Botulinum Toxin Treatment in Multiple Sclerosis-a Review

Area of Science:

• Neurology
• Pharmacology

Background:

• Multiple sclerosis (MS) is a chronic neurological disease affecting the central nervous system.
• MS can lead to a variety of debilitating symptoms, impacting quality of life.
• Botulinum neurotoxin (BoNT) therapy has emerged as a potential treatment for various neurological conditions.

Purpose of the Study:

• To provide an updated review on the efficacy of botulinum neurotoxin (BoNT) therapy for managing symptoms associated with multiple sclerosis (MS).
• To identify specific MS symptoms that are amenable to treatment with BoNT therapy.

Main Methods:

• Literature search conducted up to April 1st, 2017, utilizing Yale University Library resources (including PubMed and Ovis SP).
• Efficacy assessment based on criteria from the American Academy of Neurology's Subcommittee on Guideline Development.
• Inclusion of studies ranging from blinded trials (Class I and II) to open-label and retrospective studies (Class IV).

Main Results:

• Level A evidence confirms BoNT-A injections into the detrusor muscle improve MS-related neurogenic detrusor overactivity (NDO) and overactive (OA) bladder.
• Level B evidence supports the utility of intramuscular BoNT-A for MS-related spasticity.
• Emerging data suggests potential benefits of BoNTs for focal tonic spasms, focal myokymia, spastic dysphagia, and internuclear ophthalmoplegia in MS patients.

Conclusions:

• Botulinum neurotoxin therapy is an effective treatment for MS-related overactive bladder.
• Intramuscular BoNT injections are probably effective for managing spasticity in multiple sclerosis.
• Further investigation is warranted for BoNT therapy in MS-related trigeminal neuralgia and sialorrhea, given its efficacy in other populations.