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White Matter Changes in Cervical Dystonia Relate to Clinical Effectiveness of Botulinum Toxin Treatment982.55 kB
Published VersionCC BY V4.0, Open Access
Journal article
White Matter Changes in Cervical Dystonia Relate to Clinical Effectiveness of Botulinum Toxin Treatment
Frontiers in Neurology, Vol.10, pp.1-17
2019
Abstract
In a previous report showing white matter microstructural hemispheric asymmetries medial to the pallidum in focal dystonias, we showed preliminary evidence that this abnormality was reduced 4 weeks after botulinum toxin (BTX) injections. In the current study we report the completed treatment study in a full-size cohort of CD patients (n = 14). In addition to showing a shift toward normalization of the hemispheric asymmetry, we evaluated clinical relevance of these findings by relating white matter changes to degree of symptom improvement. We also evaluated whether the magnitude of the white matter asymmetry before treatment was related to severity, laterality, duration of dystonia, and/or number of previous BTX injections. Our results confirm the findings of our preliminary report: we observed significant fractional anisotropy (FA) changes medial to the pallidum 4 weeks after BTX in CD participants that were not observed in controls scanned at the same interval. There was a significant relationship between magnitude of hemispheric asymmetry and dystonia symptom improvement, as measured by percent reduction in dystonia scale scores. There was also a trend toward a relationship between magnitude of pre-injection white matter asymmetry and symptom severity, but not symptom laterality, disorder duration, or number of previous BTX injections. Post-hoc analyses suggested the FA changes at least partially reflected changes in pathophysiology, but a dissociation between patient perception of benefit from injections and FA changes suggested the changes did not reflect changes to the primary “driver” of the dystonia. In contrast, there were no changes or group differences in DTI diffusivity measures, suggesting the hemispheric asymmetry in CD does not reflect irreversible white matter tissue loss. These findings support the hypothesis that central nervous system white matter changes are involved in the mechanism by which BTX exerts clinical benefit.
Details
- Title
- White Matter Changes in Cervical Dystonia Relate to Clinical Effectiveness of Botulinum Toxin Treatment
- Authors
- Anne J Blood (Author) - Massachusetts General HospitalJohn K Kuster (Author) - Massachusetts General HospitalJeff L Waugh (Author) - Massachusetts General HospitalJacob Levenstein (Author) - Massachusetts General HospitalTrisha J Multhaupt-Buell (Author) - Massachusetts General HospitalLewis R Sudarsky (Author) - Harvard Medical SchoolHans C Breiter (Author) - Massachusetts General HospitalNutan Sharma (Author) - Massachusetts General Hospital
- Publication details
- Frontiers in Neurology, Vol.10, pp.1-17
- Publisher
- Frontiers Research Foundation
- Date published
- 2019
- DOI
- 10.3389/fneur.2019.00265
- ISSN
- 1664-2295
- Copyright note
- © 2019 Blood, Kuster, Waugh, Levenstein, Multhaupt-Buell, Sudarsky, Breiter and Sharma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
- Organisation Unit
- University of the Sunshine Coast, Queensland; Thompson Institute
- Language
- English
- Record Identifier
- 99639279002621
- Output Type
- Journal article
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- Domestic collaboration
- Web Of Science research areas
- Clinical Neurology
- Neurosciences
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