Abstract
BackgroundBotulinum toxin (BoNT) is a valuable treatment in movement disorders; however, time to onset and duration of efficacy may widely differ among patients. We aimed to clarify the impact of main demographic and clinical features on time to onset and duration of BoNT efficacy.MethodsWe analyzed time-to-onset and duration of BoNT efficacy in 186 consecutive patients treated with BoNT for blepharospasm, cervical dystonia, facial hemispasm, oromandibular dystonia, limb dystonia, and sialorrhea due to Parkinsonism. The following factors were considered as potential efficacy predictors: doses and types of toxin, sex, age, years of treatment, and clinical condition. Kruskall–Wallis, Spearman correlation, and multivariate linear regression were used for statistical analysis.ResultsThe average time to onset was 6.7 ± 5 days and duration of BONT efficacy 78.5 ± 28.4 days. Both time to onset and duration of efficacy were correlated with BoNT doses (p: 0.007 and p: 0.02). The multiple regression analysis showed that sex, age, years of BoNT treatment, doses, type of toxin, and clinical condition significantly predicted time to onset (F(11, 171) = 2.146, p: 0.020) with age being the strongest predictor (p: 0.004).The same model explained 20.1% of the variance of duration of BoNT efficacy, showing a significant prediction of the outcome (F(11, 164) = 3.754, p < 0.001), with doses (p < 0.001), type of toxin (p: 0.017), and clinical condition (p < 0.001) being the strongest predictors.ConclusionOur findings suggest that age, type of toxin, clinical condition and especially doses may account for the variability of BoNT efficacy in terms of time to onset and duration.
Highlights
Botulinum toxin (BoNT) is one of the most potent biological toxins and has emerged as a valuable and versatile therapeutic agent for many neurological applications [1].BoNT acts by inhibiting the release of acetylcholine from the presynaptic terminal at the neuromuscular junction, leading to inhibition of neurotransmitter release and temporary weakness of the target muscle [1, 2]
We enrolled 186 patients treated with BoNT for the following conditions: 34.9% (n = 65/186) for blepharospasm, 24.7% (n = 46/186) for cervical dystonia, 21.5% (n = 40/186) for hemifacial spasm, 7.5% (n = 14/186) for sialorrhea due to parkinsonism, 8.6% (n = 16/186) for focal or segmental limb dystonia, and 2.7% (n = 5/186) for oromandibular dystonia
In our study on 186 patients treated with BoNT for movement disorders or sialorrhea, we observed a high variability in time to onset and duration of BoNT efficacy
Summary
Botulinum toxin (BoNT) is one of the most potent biological toxins and has emerged as a valuable and versatile therapeutic agent for many neurological applications [1].BoNT acts by inhibiting the release of acetylcholine from the presynaptic terminal at the neuromuscular junction, leading to inhibition of neurotransmitter release and temporary weakness of the target muscle [1, 2]. There are three main BoNT type A preparations used in Europe in clinical practice: onabotulinumtoxinA (onaBoNTA), abobotulinumtoxinA (aboBoNT-A) and incobotulinumtoxinA (incoBoNT-A) [4, 5]. These three formulations are considered to have similar efficacy and safety profile, but. Botulinum toxin (BoNT) is a valuable treatment in movement disorders; time to onset and duration of efficacy may widely differ among patients. The multiple regression analysis showed that sex, age, years of BoNT treatment, doses, type of toxin, and clinical condition significantly predicted time to onset (F(11, 171) = 2.146, p: 0.020) with age being the strongest predictor (p: 0.004). Conclusion Our findings suggest that age, type of toxin, clinical condition and especially doses may account for the variability of BoNT efficacy in terms of time to onset and duration
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