A Multimodal Approach to Cervical Dystonia Treatment With Association of Botulinum Toxin and Motor Learning Techniques
- Conditions
- Cervical Dystonia,Primary
- Interventions
- Combination Product: Botulinum Toxin+SPRInt
- Registration Number
- NCT03247868
- Lead Sponsor
- Fondazione Don Carlo Gnocchi Onlus
- Brief Summary
the aim of this study protocol is to describe, using a longitudinal study, a multimodal approach of treatment of cervical dystonia with botulinum toxin (BoNTA) and a new rehabilitation protocol named SPRInt (Sensory-motor perceptive rehabilitation integrated) approach based on motor learning techniques and spatial rehabilitation.
- Detailed Description
Longitudinal study utilizing a multimodal treatment protocol developing in six months time:
Phase 1 : BoNTA injections localized in dystonic cervical muscles with EMG/US guides performed after polygraphy and kinematic analysis of cervical region Times: T0: pre treatment; T1: 6 weeks after T0 considered BoNTA pharmacological peak effect; T2: 12 weeks after T0 considered from guidelines and pharmaceutical data sheet the lowest BoNTA effect.
Phase 2: BoNTA performed in the same way of Phase 1 associated to SPRInt protocol Times: T2: before combination of BoNTA and rehabilitation treatment (18 sessions of 45 minutes three times a week); T3: 6 weeks after T2 considered BoNTA pharmacological peak effect and the end of SPRInt protocol; T4: 12 weeks after T2 considered from guidelines and pharmaceutical data sheet the lowest BoNTA effect and follow up of SPRInt-consolidation.
The SPRInt approach aims are to improve body perception, posture and movement quality and to restore body axis by using specific sensory feedbacks, both intrinsic (IFB) and extrinsic (EFB), and motor exercises (ME) with specific rhythmic temporal structure.The ME can be focused on different body parts (eyes, head, neck, trunk, arm) and involve different spatial planes (frontal, sagittal, horizontal, multiplanar).
The exercises can be performed with eyes closed and with an external passive motor leading in order to improve proprioception and facilitate sensory integration by excluding visual or verbal information that can be misleading for the patient. The ability to perceive and integrate intrinsic feedback is the fundamental element to create mental image that define body scheme and motor behaviour.
The extrinsic feedback can be continuous or discontinuous (on-off timing) and gives the patient information about the performance or result by positive or negative reinforcement; this process can be important to motivate and empower the patient in reaching new skills.
The final goal for the patient is to reinforce and retain the informations collected with working memory and then stored with the consolidation process which ends in learning new skills (ie rescue postural axis) and improving motor tasks (ie move the head in the opposite position).
At each time point these test are performed:
* CLINICAL SCALES i. Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)
1. Severity
2. Disability
3. Pain ii. Quality of life iii. Depression Beck Scale iv. Zung Self Rating Anxiety Scale v. Rey Test to test visuo spatial abilities
* MOVEMENT ANALYSIS and KINEMATIC AND EMG MAPPING of cervical region ( head and neck)
* FUNCTIONAL MAGNETIC RESONANCE BRAIN STUDY to perform brain measurements of functional connectivity (resting state-Default Mode Network), morphometry (volume, area, cortical thickness, cortical curvature, node degree) and tractography.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 20
- more than 18 yo
- diagnosis of idiopathic cervical dystonia
- disease duration more than 6 months
- diagnosis of secondary dystonia on previously performed neuroimaging data (ie structural lesion of cervical spine, vascular or traumatic brain injuries)
- history of neuroleptic drug treatment (antidopaminergic drugs)
- associated neurological illness
- botulinum toxin treatment in the 3 previous months before recruitment
- head tremor without dystonic posturing
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Botulinum toxin+SPRInt protocol Botulinum Toxin+SPRInt patients affected by cervical dystonia receive botulinum toxin treatment (EMG-US guided injections in dystonic muscles) for two times at T0 and T2; after T2 patients are treated also with SPRInt rehabilitation protocol based on motor learning techniques.
- Primary Outcome Measures
Name Time Method Dystonia phenomenology improvement every six weeks during six months time a clinical assessment of dystonia will be conducted at each study visit using TWSTRS
- Secondary Outcome Measures
Name Time Method depression every six weeks during six months time depression scale (BECK)
quality of life every six weeks during six months time a clinical assessment of dystonia severity will be conducted at each study visit using quality of life scale (EQ5D5L)
brain plasticity every six weeks during six months time study of functional connectivity using functional magnetic resonance
structural grey matter plasticity every six weeks during six months time brain study of morphometry using functional magnetic resonance
anxiety every six weeks during six months time anxiety scale (ZUNG)
structural white matter plasticity every six weeks during six months time tractography of brain areas using functional magnetic resonance
kinematic assessment of dystonia severity every six weeks during six months time visit with optoelectronic system
Trial Locations
- Locations (1)
IRCCS Fondazione Don Gnocchi
🇮🇹Milano, MI, Italy