New guidelines say botulinum toxin effective for many neurological disorders, but not headache

May 9 2008

New guidelines developed by the American Academy of Neurology confirm that the drug botulinum toxin is safe and effective for treating a variety of neurological conditions. Surprisingly, the drug may not be effective for chronic headaches, accrding to Allison Brashear, M.D., professor and chairman of the Department of Neurology at Wake Forest University Baptist Medical Center, who helped develop the guidelines.

"Based on currently available data, botulinum toxin injections should be offered cautiously to patients with episodic migraine and chronic tension-type headaches," said Brashear, who is a member of the American Academy of Neurology. "It can be effective for patients who have tried other therapies for these types of headache and been unsuccessful. We need to study this issue further to better determine what this finding means."

To develop the guidelines, Brashear and a panel of other experts analyzed all scientific studies on the topic. They found that the injections are effective for cervical dystonia, a condition of involuntary head tilt or neck movement, spasticity and other forms of muscle overactivity that interfere with movement in adults and children, and excessive sweating of the armpits and hands. Botulinum toxin may also be used for involuntary facial contractions (hemifacial spasm), involuntary eye closure (blepharospasm), some voice disorders (adductor laryngeal dystonia), focal limb dystonias (such as writer's cramp), essential tremor and some forms of spastic bladder disorders.

Botulinum toxin was found to be effective in the treatment of low back pain but Brashear cautioned physicians about using the drug without further research to confirm the findings. "We found that botulinum toxin is possibly effective in relieving low back pain and therefore may be considered as a treatment option," said Brashear. "However, our recommendation is based on data from only one study in a small number of patients. More research is needed to define the place of botulinum toxin in treating this condition, in comparison to other treatment options."

This guidelines project was chaired by David M. Simpson, MD, professor of neurology at Mount Sinai School of Medicine in New York and Fellow of the American Academy of Neurology.

The guidelines appeared in the May 6th issue of Neurology??, the medical journal of the American Academy of Neurology.

Since its introduction 28 years ago, botulinum toxin has become the most effective treatment for numerous movement disorders associated with increased muscle contraction. The drug is injected into affected muscles.

The guidelines are endorsed by the American Academy of Physical Medicine and Rehabilitation.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson disease, and multiple sclerosis. For more information about the American Academy of Neurology, visit www.aan.com.