New Consensus Guidelines for Botulinum Neurotoxin Therapy for Dystonia & Spasticity

This article was published in the Dystonia Dialogue.

Botulinum neurotoxin (BNT) therapy is one of the most common treatments to reduce dystonia symptoms. BNT therapy involves injecting appropriate doses of BNT into the appropriate selection of muscles. Both the muscles to be treated and the specific doses determine the dosing regimen for an individual patient. Developing the unique dosing scheme for each individual patient requires considerable experience on the part of the physician, making BNT therapy both a skill and an art. Dosing tables are available for physicians to provide a range of optimal doses for each target muscle.

An international working group of movement disorder experts recently published new and improved dosing tables for physicians with the goal of making BNT therapy more effective for patients. For the first time the dosing tables are based on statistical evaluation of real-life data from a large BNT clinic. “So far dosing tables have only been reporting dose ranges coming out of group discussions. Usually, they covered enormous ranges making them virtually useless for practical considerations,” explained Dirk Dressler, MD, PhD, first author of the study and Head of the Movement Disorders Section in the Department of Neurology, Hannover Medical School in Germany. “We give typical doses for each target muscle, we give variability, and we give limits so that the [physician] has all the information to decide the best target muscle dose.” The statistical analysis was based on treatment data from 1,831 BNT injections in 36 different target muscles in

420 dystonia patients plus 1,593 BNT injections in 31 different target muscles in 240 spasticity patients. The investigators differentiated between dosing for dystonia and spasticity, which existing dosing tables do not offer. “We are extremely grateful to our panel of 26 world class experts in BNT therapy from all over the world. We are confident that this publication will be the key source for planning and dosing BNT therapy in dystonia and spasticity for the years to come,” said Dr. Dressler.

Dressler D, Altavista MC, Altenmueller E, et al. Consensus guidelines for botulinum toxin therapy: general algorithms and dosing tables for dystonia and spasticity. J Neural Transm (Vienna). 2021:128(3):321-335.

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