Practice guideline update summary- Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache

Practice guideline update summary- Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache

Simpson DM¹, Hallett M¹, Ashman EJ¹, Comella CL¹, Green MW¹, Gronseth GS¹, Armstrong MJ¹, Gloss D¹, Potrebic S¹, Jankovic J¹, Karp BP¹, Naumann M¹, So YT¹, Yablon SA¹.

Abstract

OBJECTIVE:

To update the 2008 American Academy of Neurology (AAN) guidelines regarding botulinum neurotoxin for blepharospasm, cervical dystonia (CD), headache, and adult spasticity.

METHODS:

We searched the literature for relevant articles and classified them using 2004 AAN criteria.

RESULTS AND RECOMMENDATIONS:

Blepharospasm: OnabotulinumtoxinA (onaBoNT-A) and incobotulinumtoxinA (incoBoNT-A) are probably effective and should be considered (Level B). AbobotulinumtoxinA (aboBoNT-A) is possibly effective and may be considered (Level C). CD: AboBoNT-A and rimabotulinumtoxinB (rimaBoNT-B) are established as effective and should be offered (Level A), and onaBoNT-A and incoBoNT-A are probably effective and should be considered (Level B). Adult spasticity: AboBoNT-A, incoBoNT-A, and onaBoNT-A are established as effective and should be offered (Level A), and rimaBoNT-B is probably effective and should be considered (Level B), for upper limb spasticity. AboBoNT-A and onaBoNT-A are established as effective and should be offered (Level A) for lower-limb spasticity. Headache: OnaBoNT-A is established as effective and should be offered to increase headache-free days (Level A) and is probably effective and should be considered to improve health-related quality of life (Level B) in chronic migraine. OnaBoNT-A is established as ineffective and should not be offered for episodic migraine (Level A) and is probably ineffective for chronic tension-type headaches (Level B).

Resource: Neurology. 2016 May 10;86(19):1818-26.