[Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia]

Rev Neurol. 2018 Mar 1;66(5):163-172.
[Article in Spanish]

Abstract

Introduction: Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity.

Aim: To analyze and summarize different questions about the use of BTA in our clinical practice.

Development: A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc.

Conclusion: This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.

Title: Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.

Introduccion. La toxina botulinica de tipo A (TBA) ha supuesto una verdadera revolucion terapeutica en neurologia, y en la actualidad es el tratamiento rutinario en las distonias focales y la espasticidad. Objetivo. Plantear, revisar y responder cuestiones controvertidas en relacion con la neurofarmacologia de la TBA y su uso en las distonias en la practica clinica habitual. Desarrollo. Un grupo de expertos en trastornos del movimiento reviso una lista de temas controvertidos relacionados con la farmacologia de la TBA y su uso en las distonias. Revisamos la bibliografia e incluimos articulos relevantes especialmente en ingles, pero tambien, si su importancia lo merece, en castellano y en frances, hasta junio de 2016. El documento se estructuro como un cuestionario que incluyo las preguntas que podrian generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. Incluimos preguntas sobre diferentes aspectos de la neurofarmacologia, especialmente el mecanismo de accion, la bioequivalencia de los diferentes preparados y la inmunogenicidad. En relacion con el subapartado de las distonias, se incluyeron aspectos sobre la evaluacion y el tratamiento de las distonias focales. Conclusiones. Esta revision no pretende ser una guia, sino una herramienta practica destinada a neurologos y medicos internos residentes interesados en esta area, dentro de diferentes ambitos especificos del manejo de la TBA.

Publication types

  • Consensus Development Conference
  • Review

MeSH terms

  • Botulinum Antitoxin / biosynthesis
  • Botulinum Toxins, Type A / adverse effects
  • Botulinum Toxins, Type A / immunology
  • Botulinum Toxins, Type A / pharmacology
  • Botulinum Toxins, Type A / therapeutic use*
  • Disease Management
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Resistance
  • Drug Stability
  • Dystonic Disorders / diagnostic imaging
  • Dystonic Disorders / drug therapy*
  • Humans
  • Muscle Spasticity / drug therapy
  • Practice Guidelines as Topic
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Therapeutic Equivalency

Substances

  • Botulinum Antitoxin
  • Botulinum Toxins, Type A