤0.05). Conclusion. CD is still underdiagnosed in practice, and BT is not prescribed until several years after the onset of the disease. Regular and longterm use of BT not only reduces the severity of CD, but also reduces the severity of anxiety disorders and improves patients' quality of life.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".