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Expert Opin Drug Saf 2021 Apr 8. Epub 2021 Apr 8.

Department of Neurology, Santa Maria University Hospital, Terni, Italy.

IntroductionBotulinum toxin (BoNT) injections represent the "gold standard" treatment for cervical dystonia (CD). Different types of BoNT have been used for the treatment of CD, but only two serotypes, BoNT type A (BoNT-A) and type B (BoNT-B), have been approved by regulatory agencies. Efficacy and safety of BoNT have been well documented by many short-term studies, but the long-term effects have been investigated only relatively recently. Read More

Neurourol Urodyn 2021 Apr 8. Epub 2021 Apr 8.

Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.

Aims: Sacral neuromodulation (SNM) and Botulinum toxin A (BoNT-A) injections are well-known third-line treatment options in patients with refractory overactive bladder (OAB). Our aim is to evaluate the success rate of SNM in patients who received prior therapy with BoNT-A injections.

Methods: All patients with OAB symptoms referred for SNM between 2006 and 2019 were included. Read More

Toxins (Basel) 2021 Mar 14;13(3). Epub 2021 Mar 14.

Department of Orthopedics, Shriners Hospitals for Children, Chicago, IL 60707, USA.

We conducted a scoping review to investigate the effects of intramuscular injection of Botulinum Toxin A (BoNT-A) on bone morphology. We investigated if the muscle atrophy associated with Injection of BoNT-A had effects on the neighboring bone. We used the search terms: osteopenia, bone atrophy, Botulinum Toxin A, Micro-CT, mice or rat. Read More

Minerva Urol Nephrol 2021 Mar 26. Epub 2021 Mar 26.

Department of Medicine, University of Perugia, Perugia, Italy.

Background: A randomized, double-blind, non-inferiority clinical study was performed on the efficacy and tolerability of IncobotulinumtoxinA vs OnabotulinumtoxinA intradetrusor injections in patients with refractory neurogenic detrusor overactivity incontinence performing intermittent catheterization.

Methods: Sixty-four patients with Spinal Cord Injury or Multiple Sclerosis were randomized to receive 30 intradetrusor injections of IncobotulinumtoxinA or OnabotulinumtoxinA 200 U; 28 patients in IncobotulinumtoxinA group and 29 in OnabotulinumtoxinA group completed the study. Primary outcome measure was the noninferior variation from baseline in daily urinary incontinence episodes (week 12), with a non-inferiority margin of one episode/day. Read More

J Pediatr Urol 2021 Feb 23. Epub 2021 Feb 23.

Department of Urology, Biruni University, Istanbul, Turkey. Electronic address:

Objective: This study aimed to determine the effectiveness of intradetrusor injections of onabotulinum toxin-A (BoNT-A) in pediatric patients with neurogenic bladders (NB) due to myelomeningocele (MMC). The factors predicting success were also evaluated.

Study Design: We retrospectively identified 62 patients with NB due to MMC who underwent intravesical BoNT-A injection (100-300 U) between May 2013 and December 2018. Read More

Case Rep Neurol 2021 Jan-Apr;13(1):92-99. Epub 2021 Feb 15.

Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy.

Upper limb intention tremor is a common cause of disability in multiple sclerosis (MS). Transcranial direct current stimulation (tDCS) is an emerging form of brain stimulation used to improve sensorimotor impairments in many neurological disorders. Here, we describe a combined therapeutic approach with botulinum neurotoxin type A (BoNT-A) and tDCS for the treatment of upper limb tremor in a patient with MS. Read More

J Pers Med 2021 Feb 27;11(3). Epub 2021 Feb 27.

Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street. CHP 155, Los Angeles, CA 90033, USA.

Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7-16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. Read More

Front Neurol 2021 9;12:636590. Epub 2021 Feb 9.

Department of Neurology, University of Düsseldorf, Düsseldorf, Germany.

This study investigated the clinical long-term effect of incobotulinumtoxinA (incoBoNT/A) in 33 cervical dystonia (CD) patients who had developed partial secondary therapy failure (PSTF) under previous long-term botulinum toxin (BoNT) treatment. Patients were treated four times every 12 weeks with incoBoNT/A injections. Physicians assessed treatment efficacy using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) at the baseline visit, week 12 and 48. Read More

J Rehabil Med 2021 02 24;53(2):jrm00157. Epub 2021 Feb 24.

Departmant of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom. E-mail:

Objective: To assess the longitudinal effects of integrated spasticity management incorporating repeated cycles of botulinum toxin A type A (BoNT-A) over 2 years.

Methods: The Upper Limb International Spasticity study was a prospective, observational, cohort study following adult patients over 2 years of integrated upper-limb spasticity management including repeat botulinum toxin (BoNT-A) treatment (any commercially-available product).

Results: A total of 1,004 participants from 14 countries were enrolled, of which 953 underwent ≥ 1 BoNT-A injection cycle (median 4 cycles) and had ≥ 1 goal attainment scaling assessment. Read More

Toxins (Basel) 2021 01 29;13(2). Epub 2021 Jan 29.

Department of Neurology, University Hospital of Düsseldorf, D-40225 Düsseldorf, Germany.

Botulinum neurotoxin type A (BoNT/A) injections have to be administered repeatedly to achieve a rather stable, high level of improvement. This study aimed to take a look at changes in the daily routine of a BoNT/A outpatient clinic due to the SARS-CoV-2 pandemic lockdown, analyze the impact of SARS-CoV-2-induced re-injection delay on outcomes in patients with cervical dystonia (CD) ( = 36) and four other disease entities ( = 58), and study the influence of covariables, including previous injections and doses. For the present observational study, the first 100 patients who were scheduled to have an appointment between April 20 and May 18 during the partial lockdown and also had been treated regularly before the lockdown were recruited. Read More

Front Neurol 2020 22;11:615706. Epub 2021 Jan 22.

Department of Physical Medicine and Rehabilitation and the Department of Neurology, Northwestern University Feinberg School of Medicine and Shirley Ryan AbilityLab, Chicago, IL, United States.

The efficacy and safety of incobotulinumtoxinA ≤400 U was demonstrated in subjects with post-stroke upper-limb spasticity in a randomized, double-blind Phase 3 study with an open-label extension (OLEX; EudraCT number 2005-003951-11, NCT00432666). We report a analysis of the duration of the treatment effect. Subjects completing the placebo-controlled main period (single injection cycle with 12-20-week observation) entered the OLEX and received a maximum of five further treatments (maximum duration 69 weeks) with incobotulinumtoxinA ≤400 U at flexible intervals with a minimum duration of 12 weeks, based on clinical need. Read More

J Cosmet Dermatol 2021 Feb 4. Epub 2021 Feb 4.

Plastic and reconstructive Surgery, Clinique Santa Maria, Nice, France.

Background: Botulinum toxin type A (BoNT-A) injection remains the leading medical cosmetic procedure worldwide, with a high rate of patient satisfaction. However, it still suffers from patients' fear of being unable to transmit their emotions and of looking frozen from unnatural results.

Aim: This study aimed to determine whether BoNT-A can decrease the intensity of emotions in facial expressions. Read More

J Manag Care Spec Pharm 2021 Apr 29;27(4):478-487. Epub 2021 Jan 29.

School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine.

The Centers for Medicare & Medicaid Services (CMS) is the single largest payer for health care in the United States and the largest payer by spending globally. Medicare Part B, with more than 50 million beneficiaries, currently has no broad mechanisms in place for promoting cost-effective care of injectable drugs. To conduct a real-world utilization and cost analysis comparing botulinum toxins in movement disorders. Read More

Dev Med Child Neurol 2021 Jan 22. Epub 2021 Jan 22.

Faculty of Medicine Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey.

Aim: To assess the efficacy of intermittent serial casting in conjunction with occupational therapy and botulinum neurotoxin A (BoNT-A) in children with cerebral palsy (CP) presenting spastic wrist flexion deformity.

Method: This was a controlled, prospective study in which 34 children (19 females, 15 males; mean [SD] 11y [4y 6mo]) were randomly allocated to casting or control groups in a ratio of 2:1. Both groups were subjected to BoNT-A treatment and occupational therapy. Read More

Neurol Neurochir Pol 2021 Jan 20. Epub 2021 Jan 20.

Department of Neurological-Psychiatric Nursing, Medical University of Gdańsk, Dpt. of Neurology, St. Adalbert Hospital, Gdańsk, Poland.

Aim Of Study: Botulinum neurotoxin type A (BoNT/A) injections are the established treatment in cervical dystonia (CD). But clinical practice regarding the choice of muscles into which injections are made varies between centres. Until now, there have been no dose-per-muscle recommendations based on 'searching the dose' clinical trial data. Read More

Rehabilitacion (Madr) 2021 Jan 16. Epub 2021 Jan 16.

Unidad Gestión Clínica Medicina Física y Rehabilitación, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España; Grupo iRehab, Instituto de Investigación e Innovación Biomédica de Cádiz, Cádiz, España.

Objective: This study aimed to describe our experience with a protocol based on sevoflurane sedation to control pain and agitation during botulinum toxin-A (BoNT-A) infiltration in children with cerebral palsy (CP), especially in terms of safety and efficacy.

Material And Methods: We conducted a retrospective observational study of patients diagnosed with CP who underwent BoNT-A infiltration with sevoflurane sedation from November 2012 to December 2019. Demographic, clinical and functional characteristics, the effectiveness of sedation, adverse events (AE) and professional satisfaction were reviewed. Read More

Tremor Other Hyperkinet Mov (N Y) 2020 12 31;10:61. Epub 2020 Dec 31.

Yale University, New Haven, CT, US.

Background: Hand tremor associated with Parkinson disease (PD) and essential tremor (ET) can often become challenging to treat in clinical practice. Local injections of botulinum toxin-A (BoNT-A) for hand tremor is an evolving field with newer injection techniques being utilized in clinical studies. The utility of BoNT-A therapy for ET and PD-tremor however, has been questioned based on the high incidence of finger and hand weakness after treatment. Read More

Toxins (Basel) 2020 Dec 20;12(12). Epub 2020 Dec 20.

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.

In this first, double-blind, randomized, placebo-controlled exploratory trial, we evaluate the efficacy and safety of incobotulinumtoxinA and feasibility of using kinematic tremor assessment to aid in the planning of muscle selection in a multicenter setting. Reproducibility of the planning technology to other clinical sites was explored. In this trial (NCT02207946), patients with upper-limb essential tremor (ET) were randomized 2:1 to a single treatment cycle of incobotulinumtoxinA or placebo. Read More

Int Neurourol J 2020 Dec 31;24(4):301-312. Epub 2020 Dec 31.

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan.

Patients with neurogenic lower urinary tract dysfunction (NLUTD) experience urinary incontinence with or without difficult urination, which might promote recurrent urinary tract infection (UTI) and exacerbate upper urinary tract function. Nonetheless, appropriate bladder management has been shown to reduce urological complications and improve quality of life. In addition to pharmacological therapy and surgical intervention, botulinum toxin A (BoNT-A) has been widely utilized in NLUTD. Read More

Muscle Nerve 2021 Apr 22;63(4):525-530. Epub 2021 Jan 22.

UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA.

Background: Despite use of qualitative laryngeal electromyography (LEMG) guided botulinum toxin A (BoNT-A) injection for treatment of adductor spasmodic dysphonia (AdSD), unsatisfactory injections and complete "misses" remain problematic. We aimed to determine if the quantitative LEMG measure of number of small segments (NSS) correlates with voice outcomes following (BoNT-A injection for AdSD.

Methods: Automated quantitative LEMG analysis was performed during electromyography (EMG) -guided BoNT-A injection into the thyroarytenoid-lateral cricoarytenoid muscle complex for treatment of AdSD. Read More

Toxins (Basel) 2020 12 4;12(12). Epub 2020 Dec 4.

Ipsen, São Paulo 04571-010, Brazil.

Botulinum toxin type A (BoNT-A) is an effective treatment for post-stroke spasticity; however, some patients cannot access treatment until ≥1 year post-stroke. This Brazilian post-marketing study (NCT02390206) assessed the achievement of person-centered goals in patients with chronic post-stroke spasticity after a BoNT-A injection. Patients had a last documented stroke ≥1 year before study entry and post-stroke upper limb (UL) spasticity, with or without lower limb (LL) spasticity. Read More

JMIR Public Health Surveill 2020 12 7;6(4):e17928. Epub 2020 Dec 7.

Neurorehabilitation Unit, Ciudad de Telde Hospital, Las Palmas, Spain.

Background: Patient- and caregiver-reported data are lacking on the burden of spasticity, and the impact of botulinum neurotoxin type A (BoNT-A) treatment for this condition, on patients' daily lives. As recommended in recent guidance from the US Food and Drug Administration, online patient communities can represent a platform from which to gather specific information outside of a clinical trial setting on the burden of conditions experienced by patients and caregivers and their views on treatment options in order to inform evidence-based medicine and drug development.

Objective: The objective of our study is to characterize spasticity symptoms and their associated burdens on Western European and US patients and caregivers in the realms of work, daily activities, quality of life (QoL), as well as the positive and negative impacts of treatment with BoNT-A (cost, time, QoL) using Carenity, an international online community for people with chronic health conditions. Read More

Dermatol Surg 2020 12;46(12):1657-1660

Departments of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea.

Background: In clinical practice, one of the most important issues regarding the use of botulinum neurotoxin A (BoNT-A) is the proper storage conditions and the change in potency and quality over time after reconstitution.

Objective: This study aimed to investigate the change in potency and quality of reconstituted prabotulinumtoxin A (PraBoNT-A) over time when stored at different storage temperatures.

Materials And Methods: ICR/CD-1 mice and PraBoNT-A were used for the mouse intraperitoneal lethal dose 50% (LD50) test. Read More

J Pediatr Rehabil Med 2020 ;13(3):273-279

Children's Mercy Hospital Kansas City, MO, USA.

Purpose: After the onset of the Coronavirus pandemic of 2019-2020 (COVID-19), physicians who inject OnabotulinumtoxinA (BoNT-A) were left with determining risks and benefits in pediatric patients with cerebral palsy. Many of these patients have pre-existing conditions that make them more prone to COVID-19 symptoms, and this susceptibility potentially increases after BoNT-A injections.

Methods: A retrospective chart review of 500 patients identified 256 pediatric patients with cerebral palsy who received an intramuscular BoNT-A injection to determine relative doses used for each Gross Motor Functional Classification Score (GMFCS). Read More

Front Pediatr 2020 22;8:557. Epub 2020 Oct 22.

Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua City, Taiwan.

To establish a pilot study on applying two low dose (40 h) constraint-induced movement therapy (CIMT) interventions in children with hemiplegic cerebral palsy (CP) after botulinum toxin (BoNT-A) injection during preschool education. Five children with spastic CP (mean age: 5.31 years; Gross Motor Function Classification System level I and II) undergoing regular BoNT-A injections and rehabilitation programs were included. Read More

Cochrane Database Syst Rev 2020 11 12;11:CD003633. Epub 2020 Nov 12.

Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.

Background: This is an update of a Cochrane Review first published in 2005. Cervical dystonia is the most common form of focal dystonia, and is a highly disabling movement disorder, characterised by involuntary, usually painful, head posturing. Currently, botulinum toxin type A (BtA) is considered the first line therapy for this condition. Read More

Toxins (Basel) 2020 10 27;12(11). Epub 2020 Oct 27.

Department of Neurology, University of Düsseldorf, Moorenstraße 5, D-40225 Düsseldorf, Germany.

Background: Botulinum toxin type B (BoNT/B) has been recommended as an alternative for patients who have become resistant to botulinum toxin type A (BoNT/A). This study aimed to compare the clinical effect, within a patient, of four injections with low doses of rimabotulinumtoxinB with the effect of the preceding abobotulinumtoxinA (aboBoNT/A) injections.

Methods: In 17 patients with cervical dystonia (CD) who had become resistant to aboBoNT/A, the clinical effect of the first four rimabotulinumtoxinB (rimaBoNT/B) injections was compared to the effect of the first four aboBoNT/A injections using a global assessment scale and the TSUI score. Read More

J Rehabil Med 2021 Jan 5;53(1):jrm00138. Epub 2021 Jan 5.

Faculty of Medicine and Dentistry and University Hospital, Palacký University Olomouc, Olomouc, Czech Republic. E-mail:

Objective: This post hoc analysis assessed the impact of repeated incobotulinumtoxinA injections on muscle tone, disability, and caregiver burden in adults with upper-limb post-stroke spasticity.

Design: Data from the double-blind, placebo-controlled main period and three open-label extension cycles of two Phase 3, randomized, multicentre trials were pooled.

Methods: Subjects received incobotulinumtoxinA 400 Units at 12-week intervals (±3 days) (study 3001, NCT01392300) or ≤ 400 Units at ≥12-week intervals based on clinical need (study 0410, NCT00432666). Read More

Front Hum Neurosci 2020 24;14:342. Epub 2020 Aug 24.

The Royal Melbourne Hospital, Melbourne, VIC, Australia.

Spasticity and motor recovery are both related to neural plasticity after stroke. A balance of activity in the primary motor cortex (M1) in both hemispheres is essential for functional recovery. In this study, we assessed the intracortical inhibitory and facilitatory circuits in the contralesional M1 area in four patients with severe upper limb spasticity after chronic stroke and treated with botulinum toxin-A (BoNT-A) injection and 12 weeks of upper limb rehabilitation. Read More

Neurol Neurochir Pol 2020 13;54(6):561-567. Epub 2020 Oct 13.

Guangzhou University of Traditonal Chinese Medicine, No 12，Baiyun District, 510000 Guangzhou, China.

Background: Tremor is one of the most common movement disorders. It does not usually respond to first-line drug treatments (e.g. Read More