{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T18:01:54Z","timestamp":1776103314264,"version":"3.50.1"},"reference-count":11,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T00:00:00Z","timestamp":1611878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Botulinum neurotoxin type A (BoNT\/A) injections have to be administered repeatedly to achieve a rather stable, high level of improvement. This study aimed to take a look at changes in the daily routine of a BoNT\/A outpatient clinic due to the SARS-CoV-2 pandemic lockdown, analyze the impact of SARS-CoV-2-induced re-injection delay on outcomes in patients with cervical dystonia (CD) (n = 36) and four other disease entities (n = 58), and study the influence of covariables, including previous injections and doses. For the present observational study, the first 100 patients who were scheduled to have an appointment between April 20 and May 18 during the partial lockdown and also had been treated regularly before the lockdown were recruited. Clinical and demographical characteristics and treatment-related data from the previous visits were extracted from charts. Time delay, symptom severity assessment, and TSUI score (if applicable) were gathered at the first coronavirus pandemic lockdown emergency visit for each patient. Of the 94 patients who could come to the clinic, 48 reported a delay and 44 reported worsening during the delay. Delays ranged from 1 to 63 days, the mean delay was 23 days, and the mean worsening was 26% compared to the previous visit. A significant correlation was found between the duration of the delay and the patient\u2019s rating of worsening (PwP). In CD patients, the physician\u00b4s rating of CD worsening by the TSUI score (ATUSI-PTSUI) was significantly correlated with general worsening (DwP) and the TSUI at the last visit (PTSUI). A small delay of a few weeks led to a similar worsening of symptoms in CD and all other disease entities and to relapse on a higher level of severity. This relapse can only be compensated by continuous treatment up to at least 1 year until patients reach the same level of treatment efficacy as that before the SARS-CoV-2 pandemic.<\/jats:p>","DOI":"10.3390\/toxins13020101","type":"journal-article","created":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T11:34:33Z","timestamp":1611920073000},"page":"101","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Impact of SARS-CoV-2 Pandemic Lockdown on a Botulinum Toxin Outpatient Clinic in Germany"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3593-1852","authenticated-orcid":false,"given":"Sara","family":"Samadzadeh","sequence":"first","affiliation":[{"name":"Department of Neurology, University Hospital of D\u00fcsseldorf, D-40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphaela","family":"Brauns","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of D\u00fcsseldorf, D-40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dietmar","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of D\u00fcsseldorf, D-40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1069-7684","authenticated-orcid":false,"given":"Harald","family":"Hefter","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of D\u00fcsseldorf, D-40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1212\/WNL.0000000000002560","article-title":"Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology","volume":"86","author":"Simpson","year":"2016","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1007\/s00415-019-09681-7","article-title":"Effective long-term treatment with incobotulinumtoxin (Xeomin\u00ae) without neutralizing antibody induction: A monocentric, cross-sectional study","volume":"267","author":"Hefter","year":"2020","journal-title":"J. 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Infection fatality rate of SARS-CoV-2 infection in a German community with a super-spreading event. medRxiv.","DOI":"10.1101\/2020.05.04.20090076"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1212\/01.WNL.0000163767.99354.C3","article-title":"A new botulinum toxin type a free of complexing proteins for treatment of cervical dystonia","volume":"64","author":"Benecke","year":"2005","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.parkreldis.2018.07.019","article-title":"Quality of life in long-term botulinum toxin treatment of cervical dystonia: Results of a cross sectional study","volume":"57","author":"Moll","year":"2018","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_8","unstructured":"Spiess, C.E.F., Hartung, H.P., and Hefter, H. (2021, January 29). Auswirkungen unterschiedlicher Injektionsstrategien bei der Langzeitbehandlung der zervikalen Dystonie mit Botulinumtoxin, A. Available online: https:\/\/docserv.uni-duesseldorf.de\/servlets\/DocumentServlet?id=3173."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.toxicon.2020.02.020","article-title":"Clinical duration of action of different botulinum toxin types in humans","volume":"179","author":"Eleopra","year":"2020","journal-title":"Toxicon Off. J. Int. Soc. Toxinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3389\/fneur.2017.00035","article-title":"Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin","volume":"8","author":"Contarino","year":"2017","journal-title":"Front. 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