title: The effect of botulinum toxin injections to the calf muscles on freezing of gait in parkinsonism: a pilot study.
abstract: BACKGROUND
  Freezing of gait (FOG) is a common and very disabling parkinsonian symptom, which is poorly understood and responds unsatisfactorily to medical treatment. We recently reported a unique patient with Parkinson's disease (PD) who had significant alleviation of FOG shortly after she was injected with botulinum toxin type A (BTX-A) for foot dystonia (Giladi et al. 1997).
  
  
  OBJECTIVE
  To assess the effect of BTX-A injections into the calf muscles of parkinsonian patients on FOG.
  
  
  METHODS
  BTX-A was injected in an open fashion into the calf muscles of 10 parkinsonian patients (age 55-75 years) with FOG as a predominant symptom. Response of FOG was assessed subjectively by the patient from worsening (-1) to marked improvement (+3). One patient was injected in a single blind fashion with saline or BTX-A after he had an initial good response.
  
  
  RESULTS
  Seven patients reported different rates of improvement of FOG severity in 15 out of 17 therapeutic sessions. Four patients (40%) reported marked improvement (+3) of FOG in 5 sessions. Two patients reported no effect in two sessions. The mean duration of improvement was 6 weeks (range 1-12 weeks) with definite deterioration afterwards. The patient who was injected in a single blind fashion did not respond to saline injections but improved significantly with BTX-A treatment.
  
  
  CONCLUSIONS
  We observed a clear temporal relationship between BTX-A injections into the calf muscles of parkinsonian patients and improvement of FOG. A double blind placebo controlled prospective study is needed before any conclusions can be drawn about the role of BTX-A injection in FOG.
authors.affiliation: Department of Neurology, Tel-Aviv Sourasky Medical Center, Israel. ngiladi@tasmc.health.gov.il
authors.forename: N
authors.initials: N
authors.lastname: Giladi
authors.forename: T
authors.initials: T
authors.lastname: Gurevich
authors.forename: H
authors.initials: H
authors.lastname: Shabtai
authors.forename: D
authors.initials: D
authors.lastname: Paleacu
authors.forename: E S
authors.initials: ES
authors.lastname: Simon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000494:pharmacology*; D018450:Disease Progression; D005260:Female; D020233:Gait Disorders, Neurologic / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007273:Injections, Intramuscular; D007866:Leg; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000502:physiology; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy*; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins