Real‐World Patterns of Botulinum Toxin Treatment in Hyperkinetic Movement Disorders: A 9‐Year Nationwide Analysis in France

BACKGROUND: Hyperkinetic movement disorders, including dystonia, tremor, and myoclonus, are disabling conditions often managed with botulinum toxin type A (BoNT-A). Real-world evidence on treatment patterns remains limited. OBJECTIVE: This nationwide, population-based study aimed to evaluate trends in BoNT-A use in France between 2015 and 2023, using the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d'Information, PMSI). METHODS: Patients were classified into four categories (dystonia, tremor, myoclonus, and other abnormal movements), based on International Classification of Diseases, 10th Revision (ICD-10). Annual changes in the number of BoNT-A injections and treated patients were analyzed. Treatment adherence and reinjection intervals were also evaluated. RESULTS: A total of 51,861 patients received BoNT-A therapy. Dystonia was the predominant indication (44,913; 86.6%). Tremor accounted for 3690 patients (7.1%), other abnormal movements for 2423 (4.7%), and myoclonus for 835 (1.6%). Between 2015 and 2023, BoNT-A injections increased from 49,829 to 53,828 (+8.0%) and treated patients from 20,023 to 21,489 (+7.3%). While dystonia showed minimal growth in patient numbers (+0.6%), tremor and myoclonus increased substantially (+132.1% and +179.7%, respectively). Repeat BoNT-A injections were highest in dystonia, with 71.8% of patients receiving ≥3 injections and 57.9% receiving ≥5 injections in total. Median reinjection intervals ranged from 112 days in dystonia to 133 days in myoclonus. CONCLUSIONS: Dystonia remains the leading indication for BoNT-A in France, with high treatment adherence. The marked growth in tremor and myoclonus underscores the expanding therapeutic role and diversification of BoNT-A use across hyperkinetic movement disorders.