Poster Number:2220

CONCLUSIONS
The majority of patients were treated with doses that fell below
OnabotulinumtoxinA for the Management of Movement the 25th percentile, as described in the labeled dosage
guideline in India (25th-75th percentile ranges 198U-300U).
Disorders: A KAP Survey among Indian Neurologists ② Majority of physicians diagnosed CD quickly but there was
Vinay Goyal(1), Pettarusp Murzban Wadia (2), Hrishikesh Kumar (3), Prashanth L.K (4), Salil Gupta (5), Kumar Gaurav delay in initiation of OnabotA treatment for CD with shorter
(6), Ammar Raza (7), Aleks Zuzek (8), Anand Patel (9) duration of follow up.
1Department of Neurology , All India Institute of Medical Sciences, New Delhi, India; 2Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India;
③ Physician’s education on goal & expectation settings, (i.e. to
3Instituteof Neurosciences, Kolkata, West Bengal, India; 4Institute of Neurosciences , Apollo Hospital, Bengaluru, Karnataka, India; 5Army Hospital optimize dosing), adequate follow-up, and differentiating
(Research & Referral), Delhi Cantt, New Delhi, India; 6Allergan Healthcare India Private Limited, Bengaluru, Karnataka, India; 7Allergan Healthcare India primary and secondary dystonia’s is anticipated to improve
Private Limited, Bengaluru, Karnataka, India; 8Allergan plc, Irvine, CA , United States; 9Allergan plc, Buckinghamshire, United Kingdom
patient outcomes.

• This is a national, multi-centre, cross sectional, observational Figure 2: Most common misdiagnosis made in patients with CD
METHODS

survey 60% 54.76%

• Neurologist with >1 year experience in treating movement
50%

Percentage of respondents
disorders (MD) with OnabotA were included
40%
• Survey was sent out to 178 Indian Neurologists across India
after their informed consent 30%

• The survey was a 52-item questionnaire divided into three- 20% 15.48%
10.71%
sections: Demographics, infrastructure settings, and practice 10%
patterns 1.19%
RESULTS

0%
Spondylitis Arthritis Essential Tremors Any other
Disposition, Demographics, and Clinical Characteristics
• Interim results presented here are based on analyses of Figure 3: Time taken by physician in diagnosing Cervical
responses pertaining to Cervical Dystonia (CD) from 84 Dystonia from the initial complaints
neurologists, all percentages based on n=84 respondents. Time to Diagnose the CD
• Survey had a good geographic expanse with participants from 60 54.8

west (38.09%), north (34.52%), northeast (2.38%), east 50

(14.29%) and south (8.33%) India. 40

% of Patient
28.6
• Most of the respondents belonged to a corporate hospital 30

(40.48%), the least belonged to a government institution 20 16.6

(17.86%). 20.24% respondents worked at a clinic, and 19.05% 10

at a private academic institute. 0
< 6 months > 6 motnhs No response
• Majority of the neurologist (53.57%) had >6 years of
experience treating movement disorders with OnaBotulinum Figure 4: Time to initiate first OnabotA as primary therapy after
Toxin A and 25% & 19.05% percentage of neurologist had 3-5 diagnosis
and 1-2 years of experience, respectively.
Time to initiate OnabotA treatment
OnabotulinumtoxinA Treatment Information for CD 60
Percentage of Responses

Majority (67.9%) believed OnabotA is first line treatment for CD. 50

69% felt distinguishing primary from secondary dystonia’s was 40

difficult and CD was typically misdiagnosed as spondylitis by 30

54.8% respondents (Figure 1 and 2). 20

10
Majority (54.8%) diagnosed CD within 6 months and 28.6%
0
diagnosed it later than 6 months whereas 16.6% did not respond <1 Year 1-3 Years >3 Years
(Figure 3). Time taken to initiate therapy
50% stated that patients received treatment within 1 year
whereas 29.4% and 20.6% responded that patients received Figure 5: Average Total Dose-range of OnabotA for CD preferred
treatment -3 years and >3 years, respectively (Figure 4). by Physicians
Respondents were given predefined dose-ranges and asked to
choose most commonly used range for CD: 51.2% chose 100U- Preferred CD Treatment Dose-Range
60
200U; 21.4% chose 75U-100U; 7.1% used 200U-250U; 0% (251-
300U), and 20.3% did not respond (Figure 5). 50

Regarding duration of follow-up of CD patients, respondents

% of Patients

40
were provided pre-defined reinjection intervals and percentage 30
responses for each were as follows: 1-3 injection cycles: 42.9%, 20
3-6 cycles: 21.4%, 6-12 cycles: 17.9%, >12 cycles: 3.6%, and 10
14.2% did not respond (Figure 6).
0
Figure 1: How difficult it is to distinguish between Primary 75-100 U 101-200 U 201-250 U 251-300 U No response
and compensatory secondary movements in dystonia?
Figure 6: Duration of follow-up of patients who are receiving
70.00%
OnabotA Injections
59.52%
60.00%
Injection cycle
Percentage of respondents

50.00%
4% 14% 1 to 3
40.00%
3 to 6
30.00% 43%
18% 6 to 12
20.00%
9.52%
11.90% >12
10.00% 4.76%
21% did not respond
Did
0.00%
Very difficult Somewhat difficult Not difficult Quite easy
REFERENCES
INTRODUCTION

DISCLOSURES

Background: 1. Jog M, Chouinard S, Hobson D, et al This study was sponsored by Allergan plc, Dublin, Ireland. Writing and editorial assistance was
Causes for treatment delays in dystonia provided to the authors by by Mediception Science Pvt Ltd (www.mediception.com). All authors
There is variability in diagnosis and and hemifacial spasm: a Canadian met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship.
managing CD with survey. Can J Neurol Sci. 2011 Financial arrangements of the authors with companies whose products may be related to the
OnabotulinumtoxinA Sep;38(5):704-11. present report are listed below, as declared by the authors.
2. Jinnah HA, Comella CL, Perlmutter J,
Objective: Lungu C, Hallett M; Dystonia Coalition Vinay Goyal and Salil Gupta have no financial disclosure to make; Pettarusp Wadia has served
Investigators. Longitudinal studies of as a speaker and consultant for Allergan and has been member of advisory board for Allergan;
Present survey aimed to understand botulinum toxin in cervical dystonia: Why Hrishikesh Kumar has served as a speaker and consultant for Allergan and has been member of
current practices and identify unmet do patients discontinue therapy? Toxicon. advisory board for Allergan; Prashanth LK has served as a speaker and consultant for Allergan
needs in managing movement 2018 Jun 1;147:89-95. and Merz; Kumar Gaurav, Ammar Raza, Aleks Zuzek, Anand Patel are full-time employees of
disorders (MD) with Allergan.
OnabotulinumtoxinA (OnabotA). Abbreviations:
• CD- Cervical Dystonia Presented at the Asian Oceanian Congress of neurology conference (AOCN)
• Onabot A- OnabotulinumtoxinA November 8-11,2018,Seoul,South Korea