Efficacy and safety of valbenazine in the treatment of cervical dystonia: a pilot study

BackgroundVesicular monoamine transporter-2 inhibitors have provided on-label success in the treatment of tardive dyskinesia (TD) and Huntington’s disease chorea (HDC). A similar pathophysiological pathway for cervical dystonia suggests valbenazine (VBZ) could be beneficial in this condition.Objecti...

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Main Authors: Salma Aziz, Erin Pellot, Laxman Bahroo, Abhishek Wajpe, Martin T. Taylor
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Dystonia
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Online Access:https://www.frontierspartnerships.org/articles/10.3389/dyst.2025.13923/full
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author Salma Aziz
Erin Pellot
Laxman Bahroo
Abhishek Wajpe
Martin T. Taylor
author_facet Salma Aziz
Erin Pellot
Laxman Bahroo
Abhishek Wajpe
Martin T. Taylor
author_sort Salma Aziz
collection DOAJ
description BackgroundVesicular monoamine transporter-2 inhibitors have provided on-label success in the treatment of tardive dyskinesia (TD) and Huntington’s disease chorea (HDC). A similar pathophysiological pathway for cervical dystonia suggests valbenazine (VBZ) could be beneficial in this condition.ObjectiveTo determine the efficacy of VBZ in reducing symptoms of pain and posturing and improving quality of life in subjects with cervical dystonia.MethodsThis was an open-label, prospective study of subjects with a clinical diagnosis of cervical dystonia currently being treated with botulinum neurotoxin (BoNT) for >6 months. Valbenazine was titrated to 80 mg per day with no change in BoNT dosage or muscle location. Evaluations were performed 4 weeks prior to the subject’s scheduled BoNT treatment date BoNTmax/-VBZ (time 1) compared to 4 weeks prior to the subject’s next BoNT treatment date BoNTmax/+VBZ (time 4). TheBoNT injection treatment date BoNTmin/VBZ dispensing (time 2) and the next BoNT injection treatment date BoNTmin/+VBZ (time 5) were compared. Efficacy was assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTR), Neck Pain Disability Index (NPDI). Visual analog scale (VAS, 0–10) for pain/pulling/jerking, Pittsburgh Sleep Quality Index (PSQI), Clinical Global Impression of Change (CGIC) and Patient Global Impression of Change (PGIC) Scales.ResultsFourteen subjects were enrolled and followed for a total of 16 weeks. TWSTRS Total Score was significantly improved at time 4 compared to time 1 (p = 0.02), as well as VAS 0–10 scores for 24 Hour (p = 0.001), Past Week Pull (p = 0.0001), and Past Week Jerk (p = 0.04). TWSTRS Total Score was significantly improved at time 5 compared to time 2 (p = 0.02) as well as 24 Hour Pull (p = 0.01), 24 Hour Jerk (p = 0.04), Past Week Pull (p = 0.002), and Past Week Jerk (p = 0.02). Subjective improvement was reported at times 3, 4 and 5 on CGIC and PGIC Scales. No significant improvements were seen in the PSQI and NPDI. The medication was tolerated well with fatigue as the most common adverse effect.ConclusionThis exploratory study demonstrates a potential benefit in the addition of VBZ for the treatment of cervical dystonia associated with severe pain and posturing.
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spelling doaj-art-bfb5364d715f41fbafe39d9c5069501c2025-08-20T01:51:35ZengFrontiers Media S.A.Dystonia2813-21062025-05-01410.3389/dyst.2025.1392313923Efficacy and safety of valbenazine in the treatment of cervical dystonia: a pilot studySalma Aziz0Erin Pellot1Laxman Bahroo2Abhishek Wajpe3Martin T. Taylor4Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United StatesHeritage College of Osteopathic Medicine, Ohio University, Athens, OH, United StatesDepartment of Neurology, Georgetown University Medical Center, Washington, DC, United StatesHeritage College of Osteopathic Medicine, Ohio University, Athens, OH, United StatesHeritage College of Osteopathic Medicine, Ohio University, Athens, OH, United StatesBackgroundVesicular monoamine transporter-2 inhibitors have provided on-label success in the treatment of tardive dyskinesia (TD) and Huntington’s disease chorea (HDC). A similar pathophysiological pathway for cervical dystonia suggests valbenazine (VBZ) could be beneficial in this condition.ObjectiveTo determine the efficacy of VBZ in reducing symptoms of pain and posturing and improving quality of life in subjects with cervical dystonia.MethodsThis was an open-label, prospective study of subjects with a clinical diagnosis of cervical dystonia currently being treated with botulinum neurotoxin (BoNT) for >6 months. Valbenazine was titrated to 80 mg per day with no change in BoNT dosage or muscle location. Evaluations were performed 4 weeks prior to the subject’s scheduled BoNT treatment date BoNTmax/-VBZ (time 1) compared to 4 weeks prior to the subject’s next BoNT treatment date BoNTmax/+VBZ (time 4). TheBoNT injection treatment date BoNTmin/VBZ dispensing (time 2) and the next BoNT injection treatment date BoNTmin/+VBZ (time 5) were compared. Efficacy was assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTR), Neck Pain Disability Index (NPDI). Visual analog scale (VAS, 0–10) for pain/pulling/jerking, Pittsburgh Sleep Quality Index (PSQI), Clinical Global Impression of Change (CGIC) and Patient Global Impression of Change (PGIC) Scales.ResultsFourteen subjects were enrolled and followed for a total of 16 weeks. TWSTRS Total Score was significantly improved at time 4 compared to time 1 (p = 0.02), as well as VAS 0–10 scores for 24 Hour (p = 0.001), Past Week Pull (p = 0.0001), and Past Week Jerk (p = 0.04). TWSTRS Total Score was significantly improved at time 5 compared to time 2 (p = 0.02) as well as 24 Hour Pull (p = 0.01), 24 Hour Jerk (p = 0.04), Past Week Pull (p = 0.002), and Past Week Jerk (p = 0.02). Subjective improvement was reported at times 3, 4 and 5 on CGIC and PGIC Scales. No significant improvements were seen in the PSQI and NPDI. The medication was tolerated well with fatigue as the most common adverse effect.ConclusionThis exploratory study demonstrates a potential benefit in the addition of VBZ for the treatment of cervical dystonia associated with severe pain and posturing.https://www.frontierspartnerships.org/articles/10.3389/dyst.2025.13923/fullcervical dystoniavalbenazinedystoniabotulinum neurotoxinclinical research
spellingShingle Salma Aziz
Erin Pellot
Laxman Bahroo
Abhishek Wajpe
Martin T. Taylor
Efficacy and safety of valbenazine in the treatment of cervical dystonia: a pilot study
Dystonia
cervical dystonia
valbenazine
dystonia
botulinum neurotoxin
clinical research
title Efficacy and safety of valbenazine in the treatment of cervical dystonia: a pilot study
title_full Efficacy and safety of valbenazine in the treatment of cervical dystonia: a pilot study
title_fullStr Efficacy and safety of valbenazine in the treatment of cervical dystonia: a pilot study
title_full_unstemmed Efficacy and safety of valbenazine in the treatment of cervical dystonia: a pilot study
title_short Efficacy and safety of valbenazine in the treatment of cervical dystonia: a pilot study
title_sort efficacy and safety of valbenazine in the treatment of cervical dystonia a pilot study
topic cervical dystonia
valbenazine
dystonia
botulinum neurotoxin
clinical research
url https://www.frontierspartnerships.org/articles/10.3389/dyst.2025.13923/full
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