The addition of escitalopram to botulinum neurotoxin therapy provides no significant advantage for managing motor or psychiatric symptoms associated with cervical dystonia with jerks/tremor, according to a randomized, double-blind trial published in the Journal of Neurology, Neurosurgery, and Psychiatry.
Patients with cervical dystonia who were actively receiving treatment with botulinum neurotoxin were randomly assigned to either escitalopram 10 mg once daily (n = 49) or placebo (n = 48) for a 6-week duration. The investigators compared rating scales of each patient and evaluated changes in dystonia, quality of life, and psychiatric symptoms. Following the study period, independent physicians specialized in movement disorders compared the proportion of patients who demonstrated an at least 1-point improvement on the Clinical Global Impression (CGI) Scale for jerks/tremor.
Based on the CGI Scale, there was no significant difference between the escitalopram and placebo groups with regard to improvement in the severity of jerks/tremor (29% vs 23%, respectively; P =.77). Additionally, the investigators observed no differences between treatment and placebo for improvement of psychiatric symptoms (53% vs 55%, respectively; P =1.0) or dystonia (58% vs 50%, respectively; P =.39). Significant improvements in quality of life were found in both the escitalopram (P =.006) and placebo (P =.001) arms. A greater number of adverse events were found in the escitalopram (n=78) vs placebo (n=42) groups; however, statistical significance was not demonstrated.
The investigators of this trial excluded patients who were currently using or had used a selective serotonin reuptake inhibitor or antidepressant in the past 20 weeks, which limits the findings to patients not taking these medications. Additionally, the short 6-week treatment duration as well as the low escitalopram dosage prevents determining true and long-term efficacy of the therapy in patients with cervical dystonia.
Findings from this study showed that escitalopram was not associated with worsening of dystonia, and the researchers suggest “there seems to currently be no reason to withhold an approved therapy for depression and anxiety to patients with dystonia.”
Zoons E, Booij J, Delnooz CCS, et al. Randomised controlled trial of escitalopram for cervical dystonia with dystonic jerks/tremor [published online January 11, 2018]. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2017-317352