Consensus guidelines for botulinum toxin therapy: general algorithms and dosing tables for dystonia and spasticity

Dirk Dressler*, Maria Concetta Altavista, Eckart Altenmueller, Roongroj Bhidayasiri, Saeed Bohlega, Pedro Chana, Tae Mo Chung, Carlo Colosimo, Klemens Fheodoroff, Pedro J. Garcia-Ruiz, Beomseok Jeon, Lingjing Jin, Petr Kanovsky, Ivan Milanov, Federico Micheli, Olga Orlova, Sanjay Pandey, Zvezdan Pirtosek, Maja Relja, Raymond RosalesJosé Alberto Sagástegui-Rodríguez, Gholam Ali Shahidi, Sofia Timerbaeva, Xinhua Wan, Uwe Walter, Fereshte Adib Saberi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


Botulinum toxin (BT) therapy is a complex and highly individualised therapy defined by treatment algorithms and injection schemes describing its target muscles and their dosing. Various consensus guidelines have tried to standardise and to improve BT therapy. We wanted to update and improve consensus guidelines by: (1) Acknowledging recent advances of treatment algorithms. (2) Basing dosing tables on statistical analyses of real-life treatment data of 1831 BT injections in 36 different target muscles in 420 dystonia patients and 1593 BT injections in 31 different target muscles in 240 spasticity patients. (3) Providing more detailed dosing data including typical doses, dose variabilities, and dosing limits. (4) Including total doses and target muscle selections for typical clinical entities thus adapting dosing to different aetiologies and pathophysiologies. (5) In addition, providing a brief and concise review of the clinical entity treated together with general principles of its BT therapy. For this, we collaborated with IAB—Interdisciplinary Working Group for Movement Disorders which invited an international panel of experts for the support.

Original languageEnglish
Pages (from-to)321-335
Number of pages15
JournalJournal of Neural Transmission
Issue number3
Publication statusPublished - Mar 2021

Bibliographical note

Funding Information:
This project was supported by unrestricted educational grants from Allergan and from Merz Pharmaceuticals. Lingjin Jin was supported by the National Key R&D Program of China (2018YFC1314700).

Publisher Copyright:
© 2021, The Author(s).

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health
  • Biological Psychiatry


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