Botulinum Neurotoxin – An Individualised, Patient-centric Approach for the Treatment of Dystonia and Spasticity

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European Neurological Review, a peer-reviewed, open access, bi-annual neurology journal publish cutting-edge article by Maja Relja, Jorge Jacinto, Joseph Jankovic and Alberto Albanese.

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A recent online survey (n = 969) conducted in the US and EU showed that there is a need for an improvement in CD management in terms of patient satisfaction.

Abstract: Botulinum toxin A (BoNT-A) has become the first-line therapy in cervical dystonia (CD), blepharospasm and spasticity. However, the current guidelines for the clinical use of BoNT-A are based on data published more than 20 years ago and patient satisfaction with current treatment regimens is low. There is a striking difference between the injection intervals given in everyday clinical practice and the injection intervals preferred by patients. Recent data have indicated that shorter injection intervals may improve overall patient satisfaction since re-emergence of symptoms could be prevented. Three double-blind studies have demonstrated that incobotulinumtoxin A (incoBoNT-A) is suitable for use in a flexible, patient-centric approach in blepharospasm and CD, with injection intervals starting from 6 weeks. The efficacy, tolerability and safety of this regime were excellent. There is a need to optimise and individualise the treatment using the three available formulations of BoNT- A, as well as to define parameters for switching between the formulations.

Since its introduction in the 1980s, botulinum toxin type A (BoNT-A) has become the first-choice treatment for most types of focal dystonia, including cervical dystonia (CD) and blepharospasm. It is also widely used in the treatment of spasticity arising from stroke, spinal cord injury, multiple sclerosis and traumatic brain injury, as well as in the treatment of pain e.g. chronic migraine. However, the current guidelines for the clinical use of BoNT-A are based on historical data, some of which was published more than 20 years ago,1 and recent data suggest that patient satisfaction with current therapeutic regimes is low. A satellite symposium, co-chaired by Dr Maja Relja and Dr Jorge Jacinto, was held at Toxins 2015, Lisbon, Portugal, January 2015 organised by the Centro de Medicina de Reabilitação de Alcoitão, Portugal. Dr Relja presented the aims of the symposium: to review existing data on a patient-centric approach in spasticity and CD using BoNT-A; to provide information about recent clinical data; to consider how an individualised approach can be incorporated into clinical practice; and to provide practical expert guidance on evolving treatment strategies.

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Barney Kent