OF PARKINSONIAN PATIENTS WITH BOTULINUM TOXIN MAJA TROŠT DEPARTMENT FOR NEUROLOGY PARKINSONS DISEASE Motor amp non motor symptoms impair QoL Many are resistant to conventional treatment ID: 424565
Download Presentation The PPT/PDF document "COMPREHENSIVE MANAGEMENT" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
COMPREHENSIVE MANAGEMENT OF PARKINSONIAN PATIENTS WITH BOTULINUM TOXIN
MAJA TROŠT
DEPARTMENT FOR NEUROLOGYSlide2
PARKINSON’S DISEASEMotor & non motor symptoms impair QoL
Many are resistant to conventional treatmentSlide3
Indications for BoNT treatment in PD
Limb
dystonia
Blepharospasm
&
apraxia of eyelid openingBruxismAntecollisCamptocormiaTremor (hand and jaw) Painful shoulder (due to rigidity)
Freezing
of gait
Sialorrhea
Dysphagia
Seborrhea
Hyperhidrosis
Overactive bladder
ConstipationSlide4
DYSTONIA IN PDAffects 60% of patientsRisk factors for dystonia
in PD:
young age, female gender, long disease duration
Side effect of
levodopa
treatmentMechanism?Jankovic and Stacy 2007,
Jankovic
and
Tintner
2001Slide5
Blepharospasm & lid apraxiaMore common in PSP
Mechanism
?
Hallett
et al 2008, Elston 1992, Krack and Marion 1994Slide6
BoNT treatmentTime form injection to improvement: 3-5 daysDuration of benefit: 3-4 months
Frowning pre and after
BoNT
Hirota
et
al
2008Slide7
Therapeutics and Technology Assessment Subcommittee of the AAN:
level
B (probably effective) evidence for
its efficacy
, and recommended that ‘‘
BoNT injection should be considered as a treatment option for blepharospasm’’Simpson et al 2008Slide8
BruxismFocal oromandibular dystonia
Study:
18 pts with severe
bruxism
m
. masseter BoNT injection1 transient dysphagia3.4 ± 0.9 improvement (0-4)
Tan
and
Jankovic
,
2000Slide9
Limb dystoniaFoot dystonia
–
striatal
foot
Striatal
handJankovic 2005Slide10
Dystonic clenched fistLevodopa
related
dyskinesia
(painful off stage
dystonia
)Jankovic and Stacy 2007,
Pacchetti
et
al 1995Slide11
Neck dystoniaAntecollis is most common in PD & MSASlide12Slide13
Axial dystonia & camptocormia
Cervical
dystonia
Abnormal trunk posture (scoliosis,
kyphosis
, camptocormia, pisa syndrome)Slide14
Camptocormia
BoNT
in rectus
abdominis
: 9/11 pts improved
No effect of BoNT of the iliopsoas muscles
Azher
,
Jankovic
2005; von
Coelln
et al., 2008,
Mahjneh
e
tal
. 2009,
Colosimo
,
Salvatori
2009Slide15
TremorRe-emergent tremor interferes more with QoL then rest tremor
Th
:
BoNT
, DBSSlide16
TremorTwo double blind, placebo controlled studies with BoNT for essential tremor: safe and effective in reducing of tremor amplitude, but weakness of finger extensors appeared
No significant effect in PD tremor
Jaw tremor (
BoNT
in
masseter muscles)Jankovic et al 1996, Brin et al 2001, Schneider et al 2006 Slide17
Freezing of gaitMechanism?Dystonic, disinhibited
foot grasp (Brown, 1958)
BoNT
in distal leg muscles was not effectiveSlide18
SialorrheaAffects 75% of PD ptsCauses social handicap, skin irritation, infection
BoNT
in
submandibular
and parotid glands
All types of BoNT are useful Side effects: dysphagia, xerostomiaMyobloc side effect: dry mouth…
Jankovic
, 2008, 2009, Gomez-
Caravaca
et al. 2014Slide19

Egevad
et al. 2014Slide20
Dysphagia/achalasiaMechanism: degeneration of motor nucleus of n
. X,
Lewy
bodies in
myenteric
plexus of the esophagus, flexed neck, achalasiaTh: BoNT in lower esophageal sphincterSlide21
Overactive bladderTherapeutics and Technology Assessment Subcommittee of the AAN concluded that there is level A evidence for
the recommendation
that
BoNT
should be offered as a
treatment option for neurogenic detrusor overactivityBoNT into bladder wall to increase bladder capacity and to improve urge and incontinence
Patel 2006,
Naumann
et
al
2008,
Giannantoni
et al 2009,
Kulaksizoglu
,
Parman
2010Slide22
ConstipationAnismus: focal
dystonia
of striated sphincter muscles at the pelvic outlet
Several open-label studies demonstrated the benefic
Mathers
et al 1988, Albanese et al 2003, Cadeddu et al 2005Slide23
Thank you!