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Effectiveness of Botulinum Toxin in the Treatment of Movement Disorders

An evidence-based review details movement disorders for which evidence of effectiveness is sufficient, minimal, or absent.

This article is an evidence-based review of clinical trials that assessed the effectiveness of botulinum toxin in treating movement disorders. (For a discussion of a related evidence-based review of botulinum toxin for spasticity, see JW Neurol Jul 8 2008.) The authors conducted a literature search for articles that detailed the therapeutic effect of botulinum toxin treatment on specific movement disorders. They identified and reviewed data on treatment of blepharospasm, hemifacial spasm, cervical dystonia, focal arm dystonia, laryngeal dystonia, motor tics, and essential tremor of the hand. The authors provide the following conclusions:

(1) Botulinum toxin is safe and effective for the treatment of cervical dystonia and should be offered as a treatment option.

(2) Botulinum toxin is probably effective for the treatment of blepharospasm, focal arm dystonia, laryngeal adductor dystonia, and hand essential tremor, and should be considered as a treatment option.

(3) Botulinum toxin may be effective for the treatment of hemifacial spasm and motor tics and may be considered as a treatment option.

Comment: The authors concisely and carefully reviewed the literature to summarize the data regarding the safety and efficacy of botulinum toxin for the treatment of various movement disorders. As they note, additional randomized, placebo-controlled trials are needed to evaluate the safety and efficacy of botulinum neurotoxin for disorders in which its treatment was deemed "probably effective" and for additional disorders, such as phonic tics and head and voice tremor, for which they found insufficient evidence.

— Nutan Sharma, MD, PhD

Dr. Sharma is Associate Neurologist, Brigham and Women’s Hospital; Assistant in Neurology, Massachusetts General Hospital; and Assistant Professor of Neurology, Harvard Medical School, Boston. She is on the speaker’s bureau for the manufacturer of Botox (botulinum toxin type A).

Published in Journal Watch Neurology August 12, 2008

Citation(s):

Simpson DM et al. Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2008 May 6; 70:1699.

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