Botulinum neurotoxin for the treatment of movement disorders: Practical considerations

Botulinum neurotoxin (BoNT), produced by spore-forming anaerobic bacteria, is the most potent biological toxin and is a powerful therapeutic tool for several clinical indications in neurology and beyond. BoNT inhibits the release of acetylcholine from the presynaptic terminals of the neuromuscular junction by interfering with the normal process of vesicle–plasma membrane fusion. The spectrum of indications for the use of BoNT in the treatment of various disorders in neurology, ophthalmology, gastroenterology, urology, autonomic, and dermatology is widening. The major indications for BoNT are in hyperkinetic movement disorders. Because BoNT must be injected locally, neurologists should possess the appropriate expertise to effectively deliver the therapy. Although it is considered to be effective and safe, there are many limitations to its use such as the therapeutic effect wearing off and high cost. Here, we review the indications, techniques of muscle selection, and administration of BoNT for maximum benefit in various movement disorders.