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Cutrona C, Marchet F, Costanzo M, De Bartolo MI, Leodori G, Ferrazzano G, Conte A, Fabbrini G, Berardelli A, Belvisi D. Exploring the Central Mechanisms of Botulinum Toxin in Parkinson's Disease: A Systematic Review from Animal Models to Human Evidence. Toxins (Basel) 2023; 16:9. [PMID: 38251226 PMCID: PMC10818853 DOI: 10.3390/toxins16010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Botulinum toxin (BoNT) is an effective and safe therapy for the symptomatic treatment of several neurological disturbances. An important line of research has provided numerous pieces of evidence about the mechanisms of action of BoNT in the central nervous system, especially in the context of dystonia and spasticity. However, only a few studies focused on the possible central effects of BoNT in Parkinson's disease (PD). We performed a systematic review to describe and discuss the evidence from studies focused on possible central effects of BoNT in PD animal models and PD patients. To this aim, a literature search in PubMed and SCOPUS was performed in May 2023. The records were screened according to title and abstract by two independent reviewers and relevant articles were selected for full-text review. Most of the papers highlighted by our review report that the intrastriatal administration of BoNT, through local anticholinergic action and the remodulation of striatal compensatory mechanisms secondary to dopaminergic denervation, induces an improvement in motor and non-motor symptoms in the absence of neuronal loss in animal models of PD. In human subjects, the data are scarce: a single neurophysiological study in tremulous PD patients found that the change in tremor severity after peripheral BoNT administration was associated with improved sensory-motor integration and intracortical inhibition measures. Further clinical, neurophysiological, and neuroimaging studies are necessary to clarify the possible central effects of BoNT in PD.
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Affiliation(s)
- Carolina Cutrona
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
| | - Francesco Marchet
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
| | - Matteo Costanzo
- Department of Neuroscience, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Maria Ilenia De Bartolo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
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Sugar D, Patel R, Comella C, González DA, Gray G, Stebbins GT, Mahajan A. The effect of botulinum toxin on anxiety in cervical dystonia: A prospective, observational study. Parkinsonism Relat Disord 2023; 114:105792. [PMID: 37540934 DOI: 10.1016/j.parkreldis.2023.105792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Anxiety is present in 30-40% of patients with cervical dystonia (CD). It has been ascribed to a direct effect of the state of motor symptoms on related pain, disability, and disfigurement. Accordingly, any reported benefit of botulinum toxin (BoNT) on anxiety is thought to be secondary to its effect on the same. We sought to evaluate the distinctive impact of botulinum toxin (BoNT) on anxiety in cervical dystonia (CD). METHODS In this prospective observational study, 60 participants with idiopathic isolated CD were recruited from clinic. We assessed motor and anxiety burden using Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) parts I-III and State-Trait Anxiety Inventory (STAI). Assessments were done at time of BoNT (baseline) and at 6 weeks post-injection. RESULTS STAI and motor severity TWSTRS scores poorly correlated at the baseline visit (rho = -0.30, p = 0.411). Both, motor TWSTRS (Mdifference = -1.46, p < 0.024) and STAI (Mdifference = -10.37, p = 0.007) improved from baseline to 6 weeks (peak effect). The change in motor TWSTRS poorly correlated with change in anxiety scores from baseline visit to 6 weeks (rho = -0.14, p > 0.999). Of these measures of anxiety, improvement in STAI-T had the largest effect size (rank biserial = 0.52). CONCLUSION BoNT improves both motor severity and anxiety in CD. Poor correlation between motor severity and anxiety at both the time of injection and during the time of peak effect, and improvement in trait anxiety suggests that BoNT has a direct beneficial effect on anxiety.
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Affiliation(s)
- Dana Sugar
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Roshni Patel
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Cynthia Comella
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - David A González
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Gabrielle Gray
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Glenn T Stebbins
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Abhimanyu Mahajan
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA.
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