Healthcare Professionals


TWSTRS: a validated scale for assessing cervical dystonia11-13

TWSTRS is an assessment scale used to measure the impact of cervical dystonia on patients, validated by Consky et al in 1990.14 It is frequently used in clinical trials for cervical dystonia, including trials for MYOBLOC.

It is comprised of 3 subscales: Severity, Disability, and Pain, each of which is scored independently. The total of these 3 comprises the TWSTRS total score which is scored from 0–87 (best to worst).

1. Severity (0 to 35)
  • Maximal excursion (rotation, laterocollis, anterocollis/retrocollis, lateral shift, sagittal shift)
  • Duration factor (weighted x 2)
  • Effect of sensory tricks
  • Shoulder elevation/anterior displacement
  • Range of motion
  • Time (ability to maintain head within 10º of neutral position, up to 60 seconds)
2. Disability (0 to 32)
Effect of cervical dystonia on ability to perform activities, including
  • Work
  • Activities of daily living (feeding, washing, dressing)
  • Driving
  • Reading
  • Watching television
  • Activities outside the home
3. Pain (0 to 20)
  • Severity
  • Duration
  • Disability due to pain

Abbreviation: TWSTRS, Toronto Western Spasmodic Torticollis Rating Scale.

Visual Analog Scale (VAS)15

The VAS is a subjective scale for assessing a variable such as patient-reported pain. It is a 100-mm line, usually horizontal, anchored on both ends with descriptors (see figure). A patient marks the point that he/she feels represents the variable being measured (eg, pain). The score, from 0 to 100, is determined by measuring from the end of the line to the patient’s mark.

A 100-point VAS was used in pivotal clinical trials for MYOBLOC.8

See Important Safety Information below.

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