AAN Updates Guidelines on Botulinum Neurotoxins

The American Academy of Neurology (AAN) has updated its 2008 guidelines regarding botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, headache, and adult spasticity.

To construct the new guidelines, the AAN’s Guideline Development Subcommittee searched the literature for relevant articles and classified evidence as level A (strong), B (medium), and C (weak) based on 2004 AAN criteria.
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Four types of botulinum toxin are currently available in the United States, including 3 type As and 1 type B: onabotulinumtoxinA (onaBoNT-A), incobotulinumtoxinA (incoBoNT-A), abobotulinumtoxinA (aboBoNT-A), and rimabotulinumtoxinB (rimaBoNT-B).

Overall, they released the following recommendations:

  • For patients with blepharospasm, onaBoNT-A and incoBoNT-A are probably effective and should be considered (Level B). AboBoNT-A is possibly effective and may be considered (Level C).
  • For patients with cervical dystonia, aboBoNT-A and rimaBoNT-B are effective and should be offered (Level A). OnaBoNT-A and incoBoNT-A are probably effective and should be considered (Level B).
  • For patients with adult spasticity, aboBoNT-A, incoBoNT-A, and onaBoNT-A are effective and should be offered (Level A). RimaBoNT-B is probably effective and should be considered for upper-limb spasticity (Level B). AboBoNT-A and onaBoNT-A are effective and should be offered for lower-limb spasticity (Level A).
  • For patients with chronic migraines, onaBoNT-A is effective and should be offered to increase headache-free days (Level A) and is probably effective and should be considered to improve health-related quality of life (Level B). OnaBoNT-A is ineffective and should not be offered for episodic migraine (Level A) and is probably ineffective for chronic tension-type headaches (Level B).

—Amanda Balbi

Reference:
Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology [published online April, 2016]. Neurology. doi:http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000002560.