RESEARCH: Botulinum toxin treatment in atypical parkinsonian disorders associated with disabling focal dystonia.

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J Neurol 2002 Mar;249(3):300-4

Botulinum toxin treatment in atypical parkinsonian disorders associated with

disabling focal dystonia.

Muller J, Wenning GK, Wissel J, Seppi K, Poewe W.

Department of Neurology, Innsbruck University Hospital, Austria.

We investigated the efficacy of botulinum toxin A (BtxA) therapy in patients

with atypical parkinsonian disorders (APD) exhibiting different types of

disabling focal dystonia unresponsive to oral drug therapy. Eight patients

with

functionally disabling focal dystonia out of a series of 60 consecutive

patients

with APDs regularly treated at our outpatient movement disorders clinic were

included. Patients were diagnosed according to established criteria and had

disabling limb dystonia (n=4) or craniocervical dystonia (n=4) unresponsive

to

oral pharmacological treatment. Localization and dose of BtxA injections was

determined individually based on clinical examination as well as EMG in

patients

with limb dystonia. BtxA reduced dystonic symptoms in all patients; only one

developed a transient local side-effect. BtxA was particularly effective in

the

long-term treatment (up to 50 months) of blepharospasm associated with

progressive supranuclear palsy (PSP). BtxA also alleviated PSP-associated

retrocollis and orofacial dystonia with lower lip retraction associated with

PSP

and multiple system atrophy. BtxA treatment of limb dystonia in corticobasal

degeneration (CBD) temporarily improved hand and arm function in

early-disease

stages while treatment in advanced stages reduced pain, facilitated hygiene

and

prevented secondary contractures. Limb dystonia was also alleviated by BtxA

therapy in one patient with neuronal multisystem degeneration of

undetermined

cause. The results suggest that BtxA therapy may represent an effective

means of

alleviating disabling focal dystonia in different APDs. Particularly in

early

stage APD with disabling limb dystonia local BtxA injections may result in

functional improvement.

PMID: 11993530 [PubMed - in process]