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Dressler D, Altavista MC, Altenmueller E, Bhidayasiri R, Bohlega S, Chana P, Chung TM, Colosimo C, Fheodoroff K, Garcia-Ruiz PJ, Jeon B, Jin L, Kanovsky P, Milanov I, Micheli F, Orlova O, Pandey S, Pirtosek Z, Relja M, Rosales R, Sagástegui-Rodríguez JA, Shahidi GA, Timerbaeva S, Wan X, Walter U, Saberi FA. Consensus guidelines for botulinum toxin therapy: general algorithms and dosing tables for dystonia and spasticity. J Neural Transm (Vienna) 2021; 128:321-335. [PMID: 33635442 PMCID: PMC7969540 DOI: 10.1007/s00702-021-02312-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/22/2021] [Indexed: 12/01/2022]
Abstract
Botulinum toxin (BT) therapy is a complex and highly individualised therapy defined by treatment algorithms and injection schemes describing its target muscles and their dosing. Various consensus guidelines have tried to standardise and to improve BT therapy. We wanted to update and improve consensus guidelines by: (1) Acknowledging recent advances of treatment algorithms. (2) Basing dosing tables on statistical analyses of real-life treatment data of 1831 BT injections in 36 different target muscles in 420 dystonia patients and 1593 BT injections in 31 different target muscles in 240 spasticity patients. (3) Providing more detailed dosing data including typical doses, dose variabilities, and dosing limits. (4) Including total doses and target muscle selections for typical clinical entities thus adapting dosing to different aetiologies and pathophysiologies. (5) In addition, providing a brief and concise review of the clinical entity treated together with general principles of its BT therapy. For this, we collaborated with IAB—Interdisciplinary Working Group for Movement Disorders which invited an international panel of experts for the support.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | | - Eckart Altenmueller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hannover, Germany
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre for Excellence on Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Saeed Bohlega
- Department of Neurology, King Faisal Specialist Hospital, Riyyad, Kingdom of Saudi Arabia
| | - Pedro Chana
- Department of Neurology, University de Santiago de Chile, Santiago de Chile, Chile
| | | | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | | | | | - Beomseok Jeon
- Department of Neurology, Seoul National University, Seoul, Republic of Korea
| | - Lingjing Jin
- Department of Neurology, Tongji University School of Medicine, Shanghai, China
| | - Petr Kanovsky
- Department of Neurology, Palacky University, Olomouc, Czech Republic
| | - Ivan Milanov
- Department of Neurology, Medical University of Sofia, Sofia, Bulgaria
| | - Federico Micheli
- Department of Neurology, Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Zvezdan Pirtosek
- Department of Neurology, Ljubljana University, Ljubljana, Slovenia
| | - Maja Relja
- Department of Neurology, University of Zagreb, Zagreb, Croatia
| | - Raymond Rosales
- Department of Neurology, University of Santo Tomas, Manila, Philippines
| | | | - Gholam Ali Shahidi
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Xinhua Wan
- Department of Neurology, Peking Union Medical College, Beijing, China
| | - Uwe Walter
- Department of Neurology, Rostock University, Rostock, Germany
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Dressler D, Kopp B, Adib Saberi F. Botulinum toxin dosing in arm muscles: contextual factors. J Neural Transm (Vienna) 2021; 128:315-319. [PMID: 33515332 PMCID: PMC7969489 DOI: 10.1007/s00702-021-02307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022]
Abstract
Botulinum toxin (BT) has been successfully used for many years to treat various muscle hyperactivity disorders including dystonia and spasticity. Its dosing is guided by dosing tables describing target muscles and dose ranges. To refine the BT dosing, we wanted to analyse how contextual factors may influence the injector's final dosing decision. In a retrospective review of real-life data of 1170 BT treatments, we studied the influence of various contextual factors on the BT doses in 21 arm muscles of 252 patients receiving BT therapy for different muscle hyperactivity disorders. We found that BT arm doses are significantly higher in treatment of spasticity than in treatment of dystonia. We also found that spontaneous arm dystonia requires higher BT doses in a proximal application pattern, whereas task specific writer's cramp requires considerably reduced BT doses with a distal application pattern. Injections of non-arm muscles influence the BT dosing in arm muscles only marginally. Our study demonstrates that BT dosing does not only depend on the particularities of the individual target muscle injected, such as its volume and its static or phasic function. BT dosing and its application pattern rather depend on additional contextual factors such as the aetiology and pathophysiology of the muscle hyperactivity treated. These contextual factors need to be included in dosing tables and may improve the outcome of BT therapy.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Fereshte Adib Saberi
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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