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Toxins
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Advances in the Treatment of Movement Disorders with Botulinum Toxins
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Advances in the Treatment of Movement Disorders with Botulinum Toxins

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: closed (30 June 2025) | Viewed by 7214

Special Issue Editors

Dr. Alexandre Kreisler

E-Mail Website
Guest Editor
Lille University Medical Center, 59037 Lille, France
Interests: dystonia; botulinum toxin; ultrasound; Parkinson’s disease; tremor
Prof. Dr. Wolfgang Jost

E-Mail Website
Guest Editor
Parkinson-Klinik Ortenau GmbH, 77709 Wolfach, Germany
Interests: botulinum toxin; dystonia; cervical dystonia; sialorrhea; Parkinson’s disease; Blepharospasm
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We have the honor of coordinating the preparation of a Special Issue of the journal Toxins, titled “Advances in the Treatment of Movement Disorders with Botulinum Toxins”.

This Special Issue will mainly focus on dystonia. In addition to articles devoted to classic, approved indications of botulinum toxin injections, we aim to collect works of high-quality research about poorly explored common conditions such as dystonic tremors or functional dystonia, as well as rare, unapproved indications including task-specific and oromandibular dystonia. Moreover, articles devoted to other movement disorders (mainly tremors and myoclonus) will be considered. We will pay close attention to works aimed at better understanding the duration during which injections remain effective and ways to optimize the results of this treatment. This issue will also cover advances in injection techniques or dose selection. Lastly, works dedicated to new forms of botulinum toxins will be welcome.

Indeed, we want to make this issue particularly diverse and innovative, with the objectives of attracting the interest of as many people as possible and also of offering vocations for young colleagues at a time when other fields of neurology are proving increasingly attractive. Now, please go ahead and pick up your pens and surprise us!

Dr. Alexandre Kreisler
Prof. Dr. Wolfgang Jost
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Toxins is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • rare forms of dystonia
  • common but poorly explored forms of dystonia
  • tremor
  • myoclonus
  • optimization of results
  • duration of efficacy
  • guidance
  • injection techniques
  • recombinant botulinum toxin

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Published Papers (7 papers)

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Research

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9 pages, 271 KiB  
Article
Electrophysiological Evidence of Contralateral Neuromuscular Effects Following Long-Term Botulinum Toxin Therapy in Hemifacial Spasm
by Tehran Aliyeva, Mehmet Fevzi Oztekin, Yasemin Eren and Zeynep Nese Oztekin
Toxins 2025, 17(8), 407; https://doi.org/10.3390/toxins17080407 - 14 Aug 2025
Abstract
Hemifacial spasm (HFS) is a cranial nerve disorder characterized by involuntary contractions of muscles innervated by the facial nerve. Botulinum toxin type A (BoNT-A) is widely used for symptom control. Although local diffusion is well established, the extent and clinical relevance of BoNT-A [...] Read more.
Hemifacial spasm (HFS) is a cranial nerve disorder characterized by involuntary contractions of muscles innervated by the facial nerve. Botulinum toxin type A (BoNT-A) is widely used for symptom control. Although local diffusion is well established, the extent and clinical relevance of BoNT-A spread to contralateral muscles remain unclear. This study aimed to investigate the contralateral neuromuscular effects of BoNT-A in patients undergoing long-term treatment with BoNT-A. This retrospective cross-sectional study included 39 patients with HFS (mean age, 58.6 ± 8.5 years). Bilateral compound muscle action potentials (CMAPs) were recorded before and four weeks after the BoNT-A injection. Single-fiber electromyography (SFEMG) jitter and mean consecutive difference (MCD) were evaluated contralaterally using concentric needle electrodes. Patients were categorized as first-time (n = 10) or long-term (n = 29; treatment duration: 1–20 years) BoNT-A recipients. Contralateral CMAP amplitudes decreased by 21.1% post-injection (p < 0.001). MCD increased from 33.2 ± 5.6 to 37.0 ± 5.3 µs (p < 0.001), and jitter rose by 81%, from 7.9 ± 6.2 to 14.3 ± 8.1 µs (p < 0.001). The percentage increase in MCD was significantly higher in long-term versus first-time patients (12.7% vs. 7.5%; p = 0.039), suggesting a cumulative neuromuscular effect. Spontaneous myokymia or fasciculations were clinically observed in four long-term patients. These findings provide electrophysiological evidence that unilateral BoNT-A injections may induce neuromuscular transmission abnormalities in the contralateral facial muscles. This effect appears more pronounced in chronically treated individuals, highlighting the need for awareness of potential bilateral spread when planning long-term therapy. Full article
(This article belongs to the Special Issue Advances in the Treatment of Movement Disorders with Botulinum Toxins)
14 pages, 510 KiB  
Article
Is There a “Non-Motor Effect” of Botulinum Toxin Treatment in Cervical Dystonia in Addition to Its Effects on Motor Symptoms?
by Małgorzata Dudzic, Anna Pieczyńska, Artur Drużdż, Anna Rajewska and Katarzyna Hojan
Toxins 2025, 17(8), 396; https://doi.org/10.3390/toxins17080396 - 6 Aug 2025
Viewed by 245
Abstract
The efficacy of botulinum toxin A (BoNT) in alleviating motor symptoms of cervical dystonia (CD) has been well established, and it is the treatment of choice in this disease. Lately, the effect of BoNT on non-motor symptoms (NMS) such as cognitive function, depression, [...] Read more.
The efficacy of botulinum toxin A (BoNT) in alleviating motor symptoms of cervical dystonia (CD) has been well established, and it is the treatment of choice in this disease. Lately, the effect of BoNT on non-motor symptoms (NMS) such as cognitive function, depression, anxiety, pain, and sleep disturbance has been observed in patients with CD. A comprehensive clinical and functional assessment of motor (dystonia severity, gait) and non-motor symptoms (cognitive functions, depression, anxiety, sleep, and pain) has been performed in a total of 34 adult patients with cervical dystonia before and after BoNT treatment. Results have also been compared to a control group. Significant improvements in the scales assessing dystonia severity have been observed, which is in line with previous studies on the effect of BoNT on motor symptoms in dystonia. Interestingly, the results also clearly indicate that BoNT has a positive effect on NMS. Among the studied non-motor domains, depression and cognitive functions improved the most after the treatment procedure. The study highlights the potential of BoNT to positively influence non-motor symptoms in patients with cervical dystonia, although its effect on various NMS is not equal. Full article
(This article belongs to the Special Issue Advances in the Treatment of Movement Disorders with Botulinum Toxins)
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15 pages, 2397 KiB  
Article
Case Series and Literature Review on Botulinum Toxin Efficacy in Axial Extensor Truncal Dystonia
by Jarosław Sławek, Iga Alicja Łobińska, Michał Schinwelski, Joanna Kopcewicz-Wiśniewska and Anna Castagna
Toxins 2025, 17(8), 375; https://doi.org/10.3390/toxins17080375 - 29 Jul 2025
Viewed by 452
Abstract
Axial truncal dystonia can present as either flexion or extension, often with a tendency toward lateral movement. Flexion dystonia is more common and may represent a clinical spectrum associated with parkinsonism. In contrast, extensor trunk dystonia is less frequent and exhibits a diverse [...] Read more.
Axial truncal dystonia can present as either flexion or extension, often with a tendency toward lateral movement. Flexion dystonia is more common and may represent a clinical spectrum associated with parkinsonism. In contrast, extensor trunk dystonia is less frequent and exhibits a diverse range of causes. In this paper, we reviewed the literature on axial extensor trunk dystonia. We identified 11 studies involving 49 patients, of which only 10 had idiopathic trunk dystonia. Treatment with botulinum neurotoxin A (BoNT/A) emerged as the most effective therapy; however, many studies did not provide detailed descriptions of the treatment (4/11) and follow-up periods were not specified or short term (up to one–two years). We present four new, well-documented patients with the idiopathic form of extensor trunk dystonia who were treated with BoNT/A with moderate to significant effect according to Global Clinical Impression scale (GCI) and Burke-Fahn-Marsden (BFM) dystonia scale. These cases include long-term follow-up for three patients, all without any adverse events. While the diagnostic process and treatment can be challenging, we recommend using BoNT/A with adjusted doses tailored to the appropriate muscle groups as a first-line treatment. Full article
(This article belongs to the Special Issue Advances in the Treatment of Movement Disorders with Botulinum Toxins)
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13 pages, 2158 KiB  
Article
A 12-Week Prospective, Double-Blind, Multicenter, Randomized Study Comparing 100 Units of Abobotulinum Toxin Type A (Dysport®) and 33.33 Units of Neubotulinum Toxin Type A (Neuronox®) for the Treatment of Hemifacial Spasm
by Subsai Kongsaengdao, Arkhom Arayawichanont, Kanoksri Samintharapanya, Pichai Rojanapitayakorn, Benchalak Maneeton and Narong Maneeton
Toxins 2025, 17(4), 173; https://doi.org/10.3390/toxins17040173 - 2 Apr 2025
Viewed by 1048
Abstract
Previous randomized controlled trials (RCTs) investigating Botulinum toxin A (BoNT-A) for treatment of hemifacial spasm (HFS) have primarily focused on symptom relief and quality-of-life improvement. However, head-to-head comparisons of different BoNT-A formulations, particularly in terms of onset, duration of action, and efficacy, remain [...] Read more.
Previous randomized controlled trials (RCTs) investigating Botulinum toxin A (BoNT-A) for treatment of hemifacial spasm (HFS) have primarily focused on symptom relief and quality-of-life improvement. However, head-to-head comparisons of different BoNT-A formulations, particularly in terms of onset, duration of action, and efficacy, remain limited. We conducted a 12-week prospective, randomized controlled trial comparing the efficacy and safety of 33.33 units of Neubotulinum toxin A (Neu-BoNT-A) with 100 units of Abobotulinum toxin A (Abo-BoNT-A) in the treatment of HFS. A total of 87 patients were enrolled between September and December 2024. Neu-BoNT-A and Abo-BoNT-A exhibited similar onset and duration of action [5.0 ± 0.9 vs. 6.2 ± 0.7 days, respectively (p = 0.33)]. After 12 weeks of treatment, Neu-BoNT-A demonstrated superior efficacy in reducing the daily duration of HFS (2.00 ± 0.06 vs. 1.42 ± 0.10 h/day, p < 0.001) and improving sleep duration (1.37 ± 0.01 vs. 1.06 ± 0.01 h/day, p < 0.001). However, Abo-BoNT-A was associated with significantly lower absolute daily disability time compared to Neu-BoNT-A (11.4 vs. 1.2 min/day, p < 0.001). No serious adverse events were observed. Both Neu-BoNT-A and Abo-BoNT-A were safe and effective in treating HFS. However, Neu-BoNT-A was more effective in HFS with minimal symptoms without disability and Abo-BoNT-A more effective in HFS with greater duration of disability. Full article
(This article belongs to the Special Issue Advances in the Treatment of Movement Disorders with Botulinum Toxins)
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12 pages, 1393 KiB  
Article
Incidence of Dysphagia and Comorbidities in Patients with Cervical Dystonia, Analyzed by Botulinum Neurotoxin Treatment Exposure
by Richard L. Barbano, Bahman Jabbari, Marjan Sadeghi, Ahunna Ukah, Emma Yue, Kimberly Becker Ifantides, Nuo-Yu Huang and David Swope
Toxins 2025, 17(3), 148; https://doi.org/10.3390/toxins17030148 - 19 Mar 2025
Viewed by 812
Abstract
Dysphagia is prevalent in patients with cervical dystonia (CD) and is a potential adverse event in patients treated with botulinum neurotoxin (BoNT) for CD. Real-world studies may provide a better understanding of the incidence and potential risk factors of dysphagia after BoNT administration. [...] Read more.
Dysphagia is prevalent in patients with cervical dystonia (CD) and is a potential adverse event in patients treated with botulinum neurotoxin (BoNT) for CD. Real-world studies may provide a better understanding of the incidence and potential risk factors of dysphagia after BoNT administration. This retrospective cohort study used longitudinal patient-level data from Optum’s de-identified Market Clarity Data to evaluate rates of dysphagia in patients with CD exposed and unexposed to BoNT. Patients ≥18 years of age with ≥2 CD diagnoses ≥30 days apart during the study period (1 January 2017–30 September 2021) who had ≥180 days of continuous health plan enrollment prior to the cohort entry date (first CD diagnosis) were included. Overall, the mean (SD) age of all CD patients (Cohort 1; N = 81,884) was 54.00 (16.21) years, and they were mostly female (67.9%) and white (76.96%). BoNT-Exposed patients (Cohort 2; N = 19,244) had a higher incidence of dysphagia (16.3%) and comorbid conditions when compared with BoNT-Unexposed patients (Cohort 3; N = 61,154 [12.1%]). Overall, patients with pre-existing dysphagia, other dystonias, and comorbid neurologic conditions at baseline also had higher proportions of dysphagia. This real-world analysis indicates that comorbid conditions predispose patients with CD to a greater dysphagia risk during treatment. Full article
(This article belongs to the Special Issue Advances in the Treatment of Movement Disorders with Botulinum Toxins)
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16 pages, 552 KiB  
Article
Doses of Botulinum Toxin in Cervical Dystonia: Does Ultrasound Guidance Change Injection Practices?
by Alexandre Kreisler, Léa Mortain, Kaëlig Watel, Eugénie Mutez, Luc Defebvre and Alain Duhamel
Toxins 2024, 16(10), 439; https://doi.org/10.3390/toxins16100439 - 11 Oct 2024
Cited by 1 | Viewed by 1758
Abstract
Background: Cervical dystonia is widely understood to benefit from botulinum toxin injections. The injection practices may be influenced by specific factors, including the method of injection. Three main guidance methods can be used: palpation of anatomical landmarks, ultrasound, and electromyography. We investigated how [...] Read more.
Background: Cervical dystonia is widely understood to benefit from botulinum toxin injections. The injection practices may be influenced by specific factors, including the method of injection. Three main guidance methods can be used: palpation of anatomical landmarks, ultrasound, and electromyography. We investigated how target muscles and doses of botulinum toxin were modified after the transition from surface anatomy (non-guided) to ultrasound (US-guided), in patients with cervical dystonia. We also determined the long-term dose trend. Methods: We studied a group of 82 patients, who received non-guided injections (median: 16.5 cycles/5.1 years) followed by US-guided injections (median: 12.0 cycles/3.8 years). Results: More muscles, and especially deep muscles, were injected during the US-guided period. The total dose and number of injected muscles were higher when US guidance was used, but the mean dose per muscle was lower. Over the long term, the total dose stabilized, and the mean dose per muscle decreased during the US-guided period. Conclusions: According to our results, the guidance method has a strong impact on the botulinum toxin injection strategy in cervical dystonia (target muscles and dose). Also, the treatment appeared more stable when using US guidance; this could be explained by the good precision of such injections. Full article
(This article belongs to the Special Issue Advances in the Treatment of Movement Disorders with Botulinum Toxins)
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Review

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11 pages, 904 KiB  
Review
Botulinum Toxin Effects on Freezing of Gait in Parkinson’s Disease: A Systematic Review
by Nicola Tambasco, Pasquale Nigro, Alessandro Mechelli, Michele Duranti and Lucilla Parnetti
Toxins 2024, 16(11), 474; https://doi.org/10.3390/toxins16110474 - 3 Nov 2024
Viewed by 2046
Abstract
Freezing of gait is a frequent phenomenon and can be one of the most debilitating motor impairments in Parkinson’s disease, especially in the advanced stages. It is currently defined as a brief episodic absence or any marked reduction in the forward progression of [...] Read more.
Freezing of gait is a frequent phenomenon and can be one of the most debilitating motor impairments in Parkinson’s disease, especially in the advanced stages. It is currently defined as a brief episodic absence or any marked reduction in the forward progression of the feet, despite the intention to walk. Greater severity of freezing of gait has been associated with more frequent falls, postural instability, and executive dysfunction. However, botulinum neurotoxin is one of the most widely administered therapies for motor and non-motor symptoms, including freezing of gait, in parkinsonism. To date, the literature has had conflicting results on the use of botulinum toxin in the treatment of freezing of gait in Parkinson’s disease patients. In light of this, we reviewed the findings of past studies that specifically investigated the effects of botulinum toxin on freezing of gait in Parkinson’s disease in order to better understand this issue. Full article
(This article belongs to the Special Issue Advances in the Treatment of Movement Disorders with Botulinum Toxins)
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