Botulinum Toxin Therapy in Writer’s Cramp and Musician’s Dystonia
Round 1
Reviewer 1 Report
The authors present a review of selected studies (n=6) that demonstrate the utility of BoNT injections in the management of task-specific dystonia.
It is unclear whether it is a narrative review/an expert opinion/ review of the selected studies or a combination of these.
Introduction lacks clarity and needs to be restructured to make it more succinct and cohesive. Abstract also requires restructuring avoiding repetition of statements from the conclusion.
The section on surgical treatment could be eliminated as the primary focus of this review is BoNT injections. Additionally, BoNT mechanism of action could also be shortened.
In the Review of literature section, the word “recent“- line 161, doesn’t convey any clear meaning, as authors have included studies as old as those performed in 1992.
Lines 225-228 do not appear to be relevant to the current context.
Line-240 “base” to be replaced with “based”
Lines 249-250- The word ”guideline” is used loosely. It can be replaced with “approach” or a similar word.
In the section on practical guidelines, authors have referenced a study by Frucht et al, which can be moved to the section on Musicians dystonia (maybe replacing lines 225-228) where it would be more in line with the context of the paragraph.
A summary of the reviewed studies, indicating type of studies, most common type of BoNT toxin used, average dose range, most common muscle targeted, dystonia rating scale used, the extent of improvement, commonly observed side effects, would be of interest for the reader and can be either mentioned in the conclusion or in a separate section.
Overall, the authors have done commendable work reviewing studies on this topic. This manuscript however requires major modifications before it can be accepted for publication.
Author Response
- review of the selected study
- introduction has been restructured and significantly revised; abstract has also been changed to reflect feedback
- surgical therapeutic options were removed from text
- line 161 - removed
- line 225-228 - removed
- line 240 - changed to based
- line 249-250 - changed guideline to approach
- abstract and conclusion reflect the following comment: A summary of the reviewed studies, indicating type of studies, most common type of BoNT toxin used, average dose range, most common muscle targeted, dystonia rating scale used, the extent of improvement, commonly observed side effects, would be of interest for the reader and can be either mentioned in the conclusion or in a separate section.
- Thank you and we hope the changes presented are well received Overall, the authors have done commendable work reviewing studies on this topic. This manuscript however requires major modifications before it can be accepted for publication.
Reviewer 2 Report
This is a very nice review of task specific dystonias. However, it is quite verbose with long descriptions of the different task specific dystonias, their treatment including surgical treatment and background of botulinum toxin injections in general.
The description of mirror dystonia should be eliminated as there are no studies of botulinum toxin use in mirror dystonia. The descriptions of writer's cramp and musician's dystonia should be edited.
Therapy overview can be edited to reduce information regarding medications and the surgical therapy can be eliminated.
Please check your references as the remarks made on reference #32 are not found in the reference article.
Prisma criteria for review articles is lacking and should be added.
You may want to extract how each study reviewed selected target muscles and their dosing of botulinum toxin and can compare this to Dr. Dressler's data in the discussion.
Author Response
1. We have lessened length of text - This is a very nice review of task specific dystonias. However, it is quite verbose with long descriptions of the different task specific dystonias, their treatment including surgical treatment and background of botulinum toxin injections in general.
2. This has been removed from text and descriptions have been shortened significantly - The description of mirror dystonia should be eliminated as there are no studies of botulinum toxin use in mirror dystonia. The descriptions of writer's cramp and musician's dystonia should be edited.
3. This has also been eliminated/shortened - Therapy overview can be edited to reduce information regarding medications and the surgical therapy can be eliminated.
4. Reference revised - Please check your references as the remarks made on reference #32 are not found in the reference article.
5. This has been added per abstract/introduction - Prisma criteria for review articles is lacking and should be added.
6. difficult to specify given not all studies reported specific targeting of muscles - You may want to extract how each study reviewed selected target muscles and their dosing of botulinum toxin and can compare this to Dr. Dressler's data in the discussion.
Reviewer 3 Report
Dear Authors, I was glad to read your interesting manuscript. The work seems to be clear, well written and a good overview on the matter of subject. However few issues arose during the review.
1) The study design seems to be between a scoping review and a systematic review of Randomized controlled Trials. I strongly suggest the Authors to modify the manuscript according to the PRISMA guidelines for systematic reviews OR for scoping reviews (PRISMA (prisma-statement.org)). This change will improve dramatically the "weight" of the evidences described, adding the search strategy, inclusion/exclusion criteria etc...
2) Since the botulinum toxin therapy for these pathologies seems to be the aim of the paper, I would suggest to change the title accordingly.
3) In paragraph 5 i would suggest to add informations regarding injection techniques, muscle targeting, and toxin dosing that can be found in literature. (Rauso R, Lo Giudice G, Tartaro G, Zerbinati N, Nicoletti GF, Fragola R. Botulinum toxin type A injections for masticatory muscles hypertrophy: A systematic review [published online ahead of print, 2021 Sep 28]. J Craniomaxillofac Surg. 2021;S1010-5182(21)00223-7. doi:10.1016/j.jcms.2021.09.019) (Schroeder AS, Berweck S, Lee SH, Heinen F. Botulinum toxin treatment of children with cerebral palsy - a short review of different injection techniques. Neurotox Res. 2006;9(2-3):189-196. doi:10.1007/BF03033938)
4) Table 1 should be modified, adding a separate column for study design, goal, patients and methods. Moreover if a RCT is listed, the trial registry number should be included. When possible, the table informations should be more schematic rather than narrative.
Best Regards
Author Response
1) Abstract and introduction have been changed completely to reflect this feedback - The study design seems to be between a scoping review and a systematic review of Randomized controlled Trials. I strongly suggest the Authors to modify the manuscript according to the PRISMA guidelines for systematic reviews OR for scoping reviews (PRISMA (prisma-statement.org)). This change will improve dramatically the "weight" of the evidences described, adding the search strategy, inclusion/exclusion criteria etc...
2) Title revised - Since the botulinum toxin therapy for these pathologies seems to be the aim of the paper, I would suggest to change the title accordingly.
3) did not include to limit length of paper as this was a comment from all three reviewers re: length of paper - In paragraph 5 i would suggest to add informations regarding injection techniques, muscle targeting, and toxin dosing that can be found in literature. (Rauso R, Lo Giudice G, Tartaro G, Zerbinati N, Nicoletti GF, Fragola R. Botulinum toxin type A injections for masticatory muscles hypertrophy: A systematic review [published online ahead of print, 2021 Sep 28]. J Craniomaxillofac Surg. 2021;S1010-5182(21)00223-7. doi:10.1016/j.jcms.2021.09.019) (Schroeder AS, Berweck S, Lee SH, Heinen F. Botulinum toxin treatment of children with cerebral palsy - a short review of different injection techniques. Neurotox Res. 2006;9(2-3):189-196. doi:10.1007/BF03033938)
4) Table 1 revisions attached - Table 1 should be modified, adding a separate column for study design, goal, patients and methods. Moreover if a RCT is listed, the trial registry number should be included. When possible, the table informations should be more schematic rather than narrative.
Round 2
Reviewer 1 Report
Authors have made the necessary changes to the manuscript, which can now be accepted for publication in its current format.
Author Response
thank you
Reviewer 2 Report
This is a very nice review of botulinum toxin injections as treatment of focal task specific dystonia. However, it is quite verbose with long descriptions of the different task specific dystonias, their treatment including surgical treatment and background of botulinum toxin injections in general.
The description of mirror dystonia should be eliminated as there are no studies of botulinum toxin use in mirror dystonia. The descriptions of writer’s cramp and musician dystonia can be edited.
Therapy overview can be edited to reduce information regarding medications and surgical treatment can be eliminated.
Prisma guidelines for reporting of review articles is lacking and should be added.
You may want to extract how each study reviewed selected target muscles and their dosing of botulinum toxin and can compare this to Dr. Dressler’s data in the discussion.
Author Response
This is the same as the first review
Reviewer 3 Report
Dear Authors, the manuscript seems to be improved although, few minor changes are still needed.
1) In Table 1 delete "Design:" from each study design description since it is redundant with the column heading.
2) Prisma criteria for scoping review articles is still lacking and should be added. Specifically the methods section of the playlist (at least), definite search strategy with inclusion/exclusion criteria, search terms etc. (http://www.prisma-statement.org/documents/PRISMA-ScR-Fillable-Checklist_11Sept2019.pdf)
Best Regards
Author Response
- 'Design' removed from tables
- modified to include Methods section as section 7, and then data separately in section 8
