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Effects of glabellar botulinum toxin injections on resting-state functional connectivity in borderline personality disorder

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Abstract

Meta-analyses suggest a sustained alleviation of depressive symptoms through glabellar botulinum toxin (BTX) injections. This can be explained by the disruption of facial feedback loops, which may moderate and reinforce the experience of negative emotions. Borderline personality disorder (BPD) is characterized by excessive negative emotions. Here, a seed-based resting-state functional connectivity (rsFC) analysis following BTX (N = 24) or acupuncture (ACU, N = 21) treatment in BPD is presented on areas related to the motor system and emotion processing. RsFC in BPD using a seed-based approach was analyzed. MRI data were measured before and 4 weeks after treatment. Based on previous research, the rsFC focus was on limbic and motor areas as well as the salience and default mode network. Clinically, after 4 weeks both groups showed a reduction of borderline symptoms. However, the anterior cingulate cortex (ACC) and the face area in the primary motor cortex (M1) displayed aberrant rsFC after BTX compared to ACU treatment. The M1 showed higher rsFC to the ACC after BTX treatment compared to ACU treatment. In addition, the ACC displayed an increased connectivity to the M1 as well as a decrease to the right cerebellum. This study shows first evidence for BTX-specific effects in the motor face region and the ACC. The observed effects of BTX on rsFC to areas are related to motor behavior. Since symptom improvement did not differ between the two groups, a BTX-specific effect seems plausible rather than a general therapeutic effect.

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Acknowledgements

The Hannover Medical School represented by Hannover Clinical Trial Center GmbH (HCTC) acted as the study sponsor. Neither the funding sources nor the sponsor had any role in the study design, the collection, analysis, and interpretation of the data, in the writing of the publication, and in the decision to submit the paper for publication. We thank Silke Malecha who played a pivotal role in the study’s execution and sadly passed away.

Funding

This research was funded by grants of the German Research Foundation (KR 3706/3-1, TK & MAW) and the Asklepios Kliniken Hamburg GmbH Forschungsförderung (MAW).

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  1. M. Axel Wollmer and Tillmann H. C. Kruger share last authorship.

Authors and Affiliations

  1. Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Jara Schulze, Christopher Sinke & Tillmann H. C. Kruger

  2. Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Asklepios Clinic North - Ochsenzoll, Langenhorner Chaussee 560, 22419, Hamburg, Germany

    Insa Neumann & M. Axel Wollmer

  3. Asklepios Clinic North - Ochsenzoll, Clinic for Geriatric Psychiatry, Hamburg, Germany

    Insa Neumann & M. Axel Wollmer

  4. Center for Systems Neuroscience, Bünteweg 2, 30559, Hanover, Germany

    Tillmann H. C. Kruger

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Author Kruger has received honoraria for talks and/or advisory board activities from Allergan; Lilly, Lundbeck, Otsuka, Schwabe, Servier, and Trommsdorf. Authors Kruger and Wollmer were members of an advisory board of Allergan. All other authors have no conflict of interest to declare.

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Schulze, J., Sinke, C., Neumann, I. et al. Effects of glabellar botulinum toxin injections on resting-state functional connectivity in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 274, 97–107 (2024). https://doi.org/10.1007/s00406-023-01563-4

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