BOTULINUM TOXIN USE IN
MOVEMENT DISORDERS
Philip A. Hanna, MD
Parkinson's Disease and Movement Disorders Center
New Jersey Neuroscience Institute
Edison, New Jersey
Botulinum toxin (BTX or BOTOX®) has been widely used in the treatment
of dystonia and other movement disorders including hemifacial spasm,
tremor, tics, and myoclonus. Dystonia is and neurological disorder
characterized by involuntary contractions (spasms) of muscles
resulting in pulling, squeezing, twisting movements and abnormal
postures. Examples include blepharospasm (spasms of eyelids), cervical
dystonia (torticollis:spasms of neck muscles resulting in involuntary
tilting or rotation of the neck/head and neck pain), spasmodic
dysphonia (spasms of the vocal cords), oromandibular dystonia
(mouth/jaw spasms), and focal, task-specific dystonia such as writer's
cramp.
BTX is a protein which acts at nerve endings within muscles impairing
transmission of signals between the nerve and muscle resulting in
temporary weakness of the injected muscle or muscle groups. Time to
onset of improvement is usually 3-7 days with average duration of
benefit of 3-6 months after which re-injection is needed. Since BTX
acts locally at the site of injection without distributing into the
circulation, most side effects are limited to the injected site,
though rarely a transient feeling of mild general malaise may be
experienced. Injections into the eyelids may cause local swelling,
blurred vision, tearing or drooping of the eyelid while injections
into neck muscles may result in transient neck weakness, pain or
swallowing difficulty. Problems with swallowing, chewing and speech
(decreased volume) may result after injections into the jaw or vocal
cords. Such side effects are rare, almost never disabling, and usually
resolve within a few days or weeks. A temporary change to a soft or
liquid diet may rarely be needed. A small percentage of patients lose
their response to BTX injections secondary to the development of
antibodies against BTX. If this occurs, other strains of BTX such as
types B or F, instead of BTX-A (which is the currently available form
of BTX) may be used, or surgery if appropriate.
Hanna PA, Jankovic J. Comparison of mouse bioassay and
immunoprecipitation assay for botulinum toxin antibodies. J Neurol
Neurosurg Psychiatry 1999;66:612-616.
Hanna PA, Kwak CH, Jankovic J. Botulinum toxin in the treatment of
tics. 3rd International Scientific Symposium on Tourette Syndrome. New
York, NY, June 4-6, 1999.
Hanna PA, Jankovic J. Mouse bioassay versus western blot assay for
botulinum toxin antibodies: correlation with clinical response.
Neurology 1998;50:1624-1629.
Jankovic J. Use of botulinum toxin in neurology. In: Kennard C, ed.
Recent Advances in Clinical Neurology. Vol. 8, Churchill Livingstone,
London, 1995:89-110.
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