Unlocking Movement: Addressing Key Challenges and Strategic Solutions in the Use of Botulinum Toxin for Spasticity and Dystonia


Botulinum toxin (BoNT) injection is the recommended first-line treatment for focal, multifocal, or segmental presentations of spasticity and dystonia. But even though agreement on this approach is widespread, the effective employment of this strategy is not straightforward. Features such as the variety of neurotoxin formulations available, possible muscle patterns even within singular affected areas (e.g., cervical dystonia), uses and choices of injection aids (e.g., EMG, ultra sound [US]), and other treatment considerations (e.g., neurotoxin spread) present a wealth of information and host of skills for clinicians to master. The diversity of formulation indications and limited evidence describing their optimal application complicates decision-making even further. Using recent data and clinical experience, the faculty will highlight the “Top 5” critical issues prioritized by clinicians regarding the use of neurotoxin therapy in spasticity and dystonia.

Target Audience

This activity is intended for MS specialists, general neurologists, nurse practitioners, physician assistants and other healthcare professionals involved in the diagnosis and long-term management of patients with spasticity and dystonia.

Learning Objectives

Upon completion of the educational activity, participants should be able to:

  • Review the pharmacological properties, dosing considerations, and indications that differentiate approved BoNTs in order to better customize the current integration of these agents into routine practice.
  • Examine strategies to identify muscle injection sites and patterns, including the use of guidance methods (e.g., US) and spastic/dystonic movement patterns to improve the accurate delivery of BoNT treatment.
  • Discuss expert approaches to identifying sources of inadequate response to and/or adverse effects from BoNT to determine the optimal adjustments to technique and/or treatment strategy needed to maximize outcomes for individual patients.
Course summary
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  David Simpson, MD (Chair)
  Professor of Neurology, Icahn School of Medicine
  Director, Neuromuscular Division
  Director, Clinical Neurophysiology Laboratories, The Mount Sinai Hospital
  New York, New York



  Katharine Alter, MD
  Senior Physiatrist, Mount Washington Pediatric Hospital
  An Affiliate of the University of Maryland Medical System and Johns Hopkins University
  Baltimore, Maryland



  Richard Barbano, MD, PhD
  Professor of Neurology, Movement Disorders Division
  University of Rochester
  Rochester, New York


Credit for this program has expired. The accreditation information below is based on the activity release date.

This activity is jointly provided by Medical Education Resources (MER) and Efficient LLC.

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Joint Accreditation Statement



In support of improving patient care, this activity has been planned and implemented by MER and Efficient, LLC. MER is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Designation Statement

MER designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Relevant Financial Relationships

MER insures balance, independence, objectivity, and scientific rigor in all our educational activities. In accordance with this policy, MER identifies relevant financial relationships with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Reported relevant financial relationships are mitigated by MER to ensure that all scientific research referred to, reported, or used in a CE activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing learners with high-quality CE activities that promote improvements or quality in health care and not the business interest of an ineligible company.

Planners' and Managers' Disclosure
MER planners and managers have nothing to disclose. Efficient LLC planners and managers have nothing to disclose.

Faculty Disclosures

Dr. Simpson:

  • Research Support: Allergan, Merz
  • Consulting Fees: Allergan, Ipsen, Merz

Dr. Alter:

  • Patent Holder: Springer/Demos Medical Publishing

Dr. Barbano:

  • Research Support: Revance
  • Consulting Fees: AbbVie, Merz, Revance

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Commercial Support

This activity is supported by an educational grant from AbbVie.


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