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Toxins
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Botulinum Toxin in the Movement Disorders Clinic: State of the...
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Botulinum Toxin in the Movement Disorders Clinic: State of the Art

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

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 37625

Special Issue Editor

Dr. Steven J. Frucht

E-Mail Website
Guest Editor
NYU Langone, New York, NY, USA

Special Issue Information

Dear Colleagues,

Injection of botulinum toxin has revolutionized the treatment of a wide range of movement disorders. In this special issue, we focus on the evidence supporting the practical application of this technique, including relevant anatomy, technique, assessment, potential risks, and mechanism of action. This review will cover application of toxin from head to toe, including hemifacial spasm, blepharospasm and eyelid opening apraxia, lower cranial dystonia, spasmodic dysphonia and vocal tremor, cervical dystonia, writer’s cramp and musicians’ dystonia, lower extremity dystonia, spasticity in the upper and lower limb, and truncal/abdominal movement disorders. The review will close with a discussion of the possible role of botulinum toxin as a disease modifying treatment for these disorders.

Dr. Steven J. Frucht
Guest Editor

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Keywords

  • botulinum toxin
  • dystonia
  • hemifacial spasm
  • blepharospasm
  • torticollis
  • writer’s cramp
  • musicians’ dystonia
  • spasticity

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Published Papers (5 papers)

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Research

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12 pages, 460 KiB  
Article
The Lack of Systemic and Subclinical Side Effects of Botulinum Neurotoxin Type-A in Patients Affected by Post-Stroke Spasticity: A Longitudinal Cohort Study
by Marco Battaglia, Margherita Beatrice Borg, Lara Torgano, Alberto Loro, Lucia Cosenza, Michele Bertoni, Alessandro Picelli, Andrea Santamato, Marco Invernizzi, Francesca Uberti, Claudio Molinari, Stefano Carda and Alessio Baricich
Toxins 2022, 14(8), 564; https://doi.org/10.3390/toxins14080564 - 19 Aug 2022
Cited by 2 | Viewed by 2865
Abstract
Botulinum Neurotoxin type-A (BoNT-A) is the treatment of choice for focal post-stroke spasticity (PSS). Due to its mechanism of action and the administration method, some authors raised concern about its possible systemic diffusion leading to contralateral muscle weakness and autonomic nervous system (ANS) [...] Read more.
Botulinum Neurotoxin type-A (BoNT-A) is the treatment of choice for focal post-stroke spasticity (PSS). Due to its mechanism of action and the administration method, some authors raised concern about its possible systemic diffusion leading to contralateral muscle weakness and autonomic nervous system (ANS) alterations. Stroke itself is a cause of motor disability and ANS impairment; therefore, it is mandatory to prevent any source of additional loss of strength and adjunctive ANS disturbance. We enrolled 15 hemiparetic stroke survivors affected by PSS already addressed to BoNT-A treatment. Contralateral handgrip strength and ANS parameters, such as heart rate variability, impedance cardiography values, and respiratory sinus arrythmia, were measured 24 h before (T0) and 10 days after (T1) the ultrasound (US)-guided BoNT-A injection. At T1, neither strength loss nor modification of the basal ANS patterns were found. These findings support recent literature about the safety profile of BoNT-A, endorsing the importance of the US guide for a precise targeting and the sparing of “critical” structures as vessels and nerves. Full article
(This article belongs to the Special Issue Botulinum Toxin in the Movement Disorders Clinic: State of the Art)
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11 pages, 928 KiB  
Article
Botulinum Toxin for Essential Tremor and Hands Tremor in the Neurological Diseases: A Meta-Analysis of Randomized Controlled Trials
by Yen-Hui Liao, Chien-Tai Hong and Tsai-Wei Huang
Toxins 2022, 14(3), 203; https://doi.org/10.3390/toxins14030203 - 10 Mar 2022
Cited by 10 | Viewed by 7135
Abstract
Tremor is a common movement disorder. Essential tremor (ET) is the most common etiology of tremor, while hands tremor is the most disabling type of tremor. This study aimed to explore the effects of Botulinum toxin (BoNT) on tremor within 6 weeks of [...] Read more.
Tremor is a common movement disorder. Essential tremor (ET) is the most common etiology of tremor, while hands tremor is the most disabling type of tremor. This study aimed to explore the effects of Botulinum toxin (BoNT) on tremor within 6 weeks of treatment, and the muscular weakness adverse effect within 6 weeks specifically in randomized controlled trials. PubMed, Embase, and Cochrane Library databases were searched. Tremor severity and grip strength after BoNT treatment were investigated. BoNT significantly attenuated hand tremor severity in patients with either essential tremor (ET), Parkinson’s disease or multiple sclerosis (Standardized mean difference [SMD] = −0.59, 95% confidence interval [CI], −0.95 to −0.24, p = 0.001, I2 = 46%). Regarding people with ET, BoNT significantly reduced their tremor severity, including hands tremor and head tremor within 6 weeks of treatment (SMD = −0.58, 95% CI, −0.28 to −0.88, p = 0.002, I2 = 0%). Electromyography (EMG) but not anatomical guidance BoNT injection provided significant benefit on the relief of tremor in both conditions. The principal adverse event was weakness, but it did not worse within 6 weeks of BoNT treatment (SMD = −0.35, 95% CI, −0.83 to 0.12, p = 0.07, I2 = 57%), as assessed by the subjective grip strength. In conclusion, BoNT was an effective treatment for the hand tremor and ET, and EMG guidance injection was preferred. In addition, the muscular weakness adverse effect was not significant. Full article
(This article belongs to the Special Issue Botulinum Toxin in the Movement Disorders Clinic: State of the Art)
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Review

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32 pages, 3377 KiB  
Review
Botulinum Toxin Therapy for Oromandibular Dystonia and Other Movement Disorders in the Stomatognathic System
by Kazuya Yoshida
Toxins 2022, 14(4), 282; https://doi.org/10.3390/toxins14040282 - 14 Apr 2022
Cited by 27 | Viewed by 12570
Abstract
Various movement disorders, such as oromandibular dystonia, oral dyskinesia, bruxism, functional (psychogenic) movement disorder, and tremors, exist in the stomatognathic system. Most patients experiencing involuntary movements due to these disorders visit dentists or oral surgeons, who may be the first healthcare providers. However, [...] Read more.
Various movement disorders, such as oromandibular dystonia, oral dyskinesia, bruxism, functional (psychogenic) movement disorder, and tremors, exist in the stomatognathic system. Most patients experiencing involuntary movements due to these disorders visit dentists or oral surgeons, who may be the first healthcare providers. However, differential diagnoses require neurological and dental knowledge. This study aimed to review scientific advances in botulinum toxin therapy for these conditions. The results indicated that botulinum toxin injection is effective and safe, with few side effects in most cases when properly administered by an experienced clinician. The diagnosis and treatment of movement disorders in the stomatognathic system require both neurological and dental or oral surgical knowledge and skills, and well-designed multicenter trials with a multidisciplinary team approach must be necessary to ensure accurate diagnosis and proper treatment. Full article
(This article belongs to the Special Issue Botulinum Toxin in the Movement Disorders Clinic: State of the Art)
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11 pages, 238 KiB  
Review
Botulinum Toxin Therapy in Writer’s Cramp and Musician’s Dystonia
by Elina Zakin and David M. Simpson
Toxins 2021, 13(12), 899; https://doi.org/10.3390/toxins13120899 - 14 Dec 2021
Cited by 15 | Viewed by 4083
Abstract
Task-specific focal dystonia is characterized by muscle contraction(s) during a specific task, resulting in abnormal postures or movements. Specifically, writer’s cramp involves the upper extremity during the act of writing. Musician’s dystonia has a highly variable presentation, and thus makes therapeutic options more [...] Read more.
Task-specific focal dystonia is characterized by muscle contraction(s) during a specific task, resulting in abnormal postures or movements. Specifically, writer’s cramp involves the upper extremity during the act of writing. Musician’s dystonia has a highly variable presentation, and thus makes therapeutic options more limited. Treatments include oral pharmacologic agents, neuromodulation, surgery and, most often, botulinum toxin (BoNT) injection. Selection of target muscles for toxin injection continues to be an area of active research for these task-specific movements. We present a review of the literature selected from a predefined search of the MEDLINE and ClinicalTrials.gov databases. We include six controlled studies of botulinum toxin for the management of writer’s cramp and focal task-specific dystonia (FTSD), including musician’s dystonia. Overall, 139 patients were included across all studies, with 99 individuals injected for writer’s cramp and the remaining 40 individuals with FTSD. The age range of all patients was 18–80 years old. We included studies that utilized only the BoNT-A serotype. These studies utilized various severity scales to quantify response to toxin injection, with ratings of instrument or pen control included as subjective ratings. Of the included 139 patients in this review, pooled data for toxin response show that 73% of patients who received the drug demonstrated improvement. Specific techniques for muscle localization and targeting were difficult to study as variable methods were employed. This remains an area of ongoing exploration. Full article
(This article belongs to the Special Issue Botulinum Toxin in the Movement Disorders Clinic: State of the Art)
11 pages, 899 KiB  
Review
Botulinum Toxin for the Treatment of Hemifacial Spasm: An Update on Clinical Studies
by Nicola Tambasco, Marta Filidei, Pasquale Nigro, Lucilla Parnetti and Simone Simoni
Toxins 2021, 13(12), 881; https://doi.org/10.3390/toxins13120881 - 9 Dec 2021
Cited by 27 | Viewed by 9826
Abstract
Hemifacial spasm (HFS) is a movement disorder characterized by involuntary contractions of the facial muscles innervated by the seventh cranial nerve. Generally, it is associated with a poor quality of life due to social embarrassment and can lead to functional blindness. Moreover, it [...] Read more.
Hemifacial spasm (HFS) is a movement disorder characterized by involuntary contractions of the facial muscles innervated by the seventh cranial nerve. Generally, it is associated with a poor quality of life due to social embarrassment and can lead to functional blindness. Moreover, it is a chronic condition, and spontaneous recovery is rare. Intramuscular injections of Botulinum Toxin (BoNT) are routinely used as HFS treatment. Methods: We reviewed published articles between 1991 and 2021 regarding the effectiveness and safety of BoNT in HFS as well as any reported differences among BoNT formulations. Results: The efficacy of BoNT for HFS treatment ranged from 73% to 98.4%. The mean duration of the effect was around 12 weeks. Effectiveness did not decrease over time. Adverse effects were usually mild and transient. The efficacy and tolerability of the different preparations appeared to be similar. Among the studies, dosage, injected muscles, intervals of treatment, and rating scales were variable, thus leading to challenges in comparing the results. Conclusions: BoNT was the treatment of choice for HFS due to its efficacy and safety profile. Further studies are needed to investigate the factors that influence the outcome, including the optimal timing of treatment, injection techniques, dosage, and the best selection criteria for formulations. Full article
(This article belongs to the Special Issue Botulinum Toxin in the Movement Disorders Clinic: State of the Art)
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