300 Section - Botulinum neurotoxin type-A in the treatment of patients with paratonia

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Corresponding Author/Autor a quien dirigir la corr(s)

Jörg Wissel, MD

Professor
Merz Therapeutics GmbH
Potsdam, Brandenburg, Germany

Co-Author/Coautor(s)

GF

Gerard E Francisco, MD

Chair and Professor of PM&R
UTHealth McGovern Medical School
Houston, Texas, United States
dB

djamel Bensmail, PhD

Professor of Physical and Rehabilitation Medicine
Hôpital Raymond-Poincaré
Garches, Ile-de-France, France
MV

Monica Verduzco-Gutierrez, MD

Physiatrist and Professor and Chair of the Department of Rehabilitation Medicine
University of Texas Health Science Center
San Antonio, Texas, United States
JH

Jorge Hernandez Franco, MD

specialist in rehabilitation medicine and neurological rehabilitation,
Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez
Mexico City, Veracruz-Llave, Mexico

Presenting Author/Autor expositor(s)

Bo Biering-Sørensen, MD

Director, Clinical Associate Professor, Senior Consultant
Movement Disorder and Pain Research Center
Glostrup, Hovedstaden, Denmark

Objectives : ^{Paratonia is a form of hypertonia observed in patients with dementia, and is characterised by an involuntary, variable resistance during passive movement that corresponds to the intensity of the stimulus applied. Paratonia eventually affects most patients with dementia as the disease progresses, with substantial patient and caregiver burden and a reduced quality of life. Paratonia also presents in neurodegenerative conditions like Parkinson’s disease (PD) and progressive supranuclear palsy (PSP). Despite this, paratonia remains poorly understood and overlooked by clinicians, and lacks robust clinical evidence and guidelines, leaving some patients without access to potentially effective treatments like botulinum neurotoxin type-A (BoNT-A) therapy}

Design: We combined evidence from the literature with our clinical experience, including four case reports, to provide insights into recognising and managing paratonia, focusing on BoNT-A therapy and other treatment modalities for its associated complications

Results: Contractures may result from reduced mobility or failure to treat paratonia-associated hypertonia that has progressed to dystonia, leading to difficulties in washing, dressing and eating, skin breakdown, and pain. BoNT-A therapy may help prevent and treat these contractures, supported by its well-established effectiveness in managing hypertonic conditions like disabling dystonia and spasticity. Moreover, combined with physical therapy and casting, BoNT-A has shown clinical efficacy in treating contractures, indicating potential for managing paratonia-related complications associated with reduced active function.

Conclusion:

BoNT-A therapy reduced muscle tone and improved passive range of movement in two of the included cases: one with PSP and paratonia-associated dystonia, another with Parkinson syndrome, dementia, and paratonia-associated dystonic-rigid limb posturing. In our clinical experience, many patients with paratonia eventually require BoNT-A therapy to treat and prevent paratonia-associated complications. Here, we offer clinicians working in movement disorders, neurodegenerative disease, and neurorehabilitation—particularly those utilising BoNT-A therapy—a valuable resource to optimise management of paratonia-associated complications.