Botulinum neurotoxin therapy in Parkinson’s disease and aging-related movement disorders: mechanisms, biomarkers, and treatment optimization

Botulinum neurotoxin has become a cornerstone in addressing focal dystonias, sialorrhea, chronic migraine, and overactive bladder. Despite this established role, significant questions remain regarding its optimal application for the complex motor and non-motor symptoms seen in Parkinson’s disease and aging-related movement disorders. Current evidence is fragmented, with uncertainty around which patients benefit most, how underlying mechanisms influence clinical outcomes, and which biomarkers truly support precise and individualized therapy—particularly in the elderly, who often present with multifaceted symptom profiles encompassing both motor and non-motor domains, including neuropsychiatric features.This Research Topic brings focused attention to botulinum neurotoxin therapy in Parkinson’s disease and aging-related movement disorders, prioritizing three interrelated domains: the mechanistic basis of therapeutic response, the discovery and validation of actionable biomarkers, and the practical optimization of treatment strategies. Our goal is to unite mechanistic, preclinical (including animal model studies), translational, and clinical research that advances understanding of symptom-specific efficacy, refines patient selection, and translates objective measurements into real-world clinical decision-making. Emphasis is placed on studies that illuminate the neurobiological and circuit-level mechanisms tied to diverse symptoms—including neuropsychiatric complications—and on approaches that support precision medicine in older adults.We encourage submissions that directly explore botulinum neurotoxin within the context of Parkinson’s disease or aging-related movement disorders. While our main focus is on mechanistic, preclinical, translational, and clinical studies related to botulinum neurotoxin therapy, we also welcome complementary research where there is a clear and meaningful connection to its use or underlying mechanisms. Submissions centered solely on other therapeutic agents, general interventions, descriptive epidemiology, or assessment technologies without a defined mechanistic or interventional link to botulinum neurotoxin will be considered outside the primary scope. By focusing on symptom-targeted treatment, mechanistic insight, biomarker-guided stratification, translational approaches, and clinically relevant optimization, this Research Topic aims to contribute to the foundation for evidence-based, individualized care in this field.To gather further insights within these boundaries, we welcome articles addressing, but not limited to, the following themes:- Mechanisms of symptom-specific botulinum neurotoxin response:Neurobiological, neuromuscular, and circuit-level mechanisms relevant to specific motor, non-motor, and neuropsychiatric features in Parkinson’s disease and aging-related movement disorders.- Animal models and preclinical studies:Animal model and other preclinical research that advances mechanistic understanding, supports biomarker discovery, and underpins translational application of botulinum neurotoxin therapy.- Biomarkers and quantitative outcome measures:Objective markers for patient stratification, target selection, and treatment monitoring, including neuroimaging, electrophysiology, wearable sensors, and digital assessments explicitly tied to botulinum neurotoxin intervention.- Clinical efficacy, safety, and durability:Clinical and translational investigations of effectiveness, tolerability, safety, and duration of therapeutic benefit, with an emphasis on older adults.- Treatment optimization:Refinement of dosing protocols, injection techniques, anatomical targeting, and guidance methods to enhance therapeutic precision and outcomes.- Symptom-targeted applications in Parkinson’s disease and related disorders:Evidence-based use of botulinum neurotoxin for dystonia, sialorrhea, pain, tremor, and other focal motor, non-motor, and neuropsychiatric manifestations.- Combination and translational approaches:Studies integrating botulinum neurotoxin therapy with pharmacological, rehabilitative, or neurosurgical interventions where the mechanism and clinical utility are clearly defined.- Real-world and patient-centered treatment studies:Implementation science, practice-based reports, and patient-focused outcome studies that directly inform clinical use of botulinum neurotoxin. Topic editors: Alexandre Kreisler, Michel R Popoff, Anna Rita Bentivoglio, Qiu Han Source: https://www.frontiersin.org/research-topics/83182/botulinum-neurotoxin-therapy-in-parkinsons-disease-and-aging-related-movement-disorders-mechanisms-biomarkers-and-treatment-optimization