Botulinum Toxin Treatment of Motor Disorders in Parkinson Disease-A Systematic Review

This review provides an up-to-date literature account on the efficacy of Botulinum toxin treatment for common motor disorders of Parkinson Disease. The reviewed disorders include the common motor disorders in PD such as tremor, focal foot dystonia, rigidity and freezing of gait (FOG). In the area of Parkinson tremor, two newly described evaluation/injection techniques (Yale method in USA and Western University method in Canada) offer efficacy with low incidence of hand and finger weakness as side effects. Blinded studies conducted on foot dystonia of PD indicate that botulinum toxin injections into toe flexors are efficacious in alleviating this form of dystonia. Small, blinded studies suggest improvement of Parkinson rigidity after botulinum toxin injection; proof of this claim, however, requires information from larger, blinded clinical trials. In FOG, the improvement reported in open label studies could not be substantiated in blinded investigations. However, there is room for further controlled studies that include the proximal lower limb muscles in the injection plan and/or use higher doses of the injected toxin for this indication.

Automated summary

This review provides an up-to-date literature account on the efficacy of Botulinum toxin treatment for common motor disorders of Parkinson Disease. The reviewed disorders include tremor, focal foot dystonia, rigidity, and freezing of gait (FOG) in PD. The Yale method in the USA and Western University method in Canada offer efficacy with low incidence of side effects for Parkinson tremor. Botulinum toxin injections into toe flexors are effective in alleviating foot dystonia of PD. Improvement of Parkinson rigidity after botulinum toxin injection is suggested, but further larger clinical trials are needed for conclusive evidence. Improvement in FOG reported in open label studies needs confirmation in blinded investigations with potential adjustments in injection plan and dosage.