Long-term efficacy and safety of botulinum toxin treatment for cervical dystonia: a critical reappraisal.

IntroductionBotulinum toxin (BoNT) injections represent the "gold standard" treatment for cervical dystonia (CD). Different types of BoNT have been used for the treatment of CD, but only two serotypes, BoNT type A (BoNT-A) and type B (BoNT-B), have been approved by regulatory agencies. Efficacy and safety of BoNT have been well documented by many short-term studies, but the long-term effects have been investigated only relatively recently.Areas coveredIn the present review, we aimed to critically reappraise the existing evidence on the long-term efficacy and safety of BoNT treatment in CD. The examined studies mainly explored BoNT-A serotypes. Only a few studies examined the long-term effects of BoNT-B serotypes, and only one head-to-head comparison between BoNT-A and BoNT-B was found. BoNT was consistently reported to be an effective and safe treatment for CD patients, with good outcomes and a few adverse events in the long-term. However about a third of patients still drop out from the treatment during a long-term follow-up.Expert opinionWe conclude that BoNT is safe and effective in the long-term treatment of patients with CD. Additional studies are needed to further explore patients' real-life experiences and perspectives to better understand the long-term outcomes and reasons for discontinuation of treatment.