Abstract
For well over 30 years, the botulinum neurotoxin (BoNT) has been used for a large number of indications, some of which however have not been licensed. Admittedly, approval varies in many countries and this permits a large spectrum for evaluation. Thus, BoNT is used for patients with Parkinson’s disease (PD) and other Parkinson’s syndromes (PS) in varying degrees of frequency. We have to distinguish between (1) indications that are either approved or (2) those not approved, (3) indications that might be a result of PS and (4) finally those which appear independent of PS. The most important indication for BoNT in PS patients is probably sialorrhea, for which approval has been granted in the majority of countries. Cervical dystonia is a frequent symptom in PS, with anterocollis as a specific entity. A further indication is blepharospasm in the different forms, especially the inhibition of eyelid opening in atypical PS. The use of BoNT in cases of camptocormia, the Pisa syndrome and neck rigidity is still a matter of debate. In dystonia of the extremities BoNT can be recommended, especially in dystonia of the feet. One well-known indication, for which however sufficient data are still lacking, involves treating tremor with BoNT. As to autonomic symptoms: Focal hyperhidrosis and detrusor hyperactivity can be mentioned, in this last case BoNT has already been approved. A number of further but rare indications such as freezing-of-gait, dyskinesia, and dysphagia will be discussed and evaluated.
Highlights
Clinical consequence: In cases of sialorrhea resulting from swallowing disturbance, the injection of botulinum neurotoxin (BoNT) into the salivary glands is the therapy of choice
BoNT has demonstrated the capability for closing the gap in treating Parkinson symptoms and to provide symptomatic relief
BoNT has been approved in the meantime for the treatment of sialorrhea and an overactive bladder
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. In the majority of countries the following indications have been approved Dysport® , SPC Xeomin® ): torticollis spasmodicus (cervical dystonia) blepharospasm hemifacial spasm spastic equinus in cerebral palsy focal spasticity (arm and foot) axillary hyperhidrosis chronic migraine neurogenic/idiopathic bladder sialorrhea spasmodic dysphonia (approved only in some countries). Considering the use of BoNT in Parkinson’s syndrome (PS), we can distinguish between: (1) uses in indications independent of the underlying disease (co-morbidities); (2). Indications induced by the primary disease and (3) indications which represent symptoms of PS. Only those symptoms will be treated which are directly associated with the underlying disease PS itself. It is interesting to note that some indications have been formulated so strictly that the specific indication in PS does not conform to the approval
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