Objective: To examine long-term effect of botulinum toxin injection (BTX) in the external oblique muscle (EO) for camptocormia associated with Parkinson’s disease (PD).

Background: Camptocormia stands for excessive forward bending of the spine. It often associates with PD and causes significant impairment of daily activities such as walking. Precedent studies suggest EO was causative and its relaxation by lidocaine injection or BTX can improve camptocomia. However, the report of duration of therapeutic effect is scarce.

Methods: Three PD patients with camptocormia, bending in thoracic level, were included and admitted to our hospital for BTX combined with rehabilitation. After surveying their history, physical findings and laboratory data, onabotulinum toxin A, with concentration of 100 units per 4 ml normal saline, was injected in bilateral EO with sonographic guidance. The angle of camptocormia was quantified between line from acromion to greater trochanter and vertical line. As case 1 and 2 claimed abdominal stiffness, its visual analogue scale (VAS) was followed.

Results: All the three cases responded to 150 or 180 units of BTX. Therapeutic effect lasted from 2 weeks to 3 months after the injection in case 1 and from 1 to 4 weeks in case 2 and 3. The worst angle of camptocormia before treatment was 49, 20 and 83 degrees in case 1, 2 and 3, respectively. When the best, the angle was 4, 5 and 30 degrees after the treatment, respectively. VAS of abdominal stiffness was also improved. As clinical features, physical examination found abdominal stiffness in all. Also, electromyography revealed continuous repetitive discharge (CRD) of EO and rectus abdominis was observed in case 2 and 3, but persisted even after the BTX.

Conclusions: Therapeutic effect of BTX in EO for camptocormia in PD was observed. However, duration of the therapeutic effect had individual variability. Objective stiffness of abdominal muscles may predict the efficacy.

References: Furusawa Y, Mukai Y, Kobayashi Y, Sakamoto T, Murata M. Role of the external oblique muscle in upper camptocormia for patients with Parkinson’s disease. Mov Disord. 2012 May;27(6):802-3. Wijemanne S, Jimenez-Shahed J. Improvement in dystonic camptocormia following botulinum toxin injection to the external oblique muscle. Parkinsonism Relat Disord. 2014 Oct;20(10):1106-7

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-effect-of-botulinum-toxin-injection-in-the-external-oblique-muscle-to-treat-camptocormia-in-three-patients-with-parkinsons-disease/