title: Botulinum Toxin Use in Refractory Pain and Other Symptoms in Parkinsonism.
abstract: BACKGROUND
  Parkinson's disease (PD) and other parkinsonian syndromes are chronic, progressive neurodegenerative diseases. With advancing disease, both motor and non-motor symptoms represent a considerable burden and symptom relief and quality of life improvement become the main goal of treatment. Botulinum toxins (BTX) are an effective treatment modality for many neurological conditions.
  
  
  METHODS
  To understand the potential usefulness of BTX in this population, we performed a retrospective chart review of all patients with a clinical diagnosis of idiopathic PD and atypical parkinsonism who received treatment with BTX injections in our center from 1995 to 2014 for a variety of symptoms. Response to BTX was assessed using a subjective Clinical Global Impression.
  
  
  RESULTS
  Records of 160 patients were reviewed. Probable idiopathic PD was the diagnosis in 117 patients (73.1%). The main indication for BTX treatment was pain (50.6% of cases). Other indications were the treatment of functional impairment resulting from dystonia (26.25%), sialorrhea (18.75%), freezing of gait, and camptocormia. Considering pain as indication, 81% of all patients with PD reported benefits after the first BTX injections. This benefit was maintained after the last recorded visit without significant difference in outcome compared with the first injection (p=0.067). Similar results were observed in patients with atypical parkinsonism.
  
  
  CONCLUSIONS
  Our results confirm the safety and efficacy of different uses of BTX in the symptomatic treatment of patients with parkinsonism even in advanced stages of the disease, and suggest BTX treatment could have a safe and useful role in the treatment of pain in this population.
authors: 1Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,Ontario,Canada.
authors: Veronica A
authors: VA
authors: Bruno
authors: 1Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,Ontario,Canada.
authors: Susan H
authors: SH
authors: Fox
authors: 1Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,Ontario,Canada.
authors: Deborah
authors: D
authors: Mancini
authors: 2University of Alberta,Edmonton,Alberta,Canada.
authors: Janis M
authors: JM
authors: Miyasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001905:Botulinum Toxins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000627:therapeutic use*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D009498:Neurotoxins; D001905:Botulinum Toxins
keywords: Parkinson disease; movement disorders; pain; palliative care