Abstract
Local chemodenervation with botulinum toxin (BoNT) injections to relax abnormally contracting muscles has been shown to be an effective and well-tolerated treatment in a variety of movement disorders and other neurological and non-neurological disorders. Despite almost 30 years of therapeutic use, there are only few studies of patients treated with BoNT injections over long period of time. These published data clearly support the conclusion that BoNT not only provides safe and effective symptomatic relief of dystonia but also long-term benefit and possibly even favorably modifying the natural history of this disease. The adverse events associated with chronic, periodic exposure to BoNT injections are generally minor and self-limiting. With the chronic use of BoNT and an expanding list of therapeutic indications, there is a need to carefully examine the existing data on the long-term efficacy and safety of BoNT. In this review we will highlight some of the aspects of long-term effects of BoNT, including efficacy, safety, and immunogenicity.
Highlights
botulinum toxin (BoNT) is the most potent biologic toxin found in nature
Sixteen of the antibody-negative patients resumed responsiveness by dose adjustment, whereas 2 persisted as non-responders. These findings suggest that BoNT is an effective long-term treatment with adequate and persistent therapeutic response and mild side effect profile
Chronic BoNT treatment has changed the natural history of dystonia
Summary
BoNT is the most potent biologic toxin found in nature. Its pharmacological action results in inhibition of acetylcholine release into the neuromuscular junction. As a result of local chemodenervation BoNT relaxes abnormally contracting muscles which has been shown to be an Toxins 2013, 5 effective treatment in a variety of movement disorders and other neurological and non-neurological disorders. The results from the initial trial in cranial-cervical dystonia at Baylor College of Medicine [2], blepharospasm, a form of focal dystonia, was the first indication approved by the United. There are four BoNT products commercially available in the US approved for various therapeutic and cosmetic indications with the following non-proprietary and brand names: OnabotulinumtoxinA (Botox® [Type A]); IncobotulinumtoxinA (Xeomin® [Type A]); AbobotulinumtoxinA (Dysport® [Type A]); RimabotulinumtoxinB (Myobloc® [Type B]) [4]. In addition to FDA-approved indications, there is an expanding list of off-label therapeutic uses [5,6,7,8,9]. In this review we will highlight some of the aspects of long-term effects of BoNT, including efficacy, adverse effects, and immunogenicity
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