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Abstract Details

Botulinum Toxin Therapy for Medication and DBS Refractory Foot Dystonia of Parkinsonism
Movement Disorders
P16 - Poster Session 16 (5:30 PM-6:30 PM)
3-015
To determine efficacy and safety of Botulinum toxin (BTX) therapy in patients with medically refractory foot dystonia secondary to Parkinson’s disease (PD) or atypical Parkinsonism (AP).
Medically refractory foot dystonia in Parkinsonism is a disabling symptom without effective treatment. Off label use of BTX therapy has been reported with some success but studies are very limited.
We carried a retrospective chart review in a tertiary care Movement disorder clinic. All patients with PD (including those who had Deep Brain Stimulation, DBS) and AP with medically refractory disabling foot dystonia treated with BTX by a Movement disorder neurologist were included. Efficacy measure was patient-reported Clinical Global Impression Scale of Change (CGI-C). Types of BTX injected included onabotulinumtoxin A, incobotulinumtoxin A, and rimabotulinumtoxin B. Injections were repeated if a satisfactory response was noted.
53 Patients (22 male, 31 female) were included. 46 patients had PD and 7 had AP. 27 PD patients had DBS. Disease duration was 7.6 ± 5.0 years. Age was 65 ± 10.6 years. 42 patients had onabotulinumtoxin A, 8 had incobotulinumtoxin A, and 3 had rimabotulinumtoxin B. A mean CGI of 2.62 ± 1.17 was reported, which correlates between ‘much improvement’ and ‘modest improvement’ in foot dystonia from BTX. 68% of patients came back for their second injection. No adverse events occurred except one case of systemic weakness which resolved. There was no difference in response between the three types of BTX though only onabotulinumtoxin A group had large enough numbers to measure efficacy. There was no significant difference in BTX efficacy between the DBS and non-DBS groups.
In this large cohort, BTX treatment was well tolerated and resulted in patient-reported meaningful improvement in foot dystonia secondary to PD and AP. PD patients who had refractory foot dystonia despite DBS also reported similar improvement.
Authors/Disclosures
Muthu Kuzhali Ganapathy, MBBS (SUNY Upstate Medical University)
PRESENTER 		Dr. Ganapathy has nothing to disclose.
Mustafa S. Siddiqui, MD, FÂ鶹´«Ã½Ó³»­ Dr. Siddiqui has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Boston Scientific Neuromodulation. Dr. Siddiqui has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Siddiqui has received research support from Boston Scientific Neuromodulation. The institution of Dr. Siddiqui has received research support from Abbvie. The institution of Dr. Siddiqui has received research support from National Institute of Health .