{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T15:42:57Z","timestamp":1788190977959,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Rajavithi Hospital, Department of Medical Services, and Ministry of Public Health, Thailand and Chiang Mai University, Chiang Mai, Thailand","award":["RH 1\/2562 and CMU 2565\/1"],"award-info":[{"award-number":["RH 1\/2562 and CMU 2565\/1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Various types of botulinum toxin (BoNT) have been studied to treat cervical dystonia (CD). Although high-dose BoNT has proven efficacy, it increases the risk of adverse events. For this reason, this study was planned to identify the non-inferiority efficacy, tolerability, and safety of low-dose neubotulinum toxin A (Neu-BoNT-A) versus low-dose abobotulinum toxin A (Abo-BoNT-A) in CD treatment. The 48-week, prospective, randomized, controlled crossover design study of CD treatment, with 50-unit Neu-BoNT-A and 250-unit Abo-BoNT-A injections at 12-week intervals, was conducted over a 24-week treatment period. This study used the following standardized rating scales to assess the efficacy of BoNT: the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS); health-related quality of life (HRQoL); the Cervical Dystonia Impact Profile (CDIP-58); the Short Form 36 health survey questionnaire (SF-36); and, for the depressive symptoms of CD patients, the Center for Epidemiological Studies-Depression Scale (CES-D) and the Patient Health Questionnaire-9 (PHQ-9). Fifty-two CD patients were enrolled from October 2019 to January 2021. The mean scores of the TWSTRS total at the post-treatments in both Neu-BoNT-A and Abo-BoNT-A had a significant reduction from baseline (p = 0.008 and 0.002, respectively). However, the mean changes of the TWSTRS total at the 12- and 24-week treatments between the two treatment groups were not significantly different (p = 0.284 and 0.129, respectively). The mean scores of the HRQoL questionnaires (the CIDP-58 and the SF-36) and the depressive symptoms (the CES-D and the PHQ-9) in both treated groups at the post-treatments did not significantly decrease from baseline and were comparable. Two patients treated with Abo-BoNT-A (250 units) reported cervical tension and benign paroxysmal positional vertigo (BPPV). There were no serious adverse events reported. Though both low-dose BoNT-As were effective at improving clinical symptoms without significant side effects, both treatments did not predict change in quality of life and depression. With the non-inferiority criteria, low-dose Neu-BoNT-A has a similar efficacy, safety, and tolerability to Abo-BoNT-A.<\/jats:p>","DOI":"10.3390\/toxins13100694","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T01:59:47Z","timestamp":1633917587000},"page":"694","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Low-Dose Neubotulinum Toxin A versus Low-Dose Abobotulinum Toxin A Injection for the Treatment of Cervical Dystonia: A Multicenter, 48-Week, Prospective, Double-Blinded, Randomized Crossover Design Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4613-1730","authenticated-orcid":false,"given":"Subsai","family":"Kongsaengdao","sequence":"first","affiliation":[{"name":"Division of Neurology, Rajavithi Hospital, Department of Medical Services, Ministry of Public Health, Bangkok 10400, Thailand"},{"name":"Division of Neurology, Department of Medicine, College of Medicine, Rangsit University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arkhom","family":"Arayawithchanont","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani 34000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanoksri","family":"Samintharapanya","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine Lampang Hospital, Lampang 52000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pichai","family":"Rojanapitayakorn","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine Suratthani Hospital, Suratthani 84000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benchalak","family":"Maneeton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narong","family":"Maneeton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.toxicon.2013.06.014","article-title":"Effects of enzymatically inactive recombinant botulinum neurotoxin type A at the mouse neuromuscular junctions","volume":"72","author":"Baskaran","year":"2013","journal-title":"Toxicon"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S109","DOI":"10.1002\/mds.20024","article-title":"Treatment of cervical dystonia with botulinum toxin","volume":"19","author":"Jankovic","year":"2004","journal-title":"Mov. 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