Clinical Study On The Efficacy And Safety Of Botulinum Toxin A In The Treatment Of Parkinson's Disease With Depression

Objective:To evaluation the effect and safety of botulintum toxin A in the treatment of Parkinson's disease(PD)with depression,and to provide a new method for the effective treatment of PD with depression.Methods:We collected the data of forty-five PD patients with depression who were visited neurological in-patient department or outpatient in the second hospital affiliated to suzhou university between August 2016 to December 2018.These patients were divided into two groups,30 patients participated to a botulinum toxin A(BoNT-A,)treatment group(administered with 100u BoNT-A injection on patient's periocular facial expression muscles:frowning muscles,descending interbrow muscles,frontal abdomen of occipitofrontal muscle?bilateral external canthus and bilateral temporal muscles regions at 20 points),and 15 patients participated to a controlled group:sertraline treatment group(administered with 50-100mg(56.25±15.54mg)/day sertraline in the morning).Compare the scores of Hamilton Depression Rating Scale(HAMD-17),Self-rating Depression Scale(SDS),Hamilton Rating Scale for Anxiety(HAMA-14),Self-rating Anxiety Scale(SAS)after treatment for 2 weeks?4weeks?8weeks and 12weeks with the scores of each emotional rating scale for baseline respectively.Meanwhile,the differences between the two treatment groups in the scores of each emotional scales were compared,In addition,we compared the remission rates of HAMD and HAMA at each follow-up time point between the two groups,to evaluate the efficacy and safety of BoNT-A in the treatment of PD patients with depression.Results:The scores of HAMD?HAMA?SDS?SAS on BoNT-A treatment group and sertraline treatment group reduced compared to baseline(at 2nd?4th?8th?12th week)after treatment.The scores of HAMD and SDS in BoNT-A group were significantly lower(HAMD:P<0.0001,SDS:P=0.0007),while those in sertraline group were significantly lower(HAMD:P=0.0121,SDS:P=0.047),but there was no significant difference in the scores of HAMD and SDS between the two groups(P>0.05);There was no significant difference in remission rate between the two groups at each follow-up time point(P>0.05);In the BoNT-A treatment group,there was no significant difference in HAMD scores between males and females at all follow-up time points(P>0.05).Among 45 cases of patients,there were no significant difference in HAMD scores between male and female in BoNT-A treatment group(P>0.05);In BoNT-A treatment group there were 2 cases of frown muscle stiffness and 1 case of headache,which lasted for 2 weeks,1 month and 1 week respectively;In sertraline treatment group,there were 2 cases had symptoms of headache and dizziness and 2 cases had dry mouth and nausea,which improved after 2 weeks,which lasted about 2 weeks and improved.Between the two groups,no significant difference was found in the incidence of side effects(p>0.05).Conclusion:BoNT-A intraocular facial muscle injection can significantly improve the depressive symptoms of Parkinson's disease patients with depression,the effect lasts for a long time,the incidence of side effects is low,the safety is high,can be considered as a safe and effective new method for Parkinson's disease patients with depression.