Category: Dystonia: Clinical Trials and Therapy
Objective: To assess the therapeutic outcomes of botulinum toxin injections (BoNT) in patients with lower limb dystonia (LLD).
Background: BoNT to the affected muscle groups is one of the most effective treatments for dystonia. However, the current literature concerning the application of BoNT in the treatment of LLD remains relatively limited.
Method: Patients with LLD who regularly receive BoNT were enrolled. They were evaluated at two time points: during their routine BoNT clinic visit (T0) and 3-8 weeks later during their peak-dose benefit (T1). The patients completed the Clinical Global Impression Scales for gait, mobility, range of motion, abnormal position, sleep, concentration, falls, independence, and mood at both time points. A video-taped neurologic exam was also conducted, and the leg dystonia was scored according to the Unified Dystonia Rating Scale (UDRS) and the Fahn-Marsden Dystonia Rating Scale (FMDRS). Statistical analysis was done using T-Tests.
Results: 31 patients were enrolled. The average age was 67.5 years, and 61.3% were female. The most common underlying causes of LLD were parkinsonian diseases (N=22), followed by idiopathic causes (N=5) and DYT-1 (N=2). Compared to T0, patients rated a significant improvement in the severity of the following symptoms in T1: gait (T0: 4.06, T1: 2.92, p=0.007), mobility (T0: 3.87, T1: 2.83, p=0.007), range of motion (T0: 3.77, T1: 2.63, p=0.006), abnormal position (T0: 3.97, T1: 2.67, p=0.002), pain (T0: 3.39, T1:2.04, p=0.001), sleep (T0: 2.81, T1: 1.71, p=0.007), concentration (T0: 2.84, T1: 1.96, p=0.029), and mood (T0:2.71, T1: 1.75, p=0.004). Overall severity also improved (T0:4.19, T1: 2.79, p=0.0004). There was a non-significant improvement in independence (T0: 3, T1: 2.5, p=0.335). There was also a non-statistically significant improvement in the LLD portions on the UDRS and the FMDRS. UDRS Proximal (T0: 1.44, T1: 1.02, p=0.327), and UDRS Distal (T0: 4.42, T1: 3.31, p=0.079); FMDRS LLE (T0: 6.12, T1: 4.54, p=0.148), and FMDRS RLE (T0: 4.68, T1: 3.46, p=0.278). These results expand upon previous work in this area.1
Conclusion: BoNT for LLD leads to significant improvement in many subjective symptoms experienced by the patients. There is also a trend toward improvement in the objective scores of LLD following BoNT.
References: [1]. M. Wajid, J. Frey, L. Kugler, T. Stiep, J. Yu, J. Toledo, J. Lopes, A. Ramirez-Zamora, A. Rawls, A. Wagle Shukla, I. Malaty. Botulinum Toxin Outcomes in Patients with Lower Limb Dystonia [abstract]. Mov Disord. 2022; 37 (suppl 1). https://www.mdsabstracts.org/abstract/botulinum-toxin-outcomes-in-patients-with-lower-limb-dystonia/
To cite this abstract in AMA style:
M. Wajid, J. Yu, J. Frey, J. Lopes, A. Dave, L. Kugler, T. Stiep, J. Toledo, A. Ramirez-Zamora, A. Rawls, A. Wagle Shukla, I. Malaty. Updates on the Outcomes of Botulinum Toxin Injections in Patients with Lower Limb Dystonia [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/updates-on-the-outcomes-of-botulinum-toxin-injections-in-patients-with-lower-limb-dystonia/. Accessed June 14, 2025.« Back to 2023 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/updates-on-the-outcomes-of-botulinum-toxin-injections-in-patients-with-lower-limb-dystonia/