Autonomic cardiovascular function and baroreflex sensitivity in patients with cervical dystonia receiving treatment with botulinum toxin type A

• Published in: Journal of neurology Vol. 255; no. 6; pp. 843 - 847
• Main Authors: Tiple, D., Strano, S., Colosimo, C., Fabbrini, G., Calcagnini, G., Prencipe, M., Berardelli, A.
• Format: Journal Article
• Language: English
• Published: Darmstadt Steinkopff-Verlag 01.06.2008; Springer; Springer Nature B.V
• Subjects: Adult; Autonomic Dysreflexia - chemically induced; Autonomic Dysreflexia - physiopathology; Autonomic Nervous System - drug effects; Autonomic Nervous System - physiopathology; Baroreflex - drug effects; Biological and medical sciences; Blood Pressure - drug effects; Blood Pressure - physiology; Botulinum Toxins, Type A - adverse effects; Cardiovascular Physiological Phenomena - drug effects; Cardiovascular System - drug effects; Cardiovascular System - innervation; Cardiovascular System - physiopathology; Diseases of striated muscles. Neuromuscular diseases; Female; Heart Rate - drug effects; Heart Rate - physiology; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuromuscular Agents - adverse effects; Neuroradiology; Neurosciences; Original Communication; Posture - physiology; Reflex, Abnormal - drug effects; Reflex, Abnormal - physiology; Tilt-Table Test; Torticollis - drug therapy; botulinum toxin; cervical dystonia; spectral analysis; cardiovascular reflex tests; autonomic cardiovascular function; Human; Reflex; Nervous system diseases; Enzyme; Metalloendopeptidases; Spectral analysis; Involuntary movement; Cerebral disorder; Peptidases; Striated muscle disease; Bontoxilysin; Sensitivity; Treatment; Baroreflex; Central nervous system disease; Hydrolases; Dystonia; Neurological disorder; Extrapyramidal syndrome
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-008-0753-6

Objective To investigate possible changes in autonomic cardiovascular regulation and cardiopulmonary baroreflex sensitivity in patients with primary cervical dystonia receiving chronic treatment with botulinum toxin type A. Methods Short-term power spectral analysis of heart rate and systolic blood pressure variability, high-frequency and low-frequency oscillations of heart rate variability, low frequency/high frequency ratio and baroreflex sensitivity ( α index) were measured in 12 patients with cervical dystonia before and 2–4 weeks after botulinum toxin type A injection and compared with normative data. Results Before treatment, at rest, patients had significantly lower high frequency power than healthy subjects (p < 0.01), whereas no differences were found in low frequency power. Botulinum toxin injection in patients induced no changes in either power frequency. In patients before treatment and healthy subjects the low frequency oscillatory components increased similarly from rest to tilt (p < 0.01), but tilt induced lower low frequency values in patients than in healthy subjects (p < 0.01). In patients before treatment, the high frequency variations from rest to tilt remained unchanged, whereas in healthy subjects they decreased significantly (p < 0.01). Botulinum toxin type A injection in patients induced no changes in low frequency or high frequency powers. In patients before treatment the low frequency/high frequency ratio increased slightly from rest to tilt, but in healthy subjects increased significantly (p < 0.01). Botulinum toxin type A left the pretreatment low frequency/high frequency ratio unchanged. The α -index measured at rest in patients before treatment was lower than in healthy subjects (p<0.05), whereas during tilt was similar in both groups. The α -index measured after botulinum toxin injection in patients remained unchanged at rest and during tilt. Conclusions Patients with cervical dystonia receiving treatment with botulinum toxin type A have mild, subclinical abnormalities in autonomic cardiovascular regulation and cardiopulmonary baroreflex sensitivity. These changes do not worsen after acute botulinum toxin type A injection.