Movement disorders botulinum toxin

The toxin also inhibits release of Ach in all parasympathetic and cholinergic postganglionic sympathetic neurons. This has fueled interest in its use as a treatment for overactive smooth muscles (for example, in achalasia) or abnormal activity of glands (for example, hyperhidrosis). Over the past 15 years, botulinum toxin has been shown to be useful in many conditions, especially strabismus and various movement disorders (Table 16.1). 

Jonkovic J (1994) Botulinum toxin in movement disorders. Current Opinion in Neurology. 7 358-66. 

Botulinum toxin type A is approved for use in humans for the treatment of strabismus, blepharospasm associated with dystonia, head position and neck pain associated with cervical dystonia (a movement disorder characterized by involuntary muscle contractions), as well as for the temporary improvement in the appearance of moderate to severe glabellar lines in adult men and women 65 years or younger. Clinical trials have noted few adverse effects associated with use of botulinum toxin type A for these conditions. 

A prospective clinical and serological evaluation of cytokine analysis in patients receiving botulinum toxin for movement disorders prospectively studied 117 patients (females 67.5% mean age 59.74 12.39years) treated with botulinum toxin in a total of 143 treatment cycles [23 j. While no patient reported any flu-like symptoms (FLS) at baseline, the symptom complex was subsequently reported in 19 patients (16.3%) and in 20 (14%) treatment cycles, with at least one systemic symptom reported in 49 (42%) patients in 59 (41.3%) treatment cycles. FLS and at least one symptom were reported more frequently by women (p = 0.006 and p=0.049, respectively) and by younger patients (55.6 vs 61.7years (p = 0.022)). Although the symptoms were usually considered mild, they were rated as moderate to serious after 18 (12%)cycles. Interleukin (IL)-1 3, IL-8, GRO-a, eotaxin, MCP-1 and 2, RANTES, TARCs and inducible protein 10 (IPIO) showed increased levels at 7-10 days after the botulinum toxin injections but only IPIO showed significantly increased levels in patients with FLS 69 versus 3pg/mL (p=0.007). FLS and other systemic symptoms occur after about 14% severity of FLS. 

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