Slouha Ethan, Ibrahim Fadi, Esposito Sarah, Mursuli Odelin, Rezazadah Atbeen, Clunes Lucy A, Kollias Theofanis F
Pharmacology, St. George's University School of Medicine, St. George's, GRD.
Pharmacology, St George's University School of Medicine, St George's, GRD.
Cureus. 2024 Jan 31;16(1):e53309. doi: 10.7759/cureus.53309. eCollection 2024 Jan.
Parkinson's disease (PD) is a terminal, debilitating neurodegenerative disorder typically affecting individuals over 60. It is associated with various conditions that drastically affect the patient's quality of life (QoL). Although there is no cure for PD, its symptoms can be significantly improved and even resolved through different treatments. Mainstay treatments for PD include levodopa combined with carbidopa, dopamine agonists, and even deep brain stimulation (DBS) of the subthalamic nucleus. New treatment methods have emerged, such as botulinum toxin (BoNT), which further improve symptoms and, thus, the QoL of patients with PD. Botulinum toxin is a potent neurotoxin produced by that typically causes descending paralysis by suppressing acetylcholine secretion. Serotypes used to treat various disorders include serotype A (BoNT-A) and serotype B (BoNT-B). This paper aims to evaluate the outcomes of BoNT injection on different symptoms associated with PD. An extensive review using PubMed, ScienceDirect, and ProQuest articles concerning 'botulinum toxin and Parkinson's disease' was done per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, resulting in 23,803 articles. After applying strict inclusion and exclusion criteria, the total number of articles was finally 41. The results showed that movement disorders were a common occurrence in PD, consisting of tremors, dystonia, and freezing of gait (FOG), with tremors being the most common symptom. Tremors and dystonia were significantly improved following BoNT-A, correlating with significant improvements in various scales subjectively and objectively evaluating the symptoms and QoL. In contrast, FOG was not significantly improved by either BoNT-A or BoNT-B. Pain is associated with movement disorders such as PD and was the primary indication for the administration of BoNT; studies found pain and QoL were significantly improved following BoNT injection. Quality of life can also be affected by sialorrhea and overactive bladder, which often occur as the disease progresses. Injections of BoNT-A and BoNT-B were shown to significantly improve saliva production, flow rate, drooling frequency, voiding frequency, and urinary urge incontinence. Across all studies analyzed, it is evident that BoNT may have a significant effect on improving the QoL of patients suffering from PD. While research continues to find a cure or stop the progression of PD, it remains critical to continue focusing on improving patients' QoL. Future research should evaluate whether BoNT can be used to successfully treat other symptoms of PD, such as epiphora or constipation.
帕金森病（PD）是一种晚期、使人衰弱的神经退行性疾病，通常影响60岁以上的人群。它与多种严重影响患者生活质量（QoL）的病症相关。尽管帕金森病无法治愈，但其症状可通过不同治疗方法得到显著改善甚至缓解。帕金森病的主要治疗方法包括左旋多巴联合卡比多巴、多巴胺激动剂，甚至对丘脑底核进行深部脑刺激（DBS）。新的治疗方法不断涌现，如肉毒杆菌毒素（BoNT），它能进一步改善症状，从而提高帕金森病患者的生活质量。肉毒杆菌毒素是由 产生的一种强效神经毒素，通常通过抑制乙酰胆碱分泌导致下行性麻痹。用于治疗各种疾病的血清型包括A型肉毒杆菌毒素（BoNT-A）和B型肉毒杆菌毒素（BoNT-B）。本文旨在评估BoNT注射对帕金森病相关不同症状的治疗效果。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对PubMed、ScienceDirect和ProQuest上有关“肉毒杆菌毒素与帕金森病”的文章进行了广泛检索，共检索到23,803篇文章。在应用严格的纳入和排除标准后，最终纳入的文章总数为41篇。结果表明，运动障碍在帕金森病中很常见，包括震颤、肌张力障碍和步态冻结（FOG），其中震颤是最常见的症状。注射BoNT-A后，震颤和肌张力障碍得到显著改善，这与主观和客观评估症状及生活质量的各种量表的显著改善相关。相比之下，BoNT-A和BoNT-B对FOG均未产生显著改善效果。疼痛与帕金森病等运动障碍相关，是注射BoNT的主要指征；研究发现，注射BoNT后疼痛和生活质量均得到显著改善。流涎和膀胱过度活动症也会影响生活质量，且常随着疾病进展而出现。注射BoNT-A和BoNT-B可显著改善唾液分泌、流速、流涎频率、排尿频率和尿急失禁。在所有分析的研究中，很明显BoNT可能对改善帕金森病患者的生活质量有显著作用。在继续寻找治愈帕金森病或阻止其进展方法的同时，持续关注改善患者生活质量仍然至关重要。未来的研究应评估BoNT是否可成功用于治疗帕金森病的其他症状，如流泪或便秘。
