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Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review)

Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

From the Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York; Department of Otolaryngology (A. Blitzer), St. Lukes-Roosevelt Medical Center, New York, NY; Wake Forest University School of Medicine (A. Brashear), Winston-Salem, NC; Department of Neurology (C.C.), Rush University Medical Center, Chicago, IL; Department of Neurology (R.D.), University of Kansas, Kansas City; The National Institute of Neurological Disorders and Stroke (M.H., B.K., C.L.L.), Bethesda, MD; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Toronto Western Hospital (J.M.M.), Ontario, Canada; Department of Neurology (M.N.), Klinikum Augsburg, Germany; and Stanford University (Y.S.), CA.

Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Ave., St. Paul, MN 55116 guidelines{at}aan.com

Objective: To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of movement disorders.

Methods: A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and selected movement disorders. Authors reviewed, abstracted, and classified articles based on American Academy of Neurology criteria (Class I–IV).

Results: The highest quality literature available for the respective indications was as follows: blepharospasm (two Class II studies); hemifacial spasm (one Class II and one Class III study); cervical dystonia (seven Class I studies); focal upper extremity dystonia (one Class I and three Class II studies); focal lower extremity dystonia (one Class II study); laryngeal dystonia (one Class I study); motor tics (one Class II study); and upper extremity essential tremor (two Class II studies).

Recommendations: Botulinum neurotoxin should be offered as a treatment option for the treatment of cervical dystonia (Level A), may be offered for blepharospasm, focal upper extremity dystonia, adductor laryngeal dystonia, and upper extremity essential tremor (Level B), and may be considered for hemifacial spasm, focal lower limb dystonia, and motor tics (Level C). While clinicians' practice may suggest stronger recommendations in some of these indications, evidence-based conclusions are limited by the availability of data.

Abbreviations: ABSD = abductor type of spasmodic dysphonia; ADSD = adductor type of spasmodic dysphonia; BoNT = botulinum neurotoxin; CD = cervical dystonia; FDA = Food and Drug Administration.

Supplemental data at www.neurology.org

See pages 1691 and 1707.

Approved by the Therapeutics and Technology Assessment Subcommittee on March 31, 2007; by the Practice Committee on July 12, 2007; and by the AAN Board of Directors on January 30, 2008.

The Mission Statement, Conflict of Interest Statement, Subcommittee and Panel members, AAN classification of evidence, and Classification of recommendations are available as supplemental data on the Neurology® Web site at www.neurology.org.

Endorsed by the American Academy of Physical Medicine and Rehabilitation on March 14, 2008.

Disclosure: Author disclosures are provided at the end of the article.

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