Consensus guidelines for botulinum toxin therapy: general algorithms and dosing tables for dystonia and spasticity

Abstract

Botulinum toxin (BT) therapy is a complex and highly individualised therapy defined by treatment algorithms and injection schemes describing its target muscles and their dosing. Various consensus guidelines have tried to standardise and to improve BT therapy. We wanted to update and improve consensus guidelines by: (1) Acknowledging recent advances of treatment algorithms. (2) Basing dosing tables on statistical analyses of real-life treatment data of 1831 BT injections in 36 different target muscles in 420 dystonia patients and 1593 BT injections in 31 different target muscles in 240 spasticity patients. (3) Providing more detailed dosing data including typical doses, dose variabilities, and dosing limits. (4) Including total doses and target muscle selections for typical clinical entities thus adapting dosing to different aetiologies and pathophysiologies. (5) In addition, providing a brief and concise review of the clinical entity treated together with general principles of its BT therapy. For this, we collaborated with IAB—Interdisciplinary Working Group for Movement Disorders which invited an international panel of experts for the support.

Efficacy of single-photon emission computed tomography aided botulinum toxin injection in cervical dystonia: A double-blind, randomized study

“…We further analyzed the doses for each muscle and compared them with a recently published consensus guideline [21]. The average dose for SCM, LS, SPC and scalenus in the present study was similar to the guideline.…”

“…Possible reason could be that the strategy we used in most patients was to distribute the dose according to the image of SPECT/CT rather than increase the total dose. However, in future studies, increase of total dose could also be considered if we observed both activation of superficial and deep muscle, because the purpose of BTX-A injection is to "Hit the right muscle with the right dose" [21].…”

Nonlinear Changes in Botulinum Toxin Treatment of Task-Specific Dystonia during Long-Term Treatment

“…However, follow-up duration in both long-term studies was only 10 years and no specific BoTX dosage in musicians in the latter study was reported. Furthermore, our median dosage was higher than the recommended dosage of 19.9 MU BoTX for the finger flexor muscles in WC in the recently published consensus guideline for BoTX therapy [ 32 ].…”

Schwannoma de plexo braquial y toxina botulínica: a propósito de un caso

“…La toxina se reconstituyó con BBS y el volumen en total no excedió los 5 ml, de hecho, se administraron 2,5 ml en cada músculo. También en este caso se siguieron las recomendaciones generalizadas de emplear el menor volumen posible, pero adecuada al músculo a tratar, para evitar una difusión indeseable a estructuras vecinas (19,20,21,23,24).…”