---
title: "OnabotulinumtoxinA Improves Pain from Foot Dystonia in Parkinson Disease: Randomized Controlled Tr"
id: "pubmed-42753227"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42753227"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42753227/"
doi: "10.1212/CPJ.0000000000200659"
published_at: "2026-09-17T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# OnabotulinumtoxinA Improves Pain from Foot Dystonia in Parkinson Disease: Randomized Controlled Tr
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42753227
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42753227/)
- **DOI:** [10.1212/CPJ.0000000000200659](https://doi.org/10.1212%2FCPJ.0000000000200659)
- **Published At:** 2026-09-17T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This single-center, randomized, double-blind, placebo-controlled trial tested **onabotulinumtoxinA** (BTXA) for pain from **foot dystonia** in people with unilateral **Parkinson disease (PD)** refractory to medication optimization. - Thirty-three participants were randomized 1:1 (BTXA n = 16; placebo n = 17). - Intervention: single guided injections totaling **100 units** of BTXA targeting tibialis posterior, extensor hallucis longus, and flexor digitorum brevis. - Primary outcome: change from baseline in dystonia-related pain using Item 5 of the **King's Parkinson's Disease Pain Scale (KPPS)** assessed at 6 and 12 weeks. - BTXA produced a significantly greater reduction in KPPS Item 5 total score versus placebo at 6 weeks (mean difference -3.60) with effects sustained at 12 weeks (p < 0.001). - Between-group effect size for the primary outcome was large (Hedges' g -1.33; 95% CI -2.13 to -0.53). - Secondary benefits included improvements in KPPS Item 5 severity and frequency subitems and KPPS Domain 3 total score at 6 and 12 weeks; VAS pain decreased at 6 weeks but not significantly different at 12 weeks. - Responder rates (≥30% pain reduction) favored BTXA at 6 and 12 weeks (75.0% vs ≤11.8% and 5.6%, respectively; p < 0.001). - No between-group differences were seen in motor scores (MDS-UPDRS III and IV), quality of life, or adverse events; reported adverse events were mild. - Study included a 12-week open-label extension; trial registration: NCT04277247. - Findings support targeted use of **BTXA** injections for treating painful foot dystonia in PD without worsening motor function and with good tolerability.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 17. # OnabotulinumtoxinA for Painful Foot Dystonia in Parkinson Disease: A Randomized, Double-Blind, Placebo-Controlled Trial [Yasamin Mahjoub](https://pubmed.ncbi.nlm.nih.gov/?term=Mahjoub+Y&cauthor_id=42753227)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-1 "Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Canada."), [Beatrice Achen](https://pubmed.ncbi.nlm.nih.gov/?term=Achen+B&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada."), [Parisa Alizadeh](https://pubmed.ncbi.nlm.nih.gov/?term=Alizadeh+P&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-3 "Hotchkiss Brain Institute, University of Calgary, Canada."), [Ali Abusrair](https://pubmed.ncbi.nlm.nih.gov/?term=Abusrair+A&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-4 "Neurology Division, Department of Internal Medicine, Qatif Health Network, Qatif \(Al-Qatif\), Eastern Province, Saudi Arabia; and."), [Gabriel Amorelli](https://pubmed.ncbi.nlm.nih.gov/?term=Amorelli+G&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-5 "Division of Neurology, Department of Medicine, University of Ottawa, Canada."), [Alicja Cieslak](https://pubmed.ncbi.nlm.nih.gov/?term=Cieslak+A&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-3 "Hotchkiss Brain Institute, University of Calgary, Canada."), [Nancy Labelle](https://pubmed.ncbi.nlm.nih.gov/?term=Labelle+N&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada."), [Tracy Hammer](https://pubmed.ncbi.nlm.nih.gov/?term=Hammer+T&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada."), [Carol Pantella](https://pubmed.ncbi.nlm.nih.gov/?term=Pantella+C&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada."), [Veronica Bruno](https://pubmed.ncbi.nlm.nih.gov/?term=Bruno+V&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#full-view-affiliation-3 "Hotchkiss Brain Institute, University of Calgary, Canada.") Affiliations Expand ### Affiliations * 1 Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Canada. * 2 Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada. * 3 Hotchkiss Brain Institute, University of Calgary, Canada. * 4 Neurology Division, Department of Internal Medicine, Qatif Health Network, Qatif (Al-Qatif), Eastern Province, Saudi Arabia; and. * 5 Division of Neurology, Department of Medicine, University of Ottawa, Canada. * PMID: **42753227** * DOI: [ 10.1212/CPJ.0000000000200659 ](https://doi.org/10.1212/cpj.0000000000200659) Item in Clipboard Randomized Controlled Trial # OnabotulinumtoxinA for Painful Foot Dystonia in Parkinson Disease: A Randomized, Double-Blind, Placebo-Controlled Trial Yasamin Mahjoub et al. Neurol Clin Pract. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Neurol Clin Pract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neurol+Clin+Pract%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Neurol+Clin+Pract%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42753227/) . 2026 Dec;16(6):e200659. doi: 10.1212/CPJ.0000000000200659. Epub 2026 Sep 17. ### Authors [Yasamin Mahjoub](https://pubmed.ncbi.nlm.nih.gov/?term=Mahjoub+Y&cauthor_id=42753227)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-1 "Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Canada."), [Beatrice Achen](https://pubmed.ncbi.nlm.nih.gov/?term=Achen+B&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada."), [Parisa Alizadeh](https://pubmed.ncbi.nlm.nih.gov/?term=Alizadeh+P&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-3 "Hotchkiss Brain Institute, University of Calgary, Canada."), [Ali Abusrair](https://pubmed.ncbi.nlm.nih.gov/?term=Abusrair+A&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-4 "Neurology Division, Department of Internal Medicine, Qatif Health Network, Qatif \(Al-Qatif\), Eastern Province, Saudi Arabia; and."), [Gabriel Amorelli](https://pubmed.ncbi.nlm.nih.gov/?term=Amorelli+G&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-5 "Division of Neurology, Department of Medicine, University of Ottawa, Canada."), [Alicja Cieslak](https://pubmed.ncbi.nlm.nih.gov/?term=Cieslak+A&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-3 "Hotchkiss Brain Institute, University of Calgary, Canada."), [Nancy Labelle](https://pubmed.ncbi.nlm.nih.gov/?term=Labelle+N&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada."), [Tracy Hammer](https://pubmed.ncbi.nlm.nih.gov/?term=Hammer+T&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada."), [Carol Pantella](https://pubmed.ncbi.nlm.nih.gov/?term=Pantella+C&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada."), [Veronica Bruno](https://pubmed.ncbi.nlm.nih.gov/?term=Bruno+V&cauthor_id=42753227)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-2 "Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42753227/#short-view-affiliation-3 "Hotchkiss Brain Institute, University of Calgary, Canada.") ### Affiliations * 1 Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Canada. * 2 Department of Clinical Neurosciences, Movement Disorders Program, University of Calgary, Canada. * 3 Hotchkiss Brain Institute, University of Calgary, Canada. * 4 Neurology Division, Department of Internal Medicine, Qatif Health Network, Qatif (Al-Qatif), Eastern Province, Saudi Arabia; and. * 5 Division of Neurology, Department of Medicine, University of Ottawa, Canada. * PMID: **42753227** * DOI: [ 10.1212/CPJ.0000000000200659 ](https://doi.org/10.1212/cpj.0000000000200659) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background and objectives:** Pain associated with foot dystonia is a common and disabling symptom of Parkinson disease (PD), often occurring during OFF periods, yet frequently refractory to medication optimization. Evidence supporting treatments for dystonia-related pain in PD remains limited. This study evaluated the efficacy and safety of onabotulinumtoxinA (BTXA) for pain associated with foot dystonia in patients with PD. **Methods:** This single-center, randomized, double-blind, placebo-controlled trial assessed outcomes at 6 and 12 weeks, followed by a 12-week open-label extension. Adults with unilateral PD and painful foot dystonia refractory to medication optimization were randomized 1:1 to receive BTXA (100 units) or placebo using a guided injection protocol targeting the tibialis posterior, extensor hallucis longus, and flexor digitorum brevis. The primary outcome was change from baseline in dystonia-related pain assessed using Item 5 of the King's Parkinson's Disease Pain Scale (KPPS). Secondary outcomes included responder rates (≥30% pain reduction), KPPS Domain 3 total score, KPPS Item 5 pain severity and frequency subitems, Visual Analogue Scale (VAS) pain, Clinical Global Impression, motor outcomes (Movement Disorder Society-Unified Parkinson's Disease Rating Scale III and IV), quality of life, and safety. **Results:** Thirty-three participants were randomized (BTXA, n = 16; placebo, n = 17). BTXA resulted in significantly greater reduction in dystonia-related pain assessed by KPPS Item 5 total score compared with placebo at 6 weeks (mean difference -3.60), with effects sustained at 12 weeks (_p_ < 0.001). The between-group effect size for the primary outcome was large (Hedges' g -1.33; 95% CI -2.13 to -0.53). Improvements were observed in KPPS Item 5 pain severity and frequency and in KPPS Domain 3 total scores at 6 and 12 weeks. VAS pain was reduced at 6 weeks, with no significant between-group difference at 12 weeks. Responder rates (≥30% pain reduction) were higher with BTXA at both 6 and 12 weeks (75.0% vs ≤ 11.8 and 5.6%, respectively; _p_ < 0.001). No differences were observed in motor outcomes, quality of life, or adverse events, which were mild. **Discussion:** BTXA reduced pain associated with foot dystonia in PD without adversely affecting motor outcomes and was well tolerated, supporting its use as a targeted treatment for this disabling symptom. **Trial registration information:** [NCT04277247](http://clinicaltrials.gov/show/NCT04277247 "See in ClinicalTrials.gov"). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Publication types * Randomized Controlled Trial Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Randomized+Controlled+Trial%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Randomized+Controlled+Trial) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42753227/) ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42753227/) * Botulinum Toxins, Type A* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Botulinum+Toxins%2C+Type+A%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Botulinum+Toxins%2C+Type+A) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42753227/) * Botulinum Toxins, Type A* / adverse effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Botulinum+Toxins%2C+Type+A%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Botulinum+Toxins%2C+Type+A) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42753227/) * Botulinum Toxins, Type A* / pharmacology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Botulinum+Toxins%2C+Type+A%2Fpharmacology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Botulinum+Toxins%2C+Type+A) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42753227/) * Botulinum Toxins, Type A* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Botulinum+Toxins%2C+Type+A%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Botulinum+Toxins%2C+Type+A) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42753227/) * Double-Blind Method Actions * [ Sea
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