Scientific publications

Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia

Mar 1, 2018 | Magazine: Revista de Neurología

Garcia-Ruiz PJ (1), Sanz-Cartagena P (2), Martinez-Castrillo JC (3), Ares-Pensado B (4), Aviles-Olmos I (3), Blazquez-Estrada M (5), Fanjul-Arbos S (6), Garcia-Caldentey J (7), Gazulla J (8), Gutierrez-Garcia J (9), Huete-Anton B (10), Lucas-Rodenas C (11), Luquin MR (12), Martinez-Torres I (13), Medialdea-Natera P (14), Mendoza-Rodriguez A (15), Mir-Rivera P (16), Posada IJ (17), Ruiz-Martinez J (18), Sanchez-Alonso P (19), Trejo-Gabriel Y Galan JM (20), Vela L (21), Pena-Segura JL  (22).

(1) Fundacion Jimenez Diaz, 28040 Madrid, Espana.
(2) Hospital de Mataro. Consorci Sanitari del Maresme, 08304 Mataro, Espana.
(3) Hospital Universitario Ramon y Cajal, 28034 Madrid, Espana.
(4) Hospital Clinico de Santiago de Compostela, 15706 Santiago de Compostela, Espana.
(5) Hospital Universitario Central de Asturias, Oviedo, Espana.
(6) Hospital Universitario Severo Ochoa, Leganes, Espana.
(7) Clinica Rotger, 07012 Palma de Mallorca, Espana.
(8) HUMS. Hospital Universitario Miguel Servet, Zaragoza, Espana.
(9) Hospital Clinico Universitario San Cecilio, 18012 Granada, Espana.
(10) Hospital de Basurto, 48013 Bilbao, Espana.
(11) Hospital Universitario Virgen de la Arrixaca, Murcia, Espana.
(12) Clinica Universitaria de Navarra, 31008 Pamplona, Espana.
(13) Hospital La Fe, 46009 Valencia, Espana.
(14) Hospital Universitario Virgen de la Victoria, 29010 Malaga, Espana.
(15) Hospital General de Segovia, 40002 Segovia, Espana.
(16) Hospitales Universitarios Virgen del Rocio, 41013 Sevilla, Espana.
(17) Hospital Universitario 12 de Octubre, Madrid, Espana.
(18) Hospital Donostia, 20014 San Sebastian, Espana.
(19) Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, Espana.
(20) Hospital General Yague, 09005 Burgos, Espana.
(21) Hospital Universitario Fundacion Alcorcon, 28922 Alcorcon, Espana.
(22) HUMS. Hospital Universitario Miguel Servet, 50009 Zaragoza, Espana.


Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity.


To analyze and summarize different questions about the use of BTA in our clinical practice.


A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed.

The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated.

Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc.


This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.

CITATION  Rev Neurol. 2018 Mar 1;66(5):163-172

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