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Guidelines for Botulinum Neurotoxin Use Issued

Effective in the treatment of spasticity and some motor and autonomic disorders

WEDNESDAY, May 7 (HealthDay News) -- Botulinum neurotoxin is effective in treating spasticity in adults and children, cervical dystonia, and autonomic disorders such as axillary hyperhydrosis and detrusor overactivity, according to a series of evidence-based reviews published in Neurology in May.

The Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology reviewed the evidence for botulinum neurotoxin in the treatment of spasticity, movement disorders, autonomic and urologic disorders, and low back and head pain. Recommendations for treatment were graded according to strength of evidence.

The authors conclude that botulinum neurotoxin is effective in treating adult and pediatric spasticity, cervical dystonia, axillary hyperhidrosis and detrusor overactivity (Level A), and should be offered as a treatment option for these disorders. It should be considered for blepharospasm, focal upper extremity dystonia, adductor laryngeal dystonia, upper extremity essential tremor, palmar hyperhidrosis, drooling and detrusor overactivity (Level B). Finally, it may be considered for the treatment of hemifacial spasm, focal lower limb dystonia, motor tics, gustatory sweating and low back pain (Level C). Evidence is insufficient to recommend botulinum neurotoxin for the treatment of chronic daily headaches.

"The ability of botulinum neurotoxin to block acetylcholine release at neuromuscular junctions accounts for its therapeutic action to relieve dystonia, spasticity and related disorders," D.M. Simpson, M.D., of Mount Sinai Medical Center in New York City, and colleagues write.

Several authors report performing botulinum toxin injections and receiving honoraria and research support from pharmaceutical companies.

Abstract - Simpson
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Abstract - Simpson
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Abstract - Naumann
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