Wide range of dosages of botulinum toxin are used to partially paralyze arm muscles varying from patient to patient in indications arm spasticity, dystonia, tremor etc. Injection guidance and dose recommendations are established for specific indications (e.g. spasticity) backed by evidence from clinical studies. In other indications (e.g. essential, dystonic or parkinson tremor) no such evidence based guidances exist. Treatment approaches are therefore diverse (booster injections, fixed dosages to specified muscles, costumization of muscles and dosages based on visual or technical measurement of tremor severity and type). Still injection technique and injector´s skills play a significant role in maximizing the effect and minimizing side effects of appied dosages. Current rate of therapy discontinuation is reported over 20% after first injections session in tremor (due to several reasons e.g. lack of efficacy, side effects) whereby the starting dose was quite low and increased by follow-up visits to titrate the ideal dose. Muscle volume and physical activity level characteristics of patients additionally complicate the therapeutic decision (e.g. a subject with large muscle muss due to body building would require higher dosages than a patient with average daily activities and "normal muscle mass"). If minimum doses needed for full paralysis of individual muscles in a patient could be modelled by an algorithm based on evidence, it could ease dosing decision. Combined with the knowledge of functional reduction targeted by the dosing scheme could be individualized and efficacy of treatment could be maximized by applying only one injection session. Thereby the tolerability could also be optimized providing lower failure rates after first attempt.
Kindly find attached research articles whose scientific results pointed to a protocol of injection of BTX taking in consideration : the starting dose, the volume injected, the selected muscle in upper limbs, the motor point of injection and the technique of injection so as to reach the target from one session therapy.
So i think that BTX injection could follow the rules of individualized therapy. From litterature, i can't find a definitive dose but i can say that its injection is not depending on its dose alone but it also depends on the site of injection, the muscle injected "its bulk" and other factors.
I wish you can find these clinical tips helpful to answer your question.
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