Evidence-based review and assessment of botulinum neurotoxin for the treatment of movement disorders

• Published in: Toxicon (Oxford) 2013-06, Vol.67, p.94-114
• Main Authors: Hallett, Mark, Albanese, Alberto, Dressler, Dirk, Segal, Karen R., Simpson, David M., Truong, Daniel, Jankovic, Joseph
• Format: Article
• Language: English
• Subjects: AbobotulinumtoxinA; Blepharospasm - drug therapy; botulinum toxin; Botulinum Toxins, Type A - therapeutic use; Chemodenervation; Dystonia; Dystonia - drug therapy; Dystonic Disorders - drug therapy; Evidence-Based Medicine; Face; Humans; IncobotulinumtoxinA; larynx; movement disorders; Movement Disorders - drug therapy; Nerve Block - methods; Neurotoxins - therapeutic use; OnabotulinumtoxinA; RimabotulinumtoxinB; serotypes; therapeutics; Tic Disorders - drug therapy; Treatment Outcome; Tremor - drug therapy
• ISSN: 0041-0101; 1879-3150
• DOI: 10.1016/j.toxicon.2012.12.004

Botulinum neurotoxin (BoNT) can be injected to achieve therapeutic benefit across a large range of clinical conditions. To assess the efficacy and safety of BoNT injections for the treatment of certain movement disorders, including blepharospasm, hemifacial spasm, oromandibular dystonia, cervical dystonia, focal limb dystonias, laryngeal dystonia, tics, and essential tremor, an expert panel reviewed evidence from the published literature. Data sources included English-language studies identified via MEDLINE, EMBASE, CINAHL, Current Contents, and the Cochrane Central Register of Controlled Trials. Evidence tables generated in the 2008 Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (AAN) review of the use of BoNT for movement disorders were also reviewed and updated. The panel evaluated evidence at several levels, supporting BoNT as a class, the serotypes BoNT-A and BoNT-B, as well as the four individual commercially available formulations: abobotulinumtoxinA (A/Abo), onabotulinumtoxinA (A/Ona), incobotulinumtoxinA (A/Inco), and rimabotulinumtoxinB (B/Rima). The panel ultimately made recommendations for each therapeutic indication, based upon the strength of clinical evidence and following the AAN classification scale. For the treatment of blepharospasm, the evidence supported a Level A recommendation for BoNT-A, A/Inco, and A/Ona; a Level B recommendation for A/Abo; and a Level U recommendation for B/Rima. For hemifacial spasm, the evidence supported a Level B recommendation for BoNT-A and A/Ona, a Level C recommendation for A/Abo, and a Level U recommendation for A/Inco and B/Rima. For the treatment of oromandibular dystonia, the evidence supported a Level C recommendation for BoNT-A, A/Abo, and A/Ona, and a Level U recommendation for A/Inco and B/Rima. For the treatment of cervical dystonia, the published evidence supported a Level A recommendation for all four BoNT formulations. For limb dystonia, the available evidence supported a Level B recommendation for both A/Abo and A/Ona, but no published studies were identified for A/Inco or B/Rima, resulting in a Level U recommendation for these two formulations. For adductor laryngeal dystonia, evidence supported a Level C recommendation for the use of A/Ona, but a Level U recommendation was warranted for B/Rima, A/Abo, and A/Inco. For the treatment of focal tics, a Level U recommendation was warranted at this time for all four formulations. For the treat