BOTULINUM TOXIN TYPE A IN NEUROLOGY: CURRENT INDICATIONS, EFFICACY, AND SAFETY

Agnieszka Szwed; Daria Aleksandra Warzocha-Żurek; Katarzyna Anna Borzęcka; Natalia Matylda Ziemba-Furgała; Ewa Maria Polewczak-Karp; Krystian Andryszko; Katarzyna  Wawrzonek; Aleksandra Sołtys; Marcelina Dymon; Paulina Krysa

doi:10.31435/ijitss.2(50).2026.5449

Authors

Agnieszka Szwed MSWiA Hospital, Krakowska 16, 35-111 Rzeszów, Poland https://orcid.org/0009-0003-6395-5365
Daria Aleksandra Warzocha-Żurek Clinical Provincial Hospital in Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland https://orcid.org/0009-0005-5756-2404
Katarzyna Anna Borzęcka Medical Center in Łańcut Sp. z o.o., Ignacego Paderewskiego 5, 37-100 Łańcut, Poland https://orcid.org/0009-0007-4084-4370
Natalia Matylda Ziemba-Furgała MSWiA Hospital, Krakowska 16, 35-111 Rzeszów, Poland https://orcid.org/0009-0009-5031-3930
Ewa Maria Polewczak-Karp Medical Center in Łańcut Sp. z o.o., Ignacego Paderewskiego 5, 37-100 Łańcut, Poland https://orcid.org/0009-0006-6411-4826
Krystian Andryszko Clinical Regional Hospital of Saint Jadwiga The Queen in Rzeszów, Lwowska 60, 35-301 Rzeszów, Poland https://orcid.org/0009-0006-6170-5663
Katarzyna Wawrzonek Clinical Provincial Hospital in Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland https://orcid.org/0009-0007-6883-422X
Aleksandra Sołtys University of Rzeszow, Poland https://orcid.org/0009-0007-2557-2696
Marcelina Dymon University of Rzeszow, Poland https://orcid.org/0009-0000-8008-7932
Paulina Krysa City Hospital of John Paul II in Rzeszów, Rycerska 4, 35-241 Rzeszów, Poland https://orcid.org/0009-0000-6633-3586

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5449

Keywords:

Botulinum Toxin Type A, Dystonia, Spasticity, Chronic Migraine, Clinical Applications

Abstract

Background: Botulinum toxin (BoNT), a neurotoxin produced by Clostridium botulinum, has become an established therapeutic modality in neurology. Its mechanism of action—based on the inhibition of acetylcholine release through cleavage of SNARE proteins—results in reversible chemodenervation of hyperactive muscles. Beyond its neuromuscular effects, BoNT modulates sensory neurotransmission, including inhibition of calcitonin gene-related peptide (CGRP) release, which underlies its role in pain disorders. Over the past decades, its clinical indications have expanded, particularly in dystonia, spasticity, and chronic migraine.

Methods: A semi-systematic review of the literature was conducted using major medical databases, including PubMed, Scopus, and Google Scholar. The search included studies published between 2000 and 2025, with emphasis on randomized controlled trials, meta-analyses, and international guidelines. Key clinical trials, including the PREEMPT program and pivotal studies in dystonia and post-stroke spasticity, were analyzed with focus on clinical efficacy, safety, and applicability.

Results: High-level evidence supports the use of botulinum toxin type A as first-line therapy for cervical dystonia and blepharospasm (Level A recommendation). In post-stroke upper limb spasticity, BoNT-A significantly reduces muscle tone as measured by validated scales, with consistent evidence from RCTs and meta-analyses supporting its efficacy (Level A). Functional improvement is variable and depends on individualized goal setting and integration with rehabilitation. In chronic migraine, the PREEMPT trials demonstrated a significant reduction in monthly headache days and improved quality of life, establishing BoNT-A as an evidence-based preventive therapy for patients with ≥15 headache days per month. The safety profile across indications is favorable, with predominantly mild and transient adverse events.

Conclusions: Botulinum toxin represents a cornerstone of focal therapy in several neurological disorders. The strongest evidence supports its use in dystonia, focal spasticity, and chronic migraine. Appropriate patient selection, precise injection technique, and integration into comprehensive management strategies are critical for optimal outcomes. Ongoing research aims to refine patient stratification and clarify its role alongside emerging biologic therapies.

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