Anticholinergic Burden and Botulinum Toxin Needs after Deep Brain Stimulation in Adult and Pediatric Patients with Dystonia

Background Anticholinergic medications and botulinum neurotoxin injections are established treatments for dystonia, yet they carry potential side effects and practical challenges. Deep brain stimulation (DBS) is offered in case of poor response to these approaches.Objectives To assess the need for anticholinergic medications and botulinum neurotoxin injections in adult and pediatric patients at two specialized Canadian centers before and after DBS over the past 10 years.Methods 58 patients were included analyzing data before, 6 and 12 months after DBS. Clinical assessment included the Toronto Western Spasmodic Torticollis Rating Scale and Fahn-Marsden Dystonia Rating Scale. Anticholinergic burden was determined by the Anticholinergic Drug Scale (ADS).Results Severity of cervical dystonia and ADS scores reduction were statistically significant after DBS. Anticholinergic medication and Botulinum Neurotoxin injections were discontinued a year after surgery in 28.8% and 72.4% of the patients, respectively.Conclusion Simplification of anti-dystonia treatments is another added benefit of DBS.