ORIGINAL RESEARCH article
Front. Neurol.
Sec. Movement Disorders
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1553989
This article is part of the Research TopicNeurological Involvement in Heavy Metal Accumulation and Neurotoxin ExposureView all 3 articles
Do female and male patients with cervical dystonia respond differently to longterm botulinum neurotoxin therapy?
Provisionally accepted
- 1Klinik für Neurologie, Universitätsklinikum Düsseldorf, Dusseldorf, Germany
- 2Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Unverstät zu Berlin, Experimental and Clinical Research Center, 13125 Berlin, Germany, Berlin, Baden-Württemberg, Germany
- 3Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- 4Department of Neurology, Slagelse Hospital, Slagelse, Denmark
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Background: Idiopathic cervical dystonia (CD) affects more females than males. This sex-based influence on the clinical manifestation of CD may also impact outcomes after long-term BoNT therapy. Methods: To analyze the potential differential influence of sex on the efficacy of BoNT therapy, a cross-sectional study was conducted with 135 female and 85 male patients with idiopathic cervical dystonia. Demographic and treatment-related data were extracted from patient charts. The 24-item Cervical Dystonia Questionnaire (CDQ24), patients' self-assessment of CD severity (PAS), and the TSUI score were used as outcome measures. On the day of recruitment, blood samples were collected to analyze neutralizing antibody formation (NAB) using an ELISA, with confirmation by the MHDA test. Results: Male patients had significantly (p < 0.02) lower mean age and age at symptom onset and received significantly (p < 0.02) higher BoNT doses per session. Female patients had significantly worse PAS and CDQ24 scores (p < 0.006), though the TSUI score showed no significant difference (p = 0.19). Despite receiving lower BoNT doses, female patients exhibited a significantly (p < 0.006) higher risk of NAB induction.Conclusions: This reanalysis of previously published data reveals that female and male patients in this cohort were treated and responded differently to long-term BoNT therapy, a discrepancy that remained unnoticed by their treating physicians over more than 10 years of treatment.
Keywords: Cervical dystonia, Botulinum Neurotoxin, Long-term outcome, females, males, Antibody Formation
Received: 31 Dec 2024; Accepted: 26 May 2025.
Copyright: © 2025 Hefter, Samadzadeh and moll. 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) or licensor 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.
* Correspondence: Harald Hefter, Klinik für Neurologie, Universitätsklinikum Düsseldorf, Dusseldorf, Germany
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