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Botulinum Toxin Effective in Many Neurological Disorders, not Headache

New guidelines developed by the American Academy of Neurology confirm that the drug botulinum toxin is safe and effective for treating cervical dystonia, a condition of involuntary head tilt or neck movement, spasticity and other forms of muscle overactivity that interfere with movement in adults and children with an upper motor neuron syndrome, and excessive sweating of the armpits and hands.

Botulinum toxin may also be used in hemifacial spasm (involuntary facial contractions), blepharospasm, (involuntary eye closure), some voice disorders (adductor laryngeal dystonia), focal limb dystonias (such as writer’s cramp), essential tremor and some forms of spastic bladder disorders.

This guidelines project was chaired by David M. Simpson, MD, Professor of Neurology at Mount Sinai School of Medicine in New York and Fellow of the American Academy of Neurology. To develop the guidelines, the authors reviewed and analyzed systematically all available scientific studies on the topic. The guidelines appear in the May 6, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.

Since its introduction 28 years ago, botulinum toxin has become the most effective treatment for numerous movement disorders associated with increased muscle contraction. The drug is injected into affected muscles.

A surprising finding was that botulinum toxin is probably not effective in the treatment of migraine or chronic tension-type headache. “Based on currently available data, botulinum toxin injections should not be offered to patients with episodic migraine and chronic tension-type headaches,” said pain guidelines author Markus Naumann, MD, Professor of Neurology, Head of the Department of Neurology at Augsburg Hospital in Germany, and member of the American Academy of Neurology. “It is no better than placebo injections for these types of headache.”

“We found that botulinum toxin is possibly effective in relieving low back pain and therefore may be considered as a treatment option,” said Naumann. “However, our recommendation is based on data from only one study in a small number of patients. More research is needed to define the place of botulinum toxin in treating this condition, in comparison to other treatment options.”

The guidelines are endorsed by the American Academy of Physical Medicine and Rehabilitation.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson disease, and multiple sclerosis.

Angela Babb | American Academy of Neurology
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