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Toxins
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Botulinum Toxins Injections for Hypertonic Limbs—Is It So Effective?
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Botulinum Toxins Injections for Hypertonic Limbs—Is It So Effective?

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

Deadline for manuscript submissions: closed (31 January 2025) | Viewed by 6765

Special Issue Editor

Prof. Dr. Gilad Yahalom

E-Mail Website
Guest Editor
1. Department of Neurology, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
2. The Movement Disorders Clinic, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
3. The School of Medicine, The Hebrew University, Jerusalem 91905, Israel
Interests: botulinum toxins
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Botulinum toxin (BT) is a widely recognized safe and effective treatment, routinely used for various medical conditions, including cervical dystonia (CD), hemifacial spasm (HFS) and blepharospasm. It is now also used to alleviate the upper and lower spasticity of the limbs. The evidence of its efficacy in the treatment of limb dystonia is even more scarce, primarily because it is not covered by insurance in most, if not all, countries. Furthermore, the treatment's effectiveness results have varied among studies. It is uncertain whether one hyperactive disorder of a limb is more responsive to BT than another. In contrast to BT treatment for CD, HFS, post-facial paralysis synkinesis or blepharospams, which was widely proved to be effective and safe, BT treatment for hyperactive limbs lack evidence relating its efficacy. In addition, the dropout rates are high for BT injections of hyperactive limbs, while compliance of BT for facial and cervical muscles is high.

This issue of Toxins is focused on BT treatment of spastic and dystonic limbs. The aim of this issue is to increase our knowledge on the efficacy of BT injections for hyperactive limbs, in order to optimize its efficacy.

Prof. Dr. Gilad Yahalom
Guest Editor

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Keywords

  • botulinum
  • spastic limb
  • spasticity
  • dystonic limb
  • efficacy

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Published Papers (3 papers)

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Research

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9 pages, 842 KiB  
Article
Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study
by Mirko Filippetti, Stefano Tamburin, Ilaria Di Maria, Cecilia Angeli, Rita Di Censo, Elisa Mantovani, Nicola Smania and Alessandro Picelli
Toxins 2024, 16(12), 503; https://doi.org/10.3390/toxins16120503 - 21 Nov 2024
Viewed by 1674
Abstract
Clonus is characterized by involuntary, rhythmic, oscillatory muscle contractions, typically triggered by rapid muscle stretching and is frequently associated with spastic equinovarus foot (SEVF), where it may increase risk of falls and cause discomfort, pain, and sleep disorders. We hypothesize that selective diagnostic [...] Read more.
Clonus is characterized by involuntary, rhythmic, oscillatory muscle contractions, typically triggered by rapid muscle stretching and is frequently associated with spastic equinovarus foot (SEVF), where it may increase risk of falls and cause discomfort, pain, and sleep disorders. We hypothesize that selective diagnostic nerve block (DNB) of the tibial nerve motor branches can help identify which muscle is primarily responsible for clonus in patients with SEVF and provide useful information for botulinum neurotoxin type A (BoNT-A) treatment. This retrospective study explored which calf muscles contributed to clonus in 91 patients with SEFV after stroke (n = 31), multiple sclerosis (n = 21), and cerebral palsy (n = 39), using selective DNB. We found that SEVF-associated clonus was most commonly driven by the soleus muscle, followed by the gastrocnemius lateralis and medialis, tibialis posterior, and flexor digitorum longus, and that frequency differed according to SEVF etiology. Our data suggest that identifying the muscles involved in SEVF-associated clonus may aid clinicians in personalizing BoNT-A treatment to single patients. Also, the findings of this study suggest that applying a ‘stroke model’ to treating spasticity secondary to other etiologies may not always be appropriate. Full article
(This article belongs to the Special Issue Botulinum Toxins Injections for Hypertonic Limbs—Is It So Effective?)
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16 pages, 767 KiB  
Article
A Randomized, Double-Blind, Active Control, Multicenter, Phase 3 Study to Evaluate the Efficacy and Safety of Liztox® versus Botox® in Post-Stroke Upper Limb Spasticity
by Dong Hyun Ye, Min Ho Chun, Yoon Ghil Park, Nam-Jong Paik, Shi-Uk Lee, Seung Don Yoo and Deog Young Kim
Toxins 2023, 15(12), 697; https://doi.org/10.3390/toxins15120697 - 12 Dec 2023
Cited by 2 | Viewed by 3461
Abstract
Botulinum toxin type A (BTX-A) injection is a commonly used therapeutic intervention for upper limb spasticity in stroke patients. This study was designed as a randomized, active-drug-controlled, double-blind, multicenter, phase 3 clinical trial to evaluate the safety and efficacy of Liztox® in [...] Read more.
Botulinum toxin type A (BTX-A) injection is a commonly used therapeutic intervention for upper limb spasticity in stroke patients. This study was designed as a randomized, active-drug-controlled, double-blind, multicenter, phase 3 clinical trial to evaluate the safety and efficacy of Liztox® in comparison to onabotulinum toxin A (Botox®) for individuals with post-stroke upper limb spasticity. The primary outcome was the alteration in wrist flexor muscle tone from the initial assessment to the fourth week, evaluated using the modified Ashworth scale (MAS). Secondary outcomes included MAS score changes for the wrist at weeks 8 and 12 from baseline; MAS score changes for finger and elbow flexors; and changes in the Disability Assessment Scale (DAS), Subject’s Global Assessment (SGA), the Investigator’s Global Assessment (IGA), and Caregiver Burden Scale (CBS) at weeks 4, 8, and 12 from baseline. The MAS score for wrist flexor spasticity decreased by −1.14 ± 0.59 in the Liztox® group and −1.22 ± 0.59 in the Botox® group from baseline to week 4. The difference [97.5% confidence interval (CI)] between the test and control groups was 0.08 [−∞, 0.26], confirming the non-inferiority of the test group compared to the control group. Furthermore, there were consistent improvements in the IGA, SGA, and CBS scores across all assessment intervals, with no statistically significant variances detected between the two groups. No safety-related concerns were reported during the study. In conclusion, Liztox® injection proved to be a secure and efficacious intervention for managing upper extremity spasticity in post-stroke patients. Full article
(This article belongs to the Special Issue Botulinum Toxins Injections for Hypertonic Limbs—Is It So Effective?)
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Review

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12 pages, 269 KiB  
Review
Review: Botulinum Toxin for Treatment of Focal Limb Dystonia
by Emma H. Kaplan, Michele Vecchio and David M. Simpson
Toxins 2025, 17(3), 122; https://doi.org/10.3390/toxins17030122 - 4 Mar 2025
Viewed by 1100
Abstract
Focal limb dystonias (FLDs) are abnormal postures and muscle contractions in an arm or leg that can occur in the setting of specific activities or without any stimulus. This pathology can have a profound impact on quality of life and potentially limit work [...] Read more.
Focal limb dystonias (FLDs) are abnormal postures and muscle contractions in an arm or leg that can occur in the setting of specific activities or without any stimulus. This pathology can have a profound impact on quality of life and potentially limit work in those whose dystonias are brought on by activities related to their occupations. Botulinum toxin (BoNT) is approved for use in the United States by the Food and Drug Administration for several indications, including cervical dystonia and blepharospasm, but not for FLD. Despite this limitation, BoNT is frequently used clinically for FLD, generally with individualized dosing based on patient need and clinician expertise. Various methods exist for targeting treatment to the specific affected muscles and assessing the benefit of treatment. Small clinical trials have demonstrated the efficacy of BoNT, but larger controlled studies are needed. Full article
(This article belongs to the Special Issue Botulinum Toxins Injections for Hypertonic Limbs—Is It So Effective?)
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