Can Botulinum Toxin Benefit People With Parkinson’s Disease?

The literature suggests that the treatment may alleviate motor and nonmotor symptoms, but many studies had an open-label design.

Neurology Reviews. 2017 May;25(5):5-6

April 25, 2017|Neurology Reviews

Pain

Neurologists also have used botulinum toxin to treat pain in Parkinson’s disease. Bruno and colleagues performed a retrospective chart review of patients with Parkinson’s disease who received botulinum toxin for various indications over a 20-year period. The main indication for treatment was pain, and 81% of patients who received botulinum toxin for pain reported benefit after the first injection. The benefit was sustained with further injections.

Overactive Bladder

Overactive bladder affects between 38% and 71% of people with Parkinson’s disease. Symptoms include urinary urgency, urinary frequency, nocturia, and incontinence. Behavioral modification is the first-line treatment, and antimuscarinic agents may provide benefit. Overactive bladder is an approved indication for onabotulinum toxin. The usual dose is 200 units, but it can range between 100 and 300 units. Treatment is injected into the detrusor muscles, and the benefit lasts for six months to nine months. Urine retention is a potential side effect of this treatment.

—Erik Greb

Suggested Reading

Bruno VA, Fox SH, Mancini D, Miyasaki JM. Botulinum toxin use in refractory pain and other symptoms in parkinsonism. Can J Neurol Sci. 2016;43(5):697-702.

Cordivari C, Misra VP, Catania S, Lees AJ. Treatment of dystonic clenched fist with botulinum toxin. Mov Disord. 2001;16(5):907-913.

Giannantoni A, Conte A, Proietti S, et al. Botulinum toxin type A in patients with Parkinson’s disease and refractory overactive bladder. J Urol. 2011;186(3):960-964.

Glass GA, Ku S, Ostrem JL, et al. Fluoroscopic, EMG-guided injection of botulinum toxin into the longus colli for the treatment of anterocollis. Parkinsonism Relat Disord. 2009;15(8):610-613.

Gupta AD, Visvanathan R. Botulinum toxin for foot dystonia in patients with Parkinson’s disease having deep brain stimulation: A case series and a pilot study. J Rehabil Med. 2016;48(6):559-562.

Inoue K, Rogers JD. Botulinum toxin injection into Riolan’s muscle: somatosensory ‘trick’. Eur Neurol. 2007;58(3):138-141.

Pacchetti C, Albani G, Martignoni E, et al. “Off” painful dystonia in Parkinson’s disease treated with botulinum toxin. Mov Disord. 1995;10(3):333-336.

Rahimi F, Samotus O, Lee J, Jog M. Effective management of upper limb parkinsonian tremor by incobotulinumtoxinA injections using sensor-based biomechanical patterns. Tremor Other Hyperkinet Mov (NY). 2015;5:348.

Schneider SA, Edwards MJ, Cordivari C, et al. Botulinum toxin A may be efficacious as treatment for jaw tremor in Parkinson’s disease. Mov Disord. 2006;21(10):1722-1724.

Seppi K, Weintraub D, Coelho M, et al. The Movement Disorder Society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26 Suppl 3:S42-S80.