Effects of Onabotulinum Toxin A on Gait in Parkinson’s Disease Patients with Foot Dystonia

Abstract

We investigated the effects of botulinum toxin on gait in Parkinson’s disease (PD) patients with foot dystonia. Six patients underwent onabotulinum toxin A injection and were assessed by Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), visual analog scale (VAS) of pain, Timed Up and Go (TUG), Berg Balance Test (BBT), and 3D gait analysis at baseline, 1 month, and 3 months. BFMDRS (p = 0.002), VAS (p = 0.024), TUG (p = 0.028), and BBT (p = 0.034) were improved. Foot pressures at Toe 1 (p = 0.028) and Midfoot (p = 0.018) were reduced, indicating botulinum toxin’s effects in alleviating the dystonia severity and pain and improving foot pressures during walking in PD.

Botulinum Toxin Treatment of Motor Disorders in Parkinson Disease—A Systematic Review

“…Huang et al [ 30 ] in a prospective study of 6 patients with PD and foot dystonia, however, did not find improvement of gait, step length and stride length after BoNT injection into dystonic foot muscles ( Table 2 ). There was, however, significant improvement of FTM dystonia score ( p = 0.02), and dystonia associated pain, both at one month and three months after BoNT injection ( p < 0.03).…”

“…Patients affected by supination and inversion foot dystonia can experience intermittent functional paralysis and are at risk for falls. Our search found one double-blind, placebo-controlled and four prospective studies on PD related foot/toe dystonia [ 26 , 27 , 28 , 29 , 30 ] ( Table 2 ).…”

“…The data from one double-blind and four prospective studies have demonstrated the effectiveness of BoNT injection into calf and flexor/extensor toe muscles in improving dystonic posture, as well as foot and ankle pain in Parkinson patients with foot dystonia. In one study, foot pressure and balance also improved [ 30 ]. Contradictory results were noted regarding improvement of stride length, step length and improvement of gait in two of the studies [ 29 , 30 ].…”

“…In one study, foot pressure and balance also improved [ 30 ]. Contradictory results were noted regarding improvement of stride length, step length and improvement of gait in two of the studies [ 29 , 30 ]. However, the study that failed to show improvement of gait [ 30 ] had used smaller doses of the BoNT compared to the one that demonstrated improved gait [ 29 ].…”

“…Contradictory results were noted regarding improvement of stride length, step length and improvement of gait in two of the studies [ 29 , 30 ]. However, the study that failed to show improvement of gait [ 30 ] had used smaller doses of the BoNT compared to the one that demonstrated improved gait [ 29 ]. Controlled studies in larger number of patients are needed to clarify the effect of BoNT therapy on gait of patients with PD and foot dystonia.…”