Botulinum Toxin for the Treatment of Focal Task-Specific Hand Dystonias: Systematic Review and Meta-Analysis

Nigel Ashworth1, Henry Aidoo2, Alexander Doroshenko2, David Antle3, Charl Els4, David Mark Flaschner5, Douglas P. Gross6, Christine Guptill7, Patrick Potter8, Maria C. Tan9, Sebastian Straube2, *
1 Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Canada
2 Division of Preventive Medicine, Department of Medicine, University of Alberta, Canada
3 Faculty of Medicine and Dentistry, University of Alberta, Canada
4 Department of Psychiatry, University of Alberta, Canada
5 Department of Physical Medicine & Rehabilitation, University of Calgary
6 Department of Physical Therapy, University of Alberta, Canada
7 Department of Occupational Therapy, University of Alberta, Canada
8 Parkwood Institute, London, Ontario, Canada
9 John W. Scott Health Sciences Library, University of Alberta, Canada



Botulinum toxin (BTX) has become a widely used treatment in several dystonic conditions, but the evidence for its efficacy has largely come from open trials and expert opinion. This systematic review examined the efficacy and safety of BTX in the treatment of focal hand dystonia (FHD) in randomized controlled trials (RCTs).


We searched Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, SPORT Discus, SCOPUS, Web of Science, PEDro,, and the International Clinical Trials Registry Platform (ICTRP) for randomized, placebo-controlled trials on the use of BTX for FHD.


Of 1,116 publications retrieved from the databases searched, three publications were included. The evidence identified pertains to focal task-specific hand dystonias. Sixty-nine participants were involved in the three RCTs with a mean duration of symptoms of 7.5 years. Participants were assessed using a combination of self-reported and functional performance outcome measures following injections of BTX subtype A (BTX-A) or placebo. The Oxford Quality Scale was used to assess the included studies, and the three studies each scored 3/5 or above. The included studies reported no adverse events with BTX-A use, other than muscle weakness and pain at the injection sites.


The number of participants included in these three trials is too small to draw dependable conclusions about the efficacy and safety of BTX-A for FHD. There is currently not enough evidence to recommend the routine use of BTX-A for FHD.

Keywords: Botulinum Toxin, Clinical Trials, Dystonia, Meta-Analysis, Systematic Review.

Abstract Information

Identifiers and Pagination:

Year: 2019
Volume: 13
Publisher Item Identifier: EA-TONEUJ-2018-22

Article History:

Received Date: 19/10/2018
Revision Received Date: 17/01/2019
Acceptance Date: 04/02/2019
Electronic publication date: 20/02/2019
Collection year: 2019

© 2019 Ashworth et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the Division of Preventive Medicine, Department of Medicine, University of Alberta, 5–30 University Terrace, 8303 –112 Street NW, Edmonton, Alberta, T6G 2T4, Canada; Tel: +1 780 492 6291; Fax: +1 780 492 9677; E-mail: