Real-World Patterns of Botulinum Toxin Treatment in Hyperkinetic Movement Disorders: A 9-Year Nationwide Analysis in...

Hyperkinetic movement disorders, including dystonia, tremor, and myoclonus, are disabling conditions often managed with botulinum toxin type A (BoNT-A). Real-world evidence on treatment patterns remains limited.

This nationwide, population-based study aimed to evaluate trends in BoNT-A use in France between 2015 and 2023, using the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d'Information, PMSI).

Patients were classified into four categories (dystonia, tremor, myoclonus, and other abnormal movements), based on International Classification of Diseases, 10th Revision (ICD-10). Annual changes in the number of BoNT-A injections and treated patients were analyzed. Treatment adherence and reinjection intervals were also evaluated.

A total of 51,861 patients received BoNT-A therapy. Dystonia was the predominant indication (44,913; 86.6%). Tremor accounted for 3690 patients (7.1%), other abnormal movements for 2423 (4.7%), and myoclonus for 835 (1.6%). Between 2015 and 2023, BoNT-A injections increased from 49,829 to 53,828 (+8.0%) and treated patients from 20,023 to 21,489 (+7.3%). While dystonia showed minimal growth in patient numbers (+0.6%), tremor and myoclonus increased substantially (+132.1% and +179.7%, respectively). Repeat BoNT-A injections were highest in dystonia, with 71.8% of patients receiving ≥3 injections and 57.9% receiving ≥5 injections in total. Median reinjection intervals ranged from 112 days in dystonia to 133 days in myoclonus.

Dystonia remains the leading indication for BoNT-A in France, with high treatment adherence. The marked growth in tremor and myoclonus underscores the expanding therapeutic role and diversification of BoNT-A use across hyperkinetic movement disorders.