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Toxins
Special Issues
Application of Botulinum Toxins in Non-spastic and Neurodegenerative Disorders
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Application of Botulinum Toxins in Non-spastic and Neurodegenerative Disorders

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 13511

Special Issue Editors

Dr. Marjolaine Baude

E-Mail Website
Guest Editor
Service de Rééducation Neurolocomotrice, Henri Mondor University Hospitals, 94000 Créteil, France
Interests: neuroplasticity; neurorehabilitation; spasticity; movement disorders; neurodegenerative diseases; botulinum toxin; facial nerve injuries; facial paresis; motion capture
Prof. Dr. Jean-Michel Gracies

E-Mail Website
Guest Editor
Service de Rééducation Neurolocomotrice, Henri Mondor University Hospitals, 94000 Créteil, France
Interests: neuroplasticity; neurorehabilitation; movement disorders; spasticity; neurodegenerative diseases; botulinum toxin

Special Issue Information

Dear Colleagues,

In recent years, botulinum toxins (BoNT), beyond their massive use in conditions involving spastic muscle overactivity, have been used for the treatment of a large number of other medical indications, including the treatment of non-spastic motor and non-motor disorders. Many of the symptoms or syndromes for which BoNT has been found to be effective occur in a variety of neurological conditions, including neurodegenerative disorders. Botulinum toxins are highly potent biotoxins that can partially block nerve signals to muscles or other effectors. Suited doses make them potentially powerful therapeutic tools for excessive muscle contractions or autonomic dysfunctions.

This Special Issue will provide discussions on the application and development of botulinum toxins in the treatment of non-spastic motor and non-motor symptoms, particularly in the context of neurodegenerative diseases. Submissions can include reviews, systematic reviews, and meta-analyses, as well as original studies.

Dr. Marjolaine Baude
Prof. Dr. Jean-Michel Gracies
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Toxins is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • botulinum toxin
  • non-spastic neurologic disorders
  • neurodegenerative disorders
  • parkinsonian syndromes
  • idiopathic parkinson’s disease
  • tremors
  • facial paresis

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Published Papers (5 papers)

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Research

Jump to: Review, Other

14 pages, 1259 KiB  
Article
Long-Term Muscular Atrophy and Weakness Following Cessation of Botulinum Toxin Type A Injections in the Flexor Digitorum Muscle of Musicians with Focal Hand Dystonia
by Christos I. Ioannou, Franziska L. Hodde-Chriske and Eckart Altenmüller
Toxins 2023, 15(4), 296; https://doi.org/10.3390/toxins15040296 - 18 Apr 2023
Cited by 4 | Viewed by 5064
Abstract
The present study assessed muscular atrophy and weakness of the flexor digitorum superficialis (FDS) and profundus (FDP) muscle as possible long-term side effects of botulinum toxin (BoNT) injections in hand dystonia patients after the termination of their treatment. For the assessment of both [...] Read more.
The present study assessed muscular atrophy and weakness of the flexor digitorum superficialis (FDS) and profundus (FDP) muscle as possible long-term side effects of botulinum toxin (BoNT) injections in hand dystonia patients after the termination of their treatment. For the assessment of both parameters, a group of 12 musicians diagnosed with focal hand dystonia was compared with a group of 12 healthy matched musicians. The minimum and maximum times since the last injection across patients were 0.5 to 3.5 years, respectively. The thickness and strength of the FDS and FDP were assessed via ultrasonography and a strength measurement device. Group differences were estimated through the calculation of the symmetry index between the dominant and non-dominant hand. The results revealed that compared to the control group, thickness and flexion strength of the injected FDS and FDP were decreased by 10.6% ± 5.3% (95% CI) and 12.5% ± 6.4% (95% CI), respectively, in the patient group. The amount of weakness and atrophy was predicted significantly by the total amount of BoNT injected throughout the entire treatment period. In contrast, the time after the last injection did not predict the amount of strength and muscle mass recovery after the cessation of the treatment. The current study revealed that even up to 3.5 years after the termination of BoNT injections, long-term side effects such as weakness and atrophy can still be observed. We suggest that the total BoNT dose should remain as small as possible to reduce long-lasting side effects to the minimum. Although side effects differ significantly among patients, a potential full recovery of atrophy and weakness after the cessation of BoNT treatment might be observed after periods longer than 3.5 years. Full article
(This article belongs to the Special Issue Application of Botulinum Toxins in Non-spastic and Neurodegenerative Disorders)
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Review

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9 pages, 250 KiB  
Review
Role of Botulinum Toxin in Treatment of Secondary Dystonia: A Case Series and Overview of Literature
by Diksha Mohanty, Heather R. M. Riordan and Peter Hedera
Toxins 2024, 16(7), 286; https://doi.org/10.3390/toxins16070286 - 24 Jun 2024
Cited by 1 | Viewed by 1139
Abstract
Introduction: Dystonia can present in primary and secondary forms, depending on co-occurring symptoms and syndromic associations. In contrast to primary dystonia, secondary forms of dystonia are often associated with lesions in the putamen or globus pallidus. Such disorders are commonly neurodegenerative or neurometabolic [...] Read more.
Introduction: Dystonia can present in primary and secondary forms, depending on co-occurring symptoms and syndromic associations. In contrast to primary dystonia, secondary forms of dystonia are often associated with lesions in the putamen or globus pallidus. Such disorders are commonly neurodegenerative or neurometabolic conditions which produce varied neurologic as well as systemic manifestations other than dystonia. Chemo-denervation with botulinum toxin has been successfully used for focal or segmental dystonia. However, studies evaluating the effect of BoNT therapy on patients with secondary dystonia are sparse, given the heterogeneity in etiology and presentation. Methods: We present a series of patients with secondary dystonia who were managed with botulinum toxin therapy. Patients included in this series had a confirmed neurometabolic cause of dystonia. Results: A total of 14 patients, with ages ranging from 17 to 36 years, with disorders including Wilson’s disease, pantothenate kinase-associated neurodegeneration (PKAN), Niemann–Pick disease type C (NPC), glutaric aciduria type 1, Sanfilippo syndrome (Mucopolysaccharidosis Type IIIb), and GM2 gangliosidosis (Sandhoff disease) are presented. Most patients experienced a mild to moderate improvement in treated dystonia with benefits ranging from 6 to 12 weeks, with the median length of the benefits lasting approximately eight weeks, without any significant adverse effects. Conclusion: Although the secondary causes of dystonia are complex and diverse, our presented data and the available reports of the use of botulinum toxin support the conclusion that chemo-denervation plays an important role in symptom alleviation. Full article
(This article belongs to the Special Issue Application of Botulinum Toxins in Non-spastic and Neurodegenerative Disorders)
20 pages, 2131 KiB  
Review
Botulinum Toxin Injections to Manage Sequelae of Peripheral Facial Palsy
by Fabienne Carré, Jérémy Amar, Frédéric Tankéré and Claire Foirest
Toxins 2024, 16(3), 161; https://doi.org/10.3390/toxins16030161 - 20 Mar 2024
Viewed by 3753
Abstract
Long-standing facial palsy sequelae cause functional, aesthetic, and psychological problems in patients. Botulinum toxin is an effective way to manage them, but no standardized recommendations exist. Through this non-systematic review, we aimed to guide any practitioner willing to master the ins and outs [...] Read more.
Long-standing facial palsy sequelae cause functional, aesthetic, and psychological problems in patients. Botulinum toxin is an effective way to manage them, but no standardized recommendations exist. Through this non-systematic review, we aimed to guide any practitioner willing to master the ins and outs of this activity. We reviewed the existing literature and completed, with our experience as a reference center, different strategies of botulinum toxin injections used in facial palsy patients, including history, physiopathology, facial analysis, dosages, injection sites, and techniques, as well as time intervals between injections. The reader will find all the theorical information needed to best guide injections according to the patient’s complaint, which is the most important information to consider. Full article
(This article belongs to the Special Issue Application of Botulinum Toxins in Non-spastic and Neurodegenerative Disorders)
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Other

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19 pages, 528 KiB  
Systematic Review
Use of Botulinum Toxin in Upper-Limb Tremor: Systematic Review and Perspectives
by Damien Motavasseli, Cécile Delorme, Nicolas Bayle, Jean-Michel Gracies, Emmanuel Roze and Marjolaine Baude
Toxins 2024, 16(9), 392; https://doi.org/10.3390/toxins16090392 - 13 Sep 2024
Viewed by 1136
Abstract
Background: Tremor is the most common movement disorder, with significant functional and psychosocial consequences. Oral medications have been disappointing or limited by side effects. Surgical techniques are effective but associated with risks and adverse events. Botulinum toxin (BT) represents a promising avenue but [...] Read more.
Background: Tremor is the most common movement disorder, with significant functional and psychosocial consequences. Oral medications have been disappointing or limited by side effects. Surgical techniques are effective but associated with risks and adverse events. Botulinum toxin (BT) represents a promising avenue but there is still no double-blind evidence of efficacy on upper limb function. A systematic review on the effects of BT in upper-limb tremor was conducted. Methods: A systematic search of the literature was conducted up to July 2023, including the keywords “botulinum toxin” and “tremor”. All randomized controlled trials (RCTs) and open-label studies were analyzed. Independent reviewers assessed their methodological quality. Results: There were only eight published RCTs and seven published open-label studies, with relatively small sample sizes. This review suggests that BT is more effective when injections are patient-tailored, with analyses based on clinical judgement or kinematics. Subjective and objective measures frequently improve but transient weakness may occur after injections, especially if wrist or fingers extensors are targeted. A number of studies had methodological limitations. Conclusions: The authors discuss how to optimize tremor assessments and effects of BT injection. Controlled evidence is still lacking but it is suggested that distal “asymmetric” BT injections (targeting flexors/pronators while sparing extensors/supinators) and proximal injections, involving shoulder rotators when indicated, may avoid excessive weakness while optimizing functional benefit. Full article
(This article belongs to the Special Issue Application of Botulinum Toxins in Non-spastic and Neurodegenerative Disorders)
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14 pages, 994 KiB  
Systematic Review
Botulinum Toxin for Axial Postural Abnormalities in Parkinson’s Disease: A Systematic Review
by Marialuisa Gandolfi, Carlo Alberto Artusi, Gabriele Imbalzano, Serena Camozzi, Mauro Crestani, Leonardo Lopiano, Michele Tinazzi and Christian Geroin
Toxins 2024, 16(5), 228; https://doi.org/10.3390/toxins16050228 - 15 May 2024
Cited by 1 | Viewed by 1638
Abstract
Axial postural abnormalities (APAs), characterized by their frequency, disabling nature, and resistance to pharmacological treatments, significantly impact Parkinson’s disease and atypical Parkinsonism patients. Despite advancements in diagnosing, assessing, and understanding their pathophysiology, managing these complications remains a significant challenge. Often underestimated by healthcare [...] Read more.
Axial postural abnormalities (APAs), characterized by their frequency, disabling nature, and resistance to pharmacological treatments, significantly impact Parkinson’s disease and atypical Parkinsonism patients. Despite advancements in diagnosing, assessing, and understanding their pathophysiology, managing these complications remains a significant challenge. Often underestimated by healthcare professionals, these disturbances can exacerbate disability. This systematic review assesses botulinum toxin treatments’ effectiveness, alone and with rehabilitation, in addressing APAs in Parkinson’s disease, utilizing MEDLINE (PubMed), Web of Science, and SCOPUS databases for source material. Of the 1087 records retrieved, 16 met the selection criteria. Most research has focused on botulinum toxin (BoNT) as the primary treatment for camptocormia and Pisa syndrome, utilizing mostly observational methods. Despite dose and injection site variations, a common strategy was using electromyography-guided injections, occasionally enhanced with ultrasound. Patients with Pisa syndrome notably saw consistent improvements in APAs and pain. However, studies on the combined effects of botulinum toxin and rehabilitation are limited, and antecollis is significantly under-researched. These findings recommend precise BoNT injections into hyperactive muscles in well-selected patients by skilled clinicians, avoiding compensatory muscles, and underscore the necessity of early rehabilitation. Rehabilitation is crucial in a multidisciplinary approach to managing APAs, highlighting the importance of a multidisciplinary team of experts. Full article
(This article belongs to the Special Issue Application of Botulinum Toxins in Non-spastic and Neurodegenerative Disorders)
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