Impact on mental symptoms of botulinum toxin type A therapy in patients affected by focal dystonia and spasticity: preliminary results

Object:We performed a prospective study in 48 patients to evaluate the impact of botulinum toxin (BT) therapy on mental symptoms in patients affected by spasticity and focal dystonia. Method: 21 patients affected by spasticity (I group) and 27 patients affected by focal dystonia (II group) were included in the study. The patients were evaluated at baseline and 3 and 6 months after treatment; we studied the clinical effect of BT with Tsui and Columbia test in II group and with Medical Research Council Scale (MRC) and Modified Ashworth Scale in I group; all the patients were evaluated by center epidemiological study depression (CES-D), brief symptoms inventory (BSI) and attachment style questionnaire (ASQ); the II group by IIP-64, family apgar score (FAS), global clinical rating scale (GCRS), while the I group by short form-12 health survey questionnaire (SF-12); spastic patients’ caregivers were examined by CES-D and CBI. A total of 17 patients (10 with dystonia and 7 with spasticity) completed the follow up. Patients were treated with BT type A (Botox-Allergan USA, Dysport-Ipsen UK) at dosage ranging from 350 to 1,000 mouse Units (mU) for Dysport BT and 10 to 100 mU for Botox BT. Results: in patients with spasticity a positive trend was observed in CES-D whilst no differences were observed in caregivers before and after BT treatment. In dystonic patients we observed a reduction in global stress index in BSI after BT and no difference in CES-D while neurological scales showed an improvement after therapy. In conclusion psycopathological assessment is crucial in evaluating BT therapy benefits in addition to neurological evaluation.