Use of Botulinum Neurotoxin in Parkinson’s Disease: A Critical Appraisal

Abstract

For well over 30 years, the botulinum neurotoxin (BoNT) has been used for a large number of indications, some of which however have not been licensed. Admittedly, approval varies in many countries and this permits a large spectrum for evaluation. Thus, BoNT is used for patients with Parkinson’s disease (PD) and other Parkinson’s syndromes (PS) in varying degrees of frequency. We have to distinguish between (1) indications that are either approved or (2) those not approved, (3) indications that might be a result of PS and (4) finally those which appear independent of PS. The most important indication for BoNT in PS patients is probably sialorrhea, for which approval has been granted in the majority of countries. Cervical dystonia is a frequent symptom in PS, with anterocollis as a specific entity. A further indication is blepharospasm in the different forms, especially the inhibition of eyelid opening in atypical PS. The use of BoNT in cases of camptocormia, the Pisa syndrome and neck rigidity is still a matter of debate. In dystonia of the extremities BoNT can be recommended, especially in dystonia of the feet. One well-known indication, for which however sufficient data are still lacking, involves treating tremor with BoNT. As to autonomic symptoms: Focal hyperhidrosis and detrusor hyperactivity can be mentioned, in this last case BoNT has already been approved. A number of further but rare indications such as freezing-of-gait, dyskinesia, and dysphagia will be discussed and evaluated.

Striatal Hand Deformities in Parkinson's Disease: Hand Surgical Perspectives

“…Table 4 describes differences in clinical and radiological features of patients with SHD and the rheumatoid hand deformity. The etiology of the intrinsic‐plus hand seen in PD is less understood but may be caused by local muscle rigidity and/or dystonia 3,4,7 . Gortvai recognized the significance of the intrinsic muscles and its innervation, and demonstrated that SHD in PD patients could be reversed by blocking the ulnar nerve at wrist level with local anesthesia 23 …”

“…The hands were also clinically screened for other PD related deformities, such as dystonic involuntary movements/abnormal positions at rest, and/or induced/aggravated by actions 20 such as rapid altered movement according to item 25 of motor examination 17 and gait 7 . Abnormalities were observed with respect to the intrinsic muscles (ie, the short muscles of the hand) and the extrinsic muscles of forearm (ie, the long flexor and/or extensor muscles) and their specific functions.…”

“…Thus, SHD in Parkinson's disease (PD), occurring in 8–10% of PD patients, 4,5 is still relatively unrecognized and not fully understood 1,4,5 . It seems as SHD is poorly responsive to medication effects, 2 is not action‐induced 6 and is still present with the hands relaxed and during sleep, 1,6 indicating that a SHD shares features with rigidity, although dystonia has been discussed in relation to the origin of SHD 3,4,7 . Also, other PD related deformities, such as “clenched fist” 8 or wrist flexion while walking related to motor fluctuations, 9 are closely related to dystonia.…”

Cervical dystonia in Parkinson’s Disease: frequency of occurrence and subtypes

“…Cervical dystonia (CD) is one of the most common focal dystonias, being well known for example as a symptom in atypical Parkinson's syndrome (PS) [1]. In Parkinson's Disease (PD) CD is also known, but there is a lack of descriptive studies [2]. In PD it is mostly referred to as a consequence of the disease progress and/or as a consequence of dopaminergic medication [3].…”

Movement Disorders and Musculoskeletal System: A Reciprocal Relationship

“…Local injecting chemodenervations, including botulinum toxin serotype A (BTX-A) and lidocaine, may be considered another treatment option. 4,15 For surgical management, spinal column surgery showed some benefit in pain reduction and postural correction compared to the preoperative stage. 4 There was a report of a significant improvement of posture and gait in a PD patient with camptocormia who received a unilateral pallidotomy.…”