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Movement Disorders Botulinum Neurotoxin Botulinum Neurotoxin Revisited – An Individualised, Patient-centric Approach for the Treatment of Dystonia and Spasticity Report of the Proceedings of Centro de Medicina de Reabilitação de Alcoitão Symposium at Toxins 2015, Lisbon, Portugal Expert Review by: Maja Relja, 1 Jorge Jacinto, 2 Joseph Jankovic 3 and Alberto Albanese 4 1. University Hospital Center Zagreb, Croatia; 2. Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal; 3. Baylor College of Medicine, Houston, Texas, US; 4. Istituto Nazionale Neurologico Carlo Besta, Milan, Italy Abstract Botulinum toxin A (BoNT-A) has become the first-line therapy in cervical dystonia (CD), blepharospasm and spasticity. However, the current guidelines for the clinical use of BoNT-A are based on data published more than 20 years ago and patient satisfaction with current treatment regimens is low. There is a striking difference between the injection intervals given in everyday clinical practice and the injection intervals preferred by patients. Recent data have indicated that shorter injection intervals may improve overall patient satisfaction since re-emergence of symptoms could be prevented. Three double-blind studies have demonstrated that incobotulinumtoxin A (incoBoNT-A) is suitable for use in a flexible, patient-centric approach in blepharospasm and CD, with injection intervals starting from 6 weeks. The efficacy, tolerability and safety of this regime were excellent. There is a need to optimise and individualise the treatment using the three available formulations of BoNT- A, as well as to define parameters for switching between the formulations. Keywords Botulinum toxin, blepharospasm, spasticity, cervical dystonia, incobotulinum toxin A Disclosure: Maja Relja has no conflicts of interest to declare. Jorge Jacinto has received honoraria and support from Allergan, Ipsen and Merz for conferences, lectures, research projects, advisory and consultancy. He has no profit nor financial or other benefits from any of the companies. Joseph Jankovic has received research grants and is a consultant for Allergan, Ipsen and Merz. Alberto Albanese has received research grants and is a consultant for Allergan, Ipsen and Merz. Acknowledgements: Editorial assistance was provided by Katrina Mountfort of Touch Medical Media, London, UK. This article reports the proceedings of a sponsored satellite symposium and as such has not been subject to the journal’s usual peer-review process. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 15 January 2015 Accepted: 9 April 2015 Citation: European Neurological Review, 2015;10(1):28–34 Correspondence: Jorge Jacinto, Centro de Medicina de Reabilitação de Alcoitão, Serviço 3; Rua conde Barão, 2649-506 Alcabideche, Portugal. E: Support: The publication of this article was supported by Merz. The views and opinions expressed are those of the presenters and not necessarily those of Merz. Introduction Maja Relja University Hospital Center Zagreb, Croatia Since its introduction in the 1980s, botulinum toxin type A (BoNT-A) has become the first-choice treatment for most types of focal dystonia, including cervical dystonia (CD) and blepharospasm. It is also widely used in the treatment of spasticity arising from stroke, spinal cord injury, multiple sclerosis and traumatic brain injury, as well as in the treatment of pain e.g. chronic migraine. However, the current guidelines for the clinical use of BoNT-A are based on historical data, some of which was published more than 20 years ago, 1 and recent data suggest that patient satisfaction with current therapeutic 28 regimes is low. A satellite symposium, co-chaired by Dr Maja Relja and Dr Jorge Jacinto, was held at Toxins 2015, Lisbon, Portugal, January 2015 organised by the Centro de Medicina de Reabilitação de Alcoitão, Portugal. Dr Relja presented the aims of the symposium: to review existing data on a patient-centric approach in spasticity and CD using BoNT-A; to provide information about recent clinical data; to consider how an individualised approach can be incorporated into clinical practice; and to provide practical expert guidance on evolving treatment strategies. ■ Tou c h ME d ica l ME d ia