Botulinum Toxin in Movement Disorders

Abstract

Botulinum toxin inhibits the vesicular release of acetylcholine in the neuromuscular junction, resulting in a transient, localized paralysis when small doses are injected. The successful use of serotypes A and B in conditions with muscle overactivity such as dystonia and spasticity has been well established. Apart from approved indications, treatment with botulinum toxin injections is attempted in a variety of new areas of neurology, including tremor, tics, and myoclonus. This article provides an update on the uses of botulinum toxin in the field of movement disorders and draws special attention to theoretical and practical treatment issues of primary and secondary dystonic disorders. Long-term experience with this agent suggests that it is an effective and safe treatment not only for approved indications but also for the increasing number of off-label indications. However, controlled studies for many conditions are lacking, and more clinical trials in many different areas are warranted.

Repeat injection of botulinum toxin A is safe and effective for upper limb movement and function in children with cerebral palsy

“…Demographic, therapy history survey, and physical examination were administered at baseline. All other measures administered at baseline, 1, 3, and 6 months in the original trial were again administered in the extension study at 7,9,12,15,18,19,21,24,27, and 30 months. The following standardized instru-ments were used: (1) QUEST, domains of grasp and dissociated movement were averaged to generate a total possible standardized score from 100.…”

“…16 BTX-A is now regarded with some confidence as a safe and effective intervention for a variety of therapeutic indications. 17,18 Even in high doses (≥ is 15 U/kg bodyweight or ≥ is 800 total units) it has been identified to be safe for the treatment of spasticity in children and young adults. 19 The repeated long-term use of BTX-A for children with CP has rarely resulted in systemic sideeffects, possibly because of the use of multiple muscles and injection sites.…”

Effect of botulinum neurotoxin treatment in the lateral spread monitoring of microvascular decompression for hemifacial spasm

“…Botulinum neurotoxin (BtNtx) has become one of the most frequently used therapeutic agents in current medical practice 1. First utilized by neurologists in the 1980s for treatment of movement disorders characterized by dystonia,2 it is now also utilized for tremor, autonomic disorders, spasticity, pain, and headaches 3. Non‐neurological applications of BtNtx include cosmetic, ophthalmologic, and orthopedic surgery, and it is sometimes used in oncology, otolaryngology, gastroenterology, urology, and gynecology 1–4.…”

“…First utilized by neurologists in the 1980s for treatment of movement disorders characterized by dystonia,2 it is now also utilized for tremor, autonomic disorders, spasticity, pain, and headaches 3. Non‐neurological applications of BtNtx include cosmetic, ophthalmologic, and orthopedic surgery, and it is sometimes used in oncology, otolaryngology, gastroenterology, urology, and gynecology 1–4. BtNtx exerts its effect by blocking the liberation of acetylcholine into the synaptic cleft leading first to functional and then to physical muscle denervation,5 with subsequent progressive muscle atrophy 6.…”

A Glance into Botulinum Toxin Outpatient Clinic in Movement Disorders Practice: Self Experience

“…Targeting the acetylcholine release with consequently reduced overactive muscle contraction in the dystonic muscles at the site of injection is the main mechanism of action of BoNT leading to a reversible improvement, which makes BoNT most effective and widely used treatment in focal dystonia (13,14). The success of treatment depends on accurate diagnosis and injections that depends on the precise determination of the involved muscles, and the experience and the skills of the clinician applying the injections with appropriate doses and techniques, in which BoNT dosing and muscle targeting are mainly based on consensus and experience (15). Thus the aim of this study was to document our clinical experience in BoNT injections from the perspective of movement disorders practice in the patients with the diagnosis of focal dystonia in various types.…”