Objective: To determine efficacy and safety of BTX therapy in patients with medically refractory foot dystonia secondary to Parkinson’s disease (PD) or atypical Parkinsonism (AP)

Background: Medically refractory foot dystonia in Parkinsonism is a disabling symptom without effective treatment. Off label use of Botulinum toxin (BTX) therapy has been reported with some success but studies are very limited

Method: We carried a retrospective chart review in a tertiary care Movement disorder clinic. All patients with PD (including those who had Deep Brain Stimulation, DBS) and AP with medically refractory disabling foot dystonia treated with BTX by a Movement disorder neurologist were included. Efficacy measure was patient-reported Clinical Global Impression Scale of Change (CGI-C). Types of BTX injected included onabotulinumtoxin A, incobotulinumtoxin A, and rimabotulinumtoxin B. Injections were repeated if a satisfactory response was noted

Results: Seventy three patients (29 male, 44 female) were included. 57 patients had PD and 16 had AP. 33 PD patients had DBS. 61 patients had CGI scores documented. Disease duration was 8.4 ± 4.9 years. Average age at first injection was 66 ± 10.4 years. 61 patients had onabotulinumtoxin A, 9 had incobotulinumtoxin A, and 3 had rimabotulinumtoxin B. A mean CGI of 2.85 ± 0.99 was reported, which correlates between ‘much improvement’ and ‘modest improvement’ in foot dystonia from BTX. 60% (n=73) of patients came back for their second injection. Responder rate (mean CGI <4) was 69% (n=61). No adverse events occurred except one case of systemic weakness which resolved. There was no difference in response between the three types of BTX, though only onabotulinumtoxin A group had large enough numbers to measure efficacy. There was no significant difference in BTX efficacy between the DBS and non-DBS groups

Conclusion: In this large cohort, BTX treatment was well tolerated and resulted in patient-reported meaningful improvement in foot dystonia secondary to PD and AP. PD patients who had refractory foot dystonia despite DBS also reported similar improvement

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-therapy-for-medication-and-dbs-refractory-foot-dystonia-of-parkinsonism/