Antonia Schonwald , Katherine Amodeo , Victoria Levy , Fabio Danisi
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Botulinum toxin therapy in Parkinson disease-related lower limb dystonia. An 8 year retrospective review
Background
Lower extremity dystonia (LED) is a frequent complication of Parkinson disease (PD). Treatment with botulinum neurotoxinA (BoNTA) over 8 years was retrospectively reviewed.
Cases
14 patients with LED received an average of 3.86 injections (1–8). Mean interval was 40 weeks (median of 25). Average dose was 182 units. Injections were well-tolerated. Using a 6 point scale, there was an average of 3.37 point improvement in disability after each session, with average duration of 28.56 weeks (median 11 weeks). After mean follow-up of 101 weeks, disabling dystonia was not present in 11 of 14 patients.
Conclusions
Botulinum toxin is safe and effective in PD related LED. Good response to the first two injection sessions was significantly associated with greater likelihood of long-term response. Assertive BoNTA dosing may lead to sustained remission of symptoms. As natural history of LED in PD has not been reported, prospective placebo-controlled studies are needed.
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