Botulinum toxin therapy of dystonia
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NEUROLOGY AND PRECLINICAL NEUROLOGICAL STUDIES - REVIEW ARTICLE
Botulinum toxin therapy of dystonia Dirk Dressler1 · Fereshte Adib Saberi1 · Raymond L. Rosales2 Received: 18 August 2020 / Accepted: 9 October 2020 © The Author(s) 2020
Abstract Botulinum toxin (BT) is used to treat a large number of muscle hyperactivity syndromes. Its use in dystonia, however, is still one of the most important indications for BT therapy. When BT is injected into dystonic muscles, it produces a peripheral paresis which is localised, well controllable and follows a distinct and predictable time course of around 3 months. Adverse effects are always transient and usually mild, long-term application is safe. With this profile BT can be used to treat cranial dystonia, cervical dystonia and limb dystonia including writer’s and musician’s cramps. The recent introduction of BT high dose therapy also allows to treat more wide-spread dystonia including segmental and generalised dystonia. BT can easily be combined with other anti-dystonic treatments such as deep brain stimulation and intrathecal baclofen application. Best treatment results are obtained when BT therapy is integrated in the multimodal and long-term ’multilayer concept of treatment of dystonia’. The biggest challenge for the future will be to deliver state of the art BT therapy to all dystonia patients in need, regardless of whether they live in developed countries or beyond. Keywords Botulinum toxin · Therapy · Dystonia · Treatment strategies
Introduction
Pharmacology of botulinum toxin
Botulinum toxin (BT) is used to treat a large number of muscle hyperactivity syndromes, disorders of exocrine glands and pain conditions (Truong et al. 2013). Dystonia, however, is still one of the most important indications for BT, both with respect to the amount of BT consumed as well as with respect to the therapeutic impact generated. Hence, this review aims to elucidate the role of BT therapy for the treatment of dystonia.
Therapeutic profile As shown in Table 1, BT can be used in muscles, exocrine glands and pain associated structures. When BT is injected into muscle tissue, its therapeutic effect is a peripheral paresis which is localised, well controllable and follows a distinct and predictable time course. It manifests clinically after few days, reaches its maximum after one to two weeks, is usually stable for 6–12 weeks and then gradually, but completely resolves over several weeks. All adverse effects are also transient. They may be obligate, local and systemic. Systemic adverse effects hardly occur when BT type A drugs are used.
Botulinum toxin drugs
* Dirk Dressler dressler.dirk@mh‑hannover.de 1
Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl‑Neuberg‑Str. 1, 30625 Hannover, Germany
Department of Neurology and Psychiatry, Neuroscience Institute, University of Santo Tomas Hospital, Manila, Philippines
2
BT drugs are usually based on BT type A, such as onabotulinumtoxinA (ONA, Botox®, Allergan, Dublin, Ireland), abobotulinumtoxinA
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