Botulinum toxin in the management of parkinsonian disorders

Grippe, Talyta Cortez; Chen, Robert

doi:10.1016/j.toxicon.2023.107209

Cited by 6 publications

(1 citation statement)

References 65 publications

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“…The role of EMG study in these conditions can now be considered for evaluating hyperactive muscles, which can be possible targets of botulinum toxin (BoNT) when not considered compensatory [19,71]. Given the potential contribution of dystonic patterns to APAs in PD [2,68,69,71], and more in general, the possible recognition of hyperactivity of axial muscles, BoNT emerges as a promising therapeutic intervention in PD for the management of APAs [72][73][74][75][76][77]. Beyond its primary mechanism of action, which involves inhibiting acetylcholine release at the neuromuscular junction, thereby reducing muscle hyperactivity, BoNT also significantly affects non-motor symptoms, most notably pain [78,79].…”

Section: Introductionmentioning

confidence: 99%

Botulinum Toxin for Axial Postural Abnormalities in Parkinson’s Disease: A Systematic Review

Gandolfi,

Artusi,

Imbalzano

et al. 2024

Toxins

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Axial postural abnormalities (APAs), characterized by their frequency, disabling nature, and resistance to pharmacological treatments, significantly impact Parkinson’s disease and atypical Parkinsonism patients. Despite advancements in diagnosing, assessing, and understanding their pathophysiology, managing these complications remains a significant challenge. Often underestimated by healthcare professionals, these disturbances can exacerbate disability. This systematic review assesses botulinum toxin treatments’ effectiveness, alone and with rehabilitation, in addressing APAs in Parkinson’s disease, utilizing MEDLINE (PubMed), Web of Science, and SCOPUS databases for source material. Of the 1087 records retrieved, 16 met the selection criteria. Most research has focused on botulinum toxin (BoNT) as the primary treatment for camptocormia and Pisa syndrome, utilizing mostly observational methods. Despite dose and injection site variations, a common strategy was using electromyography-guided injections, occasionally enhanced with ultrasound. Patients with Pisa syndrome notably saw consistent improvements in APAs and pain. However, studies on the combined effects of botulinum toxin and rehabilitation are limited, and antecollis is significantly under-researched. These findings recommend precise BoNT injections into hyperactive muscles in well-selected patients by skilled clinicians, avoiding compensatory muscles, and underscore the necessity of early rehabilitation. Rehabilitation is crucial in a multidisciplinary approach to managing APAs, highlighting the importance of a multidisciplinary team of experts.

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