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May 06, 2008; 70 (19) Special Articles

Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review) [RETIRED]

Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

M. Naumann, Y. So, C. E. Argoff, M. K. Childers, D. D. Dykstra, G. S. Gronseth, B. Jabbari, H. C. Kaufmann, B. Schurch, S. D. Silberstein, D. M. Simpson
First published May 5, 2008, DOI: https://doi.org/10.1212/01.wnl.0000311390.87642.d8
M. Naumann
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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Y. So
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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C. E. Argoff
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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M. K. Childers
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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D. D. Dykstra
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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G. S. Gronseth
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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B. Jabbari
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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H. C. Kaufmann
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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B. Schurch
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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S. D. Silberstein
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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D. M. Simpson
From the Department of Neurology (M.N.), Klinikum Augsburg, Germany; Stanford University (Y.S.), CA; Department of Neurology (H.C.K.), New York University School of Medicine (C.E.A.), New York; Wake Forest University Health Sciences (M.K.C.), Winston-Salem, NC; Department of Physical Medicine and Rehabilitation (D.D.D.), University of Minnesota, Minneapolis; University of Kansas (G.S.G.), Kansas City; Department of Neurology (B.J.), Yale University School of Medicine, New Haven, CT; Balgrist University Hospital (B.S.), Zurich, Switzerland; Jefferson Headache Center (S.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA; and Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY.
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Full PDF
Citation
Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review) [RETIRED]
Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
M. Naumann, Y. So, C. E. Argoff, M. K. Childers, D. D. Dykstra, G. S. Gronseth, B. Jabbari, H. C. Kaufmann, B. Schurch, S. D. Silberstein, D. M. Simpson
Neurology May 2008, 70 (19) 1707-1714; DOI: 10.1212/01.wnl.0000311390.87642.d8

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Abstract

Objective: To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of autonomic and urologic disorders and low back and head pain.

Methods: A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and the selected indications. Authors reviewed, abstracted, and classified articles based on the quality of the study (Class I–IV). Conclusions and recommendations were developed based on the highest level of evidence and put into current clinical context.

Results: The highest quality literature available for the respective indications was as follows: axillary hyperhidrosis (two Class I studies); palmar hyperhidrosis (two Class II studies); drooling (four Class II studies); gustatory sweating (five Class III studies); neurogenic detrusor overactivity (two Class I studies); sphincter detrusor dyssynergia in spinal cord injury (two Class II studies); chronic low back pain (one Class II study); episodic migraine (two Class I and two Class II studies); chronic daily headache (four Class II studies); and chronic tension-type headache (two Class I studies).

Recommendations: Botulinum neurotoxin (BoNT) should be offered as a treatment option for the treatment of axillary hyperhidrosis and detrusor overactivity (Level A), should be considered for palmar hyperhidrosis, drooling, and detrusor sphincter dyssynergia after spinal cord injury (Level B), and may be considered for gustatory sweating and low back pain (Level C). BoNT is probably ineffective in episodic migraine and chronic tension-type headache (Level B). There is presently no consistent or strong evidence to permit drawing conclusions on the efficacy of BoNT in chronic daily headache (mainly transformed migraine) (Level U). While clinicians’ practice may suggest stronger recommendations in some of these indications, evidence-based conclusions are limited by the availability of data.

This guideline is retired. The recommendations and conclusions are no longer considered valid and no longer supported by the AAN. Retired guidelines should be used for historical reference only. Please see AAN current guidelines here: https://www.aan.com/policy-and-guidelines/guidelines/.

Letters: Rapid online correspondence

  • Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based
    • Alexander Mauskop, New York Headache Center, 30 East 76 Street, New York, NY 10021drmauskop@nyheadache.com
    • Ninan Mathew
    Submitted July 14, 2008
  • Reply from the authors
    • David M. Simpson, Department of Neurology, Mount Sinai Medical Center, One Gustave Levy Place; Box 1052, New York, NY 10029david.simpson@mssm.edu
    • Markus Naumann, Charles Argoff, Casey Childers, Janis Miyasaki, Stephen Silberstein, and Yuen So
    Submitted July 14, 2008
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