The therapeutic use of botulinum neurotoxin has exploded since the first US Food and Drug Administration indication was obtained in 1989, and today it represents the first-line therapy for several hyperkinetic movement disorders. Of the seven serotypes (A to G), types A and B have been approved for use in the United States. Two type A toxins, onabotulinumtoxinA (Botox) and abobotulinumtoxinA (Dysport), are available, and one type B toxin, rimabotulinumtoxinB (Myobloc) is available. The commercially available toxins differ by protein target, duration of action, and adverse event profile; no formula exists for interconversion. The clinical development of the toxin is outlined and methods for muscle targeting are compared. Treatment regimens should be designed to achieve a specific care or functional goal by interdisciplinary teams consisting of physicians, patients, caregivers, and therapists, when appropriate. We discuss dosing considerations and safety profiles in the context of hyperkinetic movement disorders commonly encountered by neurologists, including cervical dystonia, spasticity, pediatric spasticity, blepharospasm, focal limb dystonias, and essential tremor. Finally, the multiple illustrative cases sprinkled throughout the chapter demonstrate the highly individualized, goal-focused nature of treatment with neurotoxins.
Relationship Disclosure: Dr Charles has received personal compensation for speaking or consulting activities with Allergan, Inc., and Medtronic, Inc. Vanderbilt University receives income in the form of grants or contracts from Allergan, Inc., and Medtronic, Inc., for research led by Dr Charles. Ms Gill has nothing to disclose.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Charles discusses the unlabeled use of neurotoxin treatments for spasticity, essential tremor, and focal dystonia. Ms Gill discusses the unlabeled use of neurotoxin treatments for spasticity, essential tremor, and focal dystonia.