Consensus guidelines for botulinum toxin therapy: general algorithms and dosing tables for dystonia and spasticity

J Neural Transm (Vienna). 2021 Mar;128(3):321-335. doi: 10.1007/s00702-021-02312-4. Epub 2021 Feb 26.


Botulinum toxin (BT) therapy is a complex and highly individualised therapy defined by treatment algorithms and injection schemes describing its target muscles and their dosing. Various consensus guidelines have tried to standardise and to improve BT therapy. We wanted to update and improve consensus guidelines by: (1) Acknowledging recent advances of treatment algorithms. (2) Basing dosing tables on statistical analyses of real-life treatment data of 1831 BT injections in 36 different target muscles in 420 dystonia patients and 1593 BT injections in 31 different target muscles in 240 spasticity patients. (3) Providing more detailed dosing data including typical doses, dose variabilities, and dosing limits. (4) Including total doses and target muscle selections for typical clinical entities thus adapting dosing to different aetiologies and pathophysiologies. (5) In addition, providing a brief and concise review of the clinical entity treated together with general principles of its BT therapy. For this, we collaborated with IAB-Interdisciplinary Working Group for Movement Disorders which invited an international panel of experts for the support.

Keywords: Botulinum toxin; Consensus guidelines; Dose limits; Dose variability; Dosing tables; Dystonia; Spasticity; Target muscles; Therapy; Total dose; Treatment algorithms; Typical dose.