Botulinum toxin injections in neurology

Botulinum toxin injections to treat abnormal movements and symptoms of various neurological disorders

Botulinum toxin has revolutionized the treatment of certain abnormal movements, particularly cervical dystonia, blepharospasm, hemifacial spasm, and more. It is also used to treat some neurological conditions such as chronic migraine. At the Europe Hospitals, Dr. Françoise Piéret, neurologist, has been performing these injections since 2008 and has extensive expertise in most therapeutic indications of botulinum toxin.

Indications

Here is an overview:

• various disorders causing muscle hyperactivity such as cervical or other focal dystonias, blepharospasm, hemifacial spasm, etc.
• post-stroke spasticity, where injections considerably improve functional abilities and pain, while reducing long-term musculoskeletal complications
• spasticity in multiple sclerosis
• spasms and focal dystonias in Parkinson’s disease
• chronic migraine, i.e. at least 15 headache days per month not responding to first-line treatments
• focal hyperhidrosis (i.e. excessive localized sweating)
• certain neuropathic pains
• bruxism
• …

How are the injections performed?

“Injections are always preceded by a neurological consultation in order to clearly define the indication and establish the injection plan through a careful analysis of the problem and the muscles involved in the abnormal movement,” explains the neurologist.

Depending on the indication, injections are administered either intramuscularly or subcutaneously.

“For intramuscular injections, I use a muscle detection and stimulation device that allows precise targeting of the muscles involved in the involuntary contraction,” Dr. Piéret notes.

Side effects

Botulinum neurotoxin has an excellent safety profile due to the absence of systemic effects. “Adverse effects are usually mild and temporary: local hematoma, transient weakness of a neighboring muscle, temporary swallowing difficulties, dry eyes, tearing, transient headaches, and in very rare cases, an allergic reaction may occur but is generally not serious,” the neurologist details.

Effects felt quickly

Patients can expect to feel the effect after 8 to 12 days.

The effectiveness of the treatment lasts between 3 and 6 months. Injections are repeated according to the patient’s condition and needs, but must be spaced at least 3 months apart to avoid the production of neutralizing antibodies, which could limit long-term efficacy.

Reimbursement

For certain therapeutic indications, reimbursement has been approved for three types of neurotoxins, but only in a hospital setting and under varying conditions. Please ask your neurologist for more information about this.