{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:11:21Z","timestamp":1791288681353,"version":"4.3.0"},"reference-count":20,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T00:00:00Z","timestamp":1718841600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Deep Brain Stimulation (DBS) is a recognized treatment for different dystonia subtypes and has been approved by the Food and Drug Administration (FDA) since 2003. The European Federation of Neurological Societies (EFNS) and the International Parkinson and Movement Disorders Society (MDS) recommend DBS for dystonia after failure of botulinum toxin (BoNT) and other oral medications for dystonia treatment. In addition, several long-term studies have demonstrated the continuous efficacy of DBS on motor and quality of life (QoL) scores. However, there are only a few reports comparing the overall impact of surgical treatment in BoNT protocols (e.g., dosage and number of selected muscles before and after surgery). This retrospective multicenter chart-review study analyzed botulinum toxin total dosage and dosage per muscle in 23 dystonic patients before and after DBS surgery. The study\u2019s primary outcome was to analyze whether there was a reduction in BoNT dosage after DBS surgery. The mean BoNT dosages difference between baseline and post-surgery was 293.4 units for 6 months, 292.6 units for 12 months, and 295.2 units at the last visit. The median total dose of BoNT in the preoperative period was 800 units (N = 23). At the last visit, the median was 700 units (p = 0.05). This represents a 12.5% reduction in BoNT median dosage. In conclusion, despite the limitations of this retrospective study, there was a significant reduction in BoNT doses after DBS surgery in patients with generalized dystonia.<\/jats:p>","DOI":"10.3390\/toxins16060282","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T05:27:19Z","timestamp":1718861239000},"page":"282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Botulinum Toxin and Deep Brain Stimulation in Dystonia"],"prefix":"10.3390","volume":"16","author":[{"given":"Julia","family":"de Souza","sequence":"first","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananda","family":"Falcone","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3814-691X","authenticated-orcid":false,"given":"Renata","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3725-4464","authenticated-orcid":false,"given":"Miriam","family":"Soares","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Munhoz","sequence":"additional","affiliation":[{"name":"Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson\u2019s Disease, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Farah","sequence":"additional","affiliation":[{"name":"Cajuru University Hospital, Pont\u00edficia Universidade Cat\u00f3lica do Paran\u00e1, Curitiba 80050-350, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4235-4141","authenticated-orcid":false,"given":"Tamine","family":"Capato","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"},{"name":"Department of Neurology, Radboud University Medical Center, 6525 Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Casagrande","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1603-1990","authenticated-orcid":false,"given":"Marcela","family":"Cordellini","sequence":"additional","affiliation":[{"name":"Instituto de Neurologia de Curitiba, Curitiba 81210-310, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"de Castro Micheli","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Limongi","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egberto","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarice","family":"Listik","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubens","family":"Cury","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"},{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1468-1331.2010.03042.x","article-title":"EFNS guidelines on diagnosis and treatment of primary dystonias: EFNS dystonia guidelines","volume":"18","author":"Albanese","year":"2011","journal-title":"Eur. 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