Guidelines Updated on Botulinum Toxin for Brain Disorders

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The American Academy of Neurology has updated its 2008 guidelines on using botulinum toxin for brain disorders.

One of the main changes: Botulinum toxin A is now recommended for the management of chronic migraine, defined as attacks lasting 4 or more hours on at least 15 days each month for 3 months. Previously, there wasn't enough evidence for this recommendation, but new placebo-controlled studies show a small, 15% reduction in the number of headache days with treatment. Botulinum toxin A is not recommended for less frequent, "episodic" migraine.

In addition, the guidance states that botulinum toxin is generally safe and effective for treating spasticity in adults, cervical dystonia, and blepharospasm.