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Toxins 2019, 11(1), 21;

Central Effects of Botulinum Neurotoxin—Evidence from Human Studies

Department of Neurology, Asklepios Fachklinikum Stadtroda, Bahnhofstr. 1a, D-07646 Stadtroda, Germany
Department of Neurology, University of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany
Department of Neurology and Clinical Neurophysiology, Augsburg University, Stenglinstrasse 2, D-86156 Augsburg, Germany
Authors to whom correspondence should be addressed.
Received: 12 December 2018 / Revised: 25 December 2018 / Accepted: 31 December 2018 / Published: 6 January 2019
(This article belongs to the Special Issue Botulinum Toxin Treatment of Movement Disorders)
PDF [758 KB, uploaded 6 January 2019]


For more than three decades, Botulinum neurotoxin (BoNT) has been used to treat a variety of clinical conditions such as spastic or dystonic disorders by inducing a temporary paralysis of the injected muscle as the desired clinical effect. BoNT is known to primarily act at the neuromuscular junction resulting in a biochemical denervation of the treated muscle. However, recent evidence suggests that BoNT’s pharmacological properties may not only be limited to local muscular denervation at the injection site but may also include additional central effects. In this review, we report and discuss the current evidence for BoNT’s central effects based on clinical observations, neurophysiological investigations and neuroimaging studies in humans. Collectively, these data strongly point to indirect mechanisms via changes to sensory afferents that may be primarily responsible for the marked plastic effects of BoNT on the central nervous system. Importantly, BoNT-related central effects and consecutive modulation and/or reorganization of the brain may not solely be considered “side-effects” but rather an additional therapeutic impact responsible for a number of clinical observations that cannot be explained by merely peripheral actions. View Full-Text
Keywords: Botulinum neurotoxin; central nervous system; spasticity; dystonia; human studies Botulinum neurotoxin; central nervous system; spasticity; dystonia; human studies

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Weise, D.; Weise, C.M.; Naumann, M. Central Effects of Botulinum Neurotoxin—Evidence from Human Studies. Toxins 2019, 11, 21.

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