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Sample records for botulinum toxin-a injections

  1. Local injection of botulinum toxin A: an alternative therapy for axillary osmidrosis.

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    Xie, Aiguo; Nie, Lanjun; Tan, Qian

    2014-02-01

    The objective of this study was to investigate the efficacy of local injection of botulinum toxin A for treating axillary osmidrosis. One hundred and fifty patients with axillary osmidrosis were randomly divided to receive botulinum toxin A injection treatment (50 U of botulinum toxin A was injected intracutaneously into 6-20 different sites within each axilla, n = 74) or surgical excision of the apocrine glands (n = 76). The patients were followed up for 1-3 months to analyze the therapeutic effect and complications of the two methods. The curative effect in patients with mild and moderate axillary osmidrosis was not significantly different between the botulinum toxin A injection group and operation group. However, for patients with severe axillary osmidrosis, surgery treatment seemed to be superior to botulinum toxin A treatment (P = 0.005). There was also no significant difference in the modified Dermatology Life Quality Index between the two treatments. Two cases showed complications related to hemorrhage and incision infection in the operation group. In conclusion, local injection of botulinum toxin A is a safe, fast and effective treatment for mild and moderate axillary osmidrosis, but the long-term effect remains to be further investigated.

  2. Multipoint and multilevel injection technique of botulinum toxin A in facial aesthetics.

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    Iozzo, Ivano; Tengattini, Vera; Antonucci, Valentina A

    2014-06-01

    Botulinum toxin represents one of the most frequently requested cosmetic procedures. We treated 223 patients with facial wrinkles using a new technique of injection of botulinum toxin A (BTA) called multipoint and multilevel injection technique (MMIT). The aim of MMIT was to relax the muscle and not paralyze it. Patient satisfaction was evaluated by Facial Line Treatment Satisfaction Questionnaire (FTSQ). Treatment with botulinum toxin determined a good response in all patients. Facial rhytids were completely resolved in case of young skin and well reduced in case of aged skin, leaving a natural aspect both in static and dynamic wrinkles. Patient mean overall satisfaction evaluated with FTSQ was 6.4 ± 1.1. In our experience, the use of botulin toxin by MMIT consents a better calibration of action with a soft and natural result. This can be achieved by distributing the BTA dose through various injection points for each area ("multipoint injections"). Furthermore, injections can be performed at different levels ("multilevel injections"). The level of injections regulates the potency of effect on the muscle: if the level is deep (intramuscular), the effect will be strong while if it is medium or superficial (subcutaneous and intradermal), the effect will be soft. This consents a fine calibration of action on muscle activity with a personal aesthetic result.

  3. Injection of Botulinum Toxin a to Upper Esophageal Sphincter for Oropharyngeal Dysphagia in Two Patients with Inclusion Body Myositis

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    Louis WC Liu

    2004-01-01

    Full Text Available Inclusion body myositis (IBM is a progressive degenerative skeletal muscle disease leading to weakening and atrophy of both proximal and distal muscles. Dysphagia is reported in up to 86% of IBM patients. Surgical cricopharyngeal myotomy may be effective for cricopharyngeal dysphagia and there is one published report that botulinum toxin A, injected into the cricopharyngeus muscle using a hypopharyngoscope under general anesthesia, relieved IBM-associated dysphagia. This report presents the first documentation of botulinum toxin A injection into the upper esophageal sphincter using a flexible esophagogastroduodenoscope under conscious sedation, to reduce upper esophageal sphincter pressure and successfully alleviate oropharyngeal dysphagia in two IBM patients.

  4. The Efficacy of Botulinum Toxin A Intramuscular Injections in After-Stroke Spasticity

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    Melek Karaçam

    2010-09-01

    Full Text Available OBJECTIVE: Spasticity is a common dysfunction in stroke patients. It hinders the performance of everyday living activities and lowers the quality of life. In this study, it was aimed to investigate the effects of botulinum toxin A therapy on various aspects, such as muscle tone, pain, daily living activities and disability. METHODS: Fifteen patients with stroke presenting with focal spasticity in the botulinum toxin outpatient unit were evaluated. Results before and after treatment were evaluated by applying different scales. Modified Ashworth Scale was applied for the severity of spasticity. The Medical Council Research Scale was used to test muscle power, and the disability scoring scale, Visual Analogue Pain Scale and Barthel index were the other measures tested. RESULTS: It was found that therapy with botulinum toxin A was effective in spasticity. The increased muscle tone and the disability scores decreased prominently after the treatment (p< 0.05. Lower values in pain scores (p< 0.05 also contributed to better functional outcome (p< 0.01. Along with the significantly good outcome according to the scales, the higher scores in quality of life, feeling of well-being, good performance during the physiotherapy sessions, and less medications needed for spasticity were also indications in commencing the therapy of botulinum toxin A in spasticity. CONCLUSION: Spasticity is a complicated condition causing serious disability. Botulinum toxin A is a preferred therapy when there is an increased motor activity. The effects of the agent are reversible and reliable. The duration of the treatment is long-lasting. Since botulinum toxin A is easily applied and the outcome in focal spasticity is favorable, it is recommended as the first-line choice in the treatment of focal spasticity.

  5. Predictors of Response to Intradetrusor Botulinum Toxin-A Injections in Patients with Idiopathic Overactive Bladder

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    Brian L. Cohen

    2009-01-01

    Full Text Available Objectives. To evaluate whether there are any demographic or urodynamic differences in patients with idiopathic overactive bladder (I-OAB that respond and do not respond to intradetrusor injections of botulinum toxin-A (BTX-A. Methods. This represents a secondary analysis of data collected from an investigator initiated randomized trial designed to evaluate clinical differences in outcomes for 100 versus 150 U BTX-A in patients with I-OAB. Preinjection demographic and urodynamic data were collected. Patients were evaluated 12 weeks after injection and were determined to be responders or nonresponders as defined by our criteria. Statistical comparisons were made between groups. Results. In patients with overactive bladder without incontinence (OAB-Dry, there were no variables that could be used to predict response to BTX-A. On univariate analysis, younger patients with overactive bladder with incontinence (OAB-Wet were more likely to respond to BTX-A than older patients. However, this relationship was no longer statistically significant on multivariate analysis. Conclusions. We were unable to identify any preinjection demographic or urodynamic parameters that could aid in predicting which patients will achieve clinical response to BTX-A. Future studies are necessary to further evaluate this question.

  6. An update on botulinum toxin A injections of trigger points for myofascial pain.

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    Zhou, Jon Y; Wang, Dajie

    2014-01-01

    Myofascial pain syndrome (MPS) is a common chronic pain condition that is characterized by distinct "trigger points." Despite current treatments with physical therapy, analgesics, anti-depressants and trigger-point injections, myofascial pain remains a challenging chronic pain condition in clinical practice. Botulinum toxin A (BTX-A) can cause prolonged muscle relaxation through inhibition of acetylcholine release. It may offer some advantages over the current treatments for MPS by providing a longer sustained period of pain relief. Despite numerous clinical trials, the efficacy of BTX-A in alleviating MPS is not well-established due to mixed results from recent clinical trials. Active trigger points are associated with referred pain and greatly impact many aspects of activities of daily living, mood, and health status. This review is designed to analyze the clinical trials regarding the efficacy of BTX-A injection of active trigger points as a treatment for MPS. The literature referenced was obtained via a computer search with Google Scholar, Pubmed, Medline and EMbase. Our search terms included "Botulinum toxin," "myofascial pain," "trigger points," "myofascial trigger points," "chronic pain." Additional references were retrieved from the reference list of the reports found via this search. Studies were considered eligible for inclusion if they were double-blinded, randomized, controlled trials evaluating the efficacy of BTX-A injections into trigger points for pain reduction, and if the trigger point selection in the trial included referred pain and/or local twitch response. Open-label studies, case reports, and other non-randomized studies were excluded. Eight trials were found according to the above criteria and are summarized in Table 1. There are well-designed clinical trials to support the efficacy of trigger-point injections with BTX-A for MPS. However, further clinical trials with considerations of minimizing placebo effect, repeated dosing, adequate

  7. Botulinum toxin A injection for chronic anal fissures and anal sphincter spasm improves quality of life in recessive dystrophic epidermolysis bullosa

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    Cassandra Chaptini, MBBS

    2015-12-01

    Full Text Available We report a 20-year-old female with generalized, severe, recessive dystrophic epidermolysis bullosa who developed secondary chronic anal fissures. This resulted in anal sphincter spasm and severe, disabling pain. She was treated with five botulinum toxin A injections into the internal anal sphincter over a period of 2 years and gained marked improvement in her symptoms. This case demonstrates the successful use of botulinum toxin A injections to relieve anal sphincter spasm and fissuring, with long-term improvement.

  8. Kinematic aiming task: measuring functional changes in hand and arm movements after botulinum toxin-A injections in children with spastic hemiplegia.

    NARCIS (Netherlands)

    Rameckers, E.A.A.; Speth, L.A.; Duysens, J.E.J.; Vles, J.S.; Smits-Engelsman, B.C.M.

    2007-01-01

    OBJECTIVE: To describe different aspects of a kinematic aiming task (KAT) as a quantitative way to assess changes in arm movements within 2 wks after botulinum toxin-A (BTX-A) injections in children with spastic hemiplegia. DESIGN: Intervention study randomized clinical trial; follow-up within 4 wks

  9. Botulinum toxin A for the Treatment of Overactive Bladder

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    Po-Fan Hsieh

    2016-02-01

    Full Text Available The standard treatment for overactive bladder starts with patient education and behavior therapies, followed by antimuscarinic agents. For patients with urgency urinary incontinence refractory to antimuscarinic therapy, currently both American Urological Association (AUA and European Association of Urology (EAU guidelines suggested that intravesical injection of botulinum toxin A should be offered. The mechanism of botulinum toxin A includes inhibition of vesicular release of neurotransmitters and the axonal expression of capsaicin and purinergic receptors in the suburothelium, as well as attenuation of central sensitization. Multiple randomized, placebo-controlled trials demonstrated that botulinum toxin A to be an effective treatment for patients with refractory idiopathic or neurogenic detrusor overactivity. The urinary incontinence episodes, maximum cystometric capacity, and maximum detrusor pressure were improved greater by botulinum toxin A compared to placebo. The adverse effects of botulinum toxin A, such as urinary retention and urinary tract infection, were primarily localized to the lower urinary tract. Therefore, botulinum toxin A offers an effective treatment option for patients with refractory overactive bladder.

  10. Botulinum toxin A for the Treatment of Overactive Bladder.

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    Hsieh, Po-Fan; Chiu, Hung-Chieh; Chen, Kuan-Chieh; Chang, Chao-Hsiang; Chou, Eric Chieh-Lung

    2016-02-29

    The standard treatment for overactive bladder starts with patient education and behavior therapies, followed by antimuscarinic agents. For patients with urgency urinary incontinence refractory to antimuscarinic therapy, currently both American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggested that intravesical injection of botulinum toxin A should be offered. The mechanism of botulinum toxin A includes inhibition of vesicular release of neurotransmitters and the axonal expression of capsaicin and purinergic receptors in the suburothelium, as well as attenuation of central sensitization. Multiple randomized, placebo-controlled trials demonstrated that botulinum toxin A to be an effective treatment for patients with refractory idiopathic or neurogenic detrusor overactivity. The urinary incontinence episodes, maximum cystometric capacity, and maximum detrusor pressure were improved greater by botulinum toxin A compared to placebo. The adverse effects of botulinum toxin A, such as urinary retention and urinary tract infection, were primarily localized to the lower urinary tract. Therefore, botulinum toxin A offers an effective treatment option for patients with refractory overactive bladder.

  11. Treatment of displaced mandibular condylar fracture with botulinum toxin A.

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    Akbay, Ercan; Cevik, Cengiz; Damlar, Ibrahim; Altan, Ahmet

    2014-04-01

    The aim of this case report is to discuss the effect on condylar reduction of botulinum toxin A treatment used in a child with displaced fracture at condylar neck of mandible. A 3-years old boy was admitted to our clinic for incomplete fracture of mandibular symphysis and displaced condylar fracture at the left side. An asymmetrical occlusal splint with intermaxillary fixation was used instead of open reduction and internal fixation because of incomplete fracture of symphysis and possible complications of condyle surgery. However, it was observed that condylar angulation persisted despite this procedure. Thus, botulinum toxin A was administered to masseter, temporalis and pterygoideus medialis muscles. At the end of first month, it was seen that mandibular condyle was almost completely recovered and that fusion was achieved. In conclusion, Botulinum A toxin injection aiming the suppression of masticatory muscle strength facilitates the reduction in the conservative management of displaced condyle in pediatric patients.

  12. Protocol for a prospective observational study of cortical lower urinary tract control changes following intradetrusor injection of botulinum toxin-A in patients with multiple sclerosis

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    Elizondo, Rodolfo A; Karmonik, Christof; Boone, Timothy B; Khavari, Rose

    2017-01-01

    Introduction Multiple sclerosis (MS) is a severe debilitating disease that affects patients' quality of life. Up to 90% of patients with MS will develop lower urinary tract dysfunction within the first 18 years of the disease. If oral pharmacotherapy with anticholinergics, behavioural modifications and pelvic floor physical therapy are unsuccessful, intradetrusor injection of botulinum toxin-A (OnaBotA; Botox Allergan, Dublin, Ireland) is a highly effective option for these patients. The local effects of OnaBotA are well understood, but not much is known of its afferent/sensory effects while treating the end organ. Our study will use functional MRI (fMRI) and task-related blood oxygen level-dependent signals to evaluate patients with MS and neurogenic detrusor overactivity (NDO) prior to, and after, intradetrusor injection of OnaBotA with simultaneous urodynamic evaluation. Urinary concentration of brain-derived neurotrophic factor and nerve growth factor will also be collected since it has been shown that patients with an overactive bladder have higher concentrations of these neuropeptides. Methods and analysis Female patients with MS and lower urinary tract symptoms who previously have undergone urodynamic screening and are refractory to conservative and oral pharmacotherapy management for NDO and are interested in OnaBotA intradetrusor injection will be invited to participate in the study. An fMRI will be performed preintradetrusor injection and postintradetrusor injection of OnaBotA with simultaneous MRI compatible with material urodynamics. Images will be collected and analysed accordingly. Ethics and dissemination All of the patients are properly consented before enrolling in this study that has been previously approved by the Institutional Review Board. Results of neural connectivity activation will be presented at national and international meetings and published in scholarly journals. PMID:28159850

  13. Botulinum toxin A for trismus in cephalic tetanus

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    Luiz Augusto F. Andrade

    1994-09-01

    Full Text Available Cephalic tetanus is a localized form of tetanus. As in generalized forms , trismus is a prominent feature of the disease, leading to considerable difficulty in feeding, swallowing of the saliva and mouth hygiene. These difficulties often precede respiratory problems and aspiration bronchopneumonia is a frequent life-threatening complication. Muscle relaxants other than curare drugs may show a limited benefit for relieving trismus. Tetanospasmin, the tetanic neurotoxin, and botulinum toxin share many similarities, having a closely related chemical structure, an origin from related microorganisms (Clostridium tetani and Clostridium botulinum, respectively, and presumably, the same mechanisms of action in the neuron. The difference between the two lies in their peculiar neurospecificity, acting in different neurons. Injection of minute doses of botulinum toxin in the muscles involved in focal dystonias or other localized spastic disorders have proved to be very effective in these conditions. We describe the use of botulinum toxin A in the successful treatment of trismus in a patient suffering from cephalic tetanus. We believe that this form of treatment may be of value in lowering the risk of pulmonary complications in tetanic patients.

  14. A型肉毒毒素临床应用现状%Current injection application of botulinum toxin A type

    Institute of Scientific and Technical Information of China (English)

    陈俊男; 李治桦; 吕晓杰

    2011-01-01

    @@ 注射用A型肉毒毒素是第一个应用于临床的微生物毒素制品.肉毒杆菌毒素(botulinum toxin,BT)早在1897年被发现,1946年Schantz EJ提纯出A型肉毒毒索(BTA)结晶.1973年,Scott AB首先报道了BTA对猴眼外肌有麻痹作用,引起医学界重视,许多学者开始致力于BTA动物实验以及临床方面的研究,成果显著,1989年被美周食品与药品管理局(FDA)批准用于临床.目前,BTA的临床应用越来越广泛,对不少疾病疗效肯定,本文就近年来BTA的临床应用进展做一总结.

  15. INJECTION BOTULINUM IN PARALYTIC STRABISMUS

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    Krishna Kishore

    2015-09-01

    Full Text Available AIM: To assess the effectiveness of botulinum toxin injection to the antagonist muscle in paralytic strabismus. OBJECTIVE: To study the effect of botulinum toxin a injection into the antagonist muscle in cases of paralytic strabismus to alleviate diplopia. MATERIAL AND METHODS: This was a tertiary eye care hospital based prospective interventional study in the department of Orthoptics over a period from October 2011 to October 2013. 36 patients with paralytic strabismus of recent onset within 3 months, with chief complaint of double vision were included. RESULTS: The study data analysis of 36 patients of paralytic strabismus of recent onset (within 3 months with chief complaints of double vision showed a ge wise distribution as 3(8.33% in 0 - 20 years, 16(44.44% in 21 - 40 years, 16(44.44% in 41 - 60 years, 1(2.78% > 60 years. g ender wise 26(72.22% males, 10 (27.28% females, a etiology wise 15(41.67% were diabetic, 4(11.11% were traumatic, 11(30.56% were Id iopathic, 2(5.56% were due to CSOM and 4(11.11% due to Diabetes and Hypertension. All patients were treated with botulinum toxin injection to the antagonist nonoperatic muscle and were followed at an interval of 1 week, 1 month and 3 months. Thorough cli nical examination and Diplopia charting were done before and after treatment. CONCLUSION: Injection botulinum into the antagonist muscle during the first three months after the onset allows the patients to enjoy and appreciate fusion in primary gaze without necessity for head turn, Prevents contracture of antagonist muscle. Thus botulinum toxin is useful in the treatment of acute paretic loss of ocular muscle function when surgical treatment of the ocular muscles is not yet possible but the patient is obviously disturbed by diplopia or forced head posture. The procedure is simple, safe and effective method.

  16. Botulinum Toxin-A Therapy in Pediatric Urology: Indications for the Neurogenic and Non-Neurogenic Neurogenic Bladder

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    Lori Dyer

    2009-01-01

    Full Text Available Although, the role of Botulinum Toxin-A in the treatment of the neurogenic and non-neurogenic neurogenic bladder is becoming more defined, this is the first review article to characterize the emerging role of Botulinum Toxin-A in the pediatric urologic population. Injection of Botulinum Toxin-A at the level of the bladder works by inhibiting uninhibited bladder contractions and, possibly, by blocking some of the sensory nerve fibers. In children with sphincter dyssynergy, injection at the level of the urethral sphincter works by inhibiting the involuntary guarding reflex and blocking dyssynergic voiding.

  17. Feasibility of a Day-Camp Model of Modified Constraint-Induced Movement Therapy with and without Botulinum Toxin A Injection for Children with Hemiplegia

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    Eliasson, Ann-Christin; Shaw, Karin; Ponten, Eva; Boyd, Roslyn; Krumlinde-Sundholm, Lena

    2009-01-01

    The objective of the study was to investigate the feasibility of modified constraint-induced (CI) therapy provided in a 2-week day-camp model with and without intramuscular botulinum toxin type A (BoNT-A) injections for children with congenital cerebral palsy. Sixteen children with congenital hemiplegia, Manual Ability Classification System (MACS)…

  18. Botulinum toxin A injection for facial analysis the clinical efficacy and safety of facial wrinkles%A型肉毒毒素面部除皱的临床观察

    Institute of Scientific and Technical Information of China (English)

    王忠志; 刘茜

    2014-01-01

    目的:了解A型肉毒毒素面部注射进行面部除皱的临床疗效及安全性。方法回顾性分析我院2012年3月至2014年3月收治的64例行面部除皱的患者的临床资料,均应用A型肉毒毒素进行面部注射治疗,分析其临床疗效与安全性。结果64例患者经由A型肉毒毒素面部注射治疗后,所取得的效果较为理想,仅1例鼻部除皱术疗效欠佳。结论 A型肉毒毒素面部注射进行面部除皱临床疗效确切,不良反应少,值得临床大力推广与应用。%Objective: To investigate the botulinum toxin type A injection for facial clinical efficacy and safety of facial wrinkles. Methods: retrospective analysis of clinical data in our hospital from 2012 March to 2014 March treated 64 cases of facial wrinkles patients, both the application of botulinum toxin type A injection in the treatment of facial, analyze its clinical efficacy and safety. Results: 64 patients with botulinum toxin A injection for facial treatment, the effect is more ideal, only 1 cases of nasal rhytidectomy curative effect. Conclusion: botulinum toxin A injection for facial facial rhytidectomy clinical curative effect, less adverse reaction, it is worthy of clinical popularization and application.

  19. Bruxism secondary to brain injury treated with Botulinum toxin-A: a case report

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    El Maaytah, Mohammed; Jerjes, Waseem; Upile, Tahwinder; Swinson, Brian; Hopper, Colin; Ayliffe, Peter

    2006-01-01

    We report a successful treatment of bruxism in a patient with anoxic brain injury using botulinum toxin-A (BTX-A). On examination the mouth opening was 0 mm, no feeding was possible through the mouth. Botulinum toxin was injected into the masseter and temporalis; great improvement in trismus and bruxism was noted after 3 weeks. One further treatment improved the mouth opening on the following week and the patient was discharged from our care to be reviewed when required. PMID:17123443

  20. Dataset of botulinum toxin A influence on interleukins under neuropathy.

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    Zychowska, Magdalena; Rojewska, Ewelina; Makuch, Wioletta; Luvisetto, Siro; Pavone, Flaminia; Marinelli, Sara; Przewlocka, Barbara; Mika, Joanna

    2016-12-01

    Our data show that botulinum toxin A (BoNT/A) didn't influence motor functions in naïve and CCI-exposed rats, but diminished the neuropathic pain-related behavior. The results indicate that BoNT/A administration diminished the spinal Iba-1 positive cells activation and, in parallel, downregulated IL-1beta. Moreover, we observed that in DRG the protein level of pronociceptive factors (IL-1beta and IL-18) decreased and antinociceptive (IL-10 and IL-1RA) factors increased. Additionally, our behavioral analysis shows that chronic minocycline treatment together with a single BoNT/A injection in CCI-exposed rats has beneficial analgesic effects (M. Zychowska, E. Rojewska, W. Makuch, S. Luvisetto, F. Pavone, S. Marinelli, B. Przewlocka, J. Mika, 2016) [1].

  1. Dataset of botulinum toxin A influence on interleukins under neuropathy

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    Magdalena Zychowska

    2016-12-01

    Full Text Available Our data show that botulinum toxin A (BoNT/A didn’t influence motor functions in naïve and CCI-exposed rats, but diminished the neuropathic pain-related behavior. The results indicate that BoNT/A administration diminished the spinal Iba-1 positive cells activation and, in parallel, downregulated IL-1beta. Moreover, we observed that in DRG the protein level of pronociceptive factors (IL-1beta and IL-18 decreased and antinociceptive (IL-10 and IL-1RA factors increased. Additionally, our behavioral analysis shows that chronic minocycline treatment together with a single BoNT/A injection in CCI-exposed rats has beneficial analgesic effects (M. Zychowska, E. Rojewska, W. Makuch, S. Luvisetto, F. Pavone, S. Marinelli, B. Przewlocka, J. Mika, 2016 [1].

  2. Botulinum toxin A inhibits salivary secretion of rabbit submandibular gland

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    Xiao-Feng Shan; Hui Xu; Zhi-Gang Cai; Li-Ling Wu; Guang-Yan Yu

    2013-01-01

    Botulinum toxin A (BTXA) has been used in several clinical trials to treat excessive glandular secretion;however, the precise mechanism of its action on the secretory function of salivary gland has not been fully elucidated. In this study, we aimed to investigate the effect of BTXA on secretion of submandibular gland in rabbits and to identify its mechanism of action on the secretory function of salivary gland. At 12 weeks after injection with 5 units of BTXA, we found a significant decrease in the saliva flow from submandibular glands, while the salivary amylase concentration increased. Morphological analysis revealed reduction in the size of acinar cells with intracellular accumulation of secretory granules that coalesced to form a large ovoid structure. Expression of M3-muscarinic acetylcholine receptor (M3 receptor) and aquaporin-5 (AQP5) mRNA decreased after BTXA treatment, and distribution of AQP5 in the apical membrane was reduced at 1, 2 and 4 weeks after BTXA injection. Furthermore, BTXA injection was found to induce apoptosis of acini. These results indicate that BTXA decreases the fluid secretion of submandibular glands and increases the concentration of amylase in saliva. Decreased expression of M3 receptor and AQP5, inhibition of AQP5 translocation, and cell apoptosis might involve in BTXA-reduced fluid secretion of submandibular glands.

  3. A型肉毒毒素联合透明质酸注射治疗面部老化临床疗效观察%Botulinum toxin A joint hyaluronic acid injection Facial aging treatment clinical curative effect observation

    Institute of Scientific and Technical Information of China (English)

    王芳芳; 张东晓; 熊玮; 王艳; 徐丽红

    2015-01-01

    Objective:To observe the clinical effect and safety of botulinum toxin type A and Hyaluronic Acid injection appliedin the treatmernt of facial skin aging.Methods:45 patients of different skin aging problem, according to botulinum toxin type A,and hyaluronic acid injection therapy. All patients were followed up and observed treatment effect and prognosis.Results:45 patients with skin aging problem has been improved to varying degrees of, treatment effective rate was 83.11%. Postoperative adverse reactions and are temporary, recovering well.Conclusion:Combined botulinum toxin A and hyaluronic acid injection treatment of facial skin aging good curative effect, patient satisfaction is high, safe and effective.%目的:探讨A型肉毒毒素、透明质酸注射联合治疗面部皮肤老化疗效及安全性。方法:对45例患者面部老化问题,采用A型肉毒毒素联合透明质酸注射治疗,观察治疗效果。结果:患者面部老化问题得到不同程度的改善,治疗有效率83.11%,术后不良反应轻且都是暂时性,恢复良好。结论:A型肉毒毒素联合透明质酸注射治疗面部皮肤老化疗效好,患者满意度高,安全有效。

  4. Bruxism secondary to brain injury treated with Botulinum toxin-A: a case report

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    Swinson Brian

    2006-11-01

    Full Text Available Abstract We report a successful treatment of bruxism in a patient with anoxic brain injury using botulinum toxin-A (BTX-A. On examination the mouth opening was 0 mm, no feeding was possible through the mouth. Botulinum toxin was injected into the masseter and temporalis; great improvement in trismus and bruxism was noted after 3 weeks. One further treatment improved the mouth opening on the following week and the patient was discharged from our care to be reviewed when required.

  5. A型肉毒毒素注射治疗卒中后上肢疼痛1例报道%Effect of Botulinum Toxin-A Injection on Upper Limb Pain after Stroke:A Case Report

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    山磊; 崔利华; 杨宇琦

    2013-01-01

    Objective To observe the effect of Botulinum toxin-A (BTX-A) injection on upper limb pain after stroke. Methods A case with upper limb pain after stroke was reported. The symptom, the location and dosage of injection, and the prognosis were recorded. Results The pain relieved after injection, and disappeared 4 weeks after injection. Conclusion BTX-A injection is effective on upper limb pain after stroke.%目的:观察A型肉毒毒素(BTX-A)注射治疗卒中后上肢疼痛的疗效。方法报道1例卒中后上肢疼痛患者的症状和体征,BTX-A注射的部位和剂量及预后。结果 BTX-A注射后患者上肢疼痛明显减轻,注射后4周时疼痛完全消失。结论 BTX-A注射对卒中后上肢疼痛有明显的治疗作用。

  6. Botulinum toxin A, brain and pain.

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    Matak, Ivica; Lacković, Zdravko

    2014-01-01

    Botulinum neurotoxin type A (BoNT/A) is one of the most potent toxins known and a potential biological threat. At the same time, it is among the most widely used therapeutic proteins used yearly by millions of people, especially for cosmetic purposes. Currently, its clinical use in certain types of pain is increasing, and its long-term duration of effects represents a special clinical value. Efficacy of BoNT/A in different types of pain has been found in numerous clinical trials and case reports, as well as in animal pain models. However, sites and mechanisms of BoNT/A actions involved in nociception are a matter of controversy. In analogy with well known neuroparalytic effects in peripheral cholinergic synapses, presently dominant opinion is that BoNT/A exerts pain reduction by inhibiting peripheral neurotransmitter/inflammatory mediator release from sensory nerves. On the other hand, growing number of behavioral and immunohistochemical studies demonstrated the requirement of axonal transport for BoNT/A's antinociceptive action. In addition, toxin's enzymatic activity in central sensory regions was clearly identified after its peripheral application. Apart from general pharmacology, this review summarizes the clinical and experimental evidence for BoNT/A antinociceptive activity and compares the data in favor of peripheral vs. central site and mechanism of action. Based on literature review and published results from our laboratory we propose that the hypothesis of peripheral site of BoNT/A action is not sufficient to explain the experimental data collected up to now.

  7. Botulinum Toxin Injection for Spastic Scapular Dyskinesia After Stroke

    Science.gov (United States)

    Hou, Saiyun; Ivanhoe, Cindy; Li, Sheng

    2015-01-01

    Abstract Spastic scapular dyskinesia after stroke is rare, which causes impaired shoulder active range of motion (ROM). To date, there has been no report about botulinum toxin injection to spastic periscapular muscles. This study presents botulinum toxin A injection for management of spastic periscapular muscles after stroke in 2 cases. This is a retrospective study of 2 cases of spastic scapular dyskinesia after stroke. Spasticity of periscapular muscles including rhomboid and lower trapezius was diagnosed by physical examination and needle electromyographic study. Botulinum toxin was injected into the spastic periscapular muscles under ultrasound imaging guidance. During the 3-week follow-up visit after injection, both patients showed increased shoulder active ROM, without any sign of scapular destabilization. The results suggest that botulinum toxin injection to spastic periscapular muscles can increase shoulder active ROM without causing scapular destabilization in patients with poststroke spastic scapular dyskinesia. PMID:26266368

  8. Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: a systematic review.

    NARCIS (Netherlands)

    Ryll, U.; Bastiaenen, C.; Bie, R. de; Staal, B.

    2011-01-01

    AIM: To assess treatment effects of botulinum toxin type A (BoNT-A) on walking of children with leg spasticity due to cerebral palsy (CP) compared with usual care. METHOD: We systematically searched the databases CINAHL, Cochrane, PEDro, EMBASE, and PubMed from July 1993 until July 2009 and addition

  9. Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Thorley Megan

    2012-08-01

    Full Text Available Abstract Background Children with cerebral palsy (CP whom are non-ambulant are at risk of reduced quality of life and poor health status. Severe spasticity leads to discomfort and pain. Carer burden for families is significant. This study aims to determine whether intramuscular injections of botulinum toxin A (BoNT-A combined with a regime of standard therapy has a positive effect on care and comfort for children with CP whom are non-ambulant (GMFCS IV/V, compared with standard therapy alone (cycle I, and whether repeated injections with the same regime of adjunctive therapy results in greater benefits compared with a single injecting episode (cycle II. The regime of therapy will include serial casting, splinting and/or provision of orthoses, as indicated, combined with four sessions of goal directed occupational therapy or physiotherapy. Method/design This study is a double blind randomized controlled trial. Forty participants will be recruited. In cycle I, participants will be randomized to either a treatment group who will receive BoNT-A injections into selected upper and/or lower limb muscles, or a control group who will undergo sham injections. Both groups will receive occupational therapy and /or physiotherapy following injections. Groups will be assessed at baseline then compared at 4 and 16 weeks following injections or sham control. Parents, treating clinicians and assessors will be masked to group allocation. In cycle II, all participants will undergo intramuscular BoNT-A injections to selected upper and/or lower limb muscles, followed by therapy. The primary outcome measure will be change in parent ratings in identified areas of concern for their child’s care and comfort, using the Canadian Occupational Performance Measure (COPM. Secondary measures will include the Care and Comfort Hypertonicity Scale (ease of care, the Cerebral Palsy Quality of Life Questionnaire (CP QoL–Child (quality of life, the Caregiver Priorities and Child

  10. Adductor laryngeal breathing dystonia in NBIA treated with botulinum toxin-A

    Directory of Open Access Journals (Sweden)

    Vinod Rai

    2013-01-01

    Full Text Available We report a rare case of neurodegeneration with brain iron accumulation (NBIA presented with episodic inspiratory stridor. A 10-year-old boy presented with 3-year history of gradually progressive spastic gait and generalized dystonia (involving all four limbs, neck, jaw, and speech. MRI brain showed "Eye of Tiger" sign. He recently developed severe inspiratory stridor associated with almost gasping respiration. Direct video laryngoscopy showed paradoxical vocal cord closure during inspiration. He was treated with EMG-guided botulinum toxin-A injection given into bilateral thyroarytenoid muscles, resulting in dramatic response with complete disappearance of the stridor within a week. The effect lasted 18 months.

  11. Curative effect of botulinum toxin A injection guided by electrical stimulation on spastic cerebral palsy%电刺激引导 A 型肉毒毒素治疗痉挛型脑性瘫痪的疗效

    Institute of Scientific and Technical Information of China (English)

    李同欢; 毕小燕; 谢能杜; 浦才洪; 束晓梅

    2015-01-01

    目的:探讨电刺激定位引导A型肉毒毒素治疗痉挛型脑性瘫痪患儿的疗效。方法62例跖屈畸形的痉挛型脑性瘫痪患儿在电刺激引导下给予A型肉毒毒素局部注射,3d、1周、1个月、3个月和6个月后测量患儿踝关节活动度,并应用改良Ashworth痉挛评定量表评定小腿三头肌肌张力变化。结果62例患儿在注射后1个月和3个月小腿三头肌肌张力和踝关节活动度较注射前改善(P<0.05);注射前小腿三头肌痉挛程度越轻,则起效越快,维持时间越长。无一例患儿出现过敏反应。结论电刺激引导A型肉毒毒素局部肌肉注射能在较短时间缓解痉挛型脑性瘫痪患儿的肌肉痉挛,改善异常姿势及其运功功能。%Objective To investigate the curative effect of botulinum toxin A (BTX‐A) injection guided by electrical stimulation on spastic cerebral palsy (SCP) in children .Methods Sixty‐two SCP children with tiptoe deformation were received intramuscular injection of BTX‐A guided by electrical stimulation .The range of motion in ankle joint was measured on the 3rd day ,in the 1st week and 1st , 3rd and 6th month after injection ,and the muscle tone of triceps surae was evaluated by modified Ashworth scale .Results Both muscle tone of triceps surae and range of motion in ankle joint in the 1st and 3rd month after BTX‐A injection were significantly improved compared to those before (P<0 .05) .The efficacy was quicker and longer in those with lighter spasm degree of triceps surae before injection .Allergic reaction was not occurred in any case .Conclusion Intramuscular injection of BTX‐A guided by electrical stimulation can rapidly relieve muscle spasm ,improve abnormal posture and movement function in SCP children .

  12. Effect of Botulinum Toxin-A Injection on Central Facial Palsy Post Stroke%A型肉毒毒素矫正脑卒中后中枢性面瘫的疗效

    Institute of Scientific and Technical Information of China (English)

    杨远滨; 张京; 张静; 肖娟

    2013-01-01

    Objective To explore the effect of Botulinum toxin-A (BTX-A) injected into the contralateral facial muscle on central facial palsy post stroke. Methods 30 stroke patients with moderate to severe central facial palsy were recruited (course of 3~10 months). They were divided into control group (n=15) and treatment group (n=15), who accepted facial training and BTX-A injection in addition, respec-tively. The bilateral deference of distance from angulus oris to the midline of the teeth(D1) and from the paropia to the angulus oris (D2) were measured before and 4 weeks after injection. Results The D1 and D2 both at resting and movement all decreased after injection in the treatment group, and decreased more than those in the control group. Conclusion BTX-A injection can further correct central facial palsy post stroke.%目的观察肉毒毒素健侧面肌注射矫正脑卒中后患者患侧中枢性面瘫的效果。方法30例脑卒中后中枢性面瘫的患者分为治疗组和对照组。对照组给予面肌运动训练,治疗组在此基础上,依据病情选择健侧面肌进行A型肉毒毒素注射。注射前、注射后4周测定嘴角至门齿中缝的双侧距离差(D1)、眼骨性外眦到嘴角的双侧距离差(D2)。结果治疗后,治疗组静态、动态D1、D2均较治疗前减小(P<0.05),且较对照组减小(P<0.05)。结论 A型肉毒毒素注射能进一步矫正中枢性面瘫。

  13. Modified constraint-induced movement therapy or bimanual occupational therapy following injection of Botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper

    Directory of Open Access Journals (Sweden)

    Imms Christine

    2010-07-01

    Full Text Available Abstract Background Use of Botulinum toxin-A (BoNT-A for treatment of upper limb spasticity in children with cerebral palsy has become routine clinical practice in many paediatric treatment centres worldwide. There is now high-level evidence that upper limb BoNT-A injection, in combination with occupational therapy, improves outcomes in children with cerebral palsy at both the body function/structure and activity level domains of the International Classification of Functioning, Disability and Health. Investigation is now required to establish what amount and specific type of occupational therapy will further enhance functional outcomes and prolong the beneficial effects of BoNT-A. Methods/Design A randomised, controlled, evaluator blinded, prospective parallel-group trial. Eligible participants were children aged 18 months to 6 years, diagnosed with spastic hemiplegic cerebral palsy and who were able to demonstrate selective motor control of the affected upper limb. Both groups received upper limb injections of BoNT-A. Children were randomised to either the modified constraint-induced movement therapy group (experimental or bimanual occupational therapy group (control. Outcome assessments were undertaken at pre-injection and 1, 3 and 6 months following injection of BoNT-A. The primary outcome measure was the Assisting Hand Assessment. Secondary outcomes included: the Quality of Upper Extremity Skills Test; Pediatric Evaluation of Disability Inventory; Canadian Occupational Performance Measure; Goal Attainment Scaling; Pediatric Motor Activity Log; modified Ashworth Scale and; the modified Tardieu Scale. Discussion The aim of this paper is to describe the methodology of a randomised controlled trial comparing the effects of modified constraint-induced movement therapy (a uni-manual therapy versus bimanual occupational therapy (a bimanual therapy on improving bimanual upper limb performance of children with hemiplegic cerebral palsy following

  14. A New therapy of localized hyperhidrosis--injection of botulinum toxin A (a review)%局部多汗症治疗新方法--注射A型肉毒毒素

    Institute of Scientific and Technical Information of China (English)

    虞瑞尧

    2001-01-01

    @@ 多汗症(hyperhidrosis)是出汗过多,可限于局部,也可为全身性.虽然多汗症不是太重要的疾病,但它严重影响病人的生活质量和工作.多汗症还没有太好的治疗方法.近10年来采用A型肉毒毒素(botulinum toxin A)局部注射治疗取得了很好的疗效,为多汗症病人解除了痛苦,找到了一种有效的新方法.

  15. The effect of botulinum toxin A injections in the spine muscles for cerebral palsy scoliosis, examined in a prospective, randomized triple-blinded study

    DEFF Research Database (Denmark)

    Wong, Christian; Pedersen, Søren Anker; Kristensen, Billy B

    2015-01-01

    serious adverse event of pneumonia resulting in death was recorded and the study was terminated. No significant radiological or clinical changes were detected when compared to NaCl injections using Wilcoxon matched pair signed-rank test. CONCLUSION: No positive radiological or clinical effects were...... off label in treating CPS. One prospective study has been conducted, demonstrating in both radiological and clinical improvement, whilst showing no side effects or complications. METHODS: Subjects (brace treated CPS between 2 and 18 years) were injected using ultrasonic-guidance with either Saline...... as an effect (1 SD). Radiological parameters were measured before and 6 weeks after treatment by 3 experienced doctors separately. Moreover, clinical results were evaluated by the pediatric quality of life (PQL) score and systematic open questioning of the parents about the child's wellbeing. Subjects...

  16. Effect of different-dose botulinum toxin A intradermal injection on axillary hyperhidrosis%不同剂量A型肉毒毒素皮内注射治疗腋部多汗症效果观察

    Institute of Scientific and Technical Information of China (English)

    高扬; 杨亚东; 王元元; 杨洋; 鲁元刚

    2013-01-01

    目的 评估不同剂量A型肉毒毒素治疗腋部多汗症的时效.方法 腋部多汗症患者86例,患者左右侧腋窝自身对照:左侧为小剂量A型肉毒毒素注射组,皮内注射生理盐水稀释的A型肉毒毒素50U;右侧为大剂量A型肉毒毒素注射组,皮内注射生理盐水稀释的A型肉毒毒素200U;随访3~29个月,观察两组并发症,并建立两组等级资料,行x2检验,评价患者两侧腋窝维持疗效的时间差异.结果 两组疗效进行对比,大剂量与小剂量的A型肉毒毒素的疗效维持时间的差异有统计学意义(P<0.05).结论 大剂量A型肉毒毒素能够显著延长腋部多汗症疗效时间.%Objective To evaluate the long-term effectiveness of different-dose of botulinum toxin A (BTXA) therapy on axillary hyperhidrosis.Methods Total 86 patients with axillary hyperhidrosis were self-controlled.One group of left axillary was injected with a low-dose of BTXA,50U.Another group of right axillary was injected with a high-dose of BTXA.A total dose of 200 U of BTXA was used per axilla.Patients were followed-up for 29 months.To investigate the effect of two methods,we analyzed two ranked data by rank sum test and x2 test to judge the disparities of the therapeutic effect.Results The results showed that the relapse-free interval of two groups with axillary hyperhidrosis was significant difference through the statistical analysis (P < 0.05).Conclusions High-dose of BTXA treatment is capable of prolonging the antihidrotic effect on axillary hyperhidrosis.

  17. Botulinum Toxin Injections: A Treatment for Muscle Spasms

    Science.gov (United States)

    ... Your Health Resources Drugs, Procedures & Devices Procedures & Devices Botulinum Toxin Injections: A Treatment for Muscle Spasms Botulinum Toxin Injections: A Treatment for Muscle Spasms Drugs, Procedures & ...

  18. Bruxism after brain injury: successful treatment with botulinum toxin-A.

    Science.gov (United States)

    Ivanhoe, C B; Lai, J M; Francisco, G E

    1997-11-01

    Bruxism, the rhythmic grinding of teeth--usually during sleep--is not an infrequent complication of traumatic brain injury. Its prevalence in the general population is 21%, but its incidence after brain injury is unknown. Untreated, bruxism causes masseter hypertrophy, headache, temporomandibular joint destruction, and total dental wear. We report a case of complete resolution of postanoxic bruxism after treatment with botulinum toxin-A (BTX-A). The patient was a 28-year-old man with no history of bruxism who sustained an anoxic brain injury secondary to cardiac arrest of unknown etiology. On admission to our rehabilitation unit 2 months after the injury, the patient presented with severe bruxism and heavy dental wear. The patient was injected with a total of 200 units of BTX-A to each masseter and temporalis. There was total resolution of bruxism 2 days after injection, with no complications. On follow-up 3 months after injection, the patient remained free of bruxism. We propose that botulinum toxin be considered as a treatment for bruxism secondary to anoxic brain injury. Further studies regarding muscle selection and medication dosage are warranted to elucidate the toxin's efficacy in this condition.

  19. God behandlingseffekt af botulinum toxin A hos systemisk sklerodermi patienter med digitale sår

    DEFF Research Database (Denmark)

    Nielsen, Jane Baumgartner; Hvid, Lone; Olesen, Anne Braae

    2014-01-01

    In this case we describe a successful combined treatment with local anaesthetics and botulinum toxin A. A 61-year-old man with systemic sclerosis of limited type presented treatment refractory digital ulcers on his toes with a poor response to conventional treatment. A combined treatment as above......-mentioned prevented a threatening amputation and improved quality of life, reduction of pain and healing of wounds. Using botulinum toxin A combined with local anaesthetics to severe toe digital ulcers in patients with systemic sclerosis may be a solution, when other treatments have been ineffective and amputation...

  20. Effect of multilevel botulinum toxin A and comprehensive rehabilitation on gait in cerebral palsy

    NARCIS (Netherlands)

    Scholtes, Vanessa A.; Dallmeijer, Annet J.; Knol, Dirk L.; Speth, Lucianne A.; Maathuis, Carel G.; Jongerius, Peter H.; Becher, Jules G.

    2007-01-01

    To evaluate the effect of multilevel botulinum toxin A and comprehensive rehabilitation on gait pattern, muscle length, and spasticity, a multicenter randomized trial was performed in 46 children with spastic cerebral palsy who walk with flexed knees. Their mean age was 8.0 years (range 4 to 11 year

  1. Botulinum Toxin Injection for Spastic Scapular Dyskinesia After Stroke: Case Series.

    Science.gov (United States)

    Hou, Saiyun; Ivanhoe, Cindy; Li, Sheng

    2015-08-01

    Spastic scapular dyskinesia after stroke is rare, which causes impaired shoulder active range of motion (ROM). To date, there has been no report about botulinum toxin injection to spastic periscapular muscles. This study presents botulinum toxin A injection for management of spastic periscapular muscles after stroke in 2 cases.This is a retrospective study of 2 cases of spastic scapular dyskinesia after stroke. Spasticity of periscapular muscles including rhomboid and lower trapezius was diagnosed by physical examination and needle electromyographic study. Botulinum toxin was injected into the spastic periscapular muscles under ultrasound imaging guidance.During the 3-week follow-up visit after injection, both patients showed increased shoulder active ROM, without any sign of scapular destabilization.The results suggest that botulinum toxin injection to spastic periscapular muscles can increase shoulder active ROM without causing scapular destabilization in patients with poststroke spastic scapular dyskinesia.

  2. Muscle selection for treatment of cervical dystonia with botulinum toxin : A systematic review

    NARCIS (Netherlands)

    Nijmeijer, S. W. R.; Koelman, J. H. T. M.; Kamphuis, D. J.; Tijssen, M. A. J.

    2012-01-01

    Rationale: Cervical dystonia, also called spasmodic torticollis, is the most common form of (primary) dystonia. Intramuscular injections with botulinum toxin are the first line of treatment for cervical dystonia. To optimise the treatment response to botulinum toxin correct muscles should be selecte

  3. Safety of Botulinum Toxin A in Children and Adolescents with Cerebral Palsy in a Pragmatic Setting

    Directory of Open Access Journals (Sweden)

    George Mitsou

    2013-03-01

    Full Text Available This retrospective study aimed to examine the safety of botulinum toxin A (BoNT-A treatment in a paediatric multidisciplinary cerebral palsy clinic. In a sample of 454 patients who had 1515 BoNT-A sessions, data on adverse events were available in 356 patients and 1382 sessions; 51 non-fatal adverse events were reported (3.3% of the total injections number, 8.7% of the patients. On five occasions, the adverse reactions observed in GMFCS V children were attributed to the sedation used (rectal midazolam plus pethidine; buccal midazolam and resulted in prolongation of hospitalization. Of the reactions attributed to the toxin, 23 involved an excessive reduction of the muscle tone either of the injected limb(s or generalized; others included local pain, restlessness, lethargy with pallor, disturbance in swallowing and speech production, seizures, strabismus, excessive sweating, constipation, vomiting, a flu-like syndrome and emerging hypertonus in adjacent muscles. Their incidence was associated with GMFCS level and with the presence of epilepsy (Odds ratio (OR = 2.74 − p = 0.016 and OR = 2.35 − p = 0.046, respectively but not with BoNT-A dose (either total or per kilogram. In conclusion, treatment with BoNT-A was safe; adverse reactions were mostly mild even for severely affected patients. Their appearance did not necessitate major changes in our practice.

  4. Botulinum Toxin A for Bladder Pain Syndrome/Interstitial Cystitis

    Directory of Open Access Journals (Sweden)

    Bin Chiu

    2016-07-01

    Full Text Available Botulinum neurotoxin A (BoNT-A, derived from Clostridium botulinum, has been used clinically for several diseases or syndrome including chronic migraine, spasticity, focal dystonia and other neuropathic pain. Chronic pelvic or bladder pain is the one of the core symptoms of bladder pain syndrome/interstitial cystitis (BPS/IC. However, in the field of urology, chronic bladder or pelvic pain is often difficult to eradicate by oral medications or bladder instillation therapy. We are looking for new treatment modality to improve bladder pain or associated urinary symptoms such as frequency and urgency for patients with BPS/IC. Recent studies investigating the mechanism of the antinociceptive effects of BoNT A suggest that it can inhibit the release of peripheral neurotransmitters and inflammatory mediators from sensory nerves. In this review, we will examine the evidence supporting the use of BoNTs in bladder pain from basic science models and review the clinical studies on therapeutic applications of BoNT for BPS/IC.

  5. Objective tinnitus from palatal myoclonus. Use of botulinum toxin: a case report.

    Science.gov (United States)

    Conill Tobías, Noemi; de Paula Vernetta, Carlos; García Callejo, Francisco Javier; Marco Algarra, Jaime

    2012-01-01

    Objective tinnitus can have many different etiologies, palatal myoclonus being one of the less frequent. This type of tinnitus is generated by involuntary rhythmic contraction of the soft palate, which generates an audible click for the patient and for the explorer. Botulinum toxin achieves temporary muscle paralysis through presynaptic inhibition of the acetylcholine level at the neuromuscular union. We present a patient with long-term objective tinnitus, along with this patient's response to botulinum toxin injection.

  6. Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders [ISRCTN68653575

    Directory of Open Access Journals (Sweden)

    Juan Francisco J

    2004-02-01

    Full Text Available Abstract Background Whiplash associated disorder is commonly linked to motor vehicle accidents and sports injuries. Cervical injury is attributed to rapid extension followed by neck flexion. The exact pathophysiology of whiplash is uncertain but probably involves some degree of aberrant muscle spasms and may produce a wide range of symptoms. The most commonly prescribed pharmacological agents for initial treatment of whiplash-associated pain are oral muscle relaxants and nonsteroidal anti-inflammatory drugs. However, potential systemic adverse effects limit these agents. Physical interventions such as mobilization, manipulation, and exercises have proved beneficial for pain and dysfunction but only on a time-limited basis. Little evidence suggests that physical therapy specifically aimed at the musculature (e.g., transcutaneous electrical nerve stimulation, ultrasonography, heat, ice, and acupuncture improves prognosis in acute whiplash associated disorder. A new approach to treatment is the use of botulinum toxin, which acts to reduce muscle spasms. Methods/design This is a prospective, randomized, controlled clinical trial and botulinum toxin-A (Botox® injections will be compared with placebo injections. The primary objective is to determine the efficacy of Botox® in the management of musculoskeletal pain in whiplash associated disorders. Discussion Botulinum toxin type-A toxin has been studied in small trials on whiplash associated disorder patients and has generally been found to relieve pain and improve range of motion. Specifically, we seek to assess the efficacy of Botox® in reducing pain and to improve the cervical spine range of movement, during the 6-month trial period.

  7. Thickened Saliva after Effective Management of Drooling with Botulinum Toxin A

    Science.gov (United States)

    Erasmus, Corrie E.; van Hulst, Karen; van den Hoogen, Frank J. A.; van Limbeek, Jacques; Roeleveld, Nel; Veerman, Enno C. I.; Rotteveel, Jan J.; Jongerius, Peter H.

    2010-01-01

    Aim: The aim of this study was to evaluate the rheological properties of saliva after submandibular botulinum toxin type A (BoNT-A) injections. Method: We enrolled 15 children (11 males and six females; age range 3-17y, mean age 9y 10mo) diagnosed with spastic (n=9) or dyskinetic (n=6) quadriplegic cerebral palsy (CP); Gross Motor Function…

  8. Ultrasound-guided botulinum toxin injections

    Directory of Open Access Journals (Sweden)

    S. E. Khatkova

    2016-01-01

    Full Text Available One of the key conditions for achieving the desirable result during botulinum toxin therapy for muscular dystonia, spasticity, and other diseases accompanied by spasm, pain, and autonomic dysfunction (dystonias, spasticity, etc. is the proper administration of the agent into the muscles directly involved in the pathological process. The exact entry of botulinum toxin into the target muscles is essential for successful and safe treatment because its injection into a normal muscle may cause side effects. The most common errors are the incorrect depth and incorrect direction of a needle on insertion. Therefore, the exact injection of the agent particularly into the shallow and deep muscles is a difficult task even for an experienced specialist and requires the use of controlling methods.The European Consensus on Botulinum Toxin Therapy points out that various injection techniques are needed for the better identification of necessary muscles. However, there are currently no reports on the clear advantage of any technique. In our country, injections using palpation and anatomical landmarks have been widely used in routine practice so far; electromyographic monitoring and electrostimulation have been less frequently applied. In recent years, the new method ultrasound-guided injection has continued to grow more popular. This effective, accessible, and easy-to-use method makes it possible to manage a real-time injection process and to ensure the exact entry of the agent into the muscle. This paper is dedicated to a comparative analysis of different injection methods and to a description of the ultrasound-guided technique and its advantages over others. 

  9. A型肉毒毒素在斜视治疗中的应用%Botulinum toxin A in treatmen of the strabismus

    Institute of Scientific and Technical Information of China (English)

    王贝贝; 胡依博; 王素萍(综述); 王瑞峰(审校)

    2016-01-01

    Botulinum toxin A injections the extraocular muscles which can cause temporary paralysis to change the positiong of eye in order to treatment of strabismus.And it can produce the extraocular muscle temporary weakness and permanent eye position change, with the advantages of repeated injections, simple operation and less side effects, etc. In this paper, botulinum toxin type A application in strabismus treatment were summarized.%肉毒毒素A型注射眼外肌可造成暂时性麻痹来改变眼位治疗斜视,可产生眼外肌暂时的无力和永久的眼位改变,并具有可重复注射,操作简单和副作用少等优点。本文对肉毒毒素A型在斜视治疗中的应用进行综述。

  10. Beneficial effect of botulinum toxin A on Raynaud's phenomenon in Japanese patients with systemic sclerosis: A prospective, case series study.

    Science.gov (United States)

    Motegi, Sei-ichiro; Yamada, Kazuya; Toki, Sayaka; Uchiyama, Akihiko; Kubota, Yuka; Nakamura, Tetsuya; Ishikawa, Osamu

    2016-01-01

    Currently, there is no satisfactory treatment for Raynaud's phenomenon (RP) in systemic sclerosis (SSc). Recently, it has been reported that botulinum toxin A (BTX-A) injection was effective for the treatment of RP in SSc patients. The objective was to assess the efficacy and safety of BTX-A on RP in Japanese SSc patients. In the prospective, case series study, 10 Japanese SSc patients with RP received 10 U of BTX-A injections into the hand. The change in severity of RP, including the frequency of attacks/pain, color changes, duration time of RP and the severity of pain, was assessed by Raynaud's score and pain visual analog scale (VAS) at each visit during 16 weeks. The recovery of skin temperature 20 min after cold water stimulation was examined by thermography at baseline and 4 weeks after injection. The number of digital ulcers (DU) and adverse effects were assessed at each visit. BTX-A injection decreased Raynaud's score and pain VAS from 2 weeks after injection, and the suppressive effect was continued until 16 weeks after injection. Skin temperature recovery after cold water stimulation at 4 weeks after injection was significantly enhanced compared with that before injection. All DU in five patients were healed within 12 weeks after injection. Neither systemic nor local adverse effects were observed in all cases. We conclude that BTX-A injection significantly improved the activity of RP in SSc patients without any adverse events, suggesting that BTX-A may have possible long-term preventive and therapeutic potentials for RP in Japanese SSc patients.

  11. Focal treatment of spasticity using botulinum toxin A in cerebral palsy cases of GMFCS level V: evaluation of adverse effects

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    Ana Paula Tedesco

    2014-08-01

    Full Text Available Objective:To report on the experience of injections of botulinum toxin A (BTA in a series of patients with cerebral palsy of Gross Motor Function Classification System (GMFCS level V.Methods:This was a retrospective case series study on 33 patients with cerebral palsy of GMFCS level V who received 89 sessions of BTA application (of which 84 were Botox® and five were other presentations, in which the basic aim was to look for adverse effects.Results:The mean number of application sessions per patient was three, and the mean age at the time of each injection was 4 + 6 years (range: 1.6–13 years. The muscles that most frequently received injections were the gastrocnemius, hamstrings, hip adductors, biceps brachii and finger flexors. The mean total dose was 193 U and the mean dose per weight was 12.5 U/kg. Only one patient received anesthesia for the injections and no sedation was used in any case. No local or systemic adverse effects were observed within the minimum follow-up of one month.Conclusion:The absence of adverse effects in our series was probably related to the use of low doses and absence of sedation or anesthesia. According to our data, BTA can be safely used for patients with cerebral palsy of GMFCS level V, using low doses and preferably without sedation or anesthesia.

  12. Comparação entre os métodos de injeção de toxina botulínica em músculo ocular externo com o uso do eletromiógrafo e com o uso da pinça de Mendonça Electromyograph assistance and Mendonça's forceps - a comparison between two methods of botulinum toxin A injection into the extraocular muscle

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    Tomás Fernando Scalamandré Mendonça

    2005-04-01

    Full Text Available OBJETIVO: Comparar dois métodos de aplicação de toxina botulínica A (TBA em músculo ocular externo: com auxílio de eletromiógrafo (EMG e com a pinça de Mendonça. MÉTODOS: Foram analisados no Departamento de Oftalmologia da UNIFESP 29 pacientes que apresentavam estrabismo e baixa acuidade visual em um olho. Foram divididos em dois grupos: grupo I - 17 pacientes que receberam a toxina botulínica A por meio de injeção com auxílio da pinça de Mendonça e grupo II - 12 pacientes que receberam a toxina botulínica A por injeção guiada pelo eletromiógrafo. Os pacientes dos dois grupos foram avaliados no 7º e no 14º dia após aplicação. Compararam-se os resultados dos dois grupos neste período de tempo. Os testes de correlação de Friedman e Mann-Whitney foram usados para análise estatística. RESULTADOS: Houve diferença estatística entre as médias de desvio pré-aplicação e em pelo menos um período (7º ou 14º dia após aplicação, tanto no grupo dos pacientes em que foi utilizada a pinça, quanto no grupo de pacientes em que foi utilizado o eletromiógrafo. Não houve diferença estatística dos desvios pré-aplicação e pós-aplicação entre os dois grupos. CONCLUSÃO: Os dois métodos de aplicação da toxina botulínica A são equivalentes e portanto, o uso da pinça de Mendonça pode ser método alternativo ao uso do eletromiógrafo, para guiar a injeção de toxina botulínica A.PURPOSE: To compare two methods of botulinum toxin A (BTA injection into the extraocular muscle (EOM: the electromyographically (EMG guided injection and the injection using Mendonça's forceps. METHODS: Twenty-nine (29 patients with strabismus and low visual acuity in one eye were examined at the Department of Ophthalmology of UNIFESP. They were divided into 2 groups - group I with 17 patients receiving the botulinum toxin A injection using Mendonça's forceps, and group II with 12 patients receiving the toxin with electromyographical

  13. Comparison of different antibiotic protocols for asymptomatic bacteriuria in patients with neurogenic bladder treated with botulinum toxin A

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    Ana Claudia Paradella

    Full Text Available ABSTRACT Intravesical botulinum toxin A (BoNTA injection has been widely used for the treatment of detrusor overactivity in patients with neurogenic bladder due to spinal cord injury who do not respond to conventional treatment. There is no consensus about antibiotic prophylaxis for this procedure. We conducted a retrospective analysis of medical records of adult patients with spinal cord injury who underwent detrusor BoNTA injection between January of 2007 and December of 2013 in a rehabilitation hospital. Occurrence of symptomatic urinary tract infection (UTI was assessed in 3 groups in accordance with their use of antibiotics (prophylactic dosage, 3 days, more than 3 days for the treatment of asymptomatic bacteriuria. All patients were performing self or assisted clean intermittent bladder catheterization and underwent a rigid cystoscopy, under general or regional anesthesia with sedation, and the drug used was Botox®. A total of 616 procedures were performed during the study period. There were 11 identified cases of UTI (1.8% with a trend to a higher rate in the group that used antibiotics for longer time. This report shows that a single dose of antibiotics before the detrusor BoNTA injection is enough to prevent UTI. Randomized clinical trial should be conducted for definitive conclusions.

  14. Unilateral transient mydriasis and ptosis after botulinum toxin injection for a cosmetic procedure

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    Akkaya S

    2015-02-01

    Full Text Available Sezen Akkaya,1 Hatice Kübra Kökcen,1 Tuğba Atakan2 1Fatih Sultan Mehmet Education and Training Hospital, Ophthalmology Clinics, Bostanci, Istanbul, 2Aksaray Hospital, Ophthalmology Clinics, Konya, Turkey Abstract: We report a case of unilateral transient mydriasis and ptosis after botulinum toxin injection applied by a medical doctor for a cosmetic procedure. A 36-year-old nurse was referred to our eye clinic with unilateral mydriasis and ptosis in the right eye 3 days after botulinum toxin injection for a cosmetic procedure. Botulinum toxin was applied to her eye by a doctor at her hospital who was not an ophthalmologist. She was treated with topical apraclonidine 0.5% ophthalmic solution. Her ptosis decreased to 2 mm with apraclonidine and her visual axis improved. Mydriasis was present for 3 weeks and then disappeared. Mild ptosis continued for 3 months, then resolved completely. Patients seeking treatment with botulinum toxin A for cosmetic purposes should be warned about the possibility of ptosis and mydriasis after injection. If these side effects are seen, the patient must be referred to an ophthalmologist for appropriate management. Keywords: botulinum toxin, mydriasis, ptosis

  15. Effect of Acupoint Injection with Botulinum Toxin A in treating No. 3 Vertebral Transverse Process Syndrome%穴位注射A型肉毒素治疗腰三横突综合征疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘臻; 苏清伦; 张喆浩

    2008-01-01

    目的:观察注射A型肉毒素(botulinum toxin type A, BTX-A)治疗第三腰椎横突综合征的临床疗效.方法:选择60例第三腰椎横突综合征患者,随机分成两组.治疗组30例,用穴位注射A型肉毒素;对照组30例,用传统针刺治疗.随访2个月,比较两组疗效.结果:治疗组痊愈率、显效率、起效时间优于对照组,两组疗效差异有统计学意义(P<0.05).结论:穴位注射A型肉毒素治疗第三腰椎横突综合征的临床疗效优于单纯针刺治疗.

  16. 穴位注射A型肉毒毒素治疗第三腰椎横突综合征%Botulinum toxin A (BTX-A) point injection for treatment of the third lumbar transverse process syndrome

    Institute of Scientific and Technical Information of China (English)

    刘臻

    2008-01-01

    目的:观察注射A型肉毒毒素(botulinum toxin type A, BTX-A)治疗第三腰椎横突综合征的临床疗效.方法:将25例第三腰椎横突综合征患者随机分成2组,穴位注射组10例,针刺组15例.穴位注射组注射BTX-A,取第三腰椎横突处压痛点或其周围腧穴为注射点;针刺组予针刺治疗,取穴同穴位注射组.随访2个月,比较2组疗效及起效时间.结果:穴位注射组痊愈率为50.0%,起效时间为(3.75±1.65)天;针刺组分别为0和(12.47±5.33)天.2组各项指标比较,穴位注射组均优于针刺组(P<0.05).结论:穴位注射A型肉毒毒素治疗第三腰椎横突综合征的临床疗效优于单纯针刺治疗.

  17. 胃镜下胃壁注射A型肉毒毒素治疗单纯性肥胖的临床研究%Endoscopic gastric intramural injection of botulinum toxin A for treatment of obesity:A randomized controlled clinical trial

    Institute of Scientific and Technical Information of China (English)

    李莉; 刘庆森; 刘文徽; 窦艳; 彭丽华; 杨云生; 孟科

    2012-01-01

    目的 研究胃镜下胃壁注射A型肉毒毒素(BTX-A)治疗单纯性肥胖的减重疗效和安全性.方法 19例单纯性肥胖患者随机分为试验组Ⅰ(BTX-A 200 U)和试验组Ⅱ(BTX-A 300 U),胃镜下将药物注射于胃壁肌层共20个点,治疗前和治疗后1周、4周、12周分别对进食量、体重、BMI、腰围、臀围、胃固体排空时间、胃电图等进行随访.结果 两组患者治疗后进食量较治疗前明显减少(P<0.05);体重、BMI、腰围、臀围均明显减少(P<0.05);胃固体半排空时间明显延长(P<0.05),胃延迟相时间延长,但无统计学差异;胃电图各指标治疗前后无明显变化.无明显不良反应发生.结论 胃镜下注射BTX-A能减慢胃排空、减少进食量,安全有效地减轻体重.%Objective To investigate the safety and efficacy of botulinum toxin A injected into the gastric wall for the treatment of obesity. Methods 19 patients with simple obesity were randomized into 2 groups( group I, 200 U BTX-A and group II ,300 U BTX-A ).20 puncture sites were selected into the gastric wall. Food intake,body weight, BMI, waistline, hip circumference, gastric emptying time and electrogastrogram were recorded before injection and 1 week,4 weeks and 12 weeks after the treatment. Results All patients reported reduced food intake after the injection( P <0. 05 ). Body weight, BMI, waistline and hip circumference decreased after the treatment P < 0. 05 ). The semi-gastric solid emptying time were significant longer than before the treatment( P < 0. 05 ). There were no differences between the two groups. No clinically significant side effects were observed. Conclusions Endoscopic injection of BTX-A can be a safe choice for weight loss of obese patients by reducing food intake and delaying gastric emptying.

  18. A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis

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    Iannitti T

    2014-07-01

    Full Text Available Tommaso Iannitti,1,2 Beniamino Palmieri,3 Anna Aspiro,3 Alessandro Di Cerbo2,3 1School of Biomedical Sciences, University of Leeds, Leeds, UK; 2Poliambulatorio del Secondo Parere, Modena, Italy; 3Department of Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy Background: Hyperhidrosis is a chronic disease characterized by increased sweat production. Local injections of botulinum toxin A (BTX-A have been extensively used for treatment of primary hyperhidrosis (idiopathic. The current treatment for this condition involves several intradermal injections, resulting in poor patient compliance due to injection-related pain. Therefore, new protocols, including an improved anesthetic regimen, are required. Aim: We designed the present study to determine whether JetPeel™-3, a medical device used for transdermal delivery of drugs by jet nebulization, could be used to deliver lidocaine prior to the standard multiple BTX-A injections or deliver lidocaine together with BTX-A in order to determine the protocol giving better results in terms of procedure-related pain, sweating, and patient satisfaction in subjects affected by primary axillary, palmar or plantar hyperhidrosis. Materials and methods: Twenty patients with a visual analog scale (VAS sweating score ≥ 8 cm were randomized to receive lidocaine 2% (5 mL delivered by JetPeel™-3 followed by multiple injections of BTX-A (100 units or lidocaine 2% (5 mL and BTX-A (50 units delivered together by JetPeel™-3. Effect of treatment on sweating was measured by VAS (0= minimum sweating; 10= maximum sweating at 3-month follow-up. Pain induced by the procedure was assessed by VAS (0= minimum pain; 10= maximum pain immediately after the procedure. Patient satisfaction was assessed at 3-month follow-up using a 5-point scale (1= not at all satisfied; 2= not satisfied; 3= partially satisfied; 4= satisfied; 5= highly satisfied. Results: Both

  19. Questionnaire about the Adverse Events and Side Effects Following Botulinum Toxin A Treatment in Patients with Cerebral Palsy

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    Izabela Blaszczyk

    2015-11-01

    Full Text Available Botulinum toxin A (BoNT-A injections for treatment of spasticity in patients with cerebral palsy (CP have been used for about two decades. The treatment is considered safe but a low frequency of adverse events (AE has been reported. A good method to report AEs is necessary to verify the safety of the treatment. We decided to use an active surveillance of treatment-induced harm using a questionnaire we created. We studied the incidence of reported AEs and side effects in patients with CP treated with BoNT-A. We investigated the relationship between the incidence of AEs or side effects and gender, age, weight, total dose, dose per body weight, Gross Motor Function Classification System (GMFCS and number of treated body parts. Seventy-four patients with CP participated in our study. In 54 (51% of 105 BoNT-A treatments performed in 45 (61% patients, there were 95 AEs and side effects reported, out of which 50 were generalized and/or focal distant. Severe AEs occurred in three patients (4%, and their BoNT-A treatment was discontinued. Consecutive collection of the AE and side-effect incidence using our questionnaire can increase the safety of BoNT-A treatment in patients with CP.

  20. Questionnaire about the Adverse Events and Side Effects Following Botulinum Toxin A Treatment in Patients with Cerebral Palsy

    Science.gov (United States)

    Blaszczyk, Izabela; Foumani, Nazli Poorsafar; Ljungberg, Christina; Wiberg, Mikael

    2015-01-01

    Botulinum toxin A (BoNT-A) injections for treatment of spasticity in patients with cerebral palsy (CP) have been used for about two decades. The treatment is considered safe but a low frequency of adverse events (AE) has been reported. A good method to report AEs is necessary to verify the safety of the treatment. We decided to use an active surveillance of treatment-induced harm using a questionnaire we created. We studied the incidence of reported AEs and side effects in patients with CP treated with BoNT-A. We investigated the relationship between the incidence of AEs or side effects and gender, age, weight, total dose, dose per body weight, Gross Motor Function Classification System (GMFCS) and number of treated body parts. Seventy-four patients with CP participated in our study. In 54 (51%) of 105 BoNT-A treatments performed in 45 (61%) patients, there were 95 AEs and side effects reported, out of which 50 were generalized and/or focal distant. Severe AEs occurred in three patients (4%), and their BoNT-A treatment was discontinued. Consecutive collection of the AE and side-effect incidence using our questionnaire can increase the safety of BoNT-A treatment in patients with CP. PMID:26561833

  1. Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment:rationale and protocol for an international, prospective, longitudinal cohort study (ULIS III)

    OpenAIRE

    Turner-Stokes, Lynne Frances; Ashford, Stephen; Jacinto, Jorge; Maisonobe, Pascal; Balcaitiene, Jovita; Fheodoroff, Klemens

    2016-01-01

    OBJECTIVES: Describe the rationale and protocol for the Upper Limb International Spasticity (ULIS)-III study, which aims to evaluate the impact of integrated spasticity management, involving multiple botulinum toxin A (BoNT-A) injection cycles and concomitant therapies, on patient-centred goal attainment. Outline novel outcome assessment methods for ULIS-III and report initial evaluation data from goal setting in early stages of the study.DESIGN: Large international longitudinal cohort study ...

  2. The Role of Botulinum Toxin A in the Treatment of Raynaud Phenomenon.

    Science.gov (United States)

    Segreto, Francesco; Marangi, Giovanni Francesco; Cerbone, Vincenzo; Persichetti, Paolo

    2016-09-01

    Raynaud phenomenon (RP) is a transient digital ischemia that occurs after exposure to cold temperature or emotional distress. It presents with a triphasic course: the initial white phase is followed by cyanotic discoloration and, subsequently, erythema. The attacks may be associated with pain, paresthesia, and complicate with nonhealing ulceration often leading to amputation. To date, there are no clear-cut therapeutic guidelines and many medications are used off-label. Encouraging results were reported with the use of botulinum neurotoxin-A (BoNT-A). However, there is still ongoing debate regarding indications, contraindications, best injection technique, and mechanism of action. The aim of this study was to address these issues by providing an up-to-date and detailed overview of the use of BoNT-A in RP.A PubMed database search was conducted. The available studies and techniques were evaluated and compared.The search yielded a total of 29 studies. Ten papers, published between 2004 and 2014, were considered relevant. A total of 128 patients underwent BoNT-A injections. Seventy-five percent to 100 % of the patients reported pain reduction after treatment. Healing of ulcers was reported in 75% to 100% of the affected patients. The most common complication was temporary hand weakness, with an average incidence of 14.1%. Injections targeting the neurovascular bundle at or slightly proximal to the A1 pulley were the most commonly performed.Botulinum neurotoxin-A injection proved to be a valid approach in both primary and secondary RP. The available evidence shows the achievement of both symptomatic and functional improvements in this debilitating condition. However, the patient should be adequately informed about the risk of transient hand weakness.

  3. Botulinum toxin A for palmar hyperhidrosis: assessment with sympathetic skin responses evoked by train of stimuli.

    Science.gov (United States)

    Al-Hashel, J Y; Youssry, D; Rashaed, H M; Shamov, T; Rousseff, R T

    2016-07-01

    Objective assessment of the effect of botulinum toxin A (BT) treatment in primary palmar hyperhidrosis (PH) is attempted by different methods. We decided to use for this purpose sympathetic skin responses evoked by train of stimuli (TSSR). Twenty patients with severe PH (five female, median age 24, range 18-36) were examined regularly over 3 months after receiving 50 UI BT in each palm. TSSR were recorded from the palms after sensory stimulation by a train of three supramaximal electric pulses 3 millisecond apart. Results were compared to longitudinally studied TSSR of 20 healthy sex- and age-matched control subjects. All hyperhidrosis patients reported excellent improvement. TSSR amplitudes decreased at week 1 (mean 54% range 48%-67%) and over the following months in a clinically significant trend (slope R=-.82, P<.0001). TSSR in controls changed insignificantly (±13% from the baseline). The difference between patients and controls was highly significant at any time point (P<.001). This study suggests that TSSR may help in assessment of treatments in PH. It confirms objectively the efficacy of BT in PH.

  4. Why do females use botulinum toxin injections?

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    Carter Singh

    2015-01-01

    Full Text Available Background: Botulinum toxin (BT use for enhancing the facial features has become a commonly accepted form of aesthetic intervention. This study conducted a self-report survey of female BT users in order to explore the motivating factors in its use (cost-benefit analysis. Settings and Design: This is a cross-sectional exploratory pilot study. Materials and Methods: Self-report questionnaires were administered to 41 consecutive clients attending an independent medical practice for BT injections for cosmetic purposes. All the participants were females and represented a range of age groups from the 20s to above 60s. Items in the nonstandardized questionnaire elicited questions relating to the reasons for and against BT use. Statistical Analysis Used: Descriptive analysis was used rather than inferential statistics, and involved ranking the responses according to the most likely reasons for using BT and disadvantages of its use. Results: In general, the primary motivating factor for BT use was to improve self-esteem, and the greatest disadvantage involved financial costs associated with the procedure. Conclusions: The main findings of this study suggest that females who use BT for aesthetic purposes are motivated by personal psychological gains (intrapersonal attributes rather than social gains (interpersonal factors. In other words, they do not believe that having BT will equate to being treated any better by other people but would rather provide them with confidence and satisfaction regarding their self-image.

  5. Treatment of chronic pain associated with nocturnal bruxism with botulinum toxin. A prospective and randomized clinical study

    Science.gov (United States)

    Al-Wayli, Hessa

    2017-01-01

    Background To evaluate the role of botulinum toxin type A (BTX-A) in the treatment of pain associated with nocturnal bruxism. Material and Methods Fifty subjects reporting nocturnal bruxism were recruited for a randomized clinical trial. Twenty five bruxers were injected with botulinum toxin in both masseters, and twenty five were treated with traditional methods of treating bruxism. Patients were evaluated at 3rd week, 2nd and 6th month and one year after injection and then used to calculate bruxism events. Bruxism symptoms were investigated using questionnaires. Results Mean pain score due to Bruxism events in the masseter muscle decreased significantly in the botulinum toxin injection group A (P =0.000, highly significant). However, in the conventional treatment group, mean pain score does not show improvement with time (p>0.05). Conclusions Our results suggest that botulinum toxin injection reduced the mean pain score and number of bruxism events, most likely by decreasing the muscle activity of masseter rather than affecting the central nervous system. Key words:Temporomandibular pain, nocturnal bruxism, botulinum toxin.

  6. Budget impact analysis of botulinum toxin A therapy for upper limb spasticity in the United Kingdom

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    Abogunrin S

    2015-04-01

    Full Text Available Seye Abogunrin,1 Linda Hortobagyi,2 Edit Remak,3 Jerome Dinet,4 Sylvie Gabriel,5 Abdel Magid O Bakheit6 1Meta Research, 2Health Economics, Evidera, London, UK; 3Health Economics, Evidera, Budapest, Hungary; 4Health Economics and Outcomes Research (Global, 5Global Market Access and Pricing, Ipsen Pharma, Boulogne-Billancourt, France; 6Neurological Rehabilitation, Moseley Hall Hospital, Birmingham, UK Background: Botulinum toxin A (BoNT-A is an effective treatment for patients with upper limb spasticity (ULS, which is a debilitating feature of upper motor neuron lesions. BoNT-A preparations available in the UK are associated with different costs. Methods: We developed a budget impact model to assess the effect of changing market shares of different BoNT-A formulations – abobotulinumtoxinA, onabotulinumtoxinA, and incobotulinumtoxinA – and best supportive care, from the UK payer perspective, over a 5-year time horizon. Epidemiological and resource use data were derived from published literature and clinical expert opinion. One-way sensitivity analyses were performed to determine parameters most influential on budget impact. Results: Base-case assumptions showed that an increased uptake of abobotulinumtoxinA resulted in a 5-year savings of £6,283,829. Treatment with BoNT-A costs less than best supportive care per patient per year, although treating a patient with onabotulinumtoxinA (£20,861 and incobotulinumtoxinA (£20,717 cost more per patient annually than with abobotulinumtoxinA (£19,800. Sensitivity analyses showed that the most influential parameters on budget were percentage of cerebral palsy and stroke patients developing ULS, and the prevalence of stroke. Conclusion: Study findings suggest that increased use of abobotulinumtoxinA for ULS in the UK could potentially reduce total ULS cost for the health system and society. Keywords: stroke, cerebral palsy, multiple sclerosis, traumatic brain injury 

  7. Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

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    S. Deffontaines-Rufin

    2011-10-01

    Full Text Available PURPOSE: Neurogenic detrusor overactivity (NDO is common in patients who suffer from multiple sclerosis (MS. When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS. MATERIALS AND METHODS: Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor, improvement, or total failure (urge incontinence and overactive detrusor. RESULTS: 77% of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001, maximum cystometric capacity (p = 0.0035, maximum detrusor pressure (p = 0.0000001. 46% of the patients were in the "full success" group. 31% of the patients had a partial improvement. 23% of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015. CONCLUSIONS: Despite that a full success was obtained in 46% of the cases, BTX-A injection therapy failed to treat refractory NDO in 23% of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anticholinergic drugs fail to reduce NDO.

  8. Botulinum toxin A in the treatment of spinal cord injury patients with refractory neurogenic detrusor overactivity

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    Ronaldo A. Alvares

    2010-12-01

    Full Text Available PURPOSE: To evaluate the efficacy of botulinum toxin type A injections in the detrusor muscle in patients with spinal cord injury and urinary incontinence due to detrusor overactivity and refractory to anticholinergic agents. MATERIALS AND METHODS: We prospectively evaluated 22 patients with spinal cord injuries, whose bladders were emptied by intermittent catheterization. All patients had detrusor overactivity and urinary incontinence that proved difficult to treat, despite using high doses of two different anticholinergics. The pre-treatment assessment included a complete urodynamic study and ultrasonography of the kidneys and urinary tract. A one-month follow-up was completed with urodynamic evaluation and the clinical response was evaluated through outpatient consultations and telephone contact. RESULTS: After the procedure, the maximum cystometric capacity and the bladder reflex volume increased, whereas the maximum detrusor pressure and compliance decreased. The mean duration of continence was 7 ± 7 months. In 18 patients (81.8%, it was necessary to administer anticholinergics to achieve continence. Five patients (22.7% had indication of reinjection, and augmentation cystoplasty was indicated in 9 patients (40.9%. CONCLUSION: The use of botulinum toxin in the treatment of neurogenic detrusor overactivity refractory to anticholinergics is an option before more invasive treatments, such as augmentation cystoplasty, are attempted. In our study as well as in the literature, there was improvement in most urodynamic parameters. Overall, 40.9% of patients underwent augmentation cystoplasty and 81.8% of patients needed anticholinergic agents to reach urinary continence. Further studies are necessary to improve the procedure and to achieve better clinical results.

  9. Injection of Botulinum toxin A into unilateral paraspinal muscles to establish scoliosis model in immature bipedal rats%A型肉毒毒素一侧椎旁肌注射建立双足直立鼠脊柱侧凸模型的初步研究

    Institute of Scientific and Technical Information of China (English)

    沈晓龙; 周许辉; 刘洋; 田野; 东人; 袁文

    2012-01-01

    Objectives: To discuss the feasibility and efficacy of injection of Botulinum toxin A into unilateral paraspinal muscles to establish scoliosis model in immature bipedal rats. Methods: 56 4-week old female SD rats were divided into 7 groups randomly. All rats underwent amputations of forelimbs under anesthesia and were kept in height-regulated cages. Group A-F received different concentrations of BTX-A respectively (100U, 50U, 25U, 12.5U, 6.25U, 3.125U, all in 0.5ml). Group G only received an injection of same amount of normal saline. 2 weeks after injection, AP X-rays were obtained under anesthesia. The rats were cut off the skin on the back. Naked-eye observations were taken. Morphological changes of paravertebral muscles were detected under light microscope. Results: The rats were observed to be able to stand bipedally immediately after the amputations of forelimbs. After BTX-A injection, the rats in group A-D were all dead, while all rats in group E, F and G survived. 2 weeks after injection, AP X-rays showed that all survived rats had developed scoliosis in group E and F, and all curves had convex towards right side. The mean Cobb angle in group E was (41.9+3.4)° at 2 weeks after injection, and the mean Cobb angle in group F and G was (33.1±3.2)° and (2.9±6.8)° respectively. Naked-eye observations showed muscle atrophy on the convex side. The his-tological findings revealed the same as naked -eye observation. Those were not observed in group G.Conclusions: Scoliosis model can be created by 6.25U or 3.125U BTX-A injection in immature bipedal rats,which indicates that paravertebral muscle imbalance can induce scoliosis.%目的:探讨应用A型肉毒毒素(BTX-A)建立双足直立鼠脊柱侧凸模型的可行性.方法:将56只4周龄雌性SD大鼠随机分为A、B、C、D、E、F、G组,每组8只.将所有大鼠截除双前肢,予高笼喂养,建立双足直立鼠模型,同时行全脊柱前后位X线片检查,剔除存在脊柱侧凸的

  10. 多点微量皮内注射A型肉毒素治疗带状疱疹后遗神经痛的临床观察%Clinical Observation of Multiple Intradermal Small Bolus Injection of Botulinum Toxin A in Treatment of Postherpetic Neuralgia

    Institute of Scientific and Technical Information of China (English)

    程鹏; 何仁亮; 向红辉; 李凤春

    2014-01-01

    Objective:To observe the effect of multiple intradermal small bolus injection of botulinum toxin type A in the treatment of postherpetic neuralgia (PHN). Method:38 cases of PHN with multi point trace superficial injection were treated with botulinum toxin type A. Changhai pain rating scale standard visual analogue scale (VAS) score was used to observe the clinical effect. Result:There was significant effect in 28 cases,effective in 9 cases and invalid in 1 cases,and the total effective rate was 97.4%. Conclusion:Multiple intradermal small bolus injection of botulinum toxin type A may be effective in the treatment of PHN, with no complications caused by muscle relaxation.%目的:观察多点微量皮内注射A型肉毒毒素治疗带状疱疹后遗神经痛(PHN)的效果。方法:对38例PHN病人采用多点微量表浅注射A型肉毒素治疗,采用长海痛尺标准进行视觉模拟量表(VAS)评分,观察治疗效果。结果:显效28例,有效9例,无效1例,总有效率为97.4%。结论:多点微量皮内注射A型肉毒素可有效治疗PHN,无肌肉松驰导致的各种并发症。

  11. Botulinum toxin

    Directory of Open Access Journals (Sweden)

    Nigam P

    2010-01-01

    Full Text Available Botulinum toxin, one of the most poisonous biological substances known, is a neurotoxin produced by the bacterium Clostridium botulinum. C. botulinum elaborates eight antigenically distinguishable exotoxins (A, B, C 1 , C 2 , D, E, F and G. All serotypes interfere with neural transmission by blocking the release of acetylcholine, the principal neurotransmitter at the neuromuscular junction, causing muscle paralysis. The weakness induced by injection with botulinum toxin A usually lasts about three months. Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, and various spastic movement disorders, headaches, hypersalivation, hyperhidrosis, and some chronic conditions that respond only partially to medical treatment. The list of possible new indications is rapidly expanding. The cosmetological applications include correction of lines, creases and wrinkling all over the face, chin, neck, and chest to dermatological applications such as hyperhidrosis. Injections with botulinum toxin are generally well tolerated and side effects are few. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice.

  12. Treatment of Palatal Myoclonus with Botulinum Toxin Injection

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    Mursalin M. Anis

    2013-01-01

    Full Text Available Palatal myoclonus is a rare cause of pulsatile tinnitus in patients presenting to the otolaryngology office. Rhythmic involuntary contractions of the palatal muscles produce the pulsatile tinnitus in these patients. Treatment of this benign but distressing condition with anxiolytics, anticonvulsants, and surgery has been largely unsuccessful. A few investigators have obtained promising results with botulinum toxin injection into the palatal muscles. We present a patient with palatal myoclonus who failed conservative treatment with anxiolytics. Unilateral injection of botulinum toxin into her tensor veli palatini muscle under electromyographic guidance resolved pulsatile tinnitus in her ipsilateral ear and unmasked pulsatile tinnitus in the contralateral ear. A novel method of following transient postinjection symptoms using a diary is presented in this study. Botulinum toxin dose must be titrated to achieve optimal results in each individual patient, analogous to titrations done for spasmodic dysphonia. Knowledge of the temporal onset of postinjection side effects and symptomatic relief may aid physicians in dose titration and surveillance. We present suggestions on titrating the botulinum toxin dose to optimal levels. A review of the literature on the use of botulinum toxin for palatal myoclonus and some common complications are discussed.

  13. Eficácia do resfriamento da pele no alívio da dor desencadeada pela injeção de toxina botulínica tipo A nas distonias faciais Skin cooling efficacy on pain relief in periocular injections with botulinum toxin A in facial dystonias

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    Paula Barros Bandeira de Mello Monteiro

    2012-12-01

    Full Text Available OBJETIVO: Avaliar a eficácia do resfriamento da pele com gelo no alívio da dor desencadeada pela injeção de toxina botulínica tipo A na região periocular em pacientes portadores de distonia facial. MÉTODOS: Neste estudo prospectivo, 13 pacientes receberam injeção de toxina botulínica tipo A em região glabelar (m. prócero e periocular (m. orbicular para tratamento de distonia facial. Antes das aplicações, um lado da região glabelar foi resfriado com gelo durante 5 minutos, enquanto no outro lado foi aplicada pomada Epitezan®, funcionando como placebo. A aplicação foi feita primeiramente no lado resfriado. Após a aplicação em cada um dos lados os pacientes foram instruídos a dar uma nota para a dor desencadeada pela injeção, em uma escala de 0 a 10 onde 0 era ausência de dor e 10 a dor mais intensa. RESULTADOS: A média das notas dadas pelos pacientes à dor desencadeada pela injeção no lado onde foi aplicado placebo foi 3,92 ± 3,28. No local onde foi aplicado gelo a média das notas foi de 2,92 ± 2,18 (p PURPOSE: To evaluate the efficacy of skin cooling with ice on pain relief in periocular injection with botulinum toxin type A in patients with facial dystonias. METHODS: In this prospective study, 13 patients received botulinum toxin type A injection in glabela (procerus m. and periocular region (orbicular m. for facial dystonias treatment. Before the injections, one side of the glabela was submitted to a 5-minute cooling period, while the opposite side had Epitezan® cream applied, as a placebo. The application was done at the cooled side first. After the application on each side the patients were instructed to rate the pain associated with the injection on a scale from 0 to 10, with 0 indicating no pain and 10 the worst pain. RESULTS: The average pain score on the side where cold was applied was 3,92 ± 3,28, while on the control side the average pain score was 2,92 ± 2,18 (p < 0,0166. CONCLUSION: In this study

  14. Central Nervous System Toxicity After Botulinum Neurotoxin Injection

    Science.gov (United States)

    Ilkhchoui, Yashar; Ghaly, Ramsis F.; Knezevic, N. Nick; Candido, Kenneth D

    2013-01-01

    Since Its first description of botulism toxicity in 1820s, specific formulations of botulinum neurotoxin (BoNT) have been introduced with different clinical benefits. However, there is increasing number of adverse events reported to Food and Drug Administration. This report presents the case of 62-year-old woman with Parkinson’s disease who received BoNT injections to treat painful spasticity in her hands. She developed severe generalized dystonia shortly after BoNT injections. PMID:24223367

  15. Usefulness of Magnetic Resonance Neurography for Diagnosis of Piriformis Muscle Syndrome and Verification of the Effect After Botulinum Toxin Type A Injection

    OpenAIRE

    Yang, Hea Eun; Park, Jung Hyun; Kim, Sungjun

    2015-01-01

    Abstract Piriformis muscle syndrome (PMS) is a controversial neuromuscular disorder that is presumed to involve compression neuropathy of the sciatic nerve at the level of the piriformis muscle. Botulinum toxin A (BTX-A) injection into the piriformis muscle is widely used as a treatment aimed at relieving sciatic nerve compression. In 2 patients with PMS, magnetic resonance neurography (MRN) was taken before and after BTX-A injection. The first MRN was performed as a diagnostic tool, and the ...

  16. Results from the Upper Limb International Spasticity Study-II (ULIS-II):a large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management

    OpenAIRE

    Turner-Stokes, Lynne; Fheodoroff, Klemens; Jacinto, Jorge; Maisonobe, Pascal

    2013-01-01

    Objective: To describe real-life practice and person-centred outcomes in the treatment of poststroke upper limb spasticity with botulinum toxin A (BoNT-A).Design: Observational, prospective study.Setting: 84 secondary care centres in 22 countries.Participants: 456 adults (≥18 years) with poststroke upper limb spasticity treated with one cycle of BoNT-A.Methods/outcomes: Muscle selection, BoNT-A preparation, injection technique and timing of follow-up were conducted according to routine practi...

  17. A型肉毒毒素治疗颞下颌关节紊乱病的临床研究%The use of botulinum toxin A for the treatment of temporomandibular joint disorder

    Institute of Scientific and Technical Information of China (English)

    刘荣光; 范建本; 王颖; 任大元

    2001-01-01

    Objective To evaluate the clinical efficacy of botulinum toxin A in the treatment of temporomandibular joint disorder (TMD).Methods 11 patients with TMD were treated with 150 units of botulinum toxin A.Both masseter muscles were injected with 50 units each.Similarly,both temporalis muscles received 25 units each.Clinical data including maximum mouth opening,pain,subjective function and tenderness to palpation were collected and then analyzed.Results The maximum mouth opening,pain,subjective function and tenderness to palpation of the patients improved significantly (P<0.05) at different period of time after injection.Conclusion The use of botulinum toxin A for treatment of TMD is effective in reducing pain,increasing mouth opening and improving quality of life in patients with TMD.%目的评价A型肉毒毒素局部注射治疗颞下颌关节紊乱病(TMD)的临床疗效。方法对11例经保守治疗无效的TMD患者,给予局部注射A型肉毒毒素150U,双侧嚼肌各50U,双侧颞肌各25U。分析治疗前后不同时期患者的最大张口度、疼痛值、口颌功能及局部压痛值的变化。结果治疗后不同时期患者最大张口度、疼痛、口颌功能及局部压痛均较治疗前有显著改善(P<0.05)。结论 A型肉毒毒素局部注射治疗TMD,能有效改善患者的张口度,缓解疼痛。

  18. Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: a case series

    Directory of Open Access Journals (Sweden)

    Delanois Ronald E

    2009-08-01

    Full Text Available Abstract Background Development of hip adductor, tensor fascia lata, and rectus femoris muscle contractures following total hip arthroplasties are quite common, with some patients failing to improve despite treatment with a variety of non-operative modalities. The purpose of the present study was to describe the use of and patient outcomes of botulinum toxin injections as an adjunctive treatment for muscle tightness following total hip arthroplasty. Methods Ten patients (14 hips who had hip adductor, abductor, and/or flexor muscle contractures following total arthroplasty and had been refractory to physical therapeutic efforts were treated with injection of botulinum toxin A. Eight limbs received injections into the adductor muscle, 8 limbs received injections into the tensor fascia lata muscle, and 2 limbs received injection into the rectus femoris muscle, followed by intensive physical therapy for 6 weeks. Results At a mean final follow-up of 20 months, all 14 hips had increased range in the affected arc of motion, with a mean improvement of 23 degrees (range, 10 to 45 degrees. Additionally all hips had an improvement in hip scores, with a significant increase in mean score from 74 points (range, 57 to 91 points prior to injection to a mean of 96 points (range, 93 to 98 at final follow-up. There were no serious treatment-related adverse events. Conclusion Botulinum toxin A injections combined with intensive physical therapy may be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are refractory to standard therapy.

  19. Altered cell metabolism in tissues of the knee joint in a rabbit model of Botulinum toxin A-induced quadriceps muscle weakness.

    Science.gov (United States)

    Leumann, A; Longino, D; Fortuna, R; Leonard, T; Vaz, M A; Hart, D A; Herzog, W

    2012-12-01

    Quadriceps muscle weakness is frequently associated with knee injuries in sports. The influence of quadriceps weakness on knee joint homeostasis remains undefined. We hypothesized that quadriceps weakness will lead to tissue-specific alterations in the cell metabolism of tissues of the knee. Quadriceps weakness was induced with repetitive injections of Botulinum toxin A in six 1-year-old New Zealand White rabbits for 6 months. Five additional animals served as controls with injections of saline/dextrose. Muscle weakness was assessed by muscle wet mass, isometric knee extensor torque, and histological morphology analysis. Cell metabolism was assessed for patellar tendon, medial and lateral collateral ligament, and medial and lateral meniscus by measuring the total RNA levels and specific mRNA levels for collagen I, collagen III, MMP-1, MMP-3, MMP-13, TGF-β, biglycan, IL-1, and bFGF by reverse transcription and polymerase chain reaction. While the total RNA levels did not change, tissue-specific mRNA levels were lower for relevant anabolic and catabolic molecules, indicating potential changes in tissue mechanical set points. Quadriceps weakness may lead to adaptations in knee joint tissue cell metabolism by altering a subset of anabolic and catabolic mRNA levels corresponding to a new functional and metabolic set point for the knee that may contribute to the high injury rate of athletes with muscle weakness.

  20. Kinetic and Reaction Pathway Analysis in the Application of Botulinum Toxin A for Wound Healing

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    Frank J. Lebeda

    2012-01-01

    Full Text Available A relatively new approach in the treatment of specific wounds in animal models and in patients with type A botulinum toxin is the focus of this paper. The indications or conditions include traumatic wounds (experimental and clinical, surgical (incision wounds, and wounds such as fissures and ulcers that are signs/symptoms of disease or other processes. An objective was to conduct systematic literature searches and take note of the reactions involved in the healing process and identify corresponding pharmacokinetic data. From several case reports, we developed a qualitative model of how botulinum toxin disrupts the vicious cycle of muscle spasm, pain, inflammation, decreased blood flow, and ischemia. We transformed this model into a minimal kinetic scheme for healing chronic wounds. The model helped us to estimate the rate of decline of this toxin's therapeutic effect by calculating the rate of recurrence of clinical symptoms after a wound-healing treatment with this neurotoxin.

  1. Remote Effects of Local Injection of Botulinum Toxin Type A

    Institute of Scientific and Technical Information of China (English)

    Wan Xinhua; Tang Xiaofu; Cui Liying

    2000-01-01

    Objective To assess the seventy and temporal profile of remote effects of botulinum toin type A, BTX-A (Botox from Allergan Inc.,USA and CBTX-A made by Lanzhou Biological Products Institute, China ) injected locally on neuromuscular transmission. Background Recently the local injection of BTX-A has been accepted as a breakthrough in the treatment of a variety of spasmodic disorders, and remote effects of BTX-A on the neuromuscular transmission are concemed. Methods Fourty patients who had enrolled in a prospective open study with Botox or CBTX-A for their movement disorders were studied, 18 cases with Botox and 22 cases with CBTX-A. SFEMG in the extensor digitorum communis muscle or tibialis anterior muscle was performed before and 2-3weeks, 5-8weeks, 4-5 months after injection of Botox or CBTX-A, totally 119 times. Results The significant increase of jitter was demonstrated 2-3weeks after injections in both groups and MCD was in direct proportion to dose of injections.Fiber density value increased at the same time or later and still existed until 4-5 months after injections. Conclusion There are subclinical effects on neuromuscular transmission of remote uninjected muscles after injections of Botox and CBTX A, which indicates that the toxin spread remotely from the site of injection.

  2. Application of Botulinum Toxin A in the Treatment of Upper Facial Wrinkles%A型肉毒毒素在上面部除皱中的应用分析

    Institute of Scientific and Technical Information of China (English)

    张栋; 司法启

    2011-01-01

    OBJECTIVE: To explore botulinum toxin A in the treatment of upper facial wrinkles. METHODS: The botulinum toxin A was diluted by normal saline into 25 u·mL-1 solution which was administered with multi-point injections at 10~14 points of frontal wrinkles, 3~4 points of fishtail lines and 4~5 points of glabellar frown lines. RESULTS: A total of 338 cases received treatment. The wrinkles relieved or disappeared after 1~3 days, and the optimal effect had been observed in 1~2 weeks after injections and maintained for 4~8 months. Effective rate was 100%. 1 case suffered from allergic shock and recovered after treatment; 4 cases suffered from mild edema, and 7 cases ecchymosis, 5 case ptosis of eyebrow. All theses complications had spontaneously improved in 2~4 weeks without any special treatment. CONCLUSION: Treatment of facial wrinkles with the injection of botulinum toxin A, while the effect of which only lasts for a period of time, is reversible and relatively safe to manage the upper facial wrinkles.%目的:探讨A型肉毒毒素在上面部除皱治疗的应用方法.方法:用生理盐水将A型肉毒毒素稀释成25u·mL-1分点注射,额横纹:10~14个注射点;鱼尾纹:3~4个注射点;眉间纹:4~5个注射点.结果:338例患者,注射后1~3 d可见皱纹减轻或消失,1~2周后出现最佳效果,可维持4~8个月,有效率达100%.1例发生休克,对症处理后好转;出现局部轻度水肿4例,局部瘀斑7例,眉型改变、眉下垂5例,以上并发症未做特殊处理,2~4周左右好转.结论:A型肉毒毒素注射除皱,虽然只能维持一定时间,但因有可逆性所以相对安全,是减少上面部动力性皱纹的有效方法.

  3. Botulinum Toxin A and Lower Urinary Tract Dysfunction: Pathophysiology and Mechanisms of Action

    Directory of Open Access Journals (Sweden)

    Jia-Fong Jhang

    2016-04-01

    Full Text Available The use of onabotulinumtoxinA (BoNT-A for the treatment of lower urinary tract diseases (LUTD has increased markedly in recent years. The indications for BoNT-A treatment of LUTD now include neurogenic or idiopathic detrusor overactivity, interstitial cystitis/bladder pain syndrome and voiding dysfunction. The mechanisms of BoNT-A action on LUTDs affect many different aspects. Traditionally, the effects of BoNT-A were believed to be attributable to inhibition of acetylcholine release from the presynaptic efferent nerves at the neuromuscular junctions in the detrusor or urethral sphincter. BoNT-A injection in the bladder also regulated sensory nerve function by blocking neurotransmitter release and reducing receptor expression in the urothelium. In addition, recent studies revealed an anti-inflammatory effect for BoNT-A. Substance P and nerve growth factor in the urine and bladder tissue decreased after BoNT-A injection. Mast cell activation in the bladder also decreased. BoNT-A-induced improvement of urothelium function plays an important mitigating role in bladder dysfunction. Vascular endothelial growth factor expression in urothelium decreased after BoNT-A injection, as did apoptosis. Studies also revealed increased apoptosis in the prostate after BoNT-A injection. Although BoNT-A injection has been widely used to treat different LUTDs refractory to conventional treatment, currently, onabotulinumtoxinA has been proven effective only on urinary incontinence due to IDO and NDO in several large-scale clinical trials. The effects of onabotulinumtoxinA on other LUTDs such as interstitial cystitis, benign prostatic hyperplasia, dysfunctional voiding or detrusor sphincter dyssynergia have not been well demonstrated.

  4. Botulinum toxin injection improved voluntary motor control in selected patients with post-stroke spasticity

    Institute of Scientific and Technical Information of China (English)

    Shuo-Hsiu Chang; Gerald E Francisco; Sheng Li

    2012-01-01

    The effect of botulinum toxin type A injection on voluntary grip control was examined in a 53-year-old female, who sustained a hemorrhagic right middle cerebral artery stroke 3 years previously, which resulted in finger flexor spasticity and residual weak finger/wrist extension. The patient received 50 units of botulinum toxin type A injection each to the motor points (2 sites/muscle) of the left flexor digitorum superficialis and flexor digitorum profundus, respectively. Botulinum toxin injection led to weakness and tone reduction in the spastic finger flexors, but improved grip release time in grip initiation/release reaction time tasks. Improved release time was accompanied by shortened extensor electromyography activity, and improved release time likely correlated with blocked co-contraction of finger flexors during voluntary finger extension. This case report demonstrated that botulinum toxin injection improved voluntary motor control of the hand in a chronic stroke patient with residual finger extension.

  5. Assessment of intralesional injection of botulinum toxin type A injection for hypertrophic scars

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    Alhasan M Elhefnawy

    2016-01-01

    Full Text Available Background: Hypertrophic scars are dermal fibroproliferative disorders that typically develop after a skin injury heals. They can cause physical, psychological, and cosmetic problems. The management of such scars remains a matter of debate due to lack of effective treatment methods and the inability to prevent recurrences. Recent reports have demonstrated that botulinum toxin type A improves wound healing so it may play a role in treating hypertrophic scars. Aims: We assessed the effectiveness of intralesional botulinum toxin type A injection for treating hypertrophic scars. Methods: This prospective clinical study included twenty patients with hypertrophic scars. Intralesional injection of botulinum toxin type A was given once a month for three months with a follow-up period of six months. Each lesion was injected until slight blanching occurred. Therapeutic satisfaction of the patient and physician were recorded. Lesions were assessed for erythema, itching and pliability. Each item was assessed on a 5-point scale. Results: Therapeutic satisfaction was recorded as 'good' in 14 patients and 'excellent' in the remaining six. The mean erythema score decreased from 3.2 to 1.0, the mean pliability score from 3.3 to 0.8 and the mean itching score from 2.7 to 0.7. All of these were statistically significant. Limitations: A larger sample size and longer follow-up period would have given a better evaluation but was not feasible due to the high expenses involved. Conclusion: Botulinum toxin type A is a novel and promising therapy for hypertrophic scars with few side effects.

  6. The use of botulinum toxin injections to manage drooling in amyotrophic lateral sclerosis/motor neurone disease: a systematic review.

    Science.gov (United States)

    Squires, Nina; Humberstone, Miles; Wills, Adrian; Arthur, Antony

    2014-08-01

    Difficulty in managing oral secretions is commonly experienced by patients with amyotrophic lateral sclerosis (ALS)/motor neurone disease (MND) and associated bulbar weakness including dysphagia. There are no definitive evidence-based treatment guidelines to manage the distressing symptom of drooling. We reviewed the evidence for the effectiveness of botulinum toxin injections to reduce saliva in ALS/MND. The search strategy was conducted in four stages: (1) electronic search of relevant databases, (2) hand searches of all international ALS/MND symposium journals, (3) email request to MND care centres in the UK and Ireland, and (4) hand searching of reference lists. All studies were critically appraised and relevant data extracted. Botulinum toxin type A and type B were analysed separately. Due to heterogeneity, it was not possible to calculate a pooled estimate of effect. Twelve studies met the inclusion criteria (9 for type A and 3 for type B). Only two randomised controlled trials were identified. Study sample sizes were small with a mean of 12.5 subjects. The most frequently reported outcomes were weight of cotton rolls and number of tissues used. All studies claimed the intervention tested was effective, but only seven studies (4 for type A and 3 for type B) reported statistically significant differences. Although there is evidence to suggest that botulinum toxin B can reduce drooling, the evidence base is limited by a lack of randomized controlled trials. Evidence to support the use of botulinum toxin A is weaker. Larger trials will help remove the uncertainty practitioners face in treating this disabling symptom.

  7. A型肉毒毒素注射治疗腋臭疗效探讨%Effect of Botulinum Toxin type A injection on axillary bromidrosis

    Institute of Scientific and Technical Information of China (English)

    茅付勇

    2015-01-01

    Objective To investigate the clinical value of Botulinum Toxin A on axillary bromidrosis by minimally invasive injection. Methods Using minimally invasive Botulinum Toxin A injection method in the 60 cases of axillary bromidrosis (all of them are bilateral axillary), and then observing the curative effect. Results Of all the 60 patients 58 cases were followed up from March 2011 to June 2014,on average one year and a half,in order to observe the effect and complications and therapeutic effect of them,and the follow- up rate was 96.7% .The curative effect is satisfied. Conclusion Minimally invasive Botulinum Toxin A injection,as a non-operation therapy for axillary bromidrosis,is a method which is simple to operation,easy to master,region without scar,and the curative effect is satisfactory.%目的:探讨微创A型肉毒毒素注射法治疗腋臭的应用价值。方法:采用微创A型肉毒毒素注射法治疗腋臭60例(均为双侧腋窝)观察治疗效果。结果:60例患者中,随访58例,随访率为96.7%。随访时间2011年3月-2014年6月,平均1.5年,疗效满意。结论:微创A型肉毒毒素注射法治疗腋臭操作简单、易于掌握、创区无瘢痕,且疗效满意。

  8. Increased levels of SV2A botulinum neurotoxin receptor in clinical sensory disorders and functional effects of botulinum toxins A and E in cultured human sensory neurons

    Directory of Open Access Journals (Sweden)

    Yiangou Y

    2011-10-01

    Full Text Available Yiangos Yiangou1 Uma Anand1,2, William R. Otto2, Marco Sinisi3, Michael Fox3, Rolfe Birch3 Keith A. Foster4, Gaurav Mukerji1,5, Ayesha Akbar1,6, Sanjiv K. Agarwal5, Praveen Anand11Department of Clinical Neuroscience, Imperial College London, Hammersmith Hospital, London; 2Histopathology Laboratory, Cancer Research UK, London Research Institute, London; 3Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore; 4Syntaxin Ltd, Oxford; 5Department of Urology; 6Department of Gastroenterology, Imperial College London, Hammersmith Hospital, London, United Kingdom Background: There is increasing evidence that botulinum neurotoxin A may affect sensory nociceptor fibers, but the expression of its receptors in clinical pain states, and its effects in human sensory neurons, are largely unknown.Methods: We studied synaptic vesicle protein subtype SV2A, a receptor for botulinum neurotoxin A, by immunostaining in a range of clinical tissues, including human dorsal root ganglion sensory neurons, peripheral nerves, the urinary bladder, and the colon. We also determined the effects of botulinum neurotoxins A and E on localization of the capsaicin receptor, TRPV1, and functional sensitivity to capsaicin stimuli in cultured human dorsal root ganglion neurons.Results: Image analysis showed that SV2A immunoreactive nerve fibers were increased in injured nerves proximal to the injury (P = 0.002, and in painful neuromas (P = 0.0027; the ratio of percentage area SV2A to neurofilaments (a structural marker was increased proximal to injury (P = 0.0022 and in neuromas (P = 0.0001, indicating increased SV2A levels in injured nerve fibers. In the urinary bladder, SV2A nerve fibers were found in detrusor muscle and associated with blood vessels, with a significant increase in idiopathic detrusor overactivity (P = 0.002 and painful bladder syndrome (P = 0.0087. Colon biopsies showed numerous SV2A-positive nerve fibers, which were increased in quiescent

  9. 胺碘酮联合肉毒素A治疗面肌痉挛的临床疗效观察%Clinical efficacy of amiodarone combined with botulinum toxin A in hemifacial spasm

    Institute of Scientific and Technical Information of China (English)

    冯建钦; 张鹏飞

    2016-01-01

    Objective To observe the clinical efficacy of amiodarone combined with botulinum toxin A in the treatment of hemifacial spasm.Methods Sixty-five patients with hemifacial spasm were randomly divided into amiodarone(n=33)and control(n=32)group.In the amiodarone group,oral amiodarone and local intramuscular injection of botulinum toxin A were administered.In the control group,only local intramuscular injections of botulinum toxin A was performed.The clinical efficacy was evaluated according to the Cohen rating on the 1st,4th,16th,32nd week.Results The Cohen rating in amiodarone group was significantly better than control group on 4th,16th,32nd week(P<0.05).The complete remission in amiodarone group was significantly higher than control group on 4th,16th,32nd week(75.8% vs.43.8%,81.8% vs.12.5%,81.8% vs.6.2%,all P <0.05).The total effective rate in amiodarone group was significantly higher than control group on 16th,32nd week(97.0%vs.75.0%,93.9% vs.65.6%,all P<0.05). There was one case of recurrence in control group on 4th week,while there was no recurrence in amiodarone group.The recurrence in control group on 16th,32nd week was higher than amiodarone group(56.3 % vs.0.0 %,65.6% vs.12.1%,all P<0.05).There was no signigicant difference in adverse reactions between amiodarone group and control group(24.2%vs.18.8%).Conclusion Combination of amiodarone and botulinum toxin A is more effective than botulinum toxin A alone in the treatment of hemifacial spasm.%目的:探讨胺碘酮( amiodarone)与肉毒素A( botulinum toxin A)联合治疗面肌痉挛的临床疗效。方法65例面肌痉挛患者,随机分为胺碘酮组(33例,胺碘酮联合肉毒素A治疗)和对照组(32例,单纯肉毒素A治疗)。2组治疗前及治疗1、4、16、32周时依据Cohen痉挛强度分级标准进行功能分级及疗效判定。结果治疗4、16、32周时,胺碘酮组Cohen分级明显优于对照组( P<0.05)。治疗4、16和32周时,胺碘酮组的完

  10. Bupivacaine and botulinum toxin to treat comitant strabismus

    Directory of Open Access Journals (Sweden)

    Luisa Moreira Hopker

    2012-04-01

    Full Text Available PURPOSE: To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A. METHODS: Eight patients (five female were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10-MHz ultrasonography (eyelid technique. RESULTS: Mean change in alignment was 10 prism diopters after 180 days (n=6. An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness. CONCLUSION: In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxinum A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.

  11. Effectiveness of botulinum toxin A for upper and lower limb spasticity in children with cerebral palsy: a summary of evidence.

    Science.gov (United States)

    Lukban, Marissa Barlaan; Rosales, Raymond L; Dressler, Dirk

    2009-03-01

    Botulinum toxin type A (BoNT-A) therapy has gained wide acceptance in the management of spasticity in cerebral palsy (CP). Clinical experience from numerous case reports and series, retrospective and prospective open label cohort studies, and randomized controlled trials (RCT) has grown over the past 10 years. Several independent systematic reviews on the role of BoNT-A for upper and lower limb spasticity have been written by various authors. The objective of this paper is to summarize past systematic reviews and recent RCT not yet included in the systematic reviews that assess the effectiveness of BoNT-A in upper and lower limb spasticity in children with CP. We reviewed four Class II RCT discussed in five independent systematic reviews and two new Class II trials on the use of BoNT-A alone or with occupational therapy compared to placebo or occupational therapy alone in children with upper limb spasticity. There were 229 children recruited in these six trials and of those, 115 children received BoNT-A in the upper limbs. Five of six RCT showed a time limited decrease in muscle tone most especially at the wrist. Four of six trials showed improvement of hand function on a few specific functional tests. Four systematic reviews concluded that there is insufficient and inconsistent evidence to support or refute the effectiveness of BoNT-A in upper limb spasticity but one recent review recommended that BoNT-A should be considered as a treatment option in upper limb spasticity. For lower limb spasticity, we reviewed 13 RCT discussed in six systematic reviews and two new trials comparing BoNT-A with placebo or other rehabilitation modalities such as physiotherapy, occupational therapy, casting or electrical stimulation. In these studies, 617 children were recruited and of those, 360 children received BoNT-A in the lower limbs. There were six Class I and nine Class II trials. Three Class I trials documented significant improvement in gait pattern in children with

  12. Evaluation of Botulinum Toxin A for Spastic Dipledia by Surface Electromyography%A型肉毒毒素治疗痉挛型双瘫患儿疗效的表面肌电分析

    Institute of Scientific and Technical Information of China (English)

    周平秋; 张惠佳; 王跑球; 胡继红; 郭春光; 李惠枝

    2011-01-01

    目的 观察A型肉毒毒素(BTX-A)注射治疗痉挛型双瘫前后表面肌电图(sEMG)的变化.方法 50例痉挛型双瘫患儿于小腿三头肌注射BTX-A,治疗前后分别用临床方法和sEMG进行评价.结果 治疗后患儿功能位测试小腿三头肌的肌电积分值降低,测试足背屈角减小.结论 sEMG可以客观评价BTX-A注射后痉挛型双瘫患儿肌张力的变化.%Objective To evaluate the effect of Botulinum Toxin A (BTX-A) on spastic diplegia by surface electromyography (sEMG).Methods 50 children with cerebral palsy following spastic diplegia were recruited and injected with BTX-A in triceps surae.They were assessed with the clinical test and the sEMG before and after the treatment.Results After the treatment the integrated electromyography(iEMG) of triceps surae and foot dorsiflexion angle all decreased Conclusion sEMG is an objective tool to assess the change of spasticity in children with diplegia after BTX-A injection.

  13. Aplicación de la toxina botulínica A para el tratamiento del síndrome de Frey Application of botulinum toxin A for the treatment of Frey’s Syndrome

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    J. Mareque Bueno

    2008-10-01

    Full Text Available El síndrome Aurículo-temporal también conocido como sudoración gustativa o síndrome de Frey, es una entidad caracterizada por sudoración y enrojecimiento de la piel del territorio inervado por el nervio aurículo-temporal durante las comidas. El síndrome de Frey es probablemente una secuela inevitable en la cirugía de la glándula parótida. Una vez que se presenta se perpetua durante toda la vida si no se realiza tratamiento. Realizando el test de Minor tras cirugía sobre la glándula parótida ha sido publicado que el 100% son positivos, y que el 50% son sintomáticos percibiendo la sudoración durante las comidas, y alrededor de un 15% consideran sus síntomas graves. En el siguiente articulo presentamos los resultados de nuestro estudio que consistió en la inyección intradérmica de toxina botulínica A a nuestros pacientes con síndrome de Frey y el seguimiento. Los resultados han sido desaparición de los síntomas durante un periodo medio de 16 meses con cierta variabilidad individual. Con estos resultados podría considerarse la inyección de toxina botulínica A como ténica de elección para el síndrome de Frey ya establecido.The auriculotemporal syndrome, also known as gustatory sweating or Frey’s syndrome, is a condition characterized by sweating and flushing of the cutaneous territory innervated by the auriculotemporal nerve while eating. Frey’s syndrome is probably an inevitable sequela of parotid gland surgery. Once it appears, it persists for the rest of the patient’s life if not treated. It has been reported that performance on the Minor test after parotid gland surgery is 100% positive and 50% of patients are symptomatic, experiencing sweating during meals. About 15% consider their symptoms serious. In this article we present the results of our study of the treatment of Frey’s syndrome by intradermal injection of botulinum toxin A and the follow-up of the patients. The patients’ symptoms disappeared during

  14. Usefulness of Magnetic Resonance Neurography for Diagnosis of Piriformis Muscle Syndrome and Verification of the Effect After Botulinum Toxin Type A Injection

    Science.gov (United States)

    Yang, Hea Eun; Park, Jung Hyun; Kim, Sungjun

    2015-01-01

    Abstract Piriformis muscle syndrome (PMS) is a controversial neuromuscular disorder that is presumed to involve compression neuropathy of the sciatic nerve at the level of the piriformis muscle. Botulinum toxin A (BTX-A) injection into the piriformis muscle is widely used as a treatment aimed at relieving sciatic nerve compression. In 2 patients with PMS, magnetic resonance neurography (MRN) was taken before and after BTX-A injection. The first MRN was performed as a diagnostic tool, and the second to identify the effect of the treatment. Signal change of the sciatic nerve under the hypertrophied piriformis muscle was confirmed by MRN. In follow-up MRN performed after BTX-A injection into the piriformis muscle, changes of the sciatic nerve and piriformis muscle were noticed as well as improvement of clinical symptoms. MRN is a useful tool to add certainty of diagnosis and verify the effect of treatment in PMS. PMID:26402805

  15. Usefulness of Magnetic Resonance Neurography for Diagnosis of Piriformis Muscle Syndrome and Verification of the Effect After Botulinum Toxin Type A Injection: Two Cases.

    Science.gov (United States)

    Yang, Hea Eun; Park, Jung Hyun; Kim, Sungjun

    2015-09-01

    Piriformis muscle syndrome (PMS) is a controversial neuromuscular disorder that is presumed to involve compression neuropathy of the sciatic nerve at the level of the piriformis muscle. Botulinum toxin A (BTX-A) injection into the piriformis muscle is widely used as a treatment aimed at relieving sciatic nerve compression. In 2 patients with PMS, magnetic resonance neurography (MRN) was taken before and after BTX-A injection. The first MRN was performed as a diagnostic tool, and the second to identify the effect of the treatment. Signal change of the sciatic nerve under the hypertrophied piriformis muscle was confirmed by MRN. In follow-up MRN performed after BTX-A injection into the piriformis muscle, changes of the sciatic nerve and piriformis muscle were noticed as well as improvement of clinical symptoms. MRN is a useful tool to add certainty of diagnosis and verify the effect of treatment in PMS.

  16. Intramural injection with botulinum toxin significantly elongates the pig esophagus

    DEFF Research Database (Denmark)

    Larsen, Heidi Fhær; Jensen, Thorbjørn Søren Rønn; Rasmussen, Lars

    2013-01-01

    Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We...

  17. Vocal aging and adductor spasmodic dysphonia: Response to botulinum toxin injection

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    Michael P Cannito

    2008-03-01

    Full Text Available Michael P Cannito, Joel C Kahane, Lesya ChornaSchool of Audiology and Speech-Language Pathology, The University of Memphis, Memphis, TN, USAAbstract: Aging of the larynx is characterized by involutional changes which alter its biomechanical and neural properties and create a biological environment that is different from younger counterparts. Illustrative anatomical examples are presented. This natural, non-disease process appears to set conditions which may influence the effectiveness of botulinum toxin injection and our expectations for its success. Adductor spasmodic dysphonia, a type of laryngeal dystonia, is typically treated using botulinum toxin injections of the vocal folds in order to suppress adductory muscle spasms which are disruptive to production of speech and voice. A few studies have suggested diminished response to treatment in older patients with adductor spasmodic dysphonia. This retrospective study provides a reanalysis of existing pre-to-post treatment data as function of age. Perceptual judgments of speech produced by 42 patients with ADSD were made by two panels of professional listeners with expertise in voice or fluency of speech. Results demonstrate a markedly reduced positive response to botulinum toxin treatment in the older patients. Perceptual findings are further elucidated by means of acoustic spectrography. Literature on vocal aging is reviewed to provide a specific set of biological mechanisms that best account for the observed interaction of botulinum toxin treatment with advancing age.Keywords: vocal aging, adductor spasmodic dysphonia, botulinum toxin, voice quality, speech fluency

  18. Treatment of Frontal Hyperhidrosis With Botulinum Toxin

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    Ayşe Esra Koku Aksu

    Full Text Available Focal hyperhidrosis is usually localized to the axillae, palms and soles. Less frequently, hyperhidrosis may be confined to the forehead and may have negative impact on patient’s quality of life. A 34-year-old man presented to our clinic with the complaint of frontal hyperhidrosis. He was treated with botulinum toxin A. Thirty points were marked over the forehead and at each injection point, 0.15 ml (3U botulinum toxin A were injected intracutaneously. Hyperhidrosis was significantly reduced and the effect lasted for 12 months. Skindex-29, a quality-of-life measure for skin disease, was administered to the patient at the beginning and at the end of second week of botulinum toxin A injection. There was a significant improvement on the Skindex-29 scale at the end of the treatment. There was no any side effect detected during and after the treatment. Botulinum toxin A treatment is considered to be effective and safe for frontal hyperhidrosis.

  19. Effect of a clown's presence at botulinum toxin injections in children: a randomized, prospective study

    DEFF Research Database (Denmark)

    Hansen, Lars Kjaersgaard; Kibaek, Maria; Martinussen, Torben;

    2011-01-01

    The effect of the presence of a hospital clown during pediatric procedures has rarely been evaluated. In a pediatric ward, botulinum toxin injection is a painful procedure and a stressful experience for the child. We undertook a study of the effect of the presence of a hospital clown on children...

  20. Tetanus Toxin and Botulinum Toxin A Utilize Unique Mechanisms To Enter Neurons of the Central Nervous System

    OpenAIRE

    Blum, Faith C.; Chen CHEN; Kroken, Abby R.; Barbieri, Joseph T

    2012-01-01

    Botulinum neurotoxins (BoNTs) and tetanus neurotoxin (TeNT) are the most toxic proteins for humans. While BoNTs cause flaccid paralysis, TeNT causes spastic paralysis. Characterized BoNT serotypes enter neurons upon binding dual receptors, a ganglioside and a neuron-specific protein, either synaptic vesicle protein 2 (SV2) or synaptotagmin, while TeNT enters upon binding gangliosides as dual receptors. Recently, TeNT was reported to enter central nervous system (CNS) neurons upon synaptic ves...

  1. Bone and cartilage changes in rabbit mandibular condyles after a single injection of botulinum toxin

    Science.gov (United States)

    Matthys, Tori; Ho Dang, Hong An; Rafferty, Katherine L.; Herring, Susan W.

    2015-01-01

    Introduction Temporary paralysis of the masseter muscle using botulinum toxin is a common treatment for temporomandibular disorders, bruxism, and muscle hypertrophy. Loss of masseter force is associated with decreased mandibular mineral density. Our objectives were (1) to establish whether bone loss at the mandibular condyle is regionally specific, and (2) to ascertain whether the treatment affects the condylar cartilage. Methods Young adult female rabbits received a unilateral masseter injection of botulinum neurotoxin serotype A (BoNT/A, n=31), saline (n=19) or no injection (n=3) and were also injected with bromodeoxyuridine (BrdU), a replication marker. Termination occurred 4 or 12 weeks following treatment. Condyles were processed by paraffin histology. Cortical thickness, cartilage thickness and trabecular bone areal density were measured, and replicating cells were counted after BrdU reaction. Results BoNT/A rabbits exhibited a high frequency of defects in the condylar bone surface, occurring equally on injected and uninjected sides. Bone loss was seen only on the side of the BoNT/A injection. Cortical as well as trabecular bone was severely affected. The midcondylar region lost the most bone. Recovery at 12 weeks was insignificant. Condylar cartilage thickness showed no treatment effect but did increase with time. Numbers of proliferating cells were similar in treatment groups, but BoNT/A animals showed more side asymmetry in association with the condylar defects. Conclusion Bone loss may be a risk factor for the use of botulinum toxin in jaw muscles. PMID:26672706

  2. Intraprostatic Botulinum Neurotoxin Type A Injection for Benign Prostatic Hyperplasia—A Spotlight in Reality

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    Yu-Chao Hsu

    2016-04-01

    Full Text Available Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum. It inhibits the release of acetylcholine and other neurotransmitters from the nerve terminal. Botulinum toxin, specifically toxin type A (BoNT-A has been used since the 1970s to reduce the muscular hypercontraction disorders. The application of BoNT-A in urology field started from intra-bladder injection for overactive bladder, which has been recognized as third line therapy in many countries. Since prostate gland as well as bladder is under the influence of autonomic innervation, theorectically, injection of BoNT-A into the prostate induces chemo-denervation and modulation of prostate function, and reduces lower urinary tract symptoms (LUTS. This article reviews the application of BoNT-A in patients with LUTS/ benign prostatic hyperplasia (BPH from mechanisms of action to clinical results. BoNT-A has been shown to induce prostate apoptosis, downregulation of alpha 1A receptors, and reduce contractile function of prostate in animal studies. Open studies of intraprostate BoNT-A injection have demonstrated promising results of reducing LUTS and improvement of voiding function in human LUTS/BPH, however, intraprostatic BoNT-A injection did not perform better than the placebo group in recent publications of placebo controlled studies. We suggested that BoNT-A prostate injection might benefit selected population of BPH/LUTS, but it is unlikely to be an effective therapy for general population of male LUTS/BPH.

  3. Treatment Efficacy of Electromyography versus Fiberscopy-Guided Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients: A Prospective Comparative Study

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    Jae Wook Kim

    2014-01-01

    Full Text Available Introduction. This study prospectively evaluates and compares the treatment efficacy of botulinum toxin injection under electromyography guidance (EMG group and percutaneous botulinum toxin injection under flexible fiberscopic guidance (fiberscopy group. Methods. Thirty patients with adductor spasmodic dysphonia (ADSD, who had never received treatment, were randomly allocated into EMG- or fiberscopy-guided botulinum toxin injections between March 2008 and February 2010. We assessed acoustic and aerodynamic voice parameters, and the voice handicap index (VHI before injection and at 1, 3, and 6 months after injection. Results. The mean total dosage of botulinum toxin was similar for both groups: 1.7 ± 0.5 U for the EMG group and 1.8 ± 0.4 U for the fiberscopy group (P>0.05. There were no significant differences in outcomes between the two groups in either the duration of effectiveness or complications such as breathy voice and aspiration. Conclusion. Botulinum toxin injection under fiberscopic guidance is a viable alternative to EMG-guided botulinum toxin injection for the treatment of adductor spasmodic dysphonia when EMG equipment is unavailable.

  4. No clinical or neurophysiological evidence of botulinum toxin diffusion to non-injected muscles in patients with hemifacial spasm.

    Science.gov (United States)

    Lorenzano, C; Bagnato, S; Gilio, F; Fabbrini, G; Berardelli, A

    2006-04-01

    Botulinum toxin injected into a muscle may diffuse to nearby muscles thus producing unwanted effects. In patients with hemifacial spasm, we evaluated clinically and neurophysiologically, whether botulinum toxin type A (BoNT-A) diffuses from the injection site (orbicularis oculi) to untreated muscles (orbicularis oris from the affected side and orbicularis oculi and oris from the unaffected side). We studied 38 patients with idiopathic hemifacial spasm. Botulinum toxin was injected into the affected orbicularis oculi muscle alone (at 3 standardized sites) at a clinically effective dose. Patients were studied before (T0) and 3-4 weeks after treatment (T1). We evaluated the clinical effects of botulinum toxin and muscle strength in the affected and unaffected muscles. We also assessed the peak-to-peak amplitude compound muscle action potential (CMAP) recorded from the orbicularis oculi and orbicularis oris muscles on both sides after supramaximal electrical stimulation of the facial nerve at the stylomastoid foramen. In all patients, botulinum toxin treatment reduced muscle spasms in the injected orbicularis oculi muscle and induced no muscle weakness in the other facial muscles. The CMAP amplitude significantly decreased in the injected orbicularis oculi muscle, but remained unchanged in the other facial muscles (orbicularis oris muscle on the affected side and contra-lateral unaffected muscles). In conclusion, in patients with hemifacial spasm, botulinum toxin, at a clinically effective dose, induces no clinical signs of diffusion and does not reduce the CMAP size in the nearby untreated orbicularis oris or contralateral facial muscles.

  5. Botulinum toxin injection to facilitate rehabilitation of muscle imbalance syndromes in sports medicine.

    Science.gov (United States)

    Cullen, D M; Boyle, J J W; Silbert, P L; Singer, B J; Singer, K P

    2007-12-15

    Intramuscular injection of Botulinum toxin to produce reduction of focal muscle overactivity, and localized muscle spasm, has been utilized therapeutically for almost two decades. Muscle overactivity in neurologically normal muscle, where an imbalance exists between a relatively overactive muscle and its less active synergist or antagonist, can inhibit control of the antagonist producing a functional muscle imbalance. This brief review provides an overview of the role of muscle imbalance in sports-related pain and dysfunction, and outlines the potential for intramuscular injection of Botulinum toxin to be used as an adjunct to specific muscle re-education and functional rehabilitation in this patient group. A comprehensive understanding of normal movement and the requirements of the sporting activity are essential to allow accurate diagnosis of abnormal motor patterns and to re-educate more appropriate movement strategies. Therapeutic management of co-impairments may include stretching of tight soft tissues, specific re-education aimed at isolation of the non-dominant weak muscles and improvement in their activation, 'unlearning' of faulty motor patterns, and eventual progression onto functional exercises to anticipate gradual return to sporting activity. Intramuscular injection of Botulinum toxin, in carefully selected cases, provides short term reduction of focal muscle overactivity, and may facilitate activation of relatively 'inhibited' muscles and assist the restoration of more appropriate motor patterns.

  6. Botulinum toxin injection causes hyper-reflexia and increased muscle stiffness of the triceps surae muscle in the rat.

    Science.gov (United States)

    Pingel, Jessica; Wienecke, Jacob; Lorentzen, Jakob; Nielsen, Jens Bo

    2016-12-01

    Botulinum toxin is used with the intention of diminishing spasticity and reducing the risk of development of contractures. Here, we investigated changes in muscle stiffness caused by reflex activity or elastic muscle properties following botulinum toxin injection in the triceps surae muscle in rats. Forty-four rats received injection of botulinum toxin in the left triceps surae muscle. Control measurements were performed on the noninjected contralateral side in all rats. Acute experiments were performed, 1, 2, 4, and 8 wk following injection. The triceps surae muscle was dissected free, and the Achilles tendon was cut and attached to a muscle puller. The resistance of the muscle to stretches of different amplitudes and velocities was systematically investigated. Reflex-mediated torque was normalized to the maximal muscle force evoked by supramaximal stimulation of the tibial nerve. Botulinum toxin injection caused severe atrophy of the triceps surae muscle at all time points. The force generated by stretch reflex activity was also strongly diminished but not to the same extent as the maximal muscle force at 2 and 4 wk, signifying a relative reflex hyperexcitability. Passive muscle stiffness was unaltered at 1 wk but increased at 2, 4, and 8 wk (P botulinum toxin causes a relative increase in reflex stiffness, which is likely caused by compensatory neuroplastic changes. The stiffness of elastic elements in the muscles also increased. The data are not consistent with the ideas that botulinum toxin is an efficient antispastic medication or that it may prevent development of contractures.

  7. Botulinum toxin injection for hypercontractile or spastic esophageal motility disorders: may high-resolution manometry help to select cases?

    Science.gov (United States)

    Marjoux, S; Brochard, C; Roman, S; Gincul, R; Pagenault, M; Ponchon, T; Ropert, A; Mion, F

    2015-01-01

    Endoscopic injections of botulinum toxin in the cardia or distal esophagus have been advocated to treat achalasia and spastic esophageal motility disorders. We conducted a retrospective study to evaluate whether manometric diagnosis using the Chicago classification in high-resolution manometry (HRM) would be predictive of the clinical response. Charts of patients with spastic and hypertensive motility disorders diagnosed with HRM and treated with botulinum toxin were retrospectively reviewed at two centers. HRM recordings were systematically reanalyzed, and a patient's phone survey was conducted. Forty-five patients treated between 2008 and 2013 were included. Most patients had achalasia type 3 (22 cases). Other diagnoses were jackhammer esophagus (8 cases), distal esophageal spasm (7 cases), esophagogastric junction outflow obstruction (5 cases), nutcracker esophagus (1 case), and 2 unclassified cases. Botulinum toxin injections were performed into the cardia only in 9 cases, into the wall of the distal esophagus in 19 cases, and in both locations (cardia and distal esophagus) in 17 cases. No complication occurred in 31 cases. Chest pain was noticed for less than 7 days in 13 cases. One death related to mediastinitis occurred 3 weeks after botulinum toxin injection. Efficacy was assessed in 42 patients: 71% were significantly improved 2 months after botulinum toxin, and 57% remained satisfied for more than 6 months. No clear difference was observed in terms of response according to manometric diagnosis; however, type 3 achalasia previously dilated and with normal integrated relaxation pressure (4s-integrated relaxation pressure botulinum toxin. Endoscopic injections of botulinum toxin may be effective in some patients with spastic or hypercontractile esophageal motility disorders. The manometric Chicago classification diagnosis does not seem to predict the results. Prospective randomized trials are required to identify patients most likely to benefit from

  8. Factors Influencing Goal Attainment in Patients with Post-Stroke Upper Limb Spasticity Following Treatment with Botulinum Toxin A in Real-Life Clinical Practice: Sub-Analyses from the Upper Limb International Spasticity (ULIS-II Study

    Directory of Open Access Journals (Sweden)

    Klemens Fheodoroff

    2015-04-01

    Full Text Available In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A treatment in 456 adults with post-stroke upper limb spasticity (ULS. Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001, contractures (soft tissue shortening [STS] (p = 0.006 and spasticity (p = 0.02 than those setting other goal types. Patients with goals categorised as active function had less motor impairment (0.0001, contracture (p < 0.0001, spasticity (p < 0.001 and shorter time since stroke (p = 0.001. Patients setting goals for pain were older (p = 0.01 with more contractures (p = 0.008. The proportion of patients achieving their primary goal was not impacted by timing of first-ever BoNT-A injection (medium-term (≤1 year vs. longer-term (>1 year post-stroke (80.0% vs. 79.2% or presence or absence of severe contractures (76.7% vs. 80.6%, although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

  9. Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

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    Abiola Jesuloba

    2009-10-01

    Full Text Available Abstract Objectives In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS system which has utility in the treatment administration. Method and materials Data were gathered prospectively on voice improvement (self-rated 6 point scale, length of response and duration of complications (breathiness, cough, dysphagia and total voice loss. Injections were performed under electromyography (EMG guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. Results Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. Conclusion Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia.

  10. Botulinum toxin injection versus lateral internal sphincterotomy in the treatment of chronic anal fissure: a non-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ulusoy Nefise B

    2004-03-01

    Full Text Available Abstract Background Although lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option. The aim of this non-randomized study is to compare the effect of lateral internal sphincterotomy and botulinum toxin injection treatments on the outcome and reduction of anal sphincter pressures in patients with chronic anal fissure. Methods Patients with chronic anal fissure were treated with either botulinum toxin injection or lateral internal sphincterotomy by their own choice. Maximal resting pressure and maximal squeeze pressure measurements were performed before and 2 weeks after treatments by anal manometry. Patients were followed for fissure relapse during 14 months. Results Twenty-one consecutive outpatients with posterior chronic anal fissure were enrolled. Eleven patients underwent surgery and ten patients received botulinum toxin injection treatment. Before the treatment, anal pressures were found to be similar in both groups. After the treatment, the maximal resting pressures were reduced from 104 ± 22 mmHg to 86 ± 15 mmHg in the surgery group (p 0.05 in the surgery group, and from 117 ± 62 mmHg to 76 ± 34 (p 0.05. There were no relapses during the 14 months of follow up. Conclusion Lateral internal sphincterotomy and botulinum toxin injection treatments both seem to be equally effective in the treatment of chronic anal fissure.

  11. Neurophysiological changes induced by the botulinum toxin type A injection in children with cerebral palsy.

    Science.gov (United States)

    Frascarelli, Flaminia; Di Rosa, Giuseppe; Bisozzi, Eleonora; Castelli, Enrico; Santilli, Valter

    2011-01-01

    In the last few years botulinum toxin type A (BTX-A) has been widely used in the management of spasticity in children with cerebral palsy in order to reduce hypertonicity and improve functional outcomes enhancing motor skill development. The botulinum toxin injection seems to interact with intrafusal and extrafusal fibers producing a reduction of hypertone both through synaptic blockade and inhibition of stretch reflex loop and these changes may influence not only the spinal cord but also the central nervous system (CNS). The purpose of our study was to determine the neurophysiological changes induced by the BTX-A through an evaluation of cortical somatosensory Evoked Potential (SEP) and Soleus H wave, that is the index of excitability of stretch reflex loop. Eighteen children with Cerebral Palsy (CP), aged between 5 and 12, were recruited at Children's Hospital "Bambino Gesù" of Rome. All children were evaluated with appropriate clinical scales before and 1 month after the BTX-A injection. Neurophysiological measurements were performed before, and 1 month after botulinum toxin injection through lower limb SEPs, M-wave and Soleus H wave recording. After the injection the results showed a statistically significant improvement both of clinical scales and the neurophysiological variables. These findings suggest that spasticity itself can be considered as a factor affecting the cortical SEPs. And even though it seems that BTX-A does not have any direct central effect on sensory pathways we suppose an indirect mechanism on modulation of afferent fibers Ia due to the modification induced by BTX-A to central loop reflex.

  12. An electromyography guided botulinum toxin injection is effective treatment for objective tinnitus as an office procedure: A case report

    Directory of Open Access Journals (Sweden)

    Emel Çadallı Tatar

    2016-11-01

    Full Text Available Patients with palatal myoclonus may suffer from pulsatile tinnitus stemming from involuntary contractions of tensor veli palatini and levator veli palatini muscles. Botulinum toxin (BTX injection to these muscles is effective in resolving pulsatile tinnitus symptom. We present a case of pulsatile tinnitus who was effectively treated with BTX injection under an electromyography guidance as an office procedure.

  13. Prospective randomised controlled trial comparing trigone-sparing versus trigone-including intradetrusor injection of abobotulinumtoxinA for refractory idiopathic detrusor overactivity.

    LENUS (Irish Health Repository)

    Manecksha, Rustom P

    2012-05-01

    Botulinum toxin A is effective for treatment of idiopathic detrusor overactivity (IDO). The trigone is generally spared because of the theoretical risk of vesicoureteric reflux (VUR), although studies assessing injection sites are lacking.

  14. Factors Influencing Goal Attainment in Patients with Post-Stroke Upper Limb Spasticity Following Treatment with Botulinum Toxin A in Real-Life Clinical Practice: Sub-Analyses from the Upper Limb International Spasticity (ULIS)-II Study

    OpenAIRE

    Fheodoroff, Klemens; Ashford, Stephen; Jacinto, Jorge; Maisonobe, Pascal; Balcaitiene, Jovita; Turner-Stokes, Lynne

    2015-01-01

    In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A) treatment in 456 adults with post-stroke upper limb spasticity (ULS). Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001), contractures (soft tissue shortening [STS]) (p = 0.006) and spasticity (p = 0.02) than those setting other goal types. Patients with goals categorised as active...

  15. Upper limb international spasticity study: rationale and protocol for a large, international, multicentre prospective cohort study investigating management and goal attainment following treatment with botulinum toxin A in real-life clinical practice

    OpenAIRE

    Turner-Stokes, Lynne; Fheodoroff, Klemens; Jacinto, Jorge; Maisonobe, Pascal; Zakine, Benjamin

    2013-01-01

    Objectives This article provides an overview of the Upper Limb International Spasticity (ULIS) programme, which aims to develop a common core dataset for evaluation of real-life practice and outcomes in the treatment of upper-limb spasticity with botulinum toxin A (BoNT-A). Here we present the study protocol for ULIS-II, a large, international cohort study, to describe the rationale and steps to ensure the validity of goal attainment scaling (GAS) as the primary outcome measure. Methods and a...

  16. Factors Influencing Goal Attainment in Patients with Post-Stroke Upper Limb Spasticity Following Treatment with Botulinum Toxin A in Real-Life Clinical Practice: Sub-Analyses from the Upper Limb International Spasticity (ULIS)-II Study

    OpenAIRE

    Klemens Fheodoroff; Stephen Ashford; Jorge Jacinto; Pascal Maisonobe; Jovita Balcaitiene; Lynne Turner-Stokes

    2015-01-01

    In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A) treatment in 456 adults with post-stroke upper limb spasticity (ULS). Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001), contractures (soft tissue shortening [STS]) (p = 0.006) and spasticity (p = 0.02) than those setting other goal types. Patients with goals categorised as act...

  17. Participation of pro- and anti-nociceptive interleukins in botulinum toxin A-induced analgesia in a rat model of neuropathic pain.

    Science.gov (United States)

    Zychowska, Magdalena; Rojewska, Ewelina; Makuch, Wioletta; Luvisetto, Siro; Pavone, Flaminia; Marinelli, Sara; Przewlocka, Barbara; Mika, Joanna

    2016-11-15

    Botulinum neurotoxin serotype A (BoNT/A) shows antinociceptive properties, and its clinical applications in pain therapy are continuously increasing. BoNT/A specifically cleaves SNAP-25, which results in the formation of a non-functional SNARE complex, thereby potently inhibiting the release of neurotransmitters and neuropeptides, including those involved in nociception. The aim of the present study was to determine the effects of BoNT/A (300pg/paw) on pain-related behavior and the levels of glial markers and interleukins in the spinal cord and dorsal root ganglia (DRG) after chronic constriction injury (CCI) to the sciatic nerve in rats. Glial activity was also examined after repeated intraperitoneal injection of minocycline combined with a single BoNT/A injection. Our results show that a single intraplantar BoNT/A injection did not influence motor function but strongly diminished pain-related behaviors in naïve and CCI-exposed rats. Additionally, microglial inhibition using minocycline enhanced the analgesic effects of BoNT/A. Western blotting results suggested that CCI induces the upregulation of the pronociceptive proteins IL-18, IL-6 and IL-1β in the ipsilateral lumbar spinal cord and DRG, but no changes in the levels of the antinociceptive proteins IL-18BP, IL-1RA and IL-10 were observed. Interestingly, BoNT/A injection suppressed the CCI-induced upregulation of IL-18 and IL-1β in the spinal cord and/or DRG and increased the levels of IL-10 and IL-1RA in the DRG. In summary, our results suggest that BoNT/A significantly attenuates pain-related behavior and microglial activation and restores the neuroimmune balance in a CCI model by decreasing the levels of pronociceptive factors (IL-1β and IL-18) and increasing the levels of antinociceptive factors (IL-10 and IL-1RA) in the spinal cord and DRG.

  18. Facial Blanching After Cosmetic Botulinum Toxin Injection: Case Series.

    Science.gov (United States)

    Warren, Donald; Woody, Meghan; Vickers, Jennifer

    2016-01-01

    Case 1 A 32-year-old woman was treated for the first time with onabotulinumtoxinA (BoNT), receiving 10 units in her forehead and 20 units in her glabella. She reported no history of skin disease and had a very active lifestyle. She first noticed blanching while doing a group workout and a friend inquired if she had "hives" on her forehead (Figure 1). She continued to note the blanching during workouts 5 months after injection. Each episode lasted 30 minutes to 2 hours. There were no associated symptoms with the blanching other than minor embarrassment. Given her active lifestyle and frequent blanching, she has elected not to receive further injections.

  19. Results from the Upper Limb International Spasticity Study-II (ULIS-II): a large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management

    Science.gov (United States)

    Turner-Stokes, Lynne; Fheodoroff, Klemens; Jacinto, Jorge; Maisonobe, Pascal

    2013-01-01

    Objective To describe real-life practice and person-centred outcomes in the treatment of poststroke upper limb spasticity with botulinum toxin A (BoNT-A). Design Observational, prospective study. Setting 84 secondary care centres in 22 countries. Participants 456 adults (≥18 years) with poststroke upper limb spasticity treated with one cycle of BoNT-A. Methods/outcomes Muscle selection, BoNT-A preparation, injection technique and timing of follow-up were conducted according to routine practice for each centre. Primary outcome: achievement of the patient's primary goal for treatment using goal-attainment scaling (GAS). Measurements of spasticity, standardised outcome measures and global benefits were also recorded. Results The median number of injected muscles was 5 (range 1–15) and the most frequently injected muscles were the long finger flexors, followed by biceps and brachioradialis. The median (range) follow-up time was 14 (2.6 to 32.3) weeks. The common primary treatment goals were passive function (132 (28.9%)), active function (104 (22.8%)), pain (61 (13.4%)), impairment (105 (23%)), involuntary movement (41 (9%)) and mobility (10 (2.2%)). Overall, 363 (79.6%) (95% CI 75.6% to 83.2%) patients achieved (or overachieved) their primary goal and 355 (75.4%) (95% CI 71.2% to 79.2%) achieved their secondary goal. Mean (SD) change from baseline in GAS T-scores was 17.6 (11.0) (95% CI 16.4 to 18.8; p<0.001). GAS T-scores were strongly correlated with global benefit and other standard measures (correlations of 0.38 and 0.63, respectively; p<0.001). Conclusions BoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper-limb spasticity following stroke. The study confirms the feasibility of a common international data set to collect systematic prospective data, and of using GAS to capture person-centred outcomes relating to passive and active functions and to pain. Registration ClinicalTrials.gov identifier: NCT

  20. Treatment of inferior lateral pterygoid muscle dystonia with zolpidem tartrate, botulinum toxin injections, and physical self-regulation procedures: a case report.

    Science.gov (United States)

    Vazquez-Delgado, Eduardo; Okeson, Jeffrey P

    2004-10-01

    The following case report depicts the management of a patient suffering with a jaw opening oromandibular dystonia using a combination of botulinum toxin injections, zolpidem, and relaxation procedures. Eventually the botulinum toxin injections were eliminated, and the patient was maintained with only zolpidem and relaxation procedures.

  1. Recurrent TMJ Dislocation Managed with Botulinum Toxin Type A Injections in a Pediatric Patient.

    Science.gov (United States)

    Stark, Thomas R; Perez, Cristina V; Okeson, Jeffrey P

    2015-01-01

    Chronic recurrent temporomandibular joint (TMJ) dislocation is an uncommon condition that is painful and distressing to patients and uniquely challenging for clinicians. Sustained TMJ dislocation is not amenable to manual reduction alone when the etiology is muscular in nature. The purpose of this report was to describe the case of a child presenting with recurring temporomandibular joint dislocation secondary to muscle hyperactivity of unknown etiology that was managed with injections of botulinum toxin type A into the inferior lateral pterygoid muscles. The use of this peripheral antispasmoic neurotoxin is a reasonable, safe, and conservative, palliative treatment option for pediatric patients suffering from chronic recurring TMJ dislocation.

  2. Botulinum Toxin Injections for Simple Partial Motor Seizures Associated with Pain

    Directory of Open Access Journals (Sweden)

    Edward C. Mader

    2012-01-01

    Full Text Available Intractable epilepsy with painful partial motor seizures is a relatively rare and difficult disorder to treat. We evaluated the usefulness of botulinum toxin to reduce ictal pain. Two patients received two or four botulinum toxin (BTX injections at one-to-two-month intervals. Patient 1 had painful seizures of the right arm and hand. Patient 2 had painful seizures involving the left foot and leg. Injections were discontinued after improved seizure control following resective surgery. Both patients received significant pain relief from the injections with analgesia lasting at least two months. Seizure severity was reduced, but seizure frequency and duration were unaffected. For these patients, BTX was effective in temporarily relieving pain associated with muscle contraction in simple partial motor seizures. Our findings do not support the hypothesis that modulation of motor end-organ feedback affects focal seizure generation. BTX is a safe and reversible treatment that should be considered as part of adjunctive therapy after failure to achieve control of painful partial motor seizures.

  3. Distribution of the Toxin following Medial Rectus Muscular Injection of Botulinum Toxin Gel in Rabbits

    Institute of Scientific and Technical Information of China (English)

    Jingchang Chen; Guanghuan Mai; Xinping Yu; Huanyuan Yu; Heping Wu; Xiaoming Lin; Daming Deng; Ying Kang

    2005-01-01

    Purpose: To determine the distribution of the toxin among individual muscles after intramuscular injection of botulinum toxin gel.Methods: One eye of 7 New Zealand white rabbits was randomized into group A, and the contralateral eye was into group B. Eyes in group A received medial rectus intramuscular injection of 2.5 IU of 125I-BTX-A gel in 0.1 ml, and those in group B received equivalent amount of 125I-BTX-A solution by medial rectus intramuscular injection. Four rectus muscles and the levator palpebrae superioris were harvested and the radioactivity of muscles was measured 16 hours after the injection.Results: In group A, the radioactivity of per gram medial rectus was significantly higher than that of other muscles (P < 0.01), and there was no statistically significant difference in the radioactivity of per gram muscles among other muscles (P > 0.05). In group B, the radioactivity of per gram medial rectus and levator palpebrae superioris was significantly higher than that of other muscles respectively(P < 0.05), and the difference in the radioactivity of per gram muscles between medial rectus and levator palpebrae superioris was not statistically significant (P > 0.05). The radioactivity of per gram medial rectus in group A was higher than that in group B (t=3.731 ,P=0.01), and there was no significant difference in the radioactivity of per gram muscles among other homonymous muscles (P > 0.05).Conclusion: The toxin dispersed principally in the injected muscle and the local concentration of the toxin was much high following intramuscular injection of botulinum toxin gel.

  4. A型肉毒素治疗脑卒中康复患者肢体痉挛的护理体会%The Nursing Experience of Botulinum Toxin A in the Treatment of Limb Spasm for Stroke Rehabilitation Patients

    Institute of Scientific and Technical Information of China (English)

    王明霞; 尚小侠; 史盼

    2016-01-01

    目的:探讨A型肉毒素注射治疗肢体痉挛的护理。方法对我科31例脑卒中后肢体痉挛患者进行A型肉毒素注射治疗的临床护理进行回顾性分析。结果31例脑卒中后肢体痉挛患者经A型肉毒素注射治疗,配合适时护理,治疗后均获得良好效果,无严重并发症。结论对患者规范细致周到的护理有助于提高肉毒素注射疗效,减少并发症。%Objective To explore Nursing care of patients with limb spasm treated with botulinum toxin type A injection.Methods The clinical nursing of 31 patients with limb spasm after stroke in our department were retrospectively analyzed with the clinical nursing of A type botulinum toxin injection. Results31 cases of cerebral apoplexy patients with limb spasm were treated with botulinum toxin type A,with timely care,good results were obtained after treatment,no serious complications.Conclusion Careful and meticulous care of patients is helpful to impove the efficacy of botulinum toxin injection and reduce the complications.

  5. Adeno-Associated Virus Transfer of a Gene Encoding SNAP-25 Resistant to Botulinum Toxin A Attenuates Neuromuscular Paralysis Associated with Botulism

    Science.gov (United States)

    2008-04-02

    refinement of the technology for application to genetic disorders of motor neurons. 15. SUBJECT TERMS Clostridium botulinum, neurotoxiin, serotype...peripherally transported transgenic protein successfully substituted for native cleavage-susceptible S25, as demonstrated by enhanced retention of nerve

  6. Intramural Injection with Botulinum Toxin Type A in Piglet Esophagus. The Influencer on Maximum Load and Elongation

    DEFF Research Database (Denmark)

    Pedersen, Mark Ellebæk; Qvist, Niels; Schrøder, Henrik Daa

    2016-01-01

    Introduction The treatment of esophageal atresia (OA) is challenging. The main goal is to achieve primary anastomosis. We have previously demonstrated in a pig model that intramural injection of botulinum toxin type A (BTX-A) resulted in significant elongation of the esophagus during tensioning...

  7. The Effect of Intramural Botulinum Toxin Injections on the Elongation of the Piglet Oesophagus Is Time Dependent

    DEFF Research Database (Denmark)

    Dibbern, Christian Bakholdt; Rose, Morten; Ellebæk, Mark Bremholm

    2017-01-01

    Introduction One in 4,000 infants is born with oesophageal atresia. Approximately 15% of these have a long gap oesophageal atresia, where primary anastomosis is difficult or impossible. Previous studies have shown an effect of intramural botulinum toxin type A (BTX-A) injections on the elongation...

  8. The treatment of drooling by ultrasound-guided intraglandular injections of botulinum toxin type A into the salivary glands.

    NARCIS (Netherlands)

    Jongerius, P.H.; Joosten, F.B.M.; Hoogen, F.J.A. van den; Gabreëls, F.J.M.; Rotteveel, J.J.

    2003-01-01

    OBJECTIVE: The aim of the study was to present the background, procedure, and technique of bilateral ultrasound-guided, single-dose injections of botulinum toxin type A (BTX) into the salivary glands in patients with severe drooling. STUDY DESIGN: Clinical trial. METHODS: Initially, an in vitro stud

  9. Botulinum toxin injection causes hyper-reflexia and increased muscle stiffness of the triceps surae muscle in the rat

    DEFF Research Database (Denmark)

    Pingel, Jessica; Wienecke, Jacob; Lorentzen, Jakob;

    2016-01-01

    and attached to a muscle puller. The resistance of the muscle to stretches of different amplitudes and velocities was systematically investigated. Reflex mediated torque was normalized to the maximal muscle force (Mmax) evoked by supramaximal stimulation of the tibial nerve. Botulinum toxin injection caused...... severe atrophy of the triceps surae muscle at all time points. The force generated by stretch reflex activity was also strongly diminished, but not to the same extent as Mmax at 2 and 4 weeks, signifying a relative reflex hyperexcitability. Passive muscle stiffness was unaltered at 1 week, but increased...... that botulinum toxin is an efficient antispastic medication or that it may prevent development of contractures....

  10. Botulinum Toxin Type a Injection, Followed by Home-Based Functional Training for Upper Limb Hemiparesis after Stroke

    Science.gov (United States)

    Takekawa, Toru; Kakuda, Wataru; Taguchi, Kensuke; Ishikawa, Atsushi; Sase, Yousuke; Abo, Masahiro

    2012-01-01

    Botulinum toxin type A (BoNT-A) has been reported to be an effective treatment for limb spasticity after stroke. However, the reduction in the spasticity after BoNT-A injection alone does not ensure an improvement in the active motor function of the affected limb. The aim of this study was to clarify the clinical effects of a BoNT-A injection,…

  11. Efectos de la toxina botulínica A (Botox® intraarticular en la artrosis de rodilla avanzada Effects of intraarticular Botulinum Toxin A (Botox® on refractory knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    P. Fenollosa Vázquez

    2011-12-01

    Full Text Available Objetivos: la osteoartritis es la enfermedad articular más común y una de los problemas de salud más frecuentes y sintomáticos en la madurez y senectud. Este trabajo describe nuestra experiencia clínica con inyecciones intraarticulares de toxina botulínica tipo A (TBA en dolor de rodilla artrósico y refractario. Materiales y métodos: doce mujeres con gonartrosis avanzada y refractaria, acudieron a consulta para el manejo del dolor de rodilla de moderado a severo. Las pacientes estuvieron en seguimiento 16 semanas, durante las que la mejoría de su estado fue valorado comparando el dolor basal respecto al dolor en el momento de la visita mediante diferentes escalas estandarizadas. Simultáneamente, se evaluaron la funcionalidad, la cantidad de medicación analgésica diaria y los efectos secundarios. Resultados: el consumo de medicación decreció de 3,6 a 2 tomas/día. No se observaron efectos secundarios. Conclusión: se evidenció un alivio del dolor que se inició en la semana 2 y se mantuvo hasta 12 semanas tras la inyección de TBA. La mediana del cambio de la escala total de WOMAC y de la EVA fue de -7,5 y -1,9 respectivamente, con una disminución significativa del dolor a las 16 semanas. No se registraron cambios en la escala WOMAC en 5 pacientes, mientras que 3 casos mostraron un descenso en dicha escala mayor del 20% y los en los 4 restantes fue superior al 40%. Las que respondieron a la infiltración notaron una mejora en las actividades de la vida diaria gracias a este alivio. El consumo de medicación decreció de 3,6 a 2 tomas/día. No se observaron efectos secundarios.Objective: osteoarthritis is the most common joint disease and it is among the most disabling health problems for middle aged and older people. Purpose: to test the effects of a single intraarticular injection of Botulinum Toxin A (BTA on refractory knee osteoarthritis. Material and method: twelve women (mean age: 72 with refractory knee osteoarthritis who

  12. Therapeutic Effects of Botulinum Toxin A at Different Dilutions in Hemifacial Spasm Patients%不同稀释度A型肉毒毒素治疗偏侧面肌痉挛的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王国栋; 赵永波

    2009-01-01

    目的 观察不同稀释度A型肉毒毒素(BTX-A)治疗偏侧面肌痉挛(HFS)的疗效.方法 65例HFS患者随机分为A组(33例)和B组(32例),分别采用25 U/ml和50 U/ml稀释度BTX-A注射治疗.观察两组的BTX-A用量、治疗效果、疗效持续时间及不良反应发生率.结果 A组注射点数为(12±2)点、BTX-A用量为(25±7) U,B组注射点数为(10±1)点、BTX-A用量为(42±9) U,两组注射点数和BTX-A用量间差异均有统计学意义(P<0.05).两组患者治疗效果和疗效持续时间比较差异均无统计学意义(P>0.05).A组共有7例发生不良反应,不良反应发生率为21.21%;B组共有13例发生不良反应,不良反应发生率为40.62%,两组不良反应发生率间差异有统计学意义(χ2=3.47,P<0.05).结论 使用25 U/ml稀释度BTX-A注射治疗HFS与使用50 U/ml稀释度的疗效相似,但可显著减少BTX-A用量和不良反应发生率.%Objective To investigate the therapeutic efficacy of Botulinum Toxin A(BTX-A) at different dilutions on patients with hemifacial spasm(HFS).Methods A total of 65 patients were at random divided as group A (n=33) given injection of 25U/ml BTX-A and group B (n=32) given injection of 50U/ml BTX-A.The BTX-A dosage,therapeutic efficacy,effect lasting time and adverse reaction rate were observed.Results The numbers of injection sites and dosages of BTX-A were (12±2)and (25±7)U in group A,and (10±1) and (42±9)U in group B,respectively,with a significant difference between the two groups (P<0.05).There was no significant difference between the two groups in therapeutic efficacy and effect lasting time (P>0.05).The adverse reaction was found in 7 patients (21.21%) in group A,and in 13 patients (40.63%) (χ2=3.47,P<0.05).Conclusion The therapeutic effects of BTX-A at 25 U/ml dilution are similar to 50 U/ml dilution on HFS by local injection,but with less adverse reaction.

  13. The Effect and Complication of Botulinum Toxin Type A Injection with Serial Casting for the Treatment of Spastic Equinus Foot

    OpenAIRE

    Lee, Sook Joung; Sung, In Young; Jang, Dae Hyun; Yi, Jin Hwa; Lee, Jin Ho; Ryu, Ju Seok

    2011-01-01

    Objective To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot. Method Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed w...

  14. Long-term curative effect of botulinum toxin A(BTXA) on treating spam of eyelid and facial muscle%肉毒杆菌毒素A治疗眼睑及面肌 痉挛远期疗效观察

    Institute of Scientific and Technical Information of China (English)

    田秋霞; 刘元真

    2000-01-01

    Objective To discuss the long-term curative effect of botulinum toxin A(BTXA) for treating spasm of eyelid and facial muscle.Methods Ninty-two patients with spasm of eyelid and facial muscle were treated with BTXA and observed for a long term.Results After being injected with BTXA for 1~4 days, the spasm relieved gradually. Sixteen weeks later, the spasm symptoms relapsed. The relapse began mostly from eyelid spasm. The facial spasm's relief time was longer. lt might be up to 24 weeks. After injection, the patients had some slight complications of facial expression numb, ptosis and fissura palpebrae. The above complication symptoms recovered by themselves after two weeks. Conclusion The curative effect of BTXA on treating spasm of eyelid and facial muscle is reliable.%目的探讨肉毒杆菌毒素A(botulinum A toxin,BTXA)治疗眼睑及面部肌肉痉挛的远期疗效。方法对92例眼睑及面部肌肉痉挛患者用BTXA注射治疗,随诊观察其远期疗效。结果 BTXA注射后1~4d痉挛逐渐缓解,维持16wk左右后症状复发。复发多由眼睑痉挛开始,面部痉挛缓解时间长,可达24wk。注射后可见表情麻木、上睑下垂、睑裂闭合不全等并发症,但均较轻,且2wk后多能自行恢复。结论 BTXA治疗眼睑面部肌肉痉挛疗效确切。

  15. Factors influencing goal attainment in patients with post-stroke upper limb spasticity following treatment with botulinum toxin A in real-life clinical practice: sub-analyses from the Upper Limb International Spasticity (ULIS)-II Study.

    Science.gov (United States)

    Fheodoroff, Klemens; Ashford, Stephen; Jacinto, Jorge; Maisonobe, Pascal; Balcaitiene, Jovita; Turner-Stokes, Lynne

    2015-04-08

    In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A) treatment in 456 adults with post-stroke upper limb spasticity (ULS). Patients with primary goals categorised as passive function had greater motor impairment (p 1 year)) post-stroke (80.0% vs. 79.2%) or presence or absence of severe contractures (76.7% vs. 80.6%), although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

  16. Changes of muscle induced with injection of botulinum toxin type A in different period of time%A型肉毒毒素肌内注射后不同时间段肌肉改变的观察

    Institute of Scientific and Technical Information of China (English)

    汪灏; 李森恺; 杨明勇; 李养群; 李强; 王伊宁; 鲍世威

    2012-01-01

    Objective To study the changes of muscle being injected with botulinum toxin A in different period of time,helping for chemically denervated muscle transplantation.Methods Sixteen rabbits were divided into 4 groups.The extensor carpi radialis muscle in one side was chosen for experimental group with the opposite muscle for control group.Morphological changes,histological changes and electron microscopic changes of muscle being injected with botulinum toxin A were observed from the first week to the fouth week.Results The quantity of glycogen and mitochondria in the muscles reduced in the first week.But it was obvious in the third week.We also found some necrotic areas in the fouth week with the muscles restoring.Conclusions The effect of metabolism slowing down and the volume of muscle reducing after botulinum toxin A injection is obvious in third weeks.It could help us choose the best time of chemically denervated muscle transplantation.%目的 通过对A型肉毒毒素肌内注射后不同时间段肌肉的改变进行观察,了解肉毒毒素对肌肉的改变过程,并为化学去神经肌肉游离移植提供理论依据.方法 对16只活体兔桡侧腕伸肌进行肉毒毒素注射,分为4组(即1、2、3、4周组),每组4个肌肉,躯体对侧作为对比.分别在注射后1~4周进行大体观察,以及组织学和电镜观察.结果 药物注射后1周,肌内酶、糖原和线粒体都开始减少,体积的减少在3周左右明显,4周后肌酶的减少更加明显,并且内部区域有坏死灶,但体积较前有所恢复.结论 A型肉毒毒素肌内注射后可以减缓肌肉代谢和缩小肌肉体积,其中以第3周最为明显,可以为化学去神经肌肉游离移植的时间选择提供参考.

  17. Long-Term Efficacy and Safety of Botulinum Toxin Injections in Dystonia

    Directory of Open Access Journals (Sweden)

    Juan Ramirez-Castaneda

    2013-02-01

    Full Text Available Local chemodenervation with botulinum toxin (BoNT injections to relax abnormally contracting muscles has been shown to be an effective and well-tolerated treatment in a variety of movement disorders and other neurological and non-neurological disorders. Despite almost 30 years of therapeutic use, there are only few studies of patients treated with BoNT injections over long period of time. These published data clearly support the conclusion that BoNT not only provides safe and effective symptomatic relief of dystonia but also long-term benefit and possibly even favorably modifying the natural history of this disease. The adverse events associated with chronic, periodic exposure to BoNT injections are generally minor and self-limiting. With the chronic use of BoNT and an expanding list of therapeutic indications, there is a need to carefully examine the existing data on the long-term efficacy and safety of BoNT. In this review we will highlight some of the aspects of long-term effects of BoNT, including efficacy, safety, and immunogenicity.

  18. Botulinum toxin in the treatment of sialorrhea

    Directory of Open Access Journals (Sweden)

    Svetel Marina

    2009-01-01

    Full Text Available Background/Aim. Botulinum toxin-A (BTX-A is known to block the release of acetylcholine from motor and autonomic nerve terminals and may significantly decrease saliva production when injected intraglandulary. The aim of this study was to evaluate effects of BTX-A injections in the treatment of disabling sialorrhea in various neurological disorders. Methods. This study included 19 consecutive patients with significant sialorrhea associated with various neurological disorders. Out of them 13 patients were with Parkinson's disease, two with pantothenate kinase-associated neurodegeneration, two with multiple system atrophy, one with Wilson's disease, and one patient with postoperative sialorrhea. Botulinum toxin-A (Dysport®, Ipsen Pharma was injected into the parotid glands with (n = 7 patients or without (n = 12 patients ultrasound guidance. All the patients were scored before and after the treatment and in weekly intervals thereafter using the salivation item of the part II (Activities of Daily Living of the Unified Parkinson's Disease Rating Scale (UPDRS. Results. Thirteen patients (68% reported beneficial effect of BTX-A injection, while 6 of them (32% had no response at all. The sialorrhea scores before and after the treatment were 3.1 ± 0.1 (range 2-4 and 1.8 ± 0.1 (range 0- 3, respectively (t = 5.636; p < 0.001. There was no difference in the magnitude of response between the groups with (t = 4.500; p = 0.004 and without (t = 3.674; p = 0.005 ultrasound control of injection sites. Adverse effects were registered in 5 patients (26%. Conclusions. Botulinum toxin-A injections to easily accessible parotid glands, without necessity for ultrasound guidance, are safe and efficaceous treatment for sialorrhea in different neurological disorders.

  19. Injection of botulinum toxin for the treatment of post-laryngectomy pharyngoesophageal spasm-related disorders

    Science.gov (United States)

    Lightbody, KA; Wilkie, MD; Kinshuck, AJ; Gilmartin, E; Lewis-Jones, H; Jones, TM; Lancaster, J

    2015-01-01

    Introduction Pharyngoesophageal spasm (PES) can cause dysphagia, central valve leak (CVL), and dypshonia in post-laryngectomy patients. Botulinum toxin has been used effectively for the treatment of PES, but data regarding patient-reported outcomes and efficacy for CVL are limited. We evaluated the results of botox injection for PES spasm using subjective and objective measures. Methods Data were collected prospectively (February 2010 to August 2013) on 13 patients undergoing botox injection for PES as identified by video fluoroscopy. We collected digital voice recordings, air-pressure measurements (APMs) for speech, and quality of life (QoL) data before and after the procedure: University of Washington QoL questionnaire (UW-QoL), MD Anderson Swallowing Inventory (MDADI) and the Voice Handicap Index (VHI-30). Results APMs for a sustained vowel decreased by 18% after botox injection, whereas maximum phonatory times increased by 63% (mean increase, 8 to 13 seconds). Sustained vowel amplitude decreased (mean, 87db to 83db) with an associated reduction in sustained vowel frequency (117Hz to 77Hz). MDADI scores improved by 10.2% overall, and UW-QoL scores showed an improvement in score of 7.6%. Mean scores for VHI-30 deteriorated by 2% overall but, when considering only those patients experiencing dysphonia, an improvement of 9.4% was seen. There was an overall net reduction for the CVL cohort of 12 speech valves in the year after injection. Conclusions Our series confirm the safety and objective efficacy of botox injection for PES. QoL measurements were less convincing, and this disparity between subjective and objective measurements must be considered when treating such patients. PMID:26414361

  20. Effect of botulinum toxin A combined with plaster cast on gross motor function of spasmodic double paralysis%A 型肉毒毒素联合石膏固定对痉挛型双瘫患儿粗大运动功能影响的疗效观察

    Institute of Scientific and Technical Information of China (English)

    蔡慧强; 彭桂兰; 胡恕香; 蔡淑英

    2016-01-01

    目的:观察 A 型肉毒毒素联合石膏固定对痉挛型双瘫患儿粗大运动功能的影响。方法2013年1月至2014年10月厦门市妇幼保健院儿童神经康复科收治住院的痉挛型双瘫患儿40例,随机分为观察组和对照组各20例。对照组单纯采用 A 型肉毒毒素注射后进行康复训练;观察组采用 A 型肉毒毒素注射联合石膏固定3周,拆除石膏后进行康复训练,分别于治疗前及治疗后1、3、6个月采用粗大运动功能量表(GMFM-88)D 区和 E 区进行评估。结果观察组治疗后1、3、6个月 GMFM-88 D 区、E 区与治疗前比较差异有统计学意义(P <0.01)。对照组治疗后3、6个月 GMFM-88 D 区、E 区与治疗前比较差异有统计学意义(P <0.01)。观察组治疗后1、3、6个月 GMFM-88 D 区、E 区与对照组比较差异有统计学意义(P <0.01)。结论A 型肉毒毒素注射联合石膏固定治疗痉挛型双瘫患儿尖足畸形,可降低肌张力,改善运动功能,有效提高粗大运动功能,比单纯采用 A 型肉毒毒素治疗疗效更好。%Objective To explore the effect of botulinum toxin A combined with plaster cast on the gross motor function of spasmodic double paralysis.Methods A total of 40 children with spasmodic double paralysis hospitalized in Xiamen Maternal and Child Healthcare Hospital from Jan.2013 to Oct.2014 were included in the study,and they were randomly divided into two groups:observation group(20 cases)and control group(20 cases).Control group was treated only with botulinum toxin A injection followed by reha-bilitation training.Observation group was given with botulinum toxin A combined with 3 weeks of plaster cast,and then rehabilitation training was carried out after removing the plaster.GMFM-88 was used to make evaluation of zone D and zone E before treatment and 1,3 and 6 months after treatment.Results Zone D and E was different 1,3 and 6 months after treatment by GMFM-88 in the observation group

  1. Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: a randomized controlled trial

    OpenAIRE

    Sun, Shu-Fen; Hsu, Chien-Wei; Lin, Huey-Shyan; Chou, Yi-Jiun; Chen, Jun-Yang; Wang, Jue-Long

    2014-01-01

    Background There was an increasing requirement for novel treatments of osteoarthritis (OA). The aim was to compare the efficacy of intraarticular Botulinum toxin type A (BoNT-A) and intraarticular hyaluronate plus rehabilitation exercise in patients with ankle OA. Methods This was a prospective, randomized, assessor-blinded study with a 6-month follow-up period, conducted in the outpatient rehabilitation department at a university-affiliated tertiary care medical center. Seventy-five patients...

  2. Intramuscular nerve distribution patterns of anterior forearm muscles in children: a guide for botulinum toxin injection.

    Science.gov (United States)

    Yang, Fangjiu; Zhang, Xiaoming; Xie, Xiadan; Yang, Shengbo; Xu, Yan; Xie, Peng

    2016-01-01

    Botulinum toxin (BoNT) can relieve muscle spasticity by blocking axon terminals acetylcholine release at the motor endplate (MEP) and is the safest and most effective agent for the treatment of muscle spasticity in children with cerebral palsy. In order to achieve maximum effect with minimum effective dose of BoNT, one needs to choose an injection site as near to the MEP zone as possible. This requires a detailed understanding about the nerve terminal distributions within the muscles targeted for BoNT injection. This study focuses on BoNT treatment in children with muscle spasms caused by cerebral palsy. Considering the differences between children and adults in anatomy, we used child cadavers and measured both the nerve entry points and nerve terminal sense zones in three deep muscles of the anterior forearm: flexor digitorum profundus (FDP), flexor pollicis longus (FPL), and pronator quadratus (PQ). We measured the nerve entry points by using the forearm midline as a reference and demonstrated intramuscular nerve terminal dense zones by using a modified Sihler's nerve staining technique. The locations of the nerve entry points and that of the nerve terminal dense zones in the muscles were compared. We found that all nerve entry points are away from the corresponding intramuscular nerve terminal dense zones. Simply selecting nerve entry points as the sites for BoNT injection may not be an optimal choice for best effects in blocking muscle spasm. We propose that the location of the nerve terminal dense zones in each individual muscle should be used as the optimal target sites for BoNT injection when treating muscle spasms in children with cerebral palsy.

  3. Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique.

    Science.gov (United States)

    Guarda-Nardini, Luca; Stecco, Antonio; Stecco, Carla; Masiero, Stefano; Manfredini, Daniele

    2012-04-01

    A randomized controlled trial was performed to compare the short-term effectiveness of botulinum toxin injections and physiatric treatment provided by means of Fascial Manipulation techniques in the management of myofascial pain of jaw muscles. Thirty patients with a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis of myofascial pain were randomized to receive either single-session botulinum toxin injections (Group A) or multiple-session Fascial Manipulation (Group B). Maximum pain levels (VAS ratings) and jaw range of motion in millimeters (maximum mouth opening, protrusion, right and left laterotrusion) were assessed at baseline, at the end of treatment, and at a three-month follow-up. Both treatment protocols provided significant improvement over time for pain symptoms. The two treatments seem to be almost equally effective, Fascial Manipulation being slightly superior to reduce subjective pain perception, and botulinum toxin injections being slightly superior to increase jaw range of motion. Differences between the two treatment protocols as to changes in the outcome parameters at the three-months follow-up were not relevant clinically. Findings from the present investigation are in line with literature data supporting the effectiveness of a wide spectrum of conservative treatment approaches to myofascial pain of the jaw muscles. Future studies on larger samples over a longer follow-up span are needed on the way to identify tailored treatment strategies.

  4. Botulinum toxin type A-a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study

    DEFF Research Database (Denmark)

    Petersen, Christina Damsted; Giraldi, Annamaria; Lundvall, Lene

    2009-01-01

    to receive Botox (N = 32) or saline placebo (N = 32). Botulinum toxin A (20 I.E.) diluted in 0.5 mL saline or 0.5 mL saline was injected in the musculus bulbospongiosus at baseline. MAIN OUTCOME MEASURES: Pain was measured monthly on a visual analog scale (VAS) Likert scale. Sexual function was measured...

  5. The changes of serum proteome and tissular pathology in mouse induced by botulinum toxin E injection.

    Science.gov (United States)

    Wang, J F; Mao, X Y; Zhao, C

    2014-01-01

    The experiment were performed to investigate the poisoning-related proteins and main pathological changes after mouse suffered from injection of botulinum toxin serotype E. Dose of 0.75 LD50 botulinum toxin serotype E per mice were administrated by intraperitoneal injection. Survival mouse were picked as experimental group. The blood were collected from orbital blood and serum sample was separated by centrifugation. The heart, liver, spleen, lung, kidney were fixed in 10 % neutral buffered formalin and then developed paraffin sections. Serum protein components were analyzed by SDS-PAGE gel electrophoresis coupled with 2-DE SDS-PAGE gel electrophoresis. Differentially expressed proteins were analyzed by PDQUest8.0 software and subjected to ion trap mass spectrometry equipped with a high performance liquid chromatography system. The observation of pathological section showed that heart, liver, spleen, lung, kidney exhibited pathological changes in different degree, especially in heart, liver and lung tissues. Heart muscle tissue display serious inflammatory response, heart muscle fiber compulsively expanded and filled with erythrocyte and inflammatory exudates, some heart muscle fiber ruptured, even necrosis; hepatic cell in edge of liver occur apoptosis and some hepatic cell have disintegrated, and even died; pulmonary alveoli broken and partial vein filled with blood. Serum proteins component present a significant changes between control serum and botulism in 24 h by SDS-PAGE gel electrophoresis and 2-DE-SDS-PAGE gel electrophoresis. Twenty differentially expressed protein spots were observed in 2-DE profiles, in which 14 protein spots were undetectable in serum proteome under botulism, 3 protein spots exclusively expressed in state of botulism, 3 protein spots were low-expressed in serum proteome under botulism. Fourteen proteins have been identified among 20 spots elected on two-dimensional electrophoresis gels. Crystal proteins family exclusively expressed in

  6. A literature review on the efficacy and safety of botulinum toxin: An injection in post-stroke spasticity

    Directory of Open Access Journals (Sweden)

    Majid Ghasemi

    2013-01-01

    Full Text Available Background: A variety of techniques for the management of spasticity have been suggested, including positioning, cryotherapy, splinting and casting, biofeedback, electrical stimulation, and medical management by pharmacological agents, Botulinum toxin A (BTA is now the pharmacological treatment of choice in focal spasticity. BTA by blocking acetylcholine release at neuromuscular junctions accounts for its therapeutic action to relieve spasticity. Methods: A computerized search of Pub Med was carried out to find the latest result about efficacy of BTA in management of post stroke spasticity. Result: Among 84 articles were found, frothy of them included in this review and divided to lower and upper extremity. Conclusions: BTA is a treatment choice in reducing tone and managing post stroke spasticity .

  7. A型肉毒毒素注射治疗眼睑及面肌痉挛的效果与护理%Effect and nursing of botulinum toxin type A injection treatment of blepharospasm and hemifacial spasm

    Institute of Scientific and Technical Information of China (English)

    刘敬楠; 董桂霞

    2010-01-01

    Objective To observe the effect of botulinum toxin type A injection treatment of blepharospasm and hemifacial spasm. Methods One hundred and five patients with blepharospasm and hemifacial spasm were given botulinum toxin A injecting on local face, the effect was analyzed. And mental nursing, injection nursing and health education were performed. Results After telephone follow-up or return visit, 105 cases were effective in 1 to 3 days on average (1.1 ±0.5) days; complete remission in 64 cases (60.95% ), apparent relieved in 28 cases (26.67%), partial remission in 6 cases (5.71% ). No systemic toxicity and allergic reactions occurred. Local side effects were minor and short. Conclusions Botulinum toxin A can effectively control blepharospasm and hemifacial spasm by injecting a little dose on local muscle. Attentive nursing measures were important to reduce physical and mental suffering for patients.%目的 探讨小剂量A型肉毒毒素多点注射治疗眼睑及面肌痉挛的临床疗效、安全性及护理方法.方法 105例眼睑及面肌痉挛患者,给予小剂量A型肉毒毒素多点注射治疗,进行复诊或电话随访,记录复诊、电话随访的临床指标,并给予心理护理、注射护理和健康教育.结果 经过电话随访或复诊,105例患者均在1~3 d内显效,平均(1.1±0.5)d;完全缓解64例(60.95%),明显缓解28例(26.67%),部分缓解6例(5.71%).无全身中毒及过敏反应,局部不良反应轻微、短暂.结论 小剂量A型肉毒毒素多点注射治疗眼睑及面肌痉挛的临床疗效确切,安全性较高,针对患者给予细心周到的护理,对患者康复、减轻其身心痛苦具有重要意义.

  8. Análise vocal em pacientes com disfonia espasmódica nos momentos pré e pós tratamento com toxina Botulínica A Vocal analysis in patients with spasmodic dysphonia before and after treatment with Botulinum toxin A

    Directory of Open Access Journals (Sweden)

    Ana Cristina Côrtes Gama

    2012-10-01

    the parameters. CONCLUSION: there was significant improvement of the vocal analysis after treatment and, therefore, injections of botulinum toxin A were effective in the treatment of spasmodic dysphonia in this group.

  9. Intragastric injection of botulinum toxin for the treatment of obesity. Where are we?

    Institute of Scientific and Technical Information of China (English)

    Diego Garcia-Compean; Hector Maldonado Garza

    2008-01-01

    Obesity has reached epidemic proportions particularly in western countries. Most non-surgical treatments of this condition are disappointing. Since 2005, several studies evaluating the effect of Botulinum Toxin type A (BT-A) in gastric antrum by means of endoscopy for the treatment of obesity have been published. This treatment modality was based on the observation that gastric injection of BT-A in laparatomized rats induced a significant reduction of food intake and body weight. Nowadays, 6 studies have been published yielding conflicting results. Differences in selection of patients, doses of BT-A, method of administration of the toxin and instruments of evaluation of some parameters among these studies may be the cause of divergent results. We discuss herein some important features of these studies pointing out on differences among them. At the same time, based on the knowledge of physiological characteristics of normal and abnormal gastric function related with feeding, we discuss the probable causes of failure observed in these trials. Finally, we give some guidelines concerning the way that future research in this field may follow, not without calling attention to disadvantages of this treatment.

  10. A prospective study of the use of botulinum toxin injections in the treatment of Raynaud's syndrome associated with scleroderma.

    Science.gov (United States)

    Uppal, L; Dhaliwal, K; Butler, P E

    2014-10-01

    Raynaud's syndrome contributes to the pain, paraesthesia, ulceration, and gangrene of scleroderma. Botulinum toxin has been shown to improve digital perfusion in patients with Raynaud's. This is the first study to objectively assess hand function following this treatment in patients with scleroderma. Twenty patients were treated with 100 units of botulinum toxin injected into the hand. An assessment of hand function and symptoms was performed prior to injection and then 8-12 weeks later. The outcomes assessed were change in pain, appearance, cold intolerance, pinch and power grip, ranges of movement, and Disabilities of the Arm, Shoulder and Hand (DASH) score. In total, 80% of patients reported an overall improvement in their symptoms, reduction in pain, and improved DASH score and 65% reported improvement in cold intolerance. Overall, 90% showed an improvement in pinch grip and 65% an improvement in power grip. Objective parameters were statistically significantly improved; however, subjective outcomes only showed a trend. We have found botulinum toxin to be an effective treatment for Raynaud's syndrome secondary to scleroderma.

  11. Effect of a clown’s presence at botulinum toxin injections in children: a randomized, prospective study

    Directory of Open Access Journals (Sweden)

    Hansen LK

    2011-09-01

    Full Text Available Lars Kjaersgaard Hansen1, Maria Kibaek1, Torben Martinussen2, Lene Kragh3, Mogens Hejl11Department of Paediatrics, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense; 2Roskilde Hospital, Roskilde; 3Department of Statistics, University of Southern Denmark, Odense, DenmarkBackground: The effect of the presence of a hospital clown during pediatric procedures has rarely been evaluated. In a pediatric ward, botulinum toxin injection is a painful procedure and a stressful experience for the child. We undertook a study of the effect of the presence of a hospital clown on children treated with botulinum toxin in an outpatient setting.Methods: In total, 60 children, the majority of whom had spastic cerebral palsy, were subjected to a total of 121 botulinum toxin treatment sessions. Thirty-two children were being treated for the first time. During a 2-year period, we enrolled 121 treatment sessions prospectively, and the children were randomized to either the presence of a female clown during treatment or to no presence of a clown. The duration of the child's crying during the procedure was used as an indicator of the effect of the presence of a clown.Results: The effect of the clown was significantly related to patient gender. Girls were found to have a significantly shorter period of crying when the clown was present. For children younger than 8 years, the effect on boys was negative. Children treated for the first time did not appear to benefit from the presence of the clown, and showed no difference in effect between genders.Conclusion: No effect of the clown was documented for children being treated for the first time. At repeat treatments, we saw a positive effect of the female clown in relation to girls, and a negative effect on boys younger than 8 years of age.Keywords: clown, injections, pain, botulinum toxin

  12. Lower facial remodeling with botulinum toxin type A for the treatment of masseter hypertrophy*

    OpenAIRE

    Klein,Fernanda Homem de Mello de Souza; Brenner,Fabiane Mulinari; Sato,Maurício Shigeru; Robert,Fernanda Manfron Batista Rosas; Helmer, Karin Adriane

    2014-01-01

    BACKGROUND: Masseter hypertrophy has been treated with botulinum toxin injections because of esthetic complaints especially in Asians. OBJECTIVES: The goal of the present study was to evaluate the efficacy of abobotulin toxin use in masseter hipertrophy treatment in Brazilians. METHODS: Ten Brazilian female patients with masseter hypertrophy were subjected to injections of 90U of abobotulinum toxin A applied on each side respecting the safety zone stabilished in literature and were followed u...

  13. Botulinum toxin A and physiotherapy intervention in the treatment of the painful shoulder after stroke: case report
    Toxina botulínica A e intervenção fisioterapêutica no tratamento do ombro doloroso pós acidente vascular cerebral: relato de caso

    OpenAIRE

    Suellen M. Marinho dos Santos Andrade; Mayara Dinamine França Dantas; Cristina Katya Dantas Torres; Karen Lúcia de Araújo Freitas Moreira

    2007-01-01

    The syndrome of the painful shoulder is considered a common finding in patients who suffered stroke. Several therapeutic modalities are suggested for the improvement of the patients’ clinical condition. In this report, a case of syndrome of the painful shoulder will be discussed, whose treatment consisted of the use of botulinum toxin A associated to physiotherapy. After a four-month treatment, significant improvements occurred concerning pain, spasticity, range of motion and quality of life,...

  14. Efficacy of two injection-site localisation techniques for botulinum toxin injections: a single-blind, crossover, randomised trial protocol among adults with hemiplegia due to stroke

    Science.gov (United States)

    Morel, Claire; Hauret, Isabelle; Andant, Nicolas; Bonnin, Armand; Pereira, Bruno; Coudeyre, Emmanuel

    2016-01-01

    Introduction Botulinum toxin injections are an effective treatment for limb spasticity following stroke. Different tracking techniques are used for this purpose: palpation, electrostimulation, electromyography and ultrasound. Yet very few studies have compared these different techniques, and none has successfully proved the superior efficacy of ultrasound-guided injections compared to another tracking method. The primary objective of our study was therefore to compare the efficacy of botulinum toxin injections depending on the tracking technique used: ultrasound versus electrostimulation. Methods and analysis This is a clinical, single-centre, prospective, interventional, single-blind, crossover, randomised trial. In total, 30 patients aged between 18 and 80 years presenting with triceps surae spasticity (evaluated >1 on the modified Ashworth scale) associated with hemiplegia sequelae due to stroke will be included. The patients will be selected among those who attend for consultation the Physical Medicine and Rehabilitation Department of the Clermont-Ferrand University Hospital. One group will receive the abobotulinumtoxinA (BoNT-A) injection guided by electrostimulation then ultrasound, and the second group's botulinum toxin injections will be guided by ultrasound then electrostimulation. For each patient, the duration of study participation is 5 months. The primary end point is variation in passive ankle dorsiflexion range of motion at slow and high speeds (Tardieu scale) with the knee straight. Ethics and dissemination This study received ethics approval form the CPP of Rhônes-Alpes region. Results will be published in a peer-reviewed journal. Trial registration number NCT01935544; pre-results. PMID:27852706

  15. Botulinum toxin improves reduced dorsiflexion after Achilles tendon surgery.

    Science.gov (United States)

    Reuter, Iris; Lorbach, Olaf; Mehnert, Sabine; Kaps, Manfred; Engelhardt, Martin

    2010-02-01

    Generally, outcome after surgical repair of complete Achilles tendon rupture is good. However, some patients have ongoing problems with dorsiflexion of the ankle joint. We report on eight patients, who did not achieve heel contact because of reduced ankle dorsiflexion 5 months after surgical repair of complete Achilles tendon rupture. All patients received at least three cycles of injections with 200-300 units of Botulinum toxin A (BOTOX) into the gastrocnemius and soleus muscle. Weakening of the triceps surae by Botulinum toxin allowed patients to perform the required exercises and to tolerate casting at night. Thus, all patients were able to tolerate plantigrade foot position 9 months after beginning of Botulinum toxin treatment. At final follow-up after 2 years, pain had significantly improved, and a mean dorsiflexion of 21 degrees was reached. In conclusion, treatment of the calf muscles with BOTOX is a safe and effective method to improve restricted dorsiflexion in patients after Achilles tendon repair.

  16. The therapeutic effect comparative study of botulinum toxin A and baclofen in hemifacial spasm%A型肉毒毒素与巴氯芬治疗偏侧面肌痉挛的疗效对比

    Institute of Scientific and Technical Information of China (English)

    辛晋敏

    2012-01-01

    Objective To compare the therapeutic effect of local injection of botulinum toxin A (BTXA) and oral baclofen in hemifacial spasm (HFS).Methods Sixty-six patients with HFS were divided into BTXA treatment group (33 patients) and baclofen treatment group (33 patients) by random digits table.The patients in BTXA treatment group was given local multipoint target muscle injection of BTXA,and the patients in baclofen treatment group was given oral baclofen.The therapeutic effect was assessed after treatment of 2 weeks and 4 weeks.Results The scores of spasticity before treatment had no significant difference between two groups (P > 0.05).After treatment of 2 weeks and 4 weeks,the scores of spasticity in BTXA treatment group and baclofen treatment group were significantly decreased [BTXA treatment group:(1.80 ±0.70),(1.57 ± 0.17) scores vs.(3.15 ±0.43) scores;baclofen treatment group:(2.14 ±0.60),(1.14 ± 0.70) scores vs.(3.00 ± 0.48) scores] (P < 0.01).The scores of spasticity in BTXA treatment group after treatment of 2 weeks and 4 weeks were significantly lower than those in baclofen treatment group (P <0.05 or <0.01).After treatment of 4 weeks,the grades of spasticity between two groups had significant difference (P <0.05).The rate of adverse reaction in BTXA treatment group [15.15% (5/33)] was significantly lower than that in baclofen treatment group [51.52% (17/33)] (P < 0.01).Conclusions Local injection of BTXA and low dose oral baclofen in treatment of HFS can reach the obvious relief.But BTXA treatment has rapid onset,Iess adverse reaction and high compliance of the patients,and also symptoms improve more completely after BTXA treatment.BTXA can be used as preferred method of treating HFS.%目的 比较局部注射A型肉毒毒素(BTXA)与口服巴氯芬治疗偏侧面肌痉挛(HFS)的效果.方法 将2010年7月至2012年6月确诊HFS患者66例按随机数字表法分为BTXA治疗组和巴氯芬治疗组,对BTXA治疗组33例患者进行

  17. No Decrease in Muscle Strength after Botulinum Neurotoxin-A Injection in Children with Cerebral Palsy

    Science.gov (United States)

    Eek, Meta N.; Himmelmann, Kate

    2016-01-01

    Spasticity and muscle weakness is common in children with cerebral palsy (CP). Spasticity can be treated with botulinum neurotoxin-A (BoNT-A), but this drug has also been reported to induce muscle weakness. Our purpose was to describe the effect on muscle strength in the lower extremities after BoNT-A injections in children with CP. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion. Twenty children with spastic CP were included in the study, 8 girls and 12 boys (mean age 7.7 years). All were able to walk without support, but with increased muscle tone interfering with motor function and gait pattern. Sixteen children had unilateral spastic CP and four bilateral spastic CP. Twenty-four legs received injections with BoNT-A in the plantar flexor muscles. The children were tested before treatment, around 6 weeks after at the peak effect of BoNT-A, and at 6 months after treatment, with measurement of muscle strength, gait analysis, and range of motion. There were no differences in muscle strength in plantar flexors of treated legs at peak effect compared to baseline. Six months after treatment, there was still no change in untreated plantar flexor muscles, but an increasing trend in plantar flexor strength in legs treated with BoNT-A. Parents reported positive effects in all children, graded as: small in three children, moderate in eight, and large in nine children. The gait analysis showed a small improvement in knee extension at initial contact, and there was a small increase in passive range of motion for ankle dorsiflexion. Two children had a period with transient weakness and pain. We found that voluntary force production in plantar flexor muscles did not decrease after BoNT-A, instead there was a trend to increased muscle strength at follow-up. The increase may be explained as an effect of the blocking of involuntary nerve impulses, leading to an opportunity to using and training the muscles with voluntary control. Adequate

  18. Accuracy of Ultrasound-Guided and Non-ultrasound-Guided Botulinum Toxin Injection Into Cadaver Salivary Glands

    Science.gov (United States)

    2017-01-01

    Objective To compare the accuracy of ultrasound (US)-guided and non-US-guided botulinum toxin (BTX) injection into the salivary glands (parotid and submandibular glands) of cadavers. Methods Two rehabilitation physician injected dye into three sites in the salivary glands (two sites in the parotid gland and one site in the submandibular gland) on one side of each cadaver (one was injected on the right side, while the other was injected on the left side), using either a non-US-guided injection procedure based on superficial landmarks or a US-guided procedure. Orange dye was used for the US-guided procedure, and green dye was used for the blind procedure. Two physicians uninvolved with the injection procedures and who were blinded to the method of injection dissected the cadavers to identify whether the dye was accurately injected into each target site. Results The accuracies of the blind and US-guided injections into the parotid gland were 79.17% and 95.83%, respectively. In the submandibular gland, the accuracies of the blind and US-guided injections were 50.00% and 91.67%, respectively. The difference in accuracy between the two procedures was statistically significant only in the submandibular gland (p=0.025). There were no significant differences in the accuracy of US-guided and non-US-guided injections between the two physicians for the two sites in the parotid gland (p=0.278 and p=0.146, respectively). Conclusion US-guided BTX injection into the submandibular gland offers significantly greater accuracy over blind injection. For the treatment of drooling by injecting BTX into the submandibular gland, clinicians should consider using US guidance for improved accuracy. PMID:28289635

  19. Outcomes of Botulinum Toxin Type A Injection Followed by Rehabilitation in Cases of Cerebral Palsy With Upper Extremity Involvement.

    Science.gov (United States)

    Karaca, Burcu; Ünlü, Ece; Köse, Gülşen; Gönen, Emel; Çakcı, Aytül

    2016-03-01

    We evaluated the efficiency of botulinum toxin type A injection followed by a rehabilitation program including individual therapy, group therapy, and occupational therapy in cases of cerebral palsy with upper extremity involvement. A total of 29 injections were performed on 25 patients, and the patients were placed on rehabilitation program. At 3-month and 6-month assessments, there was a significant improvement in lateral grip strength, 9 Hole Peg test, Upper Limb Physician's Rating Scale and pediatric functional independence measure total scores. There were significant decreases in active range of motion in elbow extension, supination, and wrist extension, and Modified Ashworth Scale in elbow flexion, elbow pronation, and wrist flexion at 6-week, 3-month, and 6-month assessments. Combination of group therapy with traditional therapy methods after injection is effective in cases of cerebral palsy with upper extremity involvement.

  20. Simplified technique for injection of Botulinum Toxin to Obturator Internus muscle using ultrasound‐guided nerve stimulation for persistent pelvic pain

    OpenAIRE

    Evans, Susan Florence; Porter, Justin Matthew

    2015-01-01

    Botulinum toxin (BoNT) injections have been used to reduce muscle spasm in the presence of severe pelvic pain. However, while pubococcygeus is easily accessed vaginally, injection to obturator internus is more complex – with variation in operative technique and needle placement confounding the ability to assess outcomes. We describe a simplified technique for BoNT injection to obturator internus using neurostimulation under ultrasound guidance.

  1. Botulinum toxin in gastric submucosa reduces stimulated HCl production in rats

    Directory of Open Access Journals (Sweden)

    Panunzi Simona

    2003-09-01

    Full Text Available Abstract Background Botulinum toxin blocks acetylcholine release from nerve endings and acts as a long term, reversible inhibitor of muscle contraction as well as of salivary, sweat gland, adrenal and prostatic secretions. The aim of the present study is to investigate whether gastric submucosal injection of botulinum toxin type A reduces stimulated gastric production of HCl. Methods Sixty-four rats were randomized in two groups and laparotomized. One group was treated with botulinum toxin-A 10 U by multiple submucosal gastric injections, while the second group was injected with saline. Two weeks later, acid secretion was stimulated by pyloric ligation and acid output was measured. Body weight, food and water intake were also recorded daily. Results HCl production after pyloric ligation was found to be significantly lower in botulinum toxin-treated rats (657 ± 90.25 micromol HCl vs. 1247 ± 152. P = 0.0017. Botulinum toxin-treated rats also showed significantly lower food intake and weight gain. Conclusions Botulinum toxin type A reduces stimulated gastric acidity. This is likely due either to inhibition of the cholinergic stimulation of gastric parietal cells, or to an action on the myenteric nervous plexuses. Reduction of growth and food intake may reflect both impaired digestion and decreased gastric motility.

  2. Age-related botulinum toxin effects on muscle fiber conduction velocity in non-injected muscles

    NARCIS (Netherlands)

    Lange, Fiete; van Weerden, Tiemen W.; van der Hoeven, Johannes H.

    2007-01-01

    Objective: We studied systemic effects of botulinum toxin (BTX) treatment on muscle fiber conduction velocity (MFCV) and possible effects of age. Methods: MFCV was determined by an invasive EMG method in the biceps brachii muscle. Seventeen BTX treated patients and 58 controls were investigated. BTX

  3. A STUDY OF VOICE CHANGES IN SPASMODIC DYSPHONIA AFTER BOTULINUM THERAPY

    Directory of Open Access Journals (Sweden)

    Sanajeet Kumar

    2016-03-01

    Full Text Available BACKGROUND Spasmodic dysphonia is a neurological disorder, which can give the voice a strained quality. There is currently no cure for spasmodic dysphonia. The most common treatment for spasmodic dysphonia is the injection of botulinum toxin. METHODS Botulinum toxin A injection was performed in 10 patients with adductor spasmodic dysphonia. Voice handicap index scoring and voice analysis was done pre- and post-injection. Fundamental frequency, standard deviation of fundamental frequency, jitter, shimmer, mean phonation time and voice noise energy was studied in voice analysis. These voice parameters were measured from sustained phonation of vowel /a/. RESULTS Results of study indicated, a Spasmodic dysphonia patients had high mean values for voice handicap index score and all voice parameters. b All parameters were reduced significantly post botulinum therapy, but remained higher than their normal value. c All voice parameters except jitter showed strong positive correlation with voice handicap index in all domains. Jitter showed moderate positive correlation with total score, physical and emotional domain and strong positive correlation with functional domain. CONCLUSION Botulinum toxin A injection improves voice in cases of spasmodic dysphonia, significantly still post procedure voice does not return to normal.

  4. Use of Botulinum Neurotoxin for the Treatment of Movement Disorders

    Science.gov (United States)

    ... FAMILIES Use of Botulinum Neurotoxin Injections to Treat Movement Disorders People often associate botulinum neurotoxin (BoNT) with the ... studies on the effect of BoNT for treating movement disorders. What is botulinum neurotoxin and how does it ...

  5. Reduced Neck Muscle Strength and Altered Muscle Mechanical Properties in Cervical Dystonia Following Botulinum Neurotoxin Injections: A Prospective Study

    Science.gov (United States)

    Mustalampi, Sirpa; Ylinen, Jari; Korniloff, Katariina; Weir, Adam; Häkkinen, Arja

    2016-01-01

    Objective To evaluate changes in the strength and mechanical properties of neck muscles and disability in patients with cervical dystonia (CD) during a 12-week period following botulinum neurotoxin (BoNT) injections. Methods Eight patients with CD volunteered for this prospective clinical cohort study. Patients had received BoNT injections regularly in neck muscles at three-month intervals for several years. Maximal isometric neck strength was measured by a dynamometer, and the mechanical properties of the splenius capitis were evaluated using two myotonometers. Clinical assessment was performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) before and at 2, 4, 8, and 12 weeks after the BoNT injections. Results Mean maximal isometric neck strength at two weeks after the BoNT injections decreased by 28% in extension, 25% in rotation of the affected side and 17% in flexion. At four weeks, muscle stiffness of the affected side decreased by 17% and tension decreased by 6%. At eight weeks, the muscle elasticity on the affected side increased by 12%. At two weeks after the BoNT injections, the TWSTRS-severity and TWSTRS-total scores decreased by 4.3 and 6.4, respectively. The strength, muscle mechanical properties and TWSTRS scores returned to baseline values at 12 weeks. Conclusions Although maximal neck strength and muscle tone decreased after BoNT injections, the disability improved. The changes observed after BoNT injections were temporary and returned to pre-injection levels within twelve weeks. Despite having a possible negative effect on function and decreasing neck strength, the BoNT injections improved the patients reported disability. PMID:26828215

  6. Reduced Neck Muscle Strength and Altered Muscle Mechanical Properties in Cervical Dystonia Following Botulinum Neurotoxin Injections: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Sirpa Mustalampi

    2016-01-01

    Full Text Available Objective To evaluate changes in the strength and mechanical properties of neck muscles and disability in patients with cervical dystonia (CD during a 12-week period following botulinum neurotoxin (BoNT injections. Methods Eight patients with CD volunteered for this prospective clinical cohort study. Patients had received BoNT injections regularly in neck muscles at three-month intervals for several years. Maximal isometric neck strength was measured by a dynamometer, and the mechanical properties of the splenius capitis were evaluated using two myotonometers. Clinical assessment was performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS before and at 2, 4, 8, and 12 weeks after the BoNT injections. Results Mean maximal isometric neck strength at two weeks after the BoNT injections decreased by 28% in extension, 25% in rotation of the affected side and 17% in flexion. At four weeks, muscle stiffness of the affected side decreased by 17% and tension decreased by 6%. At eight weeks, the muscle elasticity on the affected side increased by 12%. At two weeks after the BoNT injections, the TWSTRS-severity and TWSTRS-total scores decreased by 4.3 and 6.4, respectively. The strength, muscle mechanical properties and TWSTRS scores returned to baseline values at 12 weeks. Conclusions Although maximal neck strength and muscle tone decreased after BoNT injections, the disability improved. The changes observed after BoNT injections were temporary and returned to pre-injection levels within twelve weeks. Despite having a possible negative effect on function and decreasing neck strength, the BoNT injections improved the patients reported disability.

  7. A proposal to prevent the "Mephisto sign" side effect of botulinum toxin type A injection in chronic migraine.

    Science.gov (United States)

    Cho, Eunae S; Hwang, Jae Young; Kim, Seong Taek

    2013-11-01

    Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.

  8. Technique for iliopsoas ultrasound-guided active electromyography-directed botulinum a toxin injection in cerebral palsy.

    Science.gov (United States)

    Willenborg, Michael J; Shilt, Jeffrey S; Smith, Beth Paterson; Estrada, Roquel L; Castle, Jason A; Koman, L Andrew

    2002-01-01

    Symptomatic hip flexion deformity secondary to iliopsoas spasticity may interfere with gait, impair sitting balance, or contribute to hip subluxation or dislocation. A nonsurgical, minimally invasive technique to ameliorate iliopsoas spasticity is presented. The technique uses intramuscular injections of botulinum A toxin to provide selective neuromuscular blockade of the iliacus or psoas muscles or both. Because of the anatomic location of the target muscles, this technique uses ultrasound guidance for needle placement. Active electromyographic stimulation is used to verify the needle position adjacent to active myoneural interfaces. The authors' experience to date includes the treatment of 28 patients (53 hips). Use of this technique has resulted in improved hip range of motion. No intraoperative or postoperative adverse events or complications have been observed.

  9. Short-Term Effects of Combined Serial Casting and Botulinum Toxin Injection for Spastic Equinus in Ambulatory Children with Cerebral Palsy

    OpenAIRE

    Park, Eun Sook; Rha, Dong-Wook; Yoo, Jun Ki; Kim, Sun Mi; Chang, Won Hyuk; Song, Sang Hyuk

    2010-01-01

    Purpose The purpose of this paper is to test the hypothesis that combination therapy of serial cast and botulinum toxin type A (BTX-A) injection can further enhance the effects of a BTX-A injection in ambulant children with cerebral palsy (CP) who have an equinus foot. Materials and Methods Children in group A (30 legs of 21 children) received a serial casting application after an injection of BTX-A, and children in group B (25 legs of 17 children) received only a BTX-A injection. Assessments...

  10. AB204. Repeated intradetrusor botulinum toxin type A injections are still effective for patients with neurogenic detrusor overactivity secondary to spinal cord injury in China

    Science.gov (United States)

    Chen, Hui; Yang, Xinghua; Zeng, Jingwen; Huang, Maping; Liu, Qiuling; Huang, Jiebing; Huang, Tianhai; Xie, Keji; Jiang, Chonghe

    2016-01-01

    Objective To assess effective outcomes following repeated treatment with intradetrusor botulinum toxin type A in patients with neurogenic detrusor overactivity (NDO). Methods Patients with NDO secondary to spinal cord injury (SCI) were enrolled. Botulinum toxin type A 200 U detrusor injections by a rigid cystoscope were repeated. Primary outcomes were urodynamic variables including maximum detrusor pressure during first involuntary detrusor contraction (Pdetmax IDC) filling cystometry, detrusor compliance (DC). Secondary outcomes were improvement of the patient’s quality of life (QoL) measured by Incontinence-Specific Quality-of-Life Instrument (I-QoL), the validated short forms of Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Related adverse events were recorded. Results From 2012 to 2014, 159 injections were performed in 52 patients (44 male, 8 female). The mean age was 36.67 years. The maximum number of repeated injections was five. BC increased from (4.03–7.45) to (6.96–10.86) mL/cmH2O, Pdetmax in bladder storage decreased from (42.80–79.52) to (26.40–43.33) cmH2O, respectively. The I-QoL, UDI-6 and IIQ-7 showed a consistent improvement after repeated injections. Conclusions Repeated intradetrusor botulinum toxin type A injections remain improve QoL in patients with NDO secondary to SCI.

  11. A型肉毒毒素治疗脑卒中后上肢痉挛的疗效观察%Effect of Botulinum Toxin A on Spastic Upper Limbs Dysfunction after Stroke

    Institute of Scientific and Technical Information of China (English)

    彭华英; 傅林

    2014-01-01

    目的:探讨A型肉毒毒素治疗脑卒中后上肢痉挛的的临床效果。方法:72例脑卒中后上肢痉挛的患者被随机分为两组,对照组行传统手法按摩及功能锻炼,实验组对痉挛的肱二头肌肌腹局部注射A型肉毒毒素;采用前臂及手腕改良Ashworth 量表(MAS),Carroll上肢功能实验(upper ex-tremities function test ,UEFT)评分分别对两组患者治疗前,治疗后2周,4周,8周时的上肢痉挛情况进行比较。结果:实验组患者MAS评分较治疗前明显改善( P<0.05),而对照组MAS评分较治疗前降低,但无明显改善(P>0.05);相同时间点与对照组比较,改善明显,差异显著(P<0.05)。治疗后两组患者UEFT评分均较治疗前明显改善( P<0.05),但同时期实验组患者UEFT评分较对照组高,差异具有统计学意义( P<0.05)。结论:A型肉毒毒素能有效改善脑卒中后上肢痉挛症状,与传统治疗方式比较,具明显的优越性。%Objective:To investigate the effect of botulinum toxin type A on spastic upper limbs dysfunction after stroke . Method:72 patients with spastic upper limbs dysfunction after stroke were divided into experimental group ( 36 cases ) and control group (36 cases) randomly.The patients in control group were treated with the traditional massage , and those in experi-mental group were treated by injecting botulinum toxin type A to biceps brachii muscle belly .The modified Ashworth scale ( MAS) and Upper Extremities Functional Test ( UEFT) were employed to evaluate the condition the function of upper limbs in two groups before and 2, 4, and 8 weeks after treatment.Resu lt:The scores of MAS and UEFT in experimental group improved after treatment from2 weeks to 8 weeks ( P<0.05) .And improved much more significantly than those in control group at each time( P<0.05) .Conclusion:Botulinum toxin type A injection can improve function of upper limbs for

  12. Efficacy and safety of long-term repeated treatment of facial wrinkles with botulinum toxin A%长期重复应用A型肉毒毒素面部除皱的疗效和安全性评价

    Institute of Scientific and Technical Information of China (English)

    潘卫利; 陆威; 陶小华

    2010-01-01

    目的 评价长期重复多次应用A型肉毒毒素(botulinum toxin A,BTXA)进行面部除皱的疗效和安全性.方法 对52例多次使用国产A型肉毒毒素注射面部除皱者进行了回顾性分析总结.每次注射除皱部位均包括额纹、鱼尾纹、眉间纹、鼻背横纹.于注射前和注射后1周、1个月、3个月及再次注射时,分别进行疗效和安全性评价.结果 每例均注射除皱共8次,每次注射后开始起效时间都在3~4 d,1个月左右是最佳表现时间.疗效评价1级为很好的比例依次是额纹100%、鱼尾纹97.1%、眉间纹99.8%、鼻背横纹99.0%,评价2级为好的比例依次是额纹0、鱼尾纹2.9%、眉间纹0.2%、鼻背横纹1.0%,评价为一般、较差、差这3个等级者为0.随着注射次数增多,疗效等级不断提高.平均疗效维持时间有所延长(r=0.256,P=0.02),为(7.8±1.1)个月,呈正态分布.随着注射次数增加后,不良反应轻微,仅部分受注射者个别注射部位出现瘀斑、额部紧绷感、一定程度的表情僵化和鱼尾纹注射后下眼睑邻近部位皱纹加重.不良反应发生率随注射次数下降(r=0.850,P=0.01).所有被注射者均未出现严重不良反应.结论 长期多次应用A型肉毒毒素除皱安全可靠,且疗效不受影响,因此可以多次使用.%Objective To evaluate the clinical efficacy and safety of long-term repeated treatment of facial wrinkles with application of botulinum toxin A (BTXA). Methods A total of 52 patients had received 8 injections in seven years with BTXA against facial wrinkles, including forehead wrinkles, fishtail lines, glabellas wrinkles, and nasal dorsum transverse wrinkles. Besides day 1 (baseline) and day for the next injection (end-point), follow-up visits were scheduled on 1 week, 1 month, and 3 months after every injection. The therapy effect and safety were evaluated. Results For all the patients, it began to take effect on day 3 or 4 after the treatment and best effect

  13. Intradermal injection of Botulinum toxin type A alleviates infraorbital nerve constriction-induced thermal hyperalgesia in an operant assay.

    Science.gov (United States)

    Kumada, A; Matsuka, Y; Spigelman, I; Maruhama, K; Yamamoto, Y; Neubert, J K; Nolan, T A; Watanabe, K; Maekawa, K; Kamioka, H; Yamashiro, T; Kuboki, T; Oguma, K

    2012-01-01

    Recent studies have shown that infraorbital nerve constriction (IoNC)-induced mechanical allodynia has been attenuated by administration of highly purified 150-kDa Botulinum neurotoxin type A (BoNT/A). Here, we extend these studies to determine whether BoNT/A could attenuate IoNC-induced symptoms of thermal hyperalgesia. Instead of testing head withdrawal thresholds, a thermal operant assay was used to evaluate cortical processing of sensory input following IoNC. In this assay, a fasted rat's desire to obtain a food reward (sweetened condensed milk) is coupled to its ability to tolerate facial contact with a warm (45 °C) thermode. Bilateral IoNC decreased the ratio of thermode contact duration/event, which is an indicative of thermal hyperalgesia. BoNT/A injection intradermally in the area of infraorbital nerve (IoN) innervation 7 days after IoNC resulted in decreased number of facial contacts and increased the ratio of contact duration/event (measured at 14 days after IoNC). The BoNT/A (2-200 pg) effects were dose dependent and statistically significant at 100 and 200 pg (P thermal hyperalgesia symptoms was obtained with a 200-pg dose, without affecting sham rat behaviour. Off-site (neck) injection of BoNT/A did not relieve thermal hyperalgesia, while co-injection of BoNT/A with a neutralising antibody in the area of IoN innervation prevented relief of thermal hyperalgesia. Neither IoNC nor BoNT/A injection affected operant assay parameters with a 24 °C thermode, indicating selectivity of thermal hyperalgesia measurements. These results strongly suggest that intradermal injection of BoNT/A in the area of IoN innervation alleviates IoNC-induced thermal hyperalgesia in an operant assay.

  14. Clinical efficacy of two concentrations of diluted botulinum toxin A in treatment of dynamic frontotransverse wrinkles%两种稀释浓度A型肉毒毒素治疗动力性额横纹的疗效观察

    Institute of Scientific and Technical Information of China (English)

    朱麟; 孙波

    2015-01-01

    Objective To assess the efficacy and adverse reactions of two cconcentrations of diluted botulinum toxin A for dynamic frontotransverse wrinkles.Methods Totally 103 cases met the inclusion criteria were assigned into two groups by a random number table:high concentration group (50 U/ml,53 cases) and low concentration group (25 U/ml,50 cases).The two groups were given the local injection with 50 U/ml and 25 U/ml concentration of botulinum toxin type A,respectively.Dosage of BTX-A,the treatment effect,the duration of the effect and the incidence of adverse reactions were analyzed.Results The high concentration group were given the BTX-A (45.53±2.05) U,the low concentration group were given the BTX-A (25.71 ± 1.74) U,and the difference were statistically significant (P<0.05).The differences of post-operative evaluation,time of onset and duration between the two groups were not statistically significant (P>0.05).In the high concentration group,30 cases (88.24%) had forehead heaviness sensation,and 2 cases (5.71%) in the low concentration group,the difference were statistically significant (P<0.01).Neither of the groups was given any specific treatment,the symptoms were disappeared in two weeks.In either group there was no serious complications such as intoxication,allergy,etc.Conclusions The efficacy of local injection with two concentrations of diluted botulinum toxin A in the treatment of dynamic frontotransverse wrinkles is positive,the duration of treatment effect between the two groups is similar,and therefore the 25 U/ml concentration is recommended to reduce the forehead heaviness sensation.%目的 观察两种稀释浓度A型肉毒毒素(BTX-A)治疗动力性额横纹的疗效及不良反应.方法 将符合纳入标准的103例患者按随机数字表法分为高浓度组53例和低浓度组50例,分别采用50 U/ml和25 U/ml浓度BTX-A局部注射额部,观察两组的BTX-A用量、治疗效果、疗效持续时间及不良反应.结果

  15. High-dose botulinum toxin type A local injection therapy for axillary hyperhidrosis%大剂量A型肉毒毒素局部注射治疗腋部多汗症

    Institute of Scientific and Technical Information of China (English)

    高扬; 宋军; 李虎; 鲁元刚

    2011-01-01

    目的 探讨大剂量肉毒毒素治疗腋部多汗症的长期疗效和重复治疗的疗效.方法 92例患者随机分为两组:小剂量组为每侧腋部皮内注射生理盐水稀释的A型肉毒毒素50U;大剂量组为每侧腋部皮内注射生理盐水稀释的A型肉毒毒素200U;随访3~29个月,观察两组并发症,并建立两组等级资料,经χ2 检验,评价两组患者疗效差异.结果 两组疗效进行对照分析,经过统计学处理分析,认为对于腋部多汗症的患者,小剂量与大剂量的BTXA治疗方法的疗效间隔时间,差异有统计学意义.结论 大剂量A型肉毒毒素能够显著延长腋部多汗症复发间隔时间.%Objective Evaluate the long-term effectiveness of high-dose botulinum toxin therapy in axillary hyperhidrosis, the response to repeated treatment, and the possible side effects. Methods Totally 92 patients with axillary hyperhidrosis were randomly divided into two groups. One group were injected with low-dose botulinum toxin A( BTX-A ), 50 U was injected per axilla. Another group were injected with high-dose BTX-A. A total dose of 200 U of BTX-A was used per axilla. Patients were followed up for periods up to 29 months. To investigate the effect of two methods, we analyzed two ranked data by rank sum test and x2 test to judge the disparities of the therapeutic effect. Results The results showed that the relapse-free interval of two groups with axillary hyperhidrosis was significant difference through the statistical analysis. Conclusion High-dose BTX-A treatment is capable of prolonging the antihidrotic effect of intracutaneous.

  16. Botulinum toxin for the treatment of myofascial pain syndromes involving the neck and back: a review from a clinical perspective.

    Science.gov (United States)

    Climent, José M; Kuan, Ta-Shen; Fenollosa, Pedro; Martin-Del-Rosario, Francisco

    2013-01-01

    Introduction. Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results. Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS. Results and Discussion. Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies.

  17. Botulinum Toxin for the Treatment of Myofascial Pain Syndromes Involving the Neck and Back: A Review from a Clinical Perspective

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    José M. Climent

    2013-01-01

    Full Text Available Introduction. Botulinum toxin inhibits acetylcholine (ACh release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results. Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS. Results and Discussion. Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies.

  18. Does vitamin B alter the efficacy of botulinum toxin?

    Science.gov (United States)

    Tatlidede, Soner; Baslo, M Baris; Özkaya, Özay; Soydan, Tufan; Orhan, Elif Kocasoy; Yeşilada, Ayşin Karasoy

    2012-06-01

    Botulinum toxin prevents acetylcholine release at motor nerve terminals. Group B vitamins (B-vit) are essential for proper nerve function. The present study addresses the question of whether B-vit accelerate recovery in rat skeletal muscle after botulinum toxin A (Btx-A) injection. Forty-four adult male Wistar albino rats were used in this experimental study. Rats were divided into three groups: group 1 rats were given Btx-A injection only, group 2 rats were given B-vit supplementation before Btx-A injection, and group 3 rats were given Btx-A and B-vit injections together. During the experiment, compound muscle action potential (CMAP) of the gastrocnemius muscle was recorded before Btx-A injection and sequentially ten times after toxin injection. The statistical significance of the CMAP amplitude change among the groups was analyzed. All groups showed similar amplitude change between consecutive measurement points. In conclusion, combining Btx-A injection with B-vit supplement does not decrease the efficacy of the toxin.

  19. Botulinum toxin A in the treatment of blepharospasm: a 10-year experience Toxina botulínica tipo A no tratamento do blefaroespasmo: experiência de 10 anos de utilização

    Directory of Open Access Journals (Sweden)

    Laura Silveira-Moriyama

    2005-06-01

    Full Text Available To evaluate the long-term effect of botulinum toxin type A (BTX in the treatment of blepharospasm, a retrospective analysis was conducted from the patients seen at the Movement Disorders Clinic of the Department of Neurology, Hospital das Clínicas, University of São Paulo School of Medicine from 1993 to 2003. A total of 379 treatments with BTX were administered to 30 patients with blepharospasm. Sixty six per cent of the subjects had used oral medication for dystonia and only 15% of them reported satisfactory response to this treatment. Ninety three per cent of the patients showed significant improvement after the first BTX injection. There was no decrement in response when compared the first and the last injection recorded. Adverse effects, mostly minor, developed at least once in 53% of patients. Six patients (20% discontinued the treatment but there was no case of secondary resistance.Para avaliar os efeitos a longo prazo da toxina botulínica tipo A (BTX no tratamento do blefaroespasmo foi realizado estudo retrospectivo no Ambulatório de Distúrbios do Movimento da Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo de 1993 a 2003. Um total de 379 aplicações de BTX foram administradas a 30 pacientes com blefaroespasmo. Previamente ao tratamento com toxina botulínica 63% dos pacientes utilizaram medicação oral para blefaroespasmo, mas apenas 15% referiu resposta satisfatória a este tratamento. Noventa e três por cento dos pacientes tiveram resposta significativa à primeira aplicação de BTX. Não houve decremento na resposta quando comparada a primeira à última aplicação registrada dos pacientes. Efeitos adversos, em sua maioria leves, ocorreram pelo menos uma vez durante o tratamento em 53% dos pacientes. Seis pacientes interromperam o tratamento, mas não houve nenhum caso de resistência secundária.

  20. Effect of botulinum toxin A on tibial nerve F wave and walking ability in patients after stroke%A型肉毒毒素对脑卒中患者胫神经F波和步行能力的影响

    Institute of Scientific and Technical Information of China (English)

    王明乐; 刘俊芳; 马妮娜

    2015-01-01

    将脑卒中患者65例随机分为观察组32例和对照组33例,观察组患者则在开始常规康复训练治疗前,接受患侧下肢肌肉A型肉毒毒素局部注射治疗.观察两组患者治疗前及治疗4周后的F波波幅及M波比值(F/M值),肌张力及起立-行走计时测试(TUG)及10 m自由步行测试结果.观察组治疗2周及4周后,F波波幅及F/M值与治疗前比较均显著下降(P<0.05);治疗后各时间点指标与对照组比较,差异有统计学意义(P<0.05).对照组治疗前后肌张力评分比较,差异无统计学意义(P>0.05);观察组治疗4周后,肌张力评分显著下降(P<0.05),与对照组比较差异有统计学意义(P<0.05).治疗前,两组患者的TUG测试及10 m自由步行测试比较差异无统计学意义(P>0.05);观察组治疗4周后,TUG测试及10 m自由步行测试与治疗前比较差异有统计学意义(P<0.05);而对照组治疗前后TUG测试及10 m自由步行测试比较差异无统计学意义(P>0.05).提示,A型肉毒毒素局部注射可降低相应脊髓节段运动神经元的F波波幅,提高患者的步行能力.%Sixty five stroke patients undergoing rehabilitation training in our hospital from May 2010 to May 2013 were randomly divided into study group (n =32) and control group (n =33).Patients in study group received intramuscular injection of botulinum toxin A (BTX-A) in the affected limbs before rehabilitation training started.The F wave amplitude and F/M value,muscle tension and TUG test and 10 m free walking test results of patients in two groups were observed before and 4 weeks after treatment.Compared to the results before treatment,the amplitude of F wave and F/M value after 2 and 4 weeks of treatment in study group decreased significantly (P < 0.05).Compared to control group,the indexes at each time point after treatment in study group were significantly different (P < 0.05).The muscle tension score in study group after 4 weeks of treatment decreased

  1. Tetanus: Pathophysiology, Treatment, and the Possibility of Using Botulinum Toxin against Tetanus-Induced Rigidity and Spasms

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    Bjørnar Hassel

    2013-01-01

    Full Text Available Tetanus toxin, the product of Clostridium tetani, is the cause of tetanus symptoms. Tetanus toxin is taken up into terminals of lower motor neurons and transported axonally to the spinal cord and/or brainstem. Here the toxin moves trans-synaptically into inhibitory nerve terminals, where vesicular release of inhibitory neurotransmitters becomes blocked, leading to disinhibition of lower motor neurons. Muscle rigidity and spasms ensue, often manifesting as trismus/lockjaw, dysphagia, opistotonus, or rigidity and spasms of respiratory, laryngeal, and abdominal muscles, which may cause respiratory failure. Botulinum toxin, in contrast, largely remains in lower motor neuron terminals, inhibiting acetylcholine release and muscle activity. Therefore, botulinum toxin may reduce tetanus symptoms. Trismus may be treated with botulinum toxin injections into the masseter and temporalis muscles. This should probably be done early in the course of tetanus to reduce the risk of pulmonary aspiration, involuntary tongue biting, anorexia and dental caries. Other muscle groups are also amenable to botulinum toxin treatment. Six tetanus patients have been successfully treated with botulinum toxin A. This review discusses the use of botulinum toxin for tetanus in the context of the pathophysiology, symptomatology, and medical treatment of Clostridium tetani infection.

  2. Expression of apoptosis-regulating genes in the rat prostate following botulinum toxin type a injection

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    Gorgal Tiago

    2012-01-01

    Full Text Available Abstract Background Onabotulinumtoxin A (OnabotA injection has been investigated as a novel treatment for benign prostatic enlargement caused by benign prostatic hyperplasia. An OnabotA - induced volume reduction caused by sympathetic fibers impairment has been proposed as a potential mechanism of action. Our aim was to investigate the expression of apoptosis-regulating proteins in the rat prostate following OnabotA intraprostatic injection. Methods Adult Wistar rats were injected in the ventral lobes of the prostate with 10 U of OnabotA or saline. A set of OnabotA-injected animals was further treated with 0.5 mg/kg of phenylephrine (PHE subcutaneously daily. All animals were sacrificed after 1 week and had their prostates harvested. Immunohistochemical staining was performed for Bax, Bcl-xL and caspase-3 proteins and visualized by the avidin-biotin method. The optical density of the glandular cells was also determined, with measurement of differences between average optical densities for each group. Results Saline-treated animals showed intense epithelial staining for Bcl-xL and a faint labelling for both Bax and Caspase-3. OnabotA-treated rats showed a reduced epithelial staining of Bcl-xL and a consistently increased Bax and Caspase-3 staining when compared with saline-treated animals. PHE-treated animals showed a stronger Bcl-xL staining and reduced staining of both Bax and Caspase-3 when compared to the OnabotA group. Mean signal intensity measurements for each immunoreaction confirmed a significant decrease of the signal intensity for Bcl-xL and a significant increase of the signal intensity for Bax and Caspase 3 in OnabotA-injected animals when compared with the control group. In OnabotA+PHE treated animals mean signal intensity for Bcl-xL, Bax and Caspase 3 immunoreactions was identical to that of the control animals. Conclusions These results support the hypothesis that OnabotA activates apoptotic pathways in the rat prostate through a

  3. Long-Term Effects of Botulinum Toxin Complex Type A Injection on Mechano- and Metabo-Sensitive Afferent Fibers Originating from Gastrocnemius Muscle.

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    Guillaume Caron

    Full Text Available The aim of the present study was to investigate long term effects of motor denervation by botulinum toxin complex type A (BoNT/A from Clostridium Botulinum, on the afferent fibers originating from the gastrocnemius muscle of rats. Animals were divided in 2 experimental groups: 1 untreated animals acting as control and 2 treated animals in which the toxin was injected in the left muscle, the latter being itself divided into 3 subgroups according to their locomotor recovery with the help of a test based on footprint measurements of walking rats: i no recovery (B0, ii 50% recovery (B50 and iii full recovery (B100. Then, muscle properties, metabosensitive afferent fiber responses to potassium chloride (KCl and lactic acid injections and Electrically-Induced Fatigue (EIF, and mechanosensitive responses to tendon vibrations were measured. At the end of the experiment, rats were killed and the toxin injected muscles were weighted. After toxin injection, we observed a complete paralysis associated to a loss of force to muscle stimulation and a significant muscle atrophy, and a return to baseline when the animals recover. The response to fatigue was only decreased in the B0 group. The responses to KCl injections were only altered in the B100 groups while responses to lactic acid were altered in the 3 injected groups. Finally, our results indicated that neurotoxin altered the biphasic pattern of response of the mechanosensitive fiber to tendon vibrations in the B0 and B50 groups. These results indicated that neurotoxin injection induces muscle afferent activity alterations that persist and even worsen when the muscle has recovered his motor activity.

  4. Correction of post-traumatic anterior open bite by injection of botulinum toxin type A into the anterior belly of the digastric muscle: case report

    OpenAIRE

    2013-01-01

    Post-traumatic anterior open bite can occur as a result of broken balance among the masticatory muscles. The superior hyoid muscle group retracts the mandible downward and contributes to the anterior open bite. Denervation of the digastric muscle by injection of botulinum toxin type A (BTX-A) can reduce the power of the digastric muscle and help to resolve the post-traumatic anterior open bite. A patient with a bilateral angle fracture had an anterior open bite even after undergoing three ope...

  5. Three-dimensional CT might be a potential evaluation modality in correction of asymmetrical masseter muscle hypertrophy by botulinum toxin injection.

    Science.gov (United States)

    No, Yeon A; Ahn, Byeong Heon; Kim, Beom Joon; Kim, Myeung Nam; Hong, Chang Kwon

    2016-01-01

    For correction of this asymmetrical hypertrophy, botulinum toxin type A (BTxA) injection is one of convenient treatment modalities. Unfortunately, physical examination of masseter muscle is not enough to estimate the exact volume of muscle hypertrophy difference. Two Koreans, male and female, of bilateral masseter hypertrophy with asymmetricity were evaluated. BTxA (NABOTA(®), Daewoong, Co. Ltd., Seoul, Korea) was injected at master muscle site with total 50 U (25 U at each side) and volume change was evaluated with three-dimensional (3D) CT image analysis. Maximum reduction of masseter hypertrophy was recognized at 2-month follow-up and reduced muscle size started to restore after 3 months. Mean reduction of masseter muscle volume was 36% compared with baseline. More hypertrophied side of masseter muscle presented 42% of volume reduction at 2-month follow-up but less hypertrophied side of masseter muscle showed 30% of volume shrinkage. In conclusion, 3D CT image analysis might be the exact evaluation tool for correction of asymmetrical masseter hypertrophy by botulinum toxin injection.

  6. Botulinum Toxin in the Treatment of Facial Paralysis.

    Science.gov (United States)

    Mehdizadeh, Omid B; Diels, Jacqueline; White, William Matthew

    2016-02-01

    This article reviews the current literature supporting the use of botulinum toxin in producing symmetric facial features and reducing unwanted, involuntary movements. Methods, protocols, and adverse events are discussed. Additionally, the authors suggest that using botulinum toxin A therapy in postparalytic facial synkinesis can provide long-term results when used in conjunction with other treatment modalities.

  7. Identification of the factors that govern the ability of therapeutic antibodies to provide postchallenge protection against botulinum toxin: a model for assessing postchallenge efficacy of medical countermeasures against agents of bioterrorism and biological warfare.

    Science.gov (United States)

    Al-Saleem, Fetweh H; Nasser, Zidoon; Olson, Rebecca M; Cao, Linsen; Simpson, Lance L

    2011-08-01

    Therapeutic antibodies are one of the major classes of medical countermeasures that can provide protection against potential bioweapons such as botulinum toxin. Although a broad array of antibodies are being evaluated for their ability to neutralize the toxin, there is little information that defines the circumstances under which these antibodies can be used. In the present study, an effort was made to quantify the temporal factors that govern therapeutic antibody use in a postchallenge scenario. Experiments were done involving inhalation administration of toxin to mice, intravenous administration to mice, and direct application to murine phrenic nerve-hemidiaphragm preparations. As part of this study, several pharmacokinetic characteristics of botulinum toxin and neutralizing antibodies were measured. The core observation that emerged from the work was that the window of opportunity within which postchallenge administration of antibodies exerted a beneficial effect increased as the challenge dose of toxin decreased. The critical factor in establishing the window of opportunity was the amount of time needed for fractional redistribution of a neuroparalytic quantum of toxin from the extraneuronal space to the intraneuronal space. This redistribution event was a dose-dependent phenomenon. It is likely that the approach used to identify the factors that govern postchallenge efficacy of antibodies against botulinum toxin can be used to assess the factors that govern postchallenge efficacy of medical countermeasures against any agent of bioterrorism or biological warfare.

  8. Botulinum Neurotoxin A Injections Influence Stretching of the Gastrocnemius Muscle-Tendon Unit in an Animal Model

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    Christopher J. Tuohy

    2012-08-01

    Full Text Available Botulinum Neurotoxin A (BoNT-A injections have been used for the treatment of muscle contractures and spasticity. This study assessed the influence of (BoNT-A injections on passive biomechanical properties of the muscle-tendon unit. Mouse gastrocnemius muscle (GC was injected with BoNT-A (n = 18 or normal saline (n = 18 and passive, non-destructive, in vivo load relaxation experimentation was performed to examine how the muscle-tendon unit behaves after chemical denervation with BoNT-A. Injection of BoNT-A impaired passive muscle recovery (15% vs. 35% recovery to pre-stretching baseline, p < 0.05 and decreased GC stiffness (0.531 ± 0.061 N/mm vs. 0.780 ± 0.037 N/mm, p < 0.05 compared to saline controls. The successful use of BoNT-A injections as an adjunct to physical therapy may be in part attributed to the disruption of the stretch reflex; thereby modulating in vivo passive muscle properties. However, it is also possible that BoNT-A injection may alter the structure of skeletal muscle; thus modulating the in vivo passive biomechanical properties of the muscle-tendon unit.

  9. The Effect of Total Cumulative Dose, Number of Treatment Cycles, Interval between Injections, and Length of Treatment on the Frequency of Occurrence of Antibodies to Botulinum Toxin Type A in the Treatment of Muscle Spasticity

    Science.gov (United States)

    Bakheit, Abdel Magid O.; Liptrot, Anthea; Newton, Rachel; Pickett, Andrew M.

    2012-01-01

    A large cumulative dose of botulinum toxin type A (BoNT-A), frequent injections, a short interval between treatment cycles, and a long duration of treatment have all been suggested, but not confirmed, to be associated with a high incidence of neutralizing antibodies to the neurotoxin. The aim of this study was to investigate whether these…

  10. Observation of botulinum toxin A management in childhood with intermittent exotropia%A型肉毒毒素治疗儿童间歇性外斜视的临床观察

    Institute of Scientific and Technical Information of China (English)

    李苑; 吴晓

    2008-01-01

    Objective To observe the effeet of botulium toxin A(BTXA) management in childhood with intermittent extropia. Methods A prospective non-random clinical study was performed in 60 children aged from 4 to 12 years, who diagnosed to be intermittent exotropia. Patients were divided into surgery groups and BTXA group according to the intention of patients parent. The recession of bilateral rectus muscle was performed in 30 patients in surgery group. BTXA injection into bilateral rectus muscle was performed in 30 patients in BTXA group. Eye alignment and the binocular vision were evaluated 6 months after the treatments. Results In BTXA group, the deviation was (- 41.33±12.17)△(-30△ to - 75△) at the baseline, and (6.23±9.80) △ (-30△ to 0△)6 month after BTXA injection. Among the patients, 7 cases were under-correct. In surgery group ,the deviation was (-42.83±11.72)△ (-25△ to - 80△) at the baseline, and (2.67±5.21)△ (-15△ to + 15△)6 months after surgery. Among these patients, 1 case was under-corrected, and 2 cases were overcorrected. The recovery rate was 76.67% and 90.00% respectively in BTXA and surgery group, and was no statistically significant difference these two groups(P =0.177)and the covery rate(X2 =0.42,P =0.166). Some patients were found to have fusion and distance stereopsis re-built, while some others were found to have near stereopsis improvement in beth groups. Conclusion BTXA injection is a rapid, less invasive and effective procedure for the intermittent exotropia.%目的 观察A型肉毒毒素(BTXA)治疗儿童间歇性外斜视的临床疗效.方法 采用前瞻性非随机对照临床试验,将60例年龄于4~12岁的间歇性外斜视患儿分为2组,分别接受常规手术治疗(双外直肌后退或外直肌后退联合内直肌缩短术)和BTXA双外直肌注射治疗.治疗6个月后比较两组患儿的眼位矫正情况及双眼视觉功能改善情况.两组之间年龄分布及治疗前斜视度数分布比较采

  11. SBOTE study: extracorporeal shock wave therapy versus electrical stimulation after botulinum toxin type a injection for post-stroke spasticity-a prospective randomized trial.

    Science.gov (United States)

    Santamato, Andrea; Notarnicola, Angela; Panza, Francesco; Ranieri, Maurizio; Micello, Maria Francesca; Manganotti, Paolo; Moretti, Biagio; Fortunato, Francesca; Filoni, Serena; Fiore, Pietro

    2013-02-01

    Research is on-going to identify new methods of biostimulation to increase the effect of botulinum toxin type A (BTX-A) in the treatment of spasticity. The Spasticity treated by Botulinum Toxin and ESWT (SBOTE) study is a prospective, randomized controlled trial assessing the effectiveness of extracorporeal shock wave therapy (ESWT) given immediately after BTX-A injections compared with electrical stimulation (ES) given immediately after BTX-A therapy for the management of focal upper limb spasticity in stroke patients. ES was given for 30 min twice a day for 5 days starting at 5 Hz; ESWT was given once a day for 5 days. At study follow-up, patients treated with BTX-A injections and ESWT showed a statistically greater significance and continuous decrease of spasticity measure (modified Ashworth scale [MAS]: 1.37, 1.75 and 1.58 at 15, 30 and 90 days post-treatment, respectively), of spasms (spasm frequency scale [SFS]: 0.8 and 0.25 at 30 and 90 days post-treatment, respectively) and of pain (visual analogue scale [VAS]: 1.94 and 1.87 at 30 and 90 days, respectively) compared with patients treated with BTX-A injections and ES (MAS: 2.37, 2.18 and 2.18, respectively) (p < 0.05) (SFS: 1.5 and 1.06, respectively) (p < 0.05) (VAS: 2.44 and 2.69 respectively) (p < 0.05). ESWT enhances the effect of BTX-A to a greater extent than ES, probably by modulating rheology of the muscle and neurotransmission at the neuromuscular junction.

  12. The effect of injections of botulinum toxin type A combined with casting on the equinus gait of children with cerebral palsy.

    Science.gov (United States)

    Hayek, S; Gershon, A; Wientroub, S; Yizhar, Z

    2010-08-01

    Our aim was to evaluate the effect of adding inhibitory casting to the treatment of young children with cerebral palsy who received injections of botulinum neurotoxin A (BoNT-A) to gastrocnemius for equinus gait. Of the 20 patients in the series, 11 in group A had inhibitory casts applied on the day of the first set of BoNT-A injections and nine in group B did not have casting. Both groups received another BoNT-A injection four months later. The patients were followed for eight months and examined at five intervals. Both groups showed significant improvement in gait parameters and function (p casting enhances and prolongs the results of treatment and mainly influences the passive range of movement, while BoNT-A mostly influences the dynamic motion. The second injection further improved the results of most parameters. The gross motor function measure, the selective motor control test and the modified Tardieu scale correlated well with the results of treatment. We recommend the use of inhibitory casting whenever augmentation of the effect of treatment with BoNT-A is needed.

  13. The Efficacy of Botulinum Toxin Type a Injection in the Hamstring and Calf Muscles With and Without Serial Foot Casting in Gait Improvement in Children With Cerebral Palsy

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    Shamsodini A

    2011-11-01

    Full Text Available Background: The goal of this study was to compare the efficacy of botulinum toxin type A (BTX-A injection in the hamstring and calf muscles with and without ankle serial casting in the improvement of gait in children with cerebral palsy (CP.Methods : This double-blind prospective clinical trial was performed on 25, 2 to 8-year-old children with hemiplegic or diplegic CP in Tehran, Iran in 2010. The participants were chosen by simple randomized sampling and were matched for age, gross motor function classification system (GMFCS and type of CP and were randomly divided into two groups: children in the first group (13 only received BTX-A injection, but the second group (12 received BTX-A and serial foot casting starting one week after the injection.Results : Comparison of the gross motor function, right and left knee spasticities and passive ROM of both knees between the two groups before and 1, 3, 6 and 12 months after the injections were not statistically significant (P>0.1. Furthermore, comparison of the right and left ankle spasticities and passive ROM before the injections and in1 and 3-month follow-ups did not show a statistically significant difference (P>0.1, but the differences were significant in 6 and 12-month follow-ups (P<0.05.Conclusion: BTX-A injection with serial foot casting vs. BTX-A alone was more effective in decreasing spasticity and improving passive ROM in the ankle of children with CP, but such injections in the hamstrings were not useful in these regards.

  14. Combined effects of botulinum toxin and casting treatments on lower limb spasticity after stroke.

    Science.gov (United States)

    Farina, Simona; Migliorini, Claudia; Gandolfi, Marialuisa; Bertolasi, L; Casarotto, Matteo; Manganotti, Paolo; Fiaschi, Antonio; Smania, Nicola

    2008-01-01

    Optimal treatment of spasticity requires a combination of pharmacotherapy and muscle lengthening. We evaluated 13 stroke patients with equinovarus foot randomized to treatment with either botulinum toxin A (BTA) injection plus ankle-foot casting (n=6) or BTA alone (n=7). The tibialis posterior and calf muscles (range of BTA injection: 190 to 320 U) were treated in each patient. Castings were worn at night for four months. Each patient was examined before, and at two and four months after BTA injection using the static and dynamic baropodometric tests, the Modified Ashworth Scale and the 10-meter walking test. At two months, therapeutic effects were observed in both groups. At four months, the study group showed further clinical improvement, while the control group returned to baseline performance. Thus, prolonged stretching of spastic muscles after BTA injection affords long-lasting therapeutic benefit, enhancing the effects of the toxin alone.

  15. Botulinum toxin A and physiotherapy intervention in the treatment of the painful shoulder after stroke: case report Toxina botulínica A e intervenção fisioterapêutica no tratamento do ombro doloroso pós acidente vascular cerebral: relato de caso

    Directory of Open Access Journals (Sweden)

    Suellen M. Marinho dos Santos Andrade

    2007-10-01

    Full Text Available The syndrome of the painful shoulder is considered a common finding in patients who suffered stroke. Several therapeutic modalities are suggested for the improvement of the patients’ clinical condition. In this report, a case of syndrome of the painful shoulder will be discussed, whose treatment consisted of the use of botulinum toxin A associated to physiotherapy. After a four-month treatment, significant improvements occurred concerning pain, spasticity, range of motion and quality of life, suggesting that this therapeutic association is an efficient tool against the incapacitating effects related to this syndrome. A síndrome do ombro doloroso é considerada um achado comum em pacientes que sofreram acidente vascular cerebral. Várias modalidades terapêuticas são apontadas para melhoria do quadro clínico dos pacientes. Neste relato, será apresentado um caso de síndrome do ombro doloroso, cujo tratamento consistiu no emprego de toxina botulínica A associada à fisioterapia. Após quatro meses de tratamento, houve melhorias significativas quanto à dor, espasticidade, amplitude de movimento e qualidade de vida, e isso sugere ser essa associação terapêutica uma ferramenta eficaz contra os efeitos incapacitantes relacionados a esta síndrome.

  16. Use of Botulinum toxin in 55 children with cerebral palsy

    Directory of Open Access Journals (Sweden)

    Mohammadi M

    2000-10-01

    Full Text Available Botulinum toxin A (BTA inhibits presynaptic release of acetylcholine at the neuromuscular junction and has reportedly been successful in the treatment of spastic disorders.To evaluate the effect of botulinum toxin on cerebral palsied children with spastic or mixed type of the disease, especially those patiens having spasticity as a cardinal symptom without joint contracture, we designed the following study. Ninety-one cases (55 of referred patients to pediatic Neurology outpatient clinics of children’s Medical Center were given BTA injections in affected muscles of the lower limb. They were reevaluating 3 to 5 weeks and 3 months later for type of walking and range of affected joints’ movement. The study showed a clinically significant gait improvement in 71.2% of patients (P<0.0005 and also an overall increased range of motion in affected limbs after BTA injection (P<0.04. Side effects occurred only in two cases as transient generalized weakness, gent recurvatum and ptosis. Drug effectiveness was time-limited, lasting abot 3 months in all patients ( a golden time for rehabilitation therapists to improve the patients’ condition. Overall, BTA has improved both the type of walking as well as the range of joints motion in our patients. So its’ administration is suggested in cerebral palsied children if the spasticity is a major and disabling sign

  17. Ultrasound-Guided Injection of Botulinum Toxin Type A for Piriformis Muscle Syndrome: A Case Report and Review of the Literature.

    Science.gov (United States)

    Santamato, Andrea; Micello, Maria Francesca; Valeno, Giovanni; Beatrice, Raffaele; Cinone, Nicoletta; Baricich, Alessio; Picelli, Alessandro; Panza, Francesco; Logroscino, Giancarlo; Fiore, Pietro; Ranieri, Maurizio

    2015-08-10

    Piriformis muscle syndrome (PMS) is caused by prolonged or excessive contraction of the piriformis muscle associated with pain in the buttocks, hips, and lower limbs because of the close proximity to the sciatic nerve. Botulinum toxin type A (BoNT-A) reduces muscle hypertonia as well as muscle contracture and pain inhibiting substance P release and other inflammatory factors. BoNT-A injection technique is important considering the difficult access of the needle for deep location, the small size of the muscle, and the proximity to neurovascular structures. Ultrasound guidance is easy to use and painless and several studies describe its use during BoNT-A administration in PMS. In the present review article, we briefly updated current knowledge regarding the BoNT therapy of PMS, describing also a case report in which this syndrome was treated with an ultrasound-guided injection of incobotulinumtoxin A. Pain reduction with an increase of hip articular range of motion in this patient with PMS confirmed the effectiveness of BoNT-A injection for the management of this syndrome.

  18. Ultrasound-Guided Injection of Botulinum Toxin Type A for Piriformis Muscle Syndrome: A Case Report and Review of the Literature

    Science.gov (United States)

    Santamato, Andrea; Micello, Maria Francesca; Valeno, Giovanni; Beatrice, Raffaele; Cinone, Nicoletta; Baricich, Alessio; Picelli, Alessandro; Panza, Francesco; Logroscino, Giancarlo; Fiore, Pietro; Ranieri, Maurizio

    2015-01-01

    Piriformis muscle syndrome (PMS) is caused by prolonged or excessive contraction of the piriformis muscle associated with pain in the buttocks, hips, and lower limbs because of the close proximity to the sciatic nerve. Botulinum toxin type A (BoNT-A) reduces muscle hypertonia as well as muscle contracture and pain inhibiting substance P release and other inflammatory factors. BoNT-A injection technique is important considering the difficult access of the needle for deep location, the small size of the muscle, and the proximity to neurovascular structures. Ultrasound guidance is easy to use and painless and several studies describe its use during BoNT-A administration in PMS. In the present review article, we briefly updated current knowledge regarding the BoNT therapy of PMS, describing also a case report in which this syndrome was treated with an ultrasound-guided injection of incobotulinumtoxin A. Pain reduction with an increase of hip articular range of motion in this patient with PMS confirmed the effectiveness of BoNT-A injection for the management of this syndrome. PMID:26266421

  19. Ultrasound-Guided Injection of Botulinum Toxin Type A for Piriformis Muscle Syndrome: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Andrea Santamato

    2015-08-01

    Full Text Available Piriformis muscle syndrome (PMS is caused by prolonged or excessive contraction of the piriformis muscle associated with pain in the buttocks, hips, and lower limbs because of the close proximity to the sciatic nerve. Botulinum toxin type A (BoNT-A reduces muscle hypertonia as well as muscle contracture and pain inhibiting substance P release and other inflammatory factors. BoNT-A injection technique is important considering the difficult access of the needle for deep location, the small size of the muscle, and the proximity to neurovascular structures. Ultrasound guidance is easy to use and painless and several studies describe its use during BoNT-A administration in PMS. In the present review article, we briefly updated current knowledge regarding the BoNT therapy of PMS, describing also a case report in which this syndrome was treated with an ultrasound-guided injection of incobotulinumtoxin A. Pain reduction with an increase of hip articular range of motion in this patient with PMS confirmed the effectiveness of BoNT-A injection for the management of this syndrome.

  20. 彩超水囊引导下A型肉毒毒素治疗慢性偏头痛%Botulinum Toxin Type A Injection Under Color Ultrasound with Water Capsule Guidance for Treatment of Chronic Migraine

    Institute of Scientific and Technical Information of China (English)

    宋金辉; 丁旭东; 肖红琼; 黄瓅; 张贵斌

    2012-01-01

    目的:观察彩超水囊引导下A型肉毒毒素治疗慢性偏头痛的临床疗效和不良反应.方法:选取64例慢性偏头痛患者应用彩超水囊引导下A型肉毒毒素进行颅周肌肉注射治疗,记录患者治疗前后偏头痛发作频率、持续时间、严重程度、止痛药使用情况及恢复状况,并行VAS、MIDAS及SF-36评分.结果:所有患者经彩超水囊引导下A型肉毒毒素治疗后,慢性偏头痛发作频率、持续时间、严重程度均较治疗前明显下降(P<0.01),止痛药物的使用较治疗前减少(P<0.01),疗效可维持至少3月,且不良反应轻微.结论:彩超水囊引导下A型肉毒毒素颅周肌肉注射治疗慢性偏头痛发作临床疗效显著,不良反应轻微,值得临床推广.%Objective To observe the clinical efficacy and safety of local injection of botulinum toxin A( BTX-A) under color ultrasound with water capsule guidance in patients with chronic migraine(CM). Methods Sixty-four patients with CM were treated with BTX-A under color ultrasound and water capsule guidance. The frequency, duration and severity of CM, medication usage of painkiller as well as side effects in patients with CM were recorded by the use of questionnaire,and were compared before and 6 months after treatment. Results Compared with those before treatments,the frequency,duration and severity of CM in patients at 6 month after treatment of BTX-A under color ultrasound and water capsule guidance were reduced significantly(P <0.01) ,and so were the frequency of medication usage of painkiller and the side effects. The therapeutic effects could last for at least 3 months. Conclusion BTX-A under color ultrasound and water capsule guidance has therapeutic effects on CM with few side effects.

  1. Treatment of axillary hyperhidrosis and bromidrosis with botulinum toxin (BTX)-A injection%A型肉毒毒素注射治疗腋窝多汗症或伴腋臭症

    Institute of Scientific and Technical Information of China (English)

    王琳; 高赫; 魏丽岩; 孔雀

    2009-01-01

    Objective To probe the advantages of BTX-A for the treatment of axillary hyper-hidrosis. Methods 42 cases were treated by BTX-A injection, 50 units per axillae, 25 sites with 2 u-nits each, 1.5 cm apart. They consisted of 24 cases of axillary hyperhidrosis, 10 cases of axillary hy-perhidrosis combined bromidrosis, and 8 cases of bromidrosis. Results All hyperhidrosis patients a-chieved good effects. Among patients with axillary hyperhidrosis combined bromidrosis, it had effects on hyperhidrosis, but only one case effected on bromidrosis. Among patients with bromidrosis, only one case had effect. Conclusions In the treatment of hyperhidrosis, BTX-A is very useful, and side effect is temporary and slight. But for bromidrosis, BTX-A is not very useful.%目的 探讨A型肉毒毒素(botulinum toxin-A,BTX-A)注射治疗腋窝多汗症或伴腋臭症及单纯液臭的疗效.方法 采用BTX-A每侧腋窝注射50 U治疗,注射选点25个,间距1.5 cm,每点注射2.5 U.结果 共治疗特发性局限性腋窝多汗症或伴腋臭患者42例,其中单纯腋窝多汗症24例全部有效.腋窝多汗症伴有腋臭10例,其中注射后多汗症治疗全部有效,腋臭治疗有效者只有1例.单纯腋臭8例,碘淀粉试验阴性,注射后只有1例显效,无效7例.结论 BTX-A治疗腋窝多汗症有效,副作用轻微、一过性.BTX-A治疗多汗症所伴有的腋臭疗效欠佳,对单纯的腋臭治疗基本无效.

  2. Botulinum toxin to improve results in cleft lip repair: a double-blinded, randomized, vehicle-controlled clinical trial.

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    Chun-Shin Chang

    Full Text Available BACKGROUND: Most patients with facial scarring would value even a slight improvement in scar quality. Botulinum toxin A is widely used to alleviate facial dynamic rhytides but is also believed to improve scar quality by reducing wound tension during healing. The main objective was to assess the effect of Botulinum toxin on scars resultant from standardized upper lip wounds. METHODS: In this double-blinded, randomized, vehicle-controlled, prospective clinical trial, 60 consecutive consenting adults undergoing cleft lip scar revision (CLSR surgery between July 2010 and March 2012 were randomized to receive botulinum toxin A (n = 30 or vehicle (normal saline; n = 30 injections into the subjacent orbicularis oris muscle immediately after wound closure. Scars were independently assessed at 6-months follow-up in blinded fashion using: Vancouver Scar Scale (VSS, Visual Analogue Scale (VAS and photographic plus ultrasound measurements of scar widths. RESULTS: 58 patients completed the trial. All scar assessment modalities revealed statistically significantly better scars in the experimental than the vehicle-control group. CONCLUSION: Quality of surgical upper lip scars, which are oriented perpendicular to the direction of pull of the underlying orbicularis oris muscle, is significantly improved by its temporary paralysis during wound healing. TRIAL REGISTRATION: ClinicalTrials.gov NCT01429402.

  3. Time Course Analysis of the Effects of Botulinum Neurotoxin Type A on Pain and Vasomotor Responses Evoked by Glutamate Injection into Human Temporalis Muscles

    Directory of Open Access Journals (Sweden)

    Larissa Bittencourt da Silva

    2014-02-01

    Full Text Available The effect of botulinum neurotoxin type A (BoNTA on glutamate-evoked temporalis muscle pain and vasomotor responses was investigated in healthy men and women over a 60 day time course. Subjects participated in a pre-BoNTA session where their responses to injection of glutamate (1 M, 0.2 mL and saline (0.2 mL into the temporalis muscles were assessed. On Day 1, BoNTA (5 U was injected into one temporalis muscle and saline into the contralateral temporalis muscle, in a randomized order. Subjects then received intramuscular injections of glutamate (1 M, 0.2 mL into the left and right temporalis muscles at 3 h and subsequently 7, 30 and 60 days post-injection of BoNTA. Pain intensity, pain area, and neurogenic inflammation (skin temperature and skin blood perfusion were recorded. Prior to BoNTA treatment, glutamate evoked significantly greater pain and vasomotor reactions (P < 0.001 than saline. BoNTA significantly reduced glutamate-evoked pain intensity (P < 0.05, pain area (P < 0.01, skin blood perfusion (P < 0.05, and skin temperature (P < 0.001. The inhibitory effect of BoNTA was present at 3 h after injection, peaked after 7 days and returned to baseline by 60 days. Findings from the present study demonstrated a rapid action of BoNTA on glutamate-evoked pain and neurogenic inflammation, which is in line with animal studies.

  4. A型肉毒素治疗面部皱纹的临床疗效观察%The Observation effect of Botulinum Toxin type A injections in treatment of facial wrinkle

    Institute of Scientific and Technical Information of China (English)

    袁亮飞; 刘静; 刘安久; 曹进军

    2012-01-01

      Objective:To observe the effect of Botulinum Toxin type A injections in treatment of facial wrinkle. Methods:A total of 91 patients were included. Botulinum Toxin type A inject their facial wrinkle,the different local with different doses,fixed uniform inject. Results:91 patients were satisfied with the treatment. Conclusions:Botulinum Toxin type A injections therapy is a effective methods for treatment facial wrinkle. The therapeutic effect is obvious ,rapid and the side effects minimal.%  目的观察A型肉毒素(BTXA)治疗面部皱纹的疗效。方法对91例面部皱纹患者利用A型肉毒素根据部位不同,分别采用不同剂量,定点均匀注射。结果91例患者经治疗后均获得满意疗效。结论 A型肉毒素在面部除皱中有确切的疗效,且痛苦小、见效快、副作用少。

  5. 治疗用肉毒毒素A在面部除皱中的疗效观察%Observation of curative effect of botulinum toxin A for treatment of facial wrinkles

    Institute of Scientific and Technical Information of China (English)

    勾庆芬; 李芸; 钟文慧; 姚翠英; 田霞; 杨喆; 邵芳

    2009-01-01

    目的:探讨肉毒毒素A在面部除皱术中的维持时间、多次注射的远期疗效、不同部位的疗效差异及药物对其影响等.方法:用肉毒毒素A注射面部皱纹568例,其中490例仅进行额纹、鱼尾纹、眉间纹的注射,43例注射上述三部位加下睑皱纹,35例注射额纹、鱼尾纹、眉间纹加鼻唇沟纹;其中3例仅注射额纹、鱼尾纹、眉间纹及1例注射上述三部位加鼻唇沟纹的3 mL注射液中加入了2%利多卡因0.2 mL.568例受术者有204例进行了第2次注射,102例进行了第3次注射,35例进行了第4次注射.结果:首次注射疗效维持6~9个月者,额纹、鱼尾纹、眉间纹占65.96%,下睑纹占51.16%,鼻唇沟纹占23.53%.第1、2、3、4次注射维持时间呈递减趋势.注射液中加入利多卡因疗效明显减弱.结论:肉毒毒素A在面部除皱首次注射的维持时间多数在6~9个月之间;多次注射维持时间呈递减趋势;利多卡因可减弱药效.%OBJECTIVE To explore the maintain time, long-term effect of multiple injections, effect difference at different lo-cation and drug interaction of using BTX A for treatment of facial wrinkles. METHODS BTX A injection was given for 568 subjects with brow wrinkles, fish tail wrinkles and glabellar wrinkles, in which BTX A injection was given in 43 cases with low-er eyelid wrinkles, 35 cases with nasolabial furrow wrinkle. 0.2 mL lidoeaine hydrochloride in the injection was given in 4 cases with brow striae,fish tail striae and glabella wrinkles,and in 1 case of nasolabial furrow wrinkle. Among them 204 cases were given with the second injection, 102 cases were given with the third injection,35 cases were given with the fourth injection. RE-SULTS The first injection effect maintained 6-9 months in 65. 96% of brow wrinkles, fish tail wrinkles and glabellar wrinkles, in 51.16% of lower eyelid wrinkles, 23. 53% of nasolabial furrow wrinkles. The decreasing tendency of maintaining time was shown from the

  6. Semen parameters and seminal plasma protein and biochemical profiles of dogs with benign prostatic hyperplasia after botulinum toxin type A intraprostatic injection

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    Tathiana Ferguson Motheo

    2014-06-01

    Full Text Available This study aimed to determine the effects of different concentrations of botulinum toxin type A (BT-A on semen parameters, and seminal plasma biochemical and protein profiles of dogs with benign prostatic hyperplasia (BPH. Eighteen sexually intact male dogs with BPH were randomly divided in three groups, and received an intraprostatic injection of saline solution (control group - CG, 250UI (GI or 500UI (GII of BT-A under transabdominal ultrasound guidance. Semen was collected at baseline, 2, 4 and 8 weeks after treatment. Semen parameters were determined and seminal plasma pH, total protein (TP, total chlorides (TC, calcium (Ca, potassium (K, and sodium (Na concentrations were assessed. One-dimensional sodium dodecyl sulfatepolyacrilamide gel eletrophoresis (SDS- PAGE was performed to determine seminal plasma protein profile. Sperm parameters and seminal plasma pH, TP, TC, Ca and K mean values did not change significantly at any time point and among treated groups (P>0.05. The SDS-PAGE analysis of the pooled fractions identified 31 protein bands with molecular weights ranging from 3.9 to 106.2kDA in all treatment groups during the entire evaluation period. Regardless the used dose, intraprostatic BT-A injection do not alter semen parameters and seminal plasma biochemical and protein profiles of dogs with BPH.

  7. Face Contouring with Botulinum Toxin Type A and Lecithin Injection Lipolysis%A型肉毒毒素和卵磷脂注射溶脂联合应用修改面部轮廓

    Institute of Scientific and Technical Information of China (English)

    徐威; 袁伟; 庞星原; 王俊; 任军; 武连生

    2011-01-01

    目的:探讨A型肉毒毒素和卵磷脂注射溶脂联合应用修改面部轮廓.方法:对32例面部轮廓宽大要求瘦脸者,采用A型肉毒毒素和卵磷脂注射溶脂联合应用治疗,并观察其效果及并发症.结果:所有患者均达到良好满意面部减肥瘦脸效果,无明显并发症及不良反应.结论:A型肉毒毒素联合卵磷脂注射的方法能提高单独使用A型肉毒毒素的疗效,在面部轮廓改型中有着极其广阔的应用前景,值得进一步研究和探讨.%Objective; To evaluate the application of face contouring with botulinum toxin type A and lecithin injection lipolysis. Methods: Thirty-two cases of broad face contour were treated with injection of botulinum toxin type A combined by lecithin injection lipolysis. Results: All the patients achieved satisfactory results with 3-6 months' follow-up. No complication and side effects happened. Conclusion; The combination use of botulinum toxin type A and lecithin injection lipolysis can greatly improve the effect of botulinum and achieve satisfactory results in face contouring.

  8. Botulinum Toxin Type A Injections in the Psoas Muscle of Children with Cerebral Palsy: Muscle Atrophy after Motor End Plate-Targeted Injections

    Science.gov (United States)

    Van Campenhout, Anja; Verhaegen, Ann; Pans, Steven; Molenaers, Guy

    2013-01-01

    MEP targeting during BoNT-A injections has been demonstrated to improve outcome. Two injection techniques of the psoas muscle--proximal MEP targeting versus a widely used more distal injection technique--are compared using muscle volume assessment by digital MRI segmentation as outcome measure. Method: 7 spastic diplegic children received…

  9. Quality of life in individuals with cervical dystonia before botulinum toxin injection in a Brazilian tertiary care hospital

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    Mariana Ribeiro Queiroz

    2011-12-01

    Full Text Available OBJECTIVE: The purpose of this study was to evaluate quality of life (QoL in a Brazilian population of individuals with cervical dystonia (CD without effect of botulinum toxin (BTx or with only residual effect of BTx, and identify possible physical and social aspects that affect their QoL. METHOD: Sixty five out of sixty seven consecutive patients with CD were assessed with two instruments: Short-form Health Survey with 36 questions (SF-36 and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS. RESULTS: Severity of CD (TWSTRS correlated moderately with two SF-36 subscale: role-physical (r= -0.42 and body pain (r= -0.43. Women also scored worse in two subscale of SF-36: vitality (p<0.05 and mental-health (p<0.005. CONCLUSION: Severity of CD and gender (female were the main factors related to a worse QoL perception. These findings may help health professionals to predict which characteristics could lead to worse QoL, and therefore, better target their interventions to lessen the burden caused by CD.

  10. A型肉毒素肌注胸大肌对硅凝胶假体隆乳术形态影响的临床研究%Clinical study on the breast shape after the augmentation mammaplasty with pectoralis major injeected Botulinum Toxin A

    Institute of Scientific and Technical Information of China (English)

    赵娜; 黎冻; 周翔; 莫海燕; 韦洁; 王琪海

    2013-01-01

    目的:本研究旨在探讨A型肉毒素对假体隆乳病人术后乳房形态变化的影响.方法:40例小乳症患者行硅胶囊乳房假体隆乳术.试验组术中在胸大肌中下段注射A型肉毒素,对照组直接行隆乳术,术后两组采取照片测量进行形态评估.结果:在整体乳房形态上,试验组术后3个月大部分乳房乳头位置基本位于乳房中部,术后6个月可稍上移,幅度不大,对照组于术后3月乳头位置基本固定,大部分乳房乳头位置集中于乳房分区中部靠下,P<0.05.结论:A型肉毒素在早期可以使乳房形状更自然.%Objective To investigate the effects of botulinum toxin type A on morphological changes of patients with augmentation mammaplasty.Methods 40 cases accepted augmentation mammaplasty.The test group need pectoralis major Lower segment injection with botulinum toxin type A,and the control group accepted augmentation mammaplasty directly.After the operation,Two groups took photo measurement to the morphological evaluation.Results On the whole breast shape,In the experimental group,most of the breast nipple position were substantially in the middle of breast 3 months later,which may be slightly moved up marginally 6 months later.In the control group,the nipple position basically fixed 3 months after operation,and the majority concentrated in the breast nipple position on the lower middle partition,P<0.05.Conclusions Botulinum toxin type A in the early can make a more natural shape of the breast.

  11. Botulinum Toxin Therapy

    Science.gov (United States)

    ... care Kids’ zone Video library Find a dermatologist Botulinum toxin therapy Overview Before treatment: This woman disliked her deep frown lines. Botulinum toxin therapy: Overview Also called botulinum rejuvenation Brand names: ...

  12. Botulinum neurotoxin type A injection of the pelvic floor muscle in pain due to spasticity: a review of the current literature.

    Science.gov (United States)

    Bhide, Alka A; Puccini, Federica; Khullar, Vik; Elneil, Suzy; Digesu, G Alessandro

    2013-09-01

    The role of muscle spasm is not a new concept in the genesis of pain. Botulinum neurotoxin type A (BoNTA) has been successfully employed in a variety of muscular and inflammatory conditions. The aim of our study was to review the published literature on the role of BoNTA injection of the pelvic floor muscle in the management of women with chronic pelvic pain (CPP). A systematic search of the literature published up to June 2012 on the use of BoNTA in the treatment of female pelvic floor muscle spasm was carried out using relevant search terms in MEDLINE and EMBASE databases. The results were limited to full-text English language articles. Relevant trials as well as relevant reviews were selected and analyzed by two independent reviewers. Five studies (2 case reports, 1 prospective pilot study, 1 retrospective study and 1 randomised double-blind placebo controlled study) were included in this systematic review. Overall, BoNTA has shown to be beneficial in relieving CPP related to pelvic floor spasm. The role of BoNTA as a treatment of CPP has been recognized for more than 10 years. Although data are still scarce preliminary results are encouraging. BoNTA is an attractive option for refractory CPP related to pelvic floor muscle spasm, but further studies using validated and reproducible outcome measures are needed, to establish its effectiveness, safeness, technique, optimal dosage, and duration of symptom relief.

  13. Botulinum toxin in the treatment of orofacial tardive dyskinesia : A single blind study

    NARCIS (Netherlands)

    Slotema, Christina W.; van Harten, Peter N.; Bruggeman, Richard; Hoek, Hans W.

    2008-01-01

    Objective: Orofacial tardive dyskinesia (OTD) is difficult to treat and Botulinium Toxin A (BTA) may be an option. Methods: In a single blind (raters were blind) study (N= 12, duration 33 weeks) OTD was treated with Botulinum Toxin A in three consecutive sessions with increasing dosages. The severit

  14. The use of botulinum toxin and epidural analgesia for the treatment of spasticity and pain in a patient with maple syrup urine disease

    Directory of Open Access Journals (Sweden)

    Abdullah M Kaki

    2012-01-01

    Full Text Available A 7-year-old boy, weighing 18 kg, was diagnosed with maple syrup urine disease (MSUD. He suffered from spasticity of the lower limbs and pain that did not respond to oral medications. Injections of botulinum toxin A (BTX-A at 10 sites and epidural analgesia with 0.125% bupivacaine were used to treat spasticity with good results. We conclude that BTX-A combined with epidural analgesia may be a useful treatment option for incapacitating, painful spasticity related to MSUD. This treatment modality allowed a comprehensive rehabilitation program to be completed and it lasted longer than 9 months.

  15. Botulinum toxin in severe upper extremity spasticity among patients with traumatic brain injury: an open-labeled trial.

    Science.gov (United States)

    Yablon, S A; Agana, B T; Ivanhoe, C B; Boake, C

    1996-10-01

    We studied the effect of botulinum toxin A (BTXA) among patients with traumatic brain injury (TBI) and severe spasticity unresponsive to conservative management. Twenty-one consecutive adult patients with severe spasticity involving the wrist and finger flexor musculature were treated with BTXA injection (20 to 40 units per muscle) under EMG guidance. After injection, patients received passive range of motion (ROM) exercise, with modalities and casting as clinically indicated. Outcome measures, including wrist ROM and the modified Ashworth Scale (MAS), were assessed 2 to 4 weeks after injection. Among the respective acute and chronic groups, mean ROM improved 42.9 (p = 0.001) and 36.2 degrees (p < 0.001). Mean MAS rating improved 1.5 (p = 0.01) and 1.47 (p = 0.002) points. There were no significant adverse effects. BTXA, in conjunction with conventional modalities, significantly improves spasticity and ROM in the distal upper extremity musculature of patients with TBI.

  16. Botulinum Toxin: Pharmacology and Therapeutic Roles in Pain States.

    Science.gov (United States)

    Patil, Shilpadevi; Willett, Olga; Thompkins, Terin; Hermann, Robert; Ramanathan, Sathish; Cornett, Elyse M; Fox, Charles J; Kaye, Alan David

    2016-03-01

    Botulinum toxin, also known as Botox, is produced by Clostridium botulinum, a gram-positive anaerobic bacterium, and botulinum toxin injections are among the most commonly practiced cosmetic procedures in the USA. Although botulinum toxin is typically associated with cosmetic procedures, it can be used to treat a variety of other conditions, including pain. Botulinum toxin blocks the release of acetylcholine from nerve endings to paralyze muscles and to decrease the pain response. Botulinum toxin has a long duration of action, lasting up to 5 months after initial treatment which makes it an excellent treatment for chronic pain patients. This manuscript will outline in detail why botulinum toxin is used as a successful treatment for pain in multiple conditions as well as outline the risks associated with using botulinum toxin in certain individuals. As of today, the only FDA-approved chronic condition that botulinum toxin can be used to treat is migraines and this is related to its ability to decrease muscle tension and increase muscle relaxation. Contraindications to botulinum toxin treatments are limited to a hypersensitivity to the toxin or an infection at the site of injection, and there are no known drug interactions with botulinum toxin. Botulinum toxin is an advantageous and effective alternative pain treatment and a therapy to consider for those that do not respond to opioid treatment. In summary, botulinum toxin is a relatively safe and effective treatment for individuals with certain pain conditions, including migraines. More research is warranted to elucidate chronic and long-term implications of botulinum toxin treatment as well as effects in pregnant, elderly, and adolescent patients.

  17. Local injection of bortulinum toxin A at multiple points for decreasing the muscular tension of children with spastic cerebral palsy A comparative observation

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: More than 70% children with cerebral palsy belong to the spastic one, and the increased muscular tension results in motor dysfunction and posture abnormality.OBJECTIVE: To observe the assistant effect of the local injection of BTX-A at multiple points in the rehabilitative treatment of spastic cerebral palsy.DESIGN: A comparative observation on the clinical efficacy.SETTINGS: Rehabilitation Center,Loufeng Hospital, Suzhou Industrial Park; Gansu Rehabilitation Center Hospital.PARTICIPANTS: Sixty-nine children with cerebral palsy were selected from the outpatients and inpatients who accepted rehabilitative treatments in the Cerebral Palsy Treatment Center of Gansu Rehabilitation Center Hospital from April 2003 and October 2004. Inclusive criteria: ① Having high risk factors for brain injury before birth and within 1 month after birth, mainly manifested as central motor disorder and posture abnormality; ② Accompanied by increase of muscular tension in both lower limbs, appearing as tiptoes and scissors gaits while in standing position or walking; ③ Without fixed contracture of lower limb; ④ Had never been operated for lower limbs; ⑤ Had never been injected with BTX-A; ⑥ Clearly diagnosed to have spastic palsy. The enrolled children were not screened by disease conditions, course, age, etc., and informed consents were obtained from the parents of all the children. The children whose parents agreed to accept BTX-A treatment were taken as BTX-A treated group (n =45), and the others as control group (n = 24).METHODS: All the children accepted regular rehabilitative training after admission, 6 times a weeks,besides, those in the BTX-A treated group were given local injection of BTX-A at multiple points of target muscles, including bilateral adductor longus muscles, pectineal muscles, gastrocnemius muscles and soleus muscles. BTX-A was diluted with saline (5 U BTX-A in 0.1 mL), 3 - 4 U/kg for each piece of muscle. The number of injected sites

  18. Treatment of scar contracture with intralesional botulinum toxin type A injection%A型肉毒毒素治疗挛缩性瘢痕

    Institute of Scientific and Technical Information of China (English)

    颜彤彤; 陈敏亮; 马奎; 梁黎明; 刘畅; 赖林英; 付小兵

    2013-01-01

    Objective To evaluate the validity of botulinum toxin type A (BTXA) injections for the treatment of scar contracture.Methods 26 patients with scar contracture were randomly assigned into BTXA group and triamcinolone acetonide (TAC) group.Pinpoint tattooing was performed on each side of each scar in the plane of its longest axis.A template was used to ensure consistent length.These two tattoo points were measured to assess scar contraction at baseline,at every month for a total of 6 months.Histological analysis was conducted to study the physiological environment and immunohistochemistry to detect the expression of α-SMA and myosin-Ⅱ at different groups.Results Scar contraction was more relaxed in BTXA group than that in TAC group after 1 month (P<0.05),especially in the 6th month (the D value in BTXA group and TAC group was (1.23±0.42) cm,and (0.56±0.33) cm respectively).For immunohistochemistry,the expression of α-SMA and myosin-Ⅱ also decreased in BTXA group (P<0.05).Conclusions The treatment of scar contracture by suitable BTXA injections is safe and effective.%目的 探索A型肉毒毒素(botulinum toxin type A,BTXA)治疗挛缩性瘢痕的疗效.方法 选取26例挛缩性瘢痕患者,随机分为A型肉毒毒素组(BTXA组)和曲安奈德组(TAC组,对照组),注射药物治疗前测量各组患者瘢痕长轴长度,并于注射后再次测量其长度,1次/月,共6次,通过比较治疗前后差值评价药物疗效.切取各组瘢痕组织行免疫组织化学检测,观察α平滑肌肌动蛋白(α-SMA)及肌球蛋白-Ⅱ的表达情况.结果 药物作用1个月后,BTXA组较TAC组瘢痕挛缩程度明显减轻(P<0.05),尤以6个月时差异最明显,BTXA组和TAC组瘢痕长轴长度差值分别为(1.23±0.42) cm和(0.56±0.33) cm.免疫组织化学结果显示,BTXA组瘢痕内α-SMA及肌球蛋白-Ⅱ表达较TAC组明显减少(P<0.05).结论 A型肉毒毒素治疗挛缩性瘢痕操作简单、效果明显,值得推广应用.

  19. Botulinum Toxin

    Science.gov (United States)

    2009-01-01

    botulinum spores, which germinate and multiply into bacteria to produce neurotoxin in the food. Commonly contaminated foods include improperly preserved ... naturally occurring BoNT intoxication, it most recently occurred in Maryland as a result of a construction worker receiving a contaminated, compound...consumption and handling of meat products. Thus German physician lustinus Kerner described what he termed " sausage poisoning" (Erbguth, 2004). It was later

  20. A meta-analysis of botulinum toxin type A (BTXA) injections in the plastic surgery incision%术后行肉毒毒素注射对切口愈合效果影响的Meta分析

    Institute of Scientific and Technical Information of China (English)

    常宁; 李广帅; 刘林嶓; 魏志茹

    2015-01-01

    目的:系统评价术后行肉毒毒素注射对切口愈合效果的影响.方法:计算机检索PubMed、EMbase、Cochrane Central、CNKI、VIP等数据库,检索时间从每个数据库创建至2015年8月,纳入术后行肉毒毒素注射与行安慰剂注射的随机对照试验.提取数据,采用RevMan 5.3软件进行Meta分析.结果:共纳入6个研究, Meta分析结果示,术后行肉毒毒素注射对切口愈合效果有统计学意义(P<0.0001),OR=3.31[2.05,5.35].结论:术后行肉毒毒素注射对切口愈合效果有积极意义.%Objective To systematically evaluate the influence of botulinum toxin type A(BTXA) injections in the plastic surgery incision. Methods A systematic literature search for studies which were published on PubMed,EMbase,Cochrane Central,CNKl,VlP was performed from database establishment to August 2015.We included trails related to the influence of botulinum toxin type A (BTXA)injections in the plastic surgery incision.We extracted data RevMan5.3 was used for meta-analysis. Results A total of 6 studies were included in this study.Meta-analysis showed that there was statistically significant difference between two groups(P<0.0001),OR=3.31[2.05,5.35]. Conclusion Botulinum toxin type A(BTXA)injections in the plastic surgery incision has a positive significance.

  1. Beneficial effects of botulinum toxin type A in trigeminal neuralgia

    OpenAIRE

    Zúñiga, Carlos; Díaz,Sergio; Piedimonte, Fabián; Micheli, Federico

    2008-01-01

    Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Vis...

  2. The clinical effect of botulinum toxin A for treatment of localized muscular tension disor-der and muscle spasm%A型肉毒毒素治疗局限性肌张力障碍和肌肉痉挛的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    丛培刚; 邵威丽

    2015-01-01

    AIM:To study the clinical effect of botulinum toxin A for the treatment of localized muscular tension disorder and muscle spasm. METHODS: A total of 241 cases of limited dystonia and muscle spasm patients admitted from January 2011 to April 2012 in our hospital were randomly divided into study group and control group,with 120 cases in the study group and 121 cases in the control group. Among these cases, there are 118 cases of hemifacial spasm,64 cases of spasmodic torticollis and 59 cases of oromandibular dystonia. The two groups were treated with different methods and followed up for 2 months to 28 months. And the treatment effect of the two groups were compared with patients ’ satisfaction. RESULTS:A total of 120 cases of patients in study group were treated effectively after the treatment, and the total efficiency was 98. 33%, while 100 patients in the control group were treated effectively after the treatment,and the total efficiency was 82.64%. The effective rate of the two groups were significantly different ( P<0.05) . The treatment satisfaction in the study group (85.12%) were significantly better than it in the control group (97.50%),and the data were significantly different (P<0.05). CONCLUSION:Application of botulinum toxin A in the treat⁃ment of the patients with localized muscle tension and muscle spasm,can effectively improve the treatment effect and improve the relationship between doctors and patients, which can effectively improve patients’ satisfaction.%目的:研究分析A型肉毒毒素治疗局限性肌张力障碍和肌肉痉挛的临床效果.方法:将我院2011-01/2012-04接收治疗的241例局限性肌张力障碍和肌肉痉挛患者作为研究分析对象,将两组患者随机分为研究组( n=120)和对照组( n=121).其中包含118例侧面肌痉挛,64例痉挛性斜颈,59例口下颌肌张力障碍.两组给予不同的治疗方式,随访时间为2~28个月,将两组患者的治疗效

  3. Acrylamide inhibits nerve sprouting induced by botulinum toxin type A

    Institute of Scientific and Technical Information of China (English)

    Hong Jiang; Yi Xiang; Xingyue Hu; Huaying Cai

    2014-01-01

    Botulinum toxin type A is a potent muscle relaxant that blocks the transmission and release of acetylcholine at the neuromuscular junction. Intramuscular injection of botulinum toxin type A has served as an effective and safe therapy for strabismus and focal dystonia. However, muscular weakness is temporary and after 3-4 months, muscle strength usually recovers because function-al recovery is mediated by nerve sprouting and reconstruction of the neuromuscular junction. Acrylamide may produce neurotoxic substances that cause retrograde necrotizing neuropathy and inhibit nerve sprouting caused by botulinum toxin type A. This study investigated whether acrylamide inhibits nerve sprouting after intramuscular injection of botulinum toxin type A. A tibial nerve sprouting model was established through local injection of botulinum toxin type A into the right gastrocnemius muscle of Sprague-Dawley rats. Following intramuscular injection, rats were given intraperitoneal injection of 3%acrylamide every 3 days for 21 days. Nerve sprout-ing appeared 2 weeks after intramuscular injection of botulinum toxin type A and single-fiber electromyography revealed abnormal conduction at the neuromuscular junction 1 week after intra-muscular injection of botulinum toxin type A. Following intraperitoneal injection of acrylamide, the peak muscle ifber density decreased. Electromyography jitter value were restored to normal levels 6 weeks after injection. This indicates that the maximal decrease in ifber density and the time at which functional conduction of neuromuscular junction was restored were delayed. Addition-ally, the increase in tibial nerve ifbers was reduced. Acrylamide inhibits nerve sprouting caused by botulinum toxin type A and may be used to prolong the clinical dosage of botulinum toxin type A.

  4. 面指数测算在注射瘦脸美容中的应用%Application of Facial Index Measurement in Masseteric Injection of Botulinum Toxin Type A for Thin Face

    Institute of Scientific and Technical Information of China (English)

    李高峰; 谭军; 李波; 丁卫; 肖学敏; 刘东平

    2011-01-01

    [Objective] To explore the range of facial indices of beautiful facial forms in order to evaluate the efficacy of masseteric injection of botulinum toxin type A for thin face. [Methods] The orthophoria pictures of 50 beautiful female stars(control group) were downloaded from internet. The facial indices of these 50 beautiful female stars were calculated and compared with those of 20 cases with poor facial forms(observation group) who were treated with masseteric injection of botulinum toxin type A for thin face. The efficacy of masseteric injection of botulinum toxin type A for thin face and its effect on the facial indices were observed.[Results] Facial indices FWg/FWz and FH/FWz in control group were 0. 8209 ± 0. 0342 and 0. 8578 ± 0. 0342,respectively, and those in observation group were 0. 8787 ± 0. 0345 and 0. 8366 ± 0. 0185, respectively. The FWg/FWz in control group was significantly lower than that in observation group, while the FH/FWz in control group was higher than that in observation group. The FH/FWz in observation group after masseteric injection of botulinum toxin type A for thin face had no change, but FWg/FWz in observation group decreased significantly and inclined to that in control group. [Conclusion] Masseteric injection of botulinum toxin type Afor thin face is an effective method. Measuring facial index can be used to evaluate the efficacy of improving facial morphology.%[目的]寻求漂亮面型的面指数数值范围,以此评价注射瘦脸美容的效果.[方法]从互联网上下载50位漂亮女明星的面部正位图片(对照组),测算其面指数,并与临床上要求进行咬肌内注射A型肉毒毒素瘦脸美容的20例面型欠佳者的面指数(观察组)进行比较,观察注射瘦脸美容的效果及对面指数的影响.[结果]对照组面指数FWg/FWz和FH/FWz分别为0.8209±0.0342,0.8578±0.0342,观察组分别为0.8787±0.0345,0.8366±0.0185.对照组FWg/FWz显著低于观察组,但FH/FWz则高于观察组.

  5. Lower facial remodeling with botulinum toxin type A for the treatment of masseter hypertrophy*

    Science.gov (United States)

    Klein, Fernanda Homem de Mello de Souza; Brenner, Fabiane Mulinari; Sato, Maurício Shigeru; Robert, Fernanda Manfron Batista Rosas; Helmer, Karin Adriane

    2014-01-01

    BACKGROUND Masseter hypertrophy has been treated with botulinum toxin injections because of esthetic complaints especially in Asians. OBJECTIVES The goal of the present study was to evaluate the efficacy of abobotulin toxin use in masseter hipertrophy treatment in Brazilians. METHODS Ten Brazilian female patients with masseter hypertrophy were subjected to injections of 90U of abobotulinum toxin A applied on each side respecting the safety zone stabilished in literature and were followed up for 24 weeks. RESULTS When analyzing the coefficients between measures of middle and lower third of the face obtained from standardized photographs, an increase was observed, with statistical significance at 2 weeks (p=0.005) and 12 weeks (p=0.001). The progression of lower third reduction was 3.94%, 5.26%, 11.99%, and 5.47% (2, 4, 12, and 24 weeks respectively). All patients showed improvement in bruxism after treatment. Observed adverse effects were masticatory fatigue, smile limitation, and smile asymmetry. CONCLUSION The use of abobotulinum toxin A for masseter hypertrophy is effective in Brazilians and reached its maximum effect of facial thinning at 12 weeks. Smile limitation had a higher incidence compared to that reported in the literature and may result from risorius muscle blockage caused by toxin dissemination. Despite its side effects, 80% of the patients would like to repeat the treatment. PMID:25387491

  6. Use of botulinum toxin in musculoskeletal pain [v2; ref status: indexed, http://f1000r.es/16j

    Directory of Open Access Journals (Sweden)

    Jasvinder A Singh

    2013-07-01

    Full Text Available Chronic musculoskeletal pain is a common cause of chronic pain, which is associated with a total cost of $635 billion per year in the U.S. Emerging evidence suggests an anti-nociceptive action of botulinum toxin, independent of its muscle paralyzing action. This review provides a summary of data from both non-randomized and randomized clinical studies of botulinum toxin in back pain and various osteoarticular conditions, including osteoarthritis, tennis elbow, low back pain and hand pain. Three randomized controlled trials (RCTs of small sizes provide evidence of short-term efficacy of a single intra-articular injection of 100 units of botulinum toxin A (BoNT/A for the relief of pain and the improvement of both function and quality of life in patients with chronic joint pain due to arthritis. Three RCTs studied intramuscular BoNT/A for tennis elbow with one showing a significant improvement in pain relief compared with placebo, another one showing no difference from placebo, and the third finding that pain and function improvement with BoNT/A injection were similar to those obtained with surgical release. One RCT of intramuscular BoNT/A for low back pain found improvement in pain and function compared to placebo. Single RCTs using local injections of BoNT in patients with either temporomandibular joint (TMJ pain or plantar fasciitis found superior efficacy compared to placebo. One RCT of intramuscular BoNT/B in patients with hand pain and carpal tunnel syndrome found improvement in pain in both BoNT/B and placebo groups, but no significant difference between groups. Most evidence is based on small studies, but the use of BoNT is supported by a single, and sometimes up to three, RCTs for several chronic musculoskeletal pain conditions. This indicates that botulinum toxin may be a promising potential new treatment for chronic refractory musculoskeletal pain. Well-designed large clinical trials are needed.

  7. Effect of 3,4-Diaminopyridine on the Survival of Mice Injected with Botulinum Neurotoxin Type A, B, E, or F,

    Science.gov (United States)

    2007-11-02

    botulism Uy caused by type A versus type B toxin have been described (Hughes et al., 1981). In a review of the clinical records from 55 cases of...intestine by C. botulinum followed by production of the toxin in vivo (Arnon et al., 1977). Occasionally, cases of human botulism result from...1966), di~e-ses similar to botulism in that neuromuscular transmission is compromised, guanidine was used to treat a case of human botulism (Cherington

  8. A型肉毒杆菌毒素治疗面肌痉挛、 睑肌痉挛68例报告%Treatment of hemifacial spasm and blepharospasm with botudinum toxin A: clinical report of 68 cases

    Institute of Scientific and Technical Information of China (English)

    付耀高

    2001-01-01

    Aim: To evaluate the efficacy of Botulinum toxin A for hemifacial spasm and for the facialspasm and blepharospasm. Methods: a total of 68 individuals were enrolled in the clinical study. TheBotulinum Toxin A was locally injected into the involved muscles. The dosage for each injection was 1~2 ng/mL(2.5~50 U/mL). Results: The overall successful rate of relief of spasm was 100%. Amongthem, 85.3% of patients had excellent improvement on the spasm intensity scale, while the rest 14.7%of patients had moderate improvement. The beneficial effect began at the 4 h to 3days after the injection,and the duration of beneficial effects was 12~30 weeks. Only local side effects appeared in some pa-tients, but it was mild and reversible. Conclusion: Botulinum toxin A injection is an effective, safe andsimple therapeutic method for patients with hemifacial spasm and blepharospasm, and may be consideredas the first choice for the treatment of patients with hemifacial spasm and blepharospasm.%目的:探讨A型肉毒杆菌毒素治疗面肌痉挛和睑肌痉挛的效果。方法:应用A型肉毒杆菌毒素局部肌肉注射治疗共68例,药物浓度为0.1~0.2mg/ml(25~50 U/mL)。结果:有效率为100%,其中完全缓解85.3%,明显缓解及部分缓解14.7%,显效时间4 h~3 d,作用持续时间12~30周。无过敏和全身中毒反应。局部副作用轻微、可逆。结论:A型肉毒杆菌毒素治疗面肌痉挛和睑肌痉挛安全、简便,有效,可作为治疗面肌痉挛和睑肌痉挛的首选药物。

  9. Comparison between the effects of location by manual palpation and ultrasound guidance in botulinum toxin type A injection techniques for stroke patients' spastic equinovarus%超声引导和徒手肌肉定位法用于A型肉毒毒素治疗脑卒中患者痉挛性足下垂内翻的临床效果

    Institute of Scientific and Technical Information of China (English)

    欧海宁; 沈建虹; 陈红霞; 詹乐昌; 李梅

    2011-01-01

    Objective: To compare the clinical outcome of two different location techniques: manual palpation guidance and ultrasound guidance, for botulinum toxin type A injection into calf muscles in the treatment of spastic equinovarus in stroke patients.Method: Forty stroke patients with equinovarus were randomly assigned into two groups. All patients of both groups received injection of 300U botulinum toxin A in gastrocnemius, soleus and tibialis posterior muscles. The group A(n=18) was applied manual palpation-guided technique for location of injection. The group B(n=20) was applied ultrasound-guided technique for location of injection. Modified Ashworth scale(MAS), physician rating scale (PRS), speed of gait, passive range of motion(PROM) of ankle dorsiflexion and eversion were measured at baseline, and the 2nd, 4th, 8th, 12th week after treatment.Result: In each group, after treatment, the measurement indexes of MAS, gait pattern scale, speed of gait, PROM of ankle dorsiflexion and eversion all improved significantly(P<0.05). Group B improved significantly in MAS,PRS,speed of gait, PROM of ankle dorsiflexion and eversion at the 4th week(P<0.05), in MAS and PROM of ankle dorsiflexion at the 8th week(P<0.05), in MAS, speed of gait and PROM of ankle eversion at the 12th week comparing with group A(P<0.05). Comparing the trend of variations of measurement indexes during follow-up periods in two groups there was no statistical difference.Conclusion: The correction of equinovarus in stroke patients could be obtained by injecting botulinum toxin type A. Ultrasound-guided technique was considered to be a valid alternative technique for location of injection, which got superior clinical results than manual palpation-guided technique in some respects.%目的:比较超声引导下注射和徒手肌肉定位法在肉毒毒素注射治疗脑卒中患者足下垂内翻的临床效果.方法:46例符合纳人标准的脑卒中后足下垂内翻

  10. Quantitative Effects on Proximal Joints of Botulinum Toxin Treatment for Gastrocnemius Spasticity: A 4-Year-Old Case Study

    Directory of Open Access Journals (Sweden)

    Veronica Cimolin

    2009-01-01

    Full Text Available Botulinum toxin A (BTA is a recognized treatment for the early management of spasticity in children with Cerebral Palsy. This study quantified with Gait Analysis (GA the gait pattern of a 4-year-old diplegic child with calf contracture before, 5 days, and 3 months after BTA injections into gastrocnemius. Kinematic and kinetic data of main lower limb joints were investigated. After only 5 days, ankle dorsi-plantarflexion and knee flex-extension improved, but hip joint worsened, increasing its excessive flexion, to compensate the improvement in knee position of the treated limb and to obtain better stability. A worsening of hip power happened. After 3 months, all joints generally improved their position during gait cycle. Hip and knee joints increased their range of movement and improvements occurred at ankle kinematics and kinetisc, too; a better ankle position and an increase of its capacity of propulsion during terminal stance were evident.

  11. Predicting mobility gains among children with cerebral palsy after application of botulinum toxin A Predizendo ganhos de mobilidade em crianças com paralisia cerebral após aplicação de toxina botulínica A

    Directory of Open Access Journals (Sweden)

    VCR Cury

    2009-02-01

    Full Text Available BACKGROUND: Botulinum toxin A (BTA is commonly used to treat children with cerebral palsy (CP. However, the variables measured before BTA application and associated with motor function and independent mobility, known as predictors of functional outcomes, have not been well defined. OBJECTIVE: To identify clinical predictors of gains in functional motor skills and independence of mobility among children with CP, three and six months after BTA application. METHODS: This was a convenience sample of children with spastic CP (n=35. Measurements of quantitative gains in motor skills and independence of mobility were taken three and six months after BTA application. These outcomes were observed through repeated applications of two functional tests: GMFM (Gross Motor Function Measure and PEDI (Pediatric Evaluation of Disability Inventory. These tests evaluated gross motor function while sitting or standing and during transitions between these postures, and also during dynamic activities such as walking, running and jumping, along with the children's independence in mobility tasks. The independent variables included the children's characteristics such as age, severity, topographic diagnosis, neuromuscular-skeletal parameters (range of motion and spasticity, gait quality and performance in the functional tests before BTA. RESULTS: Four predictive models were developed (R² between 0.58 and 0.83; pCONTEXTUALIZAÇÃO: A toxina botulínica A (TBA é comumente utilizada em crianças com paralisia cerebral (PC, entretanto preditores de desfechos funcionais, ou seja, variáveis mensuradas pré-aplicação da TBA e associadas a ganho na função motora e independência na mobilidade não são bem definidos. OBJETIVO: Identificar preditores clínicos de ganho em habilidades motoras funcionais e independência em mobilidade em crianças com PC, aos três e seis meses pós-aplicação de TBA. MÉTODOS: Amostra de conveniência de crianças com PC espástica (n=35

  12. 眉间纹分类及A型肉毒毒素注射的治疗效果%Classification of Chinese glabellar wrinkles and methods of botulinum toxin type A injection

    Institute of Scientific and Technical Information of China (English)

    赵烨; 梁灵刚; 吴溯帆

    2016-01-01

    Objective To guide the botulinum toxin injections,the types of glabellar wrinkles and the corresponding muscle contraction patterns of aesthetic seeking patients were classified.Methods Sixty aesthetic seeking patients between 20 to 65 ages were selected randomly,whose glabellar wrinkles and muscle contraction patterns were classified and analyzed.Targeted injections of botulinum toxin were taken only within the muscles related to the wrinkles.Results Type " ‖ " accounts for 58.3% (35/60),type "∪" accounts for 26.7% (16/60),type "∩" accounts for 11.7% (7/60),and type " 口 " accounts for 3.3% (2/60).Muscle contraction receded 2 or 3 days after injection,reached optimum about 2 weeks,and then maintained 3 to 6 months.Higher satisfaction was obtained using classified injection methods.All objects achieved excellent results.Targeted injections of botulinum toxin on these muscles were able to achieve better clinical effects.Conclusions Using classified injection methods according to 4 types of aesthetic seeking patients’ glabellar wrinkles can achieve higher satisfaction.%目的 对美容就医者的眉间纹形态及相对应的肌肉收缩模式进行分类,用于指导A型肉毒毒素的注射治疗.方法 随机采集60例20~65岁美容就医者的眉间纹,对其进行分类,并分析各类型的肌肉收缩模式,使用A型肉毒毒素对参与收缩的肌肉进行针对性注射治疗.结果 ‖形眉间纹占比为58.3%(35/60),∪形眉间纹占比为26.7%(16/60),∩形眉间纹占比为11.7%(7/60),口形眉间纹占比为3.3%(2/60).在注射后2~3 d,开始出现肌肉收缩力减弱,2周左右效果达到顶峰,一般能够维持3~6个月.所有研究对象治疗均达到优秀效果.结论 眉间纹可分为4种类型,采用分类型注射A型肉毒毒素治疗,效果的满意度较高.

  13. [Intoxication of botulinum toxin].

    Science.gov (United States)

    Chudzicka, Aleksandra

    2015-09-01

    Botulinum toxin is an egzotoxin produced by Gram positive bacteria Clostridium botulinum. It is among the most potent toxins known. The 3 main clinical presentations of botulism are as follows: foodborne botulism, infant botulism and wound botulism. The main symptom of intoxication is flat muscles paralysis. The treatment is supportive care and administration of antitoxin. In prevention the correct preparing of canned food is most important. Botulinum toxin is accepted as a biological weapon.

  14. Comparison of Efficacy and Side Effects of Oral Baclofen Versus Tizanidine Therapy with Adjuvant Botulinum Toxin Type A in Children With Cerebral Palsy and Spastic Equinus Foot Deformity.

    Science.gov (United States)

    Dai, Alper I; Aksoy, Sefika N; Demiryürek, Abdullah T

    2016-02-01

    This retrospective study aimed to compare the therapeutic response, including side effects, for oral baclofen versus oral tizanidine therapy with adjuvant botulinum toxin type A in a group of 64 pediatric patients diagnosed with static encephalopathy and spastic equinus foot deformity. Following botulinum toxin A treatment, clinical improvement led to the gradual reduction of baclofen or tizanidine dosing to one-third of the former dose. Gross Motor Functional Measure and Caregiver Health Questionnaire scores were markedly elevated post-botulinum toxin A treatment, with scores for the tizanidine (Gross Motor Functional Measure: 74.45 ± 3.72; Caregiver Health Questionnaire: 72.43 ± 4.29) group significantly higher than for the baclofen group (Gross Motor Functional Measure: 68.23 ± 2.66; Caregiver Health Questionnaire: 67.53 ± 2.67, P baclofen with adjuvant botulinum toxin A.

  15. Botulinum toxin therapy for abductor spasmodic dysphonia.

    Science.gov (United States)

    Woodson, Gayle; Hochstetler, Heidi; Murry, Thomas

    2006-03-01

    Botulinum toxin has been widely accepted as an effective therapy for controlling the symptoms of adductor spasmodic dysphonia (ADSD). Reported experience with botulinum treatment for abductor spasmodic dysphonia (ABSD) has been less impressive. Factors that may impair outcomes for ABSD include differences in the pathophysiology of ADSD and ABSD and limitation of maximal dose from airway restriction with posterior cricoarytenoid muscle (PCA) weakness. We report our experience with botulinum injection of the PCA with an asymmetric dose escalation protocol, based on clinical observations that in ABSD, abductor spasms are often stronger on one side, usually the left. The nondominant side was injected with 1.25 units. Dominant side dose began at 5 units, with step-wise increments of 5 units per week until one of three endpoints was reached: Elimination of breathy voice breaks, complete abductor paralysis of the dominant side, or airway compromise. Fourteen of 17 patients achieved good or fair voice, with dominant-side doses ranging from 10 to 25 units. Exercise intolerance limited PCA dose in two patients. One patient had persisting breathiness that improved with medialization thyroplasty. Asymmetric botulinum toxin injection into PCA muscles can suppress abductor spasm in patients with ABSD, but breathiness may persist, because of inadequate glottal closure.

  16. The mechanism of inhibitory effect on parotid gland secretion with local injection of botulinum toxin type A in the rat%A型肉毒素对腮腺分泌功能影响的研究

    Institute of Scientific and Technical Information of China (English)

    文卫东; 袁芳; 侯一平

    2009-01-01

    Objective To determine the mechanism of inhibitory effect of botulinum toxin type A (BTX-A)on parotid gland secretion.Methods Female Wistar rats(n=18)were randomly divided into saline injection group(n=6)and BTX-A injection group(n=12),respectively.0.1 ml of saline was injected into left parotid gland and 2.5 U of BTX-A injected into right parotid gland.Rats were sacrificed at day 7,12 and 35 post-injections respectively for morphology and vasoactive intestinal polypeptide(VIP)immunoreactivity of parotid gland.Results Following BTX-A injection,some atrophic cells and reduction of number of VIP-immunoreactive(VIP-IR)fibers were found in gland and tube at day 7(P<0.05);at day 12,there was more obvious reduction of VIP-IR fibers around tube and vessels and atrophy of cells in BTX-A injection gland than saline injection gland(P<0.001);at day 35,the glandular cells and VIP-IR fibers were similar to saline injection group.Conclusions BTX-A is effective for temporary elimination of hyperfunctioning sialorrhea via inhibition of VIP release which plays a key role in modulation of parotid glands secretion.%目的 探讨大鼠腮腺注射A型肉毒素(botulinum toxin type A,BTX-A)后组织学和免疫变化的机制.方法 18只雌性Wistar大鼠分为A、B组.A组动物(n=6)右侧腮腺内注射0.1 ml的生理盐水;B组动物(n=12)右侧腮腺注射BTX-A(2.5 U/0.1 ml).两组动物分别在注射后第7、12、35天处死并行组织学及免疫组化观察.结果 A组、B组注射后第7天部分腺泡细胞轻度萎缩,血管活性肠肽免疫反应(vasoactive intestinal polypeptide immunoreaction,VIP-IR)阳性纤维密度显著减低(n=4,P<0.05);12 d萎缩的腺泡细胞和腺管明显增多,VIP-IR阳性纤维密度减低更明显(n=4,P<0.001);35 d腺细胞和VIP-IR纤维密度与生理盐水组基本相同.结论 局部注射BTX-A可以导致大鼠腮腺腺泡细胞和腺管短时性萎缩,VIP-IR表达减少,提示BTX-A通过抑制调控腮腺

  17. Botulinum Toxin Type A for Treatment of Facial Wrinkles%A型肉毒毒素用于面部除皱的护理

    Institute of Scientific and Technical Information of China (English)

    党艳茹; 卢宁; 刘玉琴; 李芊

    2014-01-01

    Objective:To explore the nursing effect of the face lift and injection of botulinum toxin A treatment,in order to improve the level and effect of facial wrinkles rhytidectomy. Method:The receiving and treatment of facial wrinkles randomness extraction in 166 cases from February,2010 to December,2013 in the hospital were analyzed retrospectively,including 150 women and 16 men. They were treated with botulinum toxin type A. The treatment effect and characteristics were analyzed. Result:After the use of botulinum toxin injection in the treatment of facial wrinkles,the effect is good,effective rate of the treatment of crow’s feet is 98%,the effective rate in treatment of forehead wrinkles is 100%,and the effective rate in treatment of wrinkles between brow is 96%. Conclusion:The facial wrinkles with botulinum toxin A injection for treatment has good effect and safety,which is under convenient operation. So it is worthy of application and popularization in facial wrinkle elimination.%目的:分析针对面部除皱采用A型肉毒毒素注射治疗的护理效果和特点,以提高面部除皱的效果。方法:从我院2010年2月至2013年12月收治的面部除皱患者中随机性抽取166例进行回顾性分析和研究,其中女性150例,男性有16例,均采用A型肉毒毒素注射治疗,分析治疗的效果和特点。结果:采用肉毒毒素注射治疗面部皱纹后,效果较好,鱼尾纹的治疗有效率为98%,额部皱纹的治疗有效率为100%,眉间皱纹的治疗有效率为96%。结论:针对面部皱纹采用注射A型肉毒毒素进行治疗,效果和安全性较好,操作方便,值得在面部皱纹消除中应用和推广。

  18. Botulinum Toxin Type A Injection Combined With Cast Immobilization for Treating Recurrent Peroneal Spastic Flatfoot Without Bone Coalitions: A Case Report and Review of the Literature.

    Science.gov (United States)

    Xu, Jian; Muhammad, Hassan; Wang, Xu; Ma, Xin

    2015-01-01

    Peroneal spastic flatfoot is an uncommon condition. It often presents as a rigid and usually painful valgus deformity in the hindfoot with peroneal muscles spasms. Although tarsal coalition is an important cause, a few patients have not undergone bone coalitions. We describe a 27-year-old female who experienced recurrent peroneal spastic flatfoot after an injury. She was treated successfully with a combination of botulinum toxin type A and immobilization of the foot in a neutral position with a cast. After 3 years, the condition had not recurred, and she was pain free and walked normally, with no increase in muscle tone. This unique treatment could be of potential use to treat many patients with such conditions.

  19. Botulinum Toxin and Muscle Atrophy: A Wanted or Unwanted Effect.

    Science.gov (United States)

    Durand, Paul D; Couto, Rafael A; Isakov, Raymond; Yoo, Donald B; Azizzadeh, Babak; Guyuron, Bahman; Zins, James E

    2016-04-01

    While the facial rejuvenating effect of botulinum toxin type A is well known and widespread, its use in body and facial contouring is less common. We first describe its use for deliberate muscle volume reduction, and then document instances of unanticipated and undesirable muscle atrophy. Finally, we investigate the potential long-term adverse effects of botulinum toxin-induced muscle atrophy. Although the use of botulinum toxin type A in the cosmetic patient has been extensively studied, there are several questions yet to be addressed. Does prolonged botulinum toxin treatment increase its duration of action? What is the mechanism of muscle atrophy and what is the cause of its reversibility once treatment has stopped? We proceed to examine how prolonged chemodenervation with botulinum toxin can increase its duration of effect and potentially contribute to muscle atrophy. Instances of inadvertent botulinum toxin-induced atrophy are also described. These include the "hourglass deformity" secondary to botulinum toxin type A treatment for migraine headaches, and a patient with atrophy of multiple facial muscles from injections for hemifacial spasm. Numerous reports demonstrate that muscle atrophy after botulinum toxin type A treatment occurs and is both reversible and temporary, with current literature supporting the notion that repeated chemodenervation with botulinum toxin likely responsible for both therapeutic and incidental temporary muscle atrophy. Furthermore, duration of response may be increased with subsequent treatments, thus minimizing frequency of reinjection. Practitioners should be aware of the temporary and reversible effect of botulinum toxin-induced muscle atrophy and be prepared to reassure patients on this matter.

  20. 双重引导下注射A型肉毒毒素治疗脑卒中肌肉痉挛%Treatment of Stroke Spasm with Type A Botulinum Toxin Injection under Double Guidance

    Institute of Scientific and Technical Information of China (English)

    丁旭东; 陈华先; 汪伟; 王汉

    2013-01-01

    Objective To observe the effects of type A botulinum toxin injection under combined guidance of nerve injury diagnosis and treatment system and ultrasound in the treatment of patients with cerebral stroke spasm. Methods From January 2008 to January 2010,the clinical data of 105 patients with cerebral stroke spasm were collected,and then randomly divided into control group(n =50) and observation group(n =55). All patients were given regular rehabilitation therapy, meanwhile ,the patients of observation group were given type A botulinum toxin injection under combined guidance of nerve injury diagnosis and treatment system and ultrasound in addition. The clinical curative effects were compared between two groups. Results The FMA,BBS and FIM were significantly improved in both two groups after treating for one month. The improvement degree of CSI,FMA,BBS and FIM scores in observation group were obviously superior to that in control group after treating for 3 and 6 months (P < 0. 05 ). Conclusion The type A botulinum toxin injection under combined guidance of nerve injury diagnosis and treatment system and ultrasound was effective in treatment of patients with cerebral stroke spasm, which was helpful for the recovery of body function and worthy of wide application.%目的:观察神经损伤诊断治疗系统定位联合超声引导下注射A型肉毒毒素治疗脑卒中肌肉痉挛的临床疗效.方法:将我院2008年1月至2010年1月间收治的105例脑中卒痉挛患者随机分为对照组(n=50)和观察组(n=55),对照组患者采取常规康复治疗,观察组在此基础上采取神经损伤诊断治疗系统定位联合超声引导下注射A型肉毒毒素治疗,分析比较两组疗效.结果:两组患者在治疗1月后FMA、BBS和FIM明显改善,观察组在治疗后3、6个月的CSI、FMA、BBS及FIM评分改善情况优于对照组,差异有统计学意义(P<0.05).结论:神经损伤诊断治疗系统定位联合超声引导下注射A型肉毒毒素

  1. Botulinum Toxin (Botox) for Facial Wrinkles

    Science.gov (United States)

    ... Stories Español Eye Health / Eye Health A-Z Botulinum Toxin (Botox) for Facial Wrinkles Sections Botulinum Toxin (Botox) ... Facial Wrinkles How Does Botulinum Toxin (Botox) Work? Botulinum Toxin (Botox) for Facial Wrinkles Written by: Kierstan Boyd ...

  2. Avaliação da fenda palpebral após aplicação de toxina botulínica tipo A em pacientes com distonias faciais Evaluation of palpebral fissure after botulinum toxin type A injection in patients with facial dystonias

    Directory of Open Access Journals (Sweden)

    Mariana Eleonora Pereira Cunial

    2012-12-01

    Full Text Available OBJETIVO: Avaliar a medida da fenda palpebral em pacientes com blefaroespasmo essencial benigno (BEB e espasmo hemifacial (EHF após a aplicação periocular de toxina botulínica tipo A. MÉTODOS: Foram estudados pacientes portadores de BEB e EHF submetidos à injeção periocular de toxina botulínica tipo A pela técnica inner orbital de aplicação. Os pacientes foram fotografados em PPO antes da aplicação e catorze dias depois dela. A fenda palpebral foi mensurada nestas imagens por meio de processamento computadorizado de imagens, utilizando o programa ImageJ. As alterações da fenda palpebral foram observadas comparando-se as medidas obtidas no pré e pós-aplicação. RESULTADOS: Comparando-se as imagens obtidas com o programa ImageJ, houve aumento estatisticamente significante (pPURPOSE: To evaluate the measurement of palpebral fissure in patients with facial dystonias before and after periocular injection with botulinum toxin type A. METHODS: We studied patients with benign essential blepharospasm and hemifacial spasm underwent periocular injection of botulinum toxin type A by the inner orbital technique of application. Patients were photographed 14 days before and after application. The palpebral fissure was measured in these images by means of computerized image processing using the program ImageJ. The palpebral fissure changes were observed by comparing the measurements obtained before and after application. RESULTS: Comparing the images obtained with the program ImageJ, there was a statistically significant increase (p <0.001 of the palpebral fissure in 14 eyes (51,8% after the application of periocular injection of botulinum toxin and the images analyzed showed no decrease of the palpebral fissure. CONCLUSION: In this study, patients with facial dystonias showed increased palpebral fissure periocular statistically significant after application of botulinum toxin type A.

  3. Acute deterioration of bulbar function after botulinum toxin treatment for sialorrhoea in amyotrophic lateral sclerosis.

    NARCIS (Netherlands)

    Meijer, J.W.; Kuijk, A.A. van; Geurts, A.C.H.; Schelhaas, H.J.; Zwarts, M.J.

    2008-01-01

    Transcutaneous botulinum toxin injection in the salivary glands was introduced in 2000 as a new treatment for sialorrhoea in amyotrophic lateral sclerosis (ALS). We describe an ALS patient who developed serious complications of botulinum toxin treatment for sialorrhoea, and we review the relevant li

  4. Botulinum neurotoxin type A in the masseter muscle: Effects on incisor eruption in rabbits

    Science.gov (United States)

    Navarrete, Alfonso L.; Rafferty, Katherine L.; Liu, Zi Jun; Ye, Wenmin; Greenlee, Geoffrey M.; Herring, Susan W.

    2015-01-01

    Introduction Botulinum neurotoxins are responsible for the paralytic food poisoning, botulism. Commercial formulations such as botulinum neurotoxin type A are increasingly used for various conditions, including cosmetic recontouring of the lower face by injection of the large masseter muscles. The paralysis of a major muscle of mastication lowers occlusal force and thus might affect tooth eruption. The purpose of this study was to investigate the effects of unilateral masseter muscle injection of botulinum neurotoxin type A on the rate of eruption of incisors in a rabbit model. We hypothesized that the teeth would overerupt in an underloaded environment. Methods Forty rabbits were injected with either botulinum neurotoxin type A or saline solution in 1 masseter muscle. Mastication and muscle force production were monitored, and incisor eruption rate was assessed by caliper measurement of grooved teeth. Results The injection of saline solution had no effect. The masseter muscle injected with botulinum neurotoxin type A showed a dramatic loss of force 3 weeks after injection despite apparently normal mastication. Incisor eruption rate was significantly decreased for the botulinum neurotoxin type A group, an effect attributed to decreased attrition. Conclusions This study has implications for orthodontics. Although findings from ever-growing rabbit incisors cannot be extrapolated to human teeth, it is clear that botulinum neurotoxin type A caused a decrease in bite force that could influence dental eruption. PMID:23561411

  5. Botulinum toxin type A and cervical dystonia: a seven-year follow-up

    Directory of Open Access Journals (Sweden)

    Carlos Henrique F. Camargo

    2011-10-01

    Full Text Available Most cases of cervical dystonia (CD are idiopathic, and focal injections of botulinum toxin A (BoNT/A are the treatment of choice. The objective of our study was to document the effects of long-term BoNT/A treatment in idiopathic CD patients. Fifty-eight patients with idiopathic CD were recruited from March 2001 to May 2002. Twenty-eight of the subjects were available for reassessment after seven years. During this period, all had received regular treatment with BoNT/A injections. Clinical information about patients and the severity of CD (TWSTRS and VAPS at baseline assessment (2001-2002 and follow-up (2008-2009 was compared. Significant motor improvement was detected based on TWSTRS scale scores, which were used to analyze clinical severity (19.6±6.6 and 17.7±4.8; p<0.05. There was no improvement in the severity of cervical pain (p=0.43. In conclusion, BoNT/A was a safe and effective long-term therapy for CD.

  6. Correção de estrabismo paralítico por injeção de toxina botulínica Management of paralytic strabismus by injection of botulinum toxin

    Directory of Open Access Journals (Sweden)

    Raquel Wattiez

    2000-02-01

    Full Text Available Objetivo: Avaliar a ação da toxina botulínica em paralisias adquiridas de VI e III nervos. Pacientes e métodos: Foram tratados com toxina botulínica 15 pacientes, com diagnóstico de paralisia de VI e III nervos, aguda ou crônica. Foram estudados de forma prospectiva, durante os meses de agosto de 1998 a maio de 1999. O estudo incluiu, além da avaliação do estrabismo, avaliação oftalmológica completa. Os pacientes foram acompanhados por um período de 2 a 7 meses após a última aplicação. Resultados: Onze pacientes (73% apresentaram paralisias do VI nervo e 4 pacientes (27%, paralisias de III nervo. Seis casos foram agudos (40% e 9 casos (60%, crônicos. Cinco dos 6 casos agudos (83% conseguiram controlar o desvio com a toxina botulínica como único tratamento e obter fusão. Dos 9 casos crônicos, 2 casos (22% corrigiram o desvio só com a toxina, os outros 7, além da aplicação, foram submetidos à cirurgia, dos quais 4 casos (46% foram corrigidos e os outros 3 casos (32% não. Conclusão: Concluímos que nos casos em que houve força muscular residual, após a paralisia, e bom potencial de fusão, a toxina botulínica foi o melhor tratamento, pois foi possível controlar o desvio e obter fusão, sem cirurgia.Purpose: To evaluate the treatment by injection of botulinum toxin in acquired sixth and third nerve palsies. Methods: Fifteen patients were treated with botulinum toxin. They were studied prospectively during nine months, between August, 1998 and May, 1999. In addition to the strabismus examination, a complete ophthalmological evaluation was performed. The patients were followed for 2 to 7 months after the last injection or surgical procedure. Results: Eleven patients (73% presented with sixth nerve palsy and four (27% with third nerve palsy. Six cases were acute (40% and 9 cases (60% were chronic. Five acute cases (83% obtained ocular alignment and controlled the deviation with toxin. Two of nine chronic cases (22

  7. Efeitos adversos associados à aplicação de toxina botulínica na face: revisão sistemática com meta-análise Adverse effects associated with facial application of botulinum toxin: a systematic review with meta-analysis

    Directory of Open Access Journals (Sweden)

    Roberta Melissa Benetti Zagui

    2008-12-01

    Full Text Available OBJETIVO: Verificar a ocorrência dos efeitos adversos relacionados ao uso da toxina botulínica na face, por meio de revisão sistemática, usando meta-análise. MÉTODOS: Foi realizada pesquisa eletrônica de artigos publicados no MEDLINE e Cochrane Library até setembro de 2007. A ocorrência dos efeitos adversos foi verificada pela freqüência relativa para os relatos de casos e do risco relativo para os estudos randomizados. A heterogeneidade foi avaliada pelo teste Q e pelo índice I². Foi utilizado o teste de significância de Egger para identificar viés de publicação e a análise de sensibilidade para verificar o efeito dos viéses de publicação. RESULTADOS: Oito estudos randomizados e treze relatos de casos preencheram os critérios de inclusão. Na revisão sistemática dos relatos de casos, 1.003 pacientes foram estudados, dos quais 182 (18,14% apresentaram efeitos adversos. O efeito adverso mais freqüente foi a ptose palpebral ocorrendo em 34 (3,39% pacientes dos relatos de casos. Na meta-análise dos estudos randomizados, o risco relativo global para os efeitos adversos como cefaléia, ptose palpebral, reação local e infecção foi 1,07, 3,25, 0,99 e 0,94, respectivamente. Para todas as comparações, o valor de P foi maior que 0,05. CONCLUSÃO: O efeito adverso mais freqüente e que apresentou o maior risco relativo relacionado ao uso da toxina botulínica na face foi a ptose palpebral. A padronização dos efeitos adversos relatados é necessária a fim de melhor estabelecer as características dos mesmos.PURPOSE: To estimate the occurrence of adverse effects associated with the use of botulinum toxin by performing a systematic review and meta-analysis. METHODS: A systematic literature search of MEDLINE and Cochrane Library was conducted until September 2007. The occurrence of the adverse effects was estimated of the relative frequency for case report and of the relative risk for randomized trials. Heterogeneity was

  8. Treatment of Chronic Migraine with Focus on Botulinum Neurotoxins

    Directory of Open Access Journals (Sweden)

    Sara M. Schaefer

    2015-07-01

    Full Text Available Migraine is the most common neurological disorder, and contributes to disability and large healthcare costs in the United States and the world. The treatment of migraine until recently has focused on medications, both abortive and prophylactic, but treatment of chronic migraine has been revolutionized with the introduction of botulinum toxin injection therapy. In this review, we explore the current understanding of migraine pathophysiology, and the evolution of the use of botulinum toxin therapy including proposed pathophysiological mechanisms through animal data. We also discuss the similarities and differences between three injection techniques.

  9. Characterization of botulinum neurotoxin type A neutralizing monoclonal antibodies and influence of their half-lives on therapeutic activity.

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    Christelle Mazuet

    Full Text Available Botulinum toxins, i.e. BoNT/A to/G, include the most toxic substances known. Since botulism is a potentially fatal neuroparalytic disease with possible use as a biowarfare weapon (Centers for Disease Control and Prevention category A bioterrorism agent, intensive efforts are being made to develop vaccines or neutralizing antibodies. The use of active fragments from non-human immunoglobulins (F(ab'(2, Fab', scFv, chemically modified or not, may avoid side effects, but also largely modify the in vivo half-life and effectiveness of these reagents. We evaluated the neutralizing activity of several monoclonal anti-BoNT/A antibodies (mAbs. F(ab'(2 fragments, native or treated with polyethyleneglycol (PEG, were prepared from selected mAbs to determine their half-life and neutralizing activity as compared with the initial mAbs. We compared the protective efficiency of the different biochemical forms of anti-toxin mAbs providing the same neutralizing activity. Among fourteen tested mAbs, twelve exhibited neutralizing activity. Fragments from two of the best mAbs (TA12 and TA17, recognizing different epitopes, were produced. These two mAbs neutralized the A1 subtype of the toxin more efficiently than the A2 or A3 subtypes. Since mAb TA12 and its fragments both exhibited the greatest neutralizing activity, they were further evaluated in the therapeutic experiments. These showed that, in a mouse model, a 2- to 4-h interval between toxin and antitoxin injection allows the treatment to remain effective, but also suggested an absence of correlation between the half-life of the antitoxins and the length of time before treatment after botulinum toxin A contamination. These experiments demonstrate that PEG treatment has a strong impact on the half-life of the fragments, without affecting the effectiveness of neutralization, which was maintained after preparation of the fragments. These reagents may be useful for rapid treatment after botulinum toxin A

  10. Application of Botulinum toxin Type A: An arsenal in dentistry

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    Lakshmana B Rao

    2011-01-01

    Full Text Available An extremely effective way of preventing damage to and enhancing treatment of dental hard tissues and restorations would be to ′′de-programme′′ the muscles responsible for excessive destructive forces and other gnathological-related diseases. The new paradigm is the intramuscular injection of Botulinum toxin type A (BOTOX into the affected muscles. It is a natural protein produced by anaerobic bacterium, Clostridium botulinum. The toxin inhibits the release of acetylcholine (ACH, a neurotransmitter responsible for the activation of muscle contraction and glandular secretion, and its administration results in reduction of tone in the injected muscle. There are seven distinct serotypes of Botulinum toxin, viz., A, B, C, D, E, F, and G, which differ in their potency, duration of action, and cellular target sites. This paper describes the different applications of BOTOX in dentistry.

  11. Development of an ELISA kit using monoclonal antibody to Clostridium difficile toxin A

    Institute of Scientific and Technical Information of China (English)

    Si-Wu Fu; Ya-Li Zhang; Dian-Yuan Zhou

    2004-01-01

    AIM: To establish an ELISA kit using monoclonal antibodiesagainst Clostridium difficile ( C. difficile) toxin A.METHODS: An indirect sandwich ElISA was described using the purified rabbit monospecific antiserum as capturing antibody. After the polystyrene microtitre plates with 96 fiat-bottomed wells were coated with rabbit antiserum, the wells were blocked with 100 g/L BSA in PBS-T. C. difficiletoxin A or culture filtrates were added to each well and then monoclonal antibodies IgG-horseradish peroxidase conjugate was added as detecting antibody, tetramethylbenzidine was used as substrate and A450 of the stopped reacting product was recorded in an automated plate reader. RESULTS: The tested specimens included culture filtrates of 2 strains of toxigenic C. difficile, 2 strains of non-toxigenic C. difficile, 26 strains of E. coli, 2 strains of S. dysenteriae, 1 strain of Bif infantis, 5 strains of V. cholera, 2 strains ofS. typhi, 7 strains of C. botulinum, 1 strain of toxigenic C. sordllii, and 1 strain of C. butyricum. A total of 47 strains of culture filtrates were all negative except for 2 strains of toxigenic C. difficile. The detective limitation of toxin A was 0.1 ng/mL.CONCLUSION: An ELISA kit with high specificity and excellent sensitivity for the rapid detection of C. difficile toxin A was established. It will be a useful tool for diagnostic test of C. difficile toxin A.

  12. Comparação entre cirurgia e aplicações unilaterais e bilaterais de toxina botulínica para o tratamento dos estrabismos Comparison between surgery and unilateral and bilateral injections of botulinum toxin to treat strabismus

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes M. M. Villas Boas

    2001-10-01

    Full Text Available Objetivo: Comparar a eficácia de 3 formas de tratamento para estrabismos de pequeno e médio ângulos: cirurgia, aplicações unilaterais e bilaterais de toxina botulínica. Métodos: Foram estudados 97 pacientes, divididos em três grupos. No grupo I foi feito um estudo prospectivo no qual 44 pacientes receberam injeção unilateral da toxina botulínica tipo A; no grupo II, 24 pacientes receberam injeção bilateral da toxina, e no grupo III foi feito estudo retrospectivo de 29 pacientes previamente operados de estrabismo. A eficácia dos tratamentos foi estudada segundo o percentual de correção do desvio ocular e segundo o índice de sucesso terapêutico, definido como um desvio residual de até 10 DP (dioptrias prismáticas. Resultados: Os percentuais de correção dos desvios horizontais, para longe, no 3º mês, foram: grupo I = 50,9%; grupo II = 55,8% e grupo III = 77,0%. Para perto, foram: 48,6%, 49,2% e 72,8%, respectivamente. Os índices de sucesso terapêutico foram: grupo I = 57,1%; grupo II = 68,4% e grupo III = 72,4%. Conclusão: Concluiu-se não ter havido diferença estatisticamente significativa entre os percentuais de correção do desvio ocular e o índice de sucesso terapêutico entre os três grupos estudados.Purpose: To compare the efficacy of three types of treatment for strabismus: surgery, unilateral and bilateral botulinum toxin injections. Methods: To compose groups I and II, a prospective study was carried out observing the pretreatment measurement of the deviation, repeated after 7, 30 and 90 days after the injection. To compose group III, a retrospective study was carried out. Results: The percentage of horizontal deviation correction for distance, in 3 months, was: group I = 50.9%; group II = 55.8%, and group III = 77.0%; for near, 48.6%, 49.2% and 72.8% respectively.The therapeutic success rate, defined as residual deviation of 10 PD (prism diopter or less, was: group I = 57.1%; group II = 68.4% and group III

  13. Clinical study of botulinum toxin type A injection on different positions of the bladder in female overactive bladder%膀胱不同部位注射A型肉毒素治疗女性难治性膀胱过度活动症的临床研究

    Institute of Scientific and Technical Information of China (English)

    李杰荣; 谢克基; 刘国庆; 王剑锋; 朵永福; 张世林; 李春景

    2015-01-01

    目的:观察膀胱不同部位注射A型肉毒素治疗女性难治性膀胱过度活动症的疗效。方法40例入选病例,随机分为逼尿肌注射组(A组)、逼尿肌联合三角区注射组(B组),评估患者治疗前及治疗后4周的临床症状(平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数)及尿动力学指标(初始尿意膀胱容量、最大膀胱容量)和 OABSS 评分、QOL 评分情况。结果经过A型肉毒素注射治疗4周后,A组平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数以及OABSS评分, QOL评分、最大膀胱容量均较B组有明显改善(P<0.05)。结论 A型肉毒素膀胱内注射治疗难治性膀胱过度活动症疗效好,无明显毒副作用,是治疗难治性膀胱过度活动的经济、有效的新方法;采用逼尿肌联合三角区部位的注射,症状缓解更为明显,值得进一步的研究及推广。%Objective To observe the different effects caused by different injection sites in bladder ,in cases of female overac‐tive bladder cured by botulinum toxin type A injection .Methods Forty cases were divided into 2 groups randomly .Cases of group A accepted botulinum toxin type A injection only on detrusor .Cases of group B accepted botulinum toxin type A injection on detru‐sor and trigone of urinary bladder .The following parameters were recorded to evaluate the effects 4 weeks later :average daytime u‐rination frequency ,urination frequency at night ,average quantity of each urination ,frequency of urgency ,bladder capacity at first de‐sire ,maxima bladder capacity ,OABSS scores and QOL scores .Results After 4‐week treatment with botulinum toxin type A ,all pa‐rameters ,average daytime urination frequency ,urination frequency at night ,average quantity of each urination ,frequency of urgen‐cy ,bladder capacity at first desire ,maxima bladder capacity ,OABSS scores and QOL scores

  14. Repeated treatments of drooling with botulinum toxin B in neurology

    DEFF Research Database (Denmark)

    Møller, Eigild; Daugaard, Dorthe; Holm, Ole

    2015-01-01

    botulinum toxin type B (BoNT-B, Neurobloc(®) ) were injected with at least 3 months intervals into parotid and submandibular glands using ultrasound guidance. Measures of drooling and saliva collection for analysis were obtained before treatment, and 6, 12, and eventually 18 weeks after. RESULTS: Number...

  15. Effects of botulinum toxin A combined with acupuncture for muscle spasm after stroke and fMRI%肉毒毒素联合针灸治疗脑梗死后上肢局部肌痉挛的疗效观察及 fMRI 研究

    Institute of Scientific and Technical Information of China (English)

    鲍晓; 王鸣鸿; 刘惠宇; 谭杰文; 黄东锋

    2015-01-01

    目的::观察肉毒毒素注射结合针灸疗法对脑梗死上肢局部肌痉挛患者疗效以及治疗前后上肢运动的 fM-RI 变化,并分析其机制。方法:脑梗死后上肢局部肌痉挛患者60例,随机分为3组各20例,A 组采用 A 型肉毒毒素注射配合针灸以及康复训练,B 组采用肉毒毒素注射及常规康复训练,C 组则仅予以常规康复训练。治疗前后采用改良 Ashworth 评分、Wolf 运动功能评定、Fugl-Meyer 上肢功能评分,并结合超声观察引起上肢屈肌痉挛肌肉的长度、厚度的变化,以及上肢运动的 fMRI 变化。结果:治疗3周后,3组患者 Fugl-Meyer 上肢功能评分及 Wolf 运动功能评定评分均较治疗前明显提高(P 0.05).Flexor muscle strength of the biceps brachii in groups A and B after treatment were significantly increased as compared with those in group C and before treatment (P <0.05).SM1 activation are-as and activation intensity were increased after treat-ment in groups A and B as compared with those before treatment,and there was no significant difference in SMA and cerebellum in groups A and B before and after treat-ment.Conclusion:The treatment of botulinum toxin type A combined with acupuncture can alleviate the muscle spasm of the upper limbs,and improve the motor function of the upper limbs and the activities of daily living after stroke.

  16. A型肉毒毒素对大鼠胃排空及血浆胃动素、血清瘦素的影响%Effects of botulinum toxin-A on gastric emptying,plasma motilin and serum leptin in rats

    Institute of Scientific and Technical Information of China (English)

    刘文徽; 刘庆森; 韩辉; 吴本俨

    2008-01-01

    目的: 探讨A型肉毒毒素(botulinum A,BTA)对大鼠胃排空及某些激素的影响.方法:选用♂Wistar大鼠40只,随机分为4组:对照组、BTA小剂量(10U)组、中剂量(20U)组及大剂量(40U)组.给药方法均为剖腹胃窦部肌层注射.观察12wk,记录进食量及体质量变化.12wk末,测定胃半排空时间,放免法测定血浆胃动素和血清瘦素含量.结果:12wk与对照组相比,中、高剂量组大鼠进食量及体质量明显降低(24.25±1.33g,25.02±1.81g vs 30.61±2.07g;441.54±14.64g,437.33±20.73g vs 517.98±24.11g ,均P<0.05),胃半排时间显著延长(161.67±23.53min, 200.33±44.37min vs 86.83±22.98min, P<0.05),血浆胃动素含量减少,差别有统计学意义(80.56±10.43ng/L, 65.99±10.50ng/L vs 123.65±31.10ng/L, P<0.05);小、中、大剂量组血清瘦素均显著低于对照组(0.99±0.13μg/L,0.97±0.18μg/L,0.83±0.23μg/L vs 1.28±0.25μg/L),差别有统计学意义 P<0.05).结论:大鼠注射BTA后体内胃动素、瘦素含量减少,其可能影响体内某些激素的分泌.

  17. MOLECULAR-BIOLOGY OF CLOSTRIDIAL TOXINS - EXPRESSION OF MESSENGER-RNAS ENCODING TETANUS AND BOTULINUM NEUROTOXINS IN APLYSIA NEURONS

    NARCIS (Netherlands)

    MOCHIDA, S; POULAIN, B; EISEL, U; BINZ, T; KURAZONO, H; NIEMANN, H; TAUC, L

    1990-01-01

    mRNAs encoding the light chain of tetanus and botulinum neurotoxins were transcribed, in vitro, from the cloned and specifically truncated genes of Clostridium tetani and Clostridium botulinum, respectively, and injected into presynaptic identified cholinergic neurons of the buccal ganglia of Aplysi

  18. Cervical dystonia : Improved treatment response to botulinum toxin after referral to a tertiary centre and the use of polymyography

    NARCIS (Netherlands)

    Nijmeijer, S. W. R.; Koelman, J. H. T. M.; Standaar, T. S. M.; Postma, Marten; Tijssen, M. A. J.

    2013-01-01

    Rationale: Cervical dystonia is the most common form of (primary) dystonia. The first line of treatment for cervical dystonia is intramuscular injections with botulinum toxin. To optimise the response to botulinum toxin proper muscles selection is required. Pre-treatment polymyographic EMG in additi

  19. Altered cortical activation from the hand after facial Botulinum Toxin treatment

    OpenAIRE

    Haenzi, Sara; Stefanics, Gabor; Lanaras, Tatjana; Calcagni, Maurizio; Ghosh, Arko

    2014-01-01

    Plastic interactions between face and hand cortical tactile circuits occur after severe injuries that affect the hand such as in amputation or spinal cord injury. However, whether loss of facial movements alters the cortical circuits involved in processing tactile inputs from the hand remains unknown. In this prospective observational study we used electroencephalography (EEG) to measure cortical activity evoked by tactile stimulation of the hands before and after botulinum toxin-A-induced fa...

  20. Growth effects of botulinum toxin type A injected unilaterally into the masseter muscle of developing rats%咬肌单侧注射A型肉毒毒素对大鼠下颌骨生长发育的影响

    Institute of Scientific and Technical Information of China (English)

    Chanyoung PARK; Kitae PARK; Jiyeon KIM

    2015-01-01

    Objective:To evaluate the effects of botulinum toxin type A (BTX-A) on mandible skeletal development by inducing muscle hypofunction. Methods:Four-week-old Sprague-Dawley rats (n=60) were divided into three groups:Group 1 animals served as controls and were injected with saline; Group 2 animals were injected unilateral y with BTX-A (the contralateral side was injected with saline);and Group 3 animals were injected bilateral y with BTX-A. In Group 2, the saline-injected side was designated the control side (Group 2-1), whereas the BTX-A-injected side was designated the experimental side (Group 2-2). After four weeks, the animals were sacrificed, dry skulls were prepared, and mandibles were measured. Results: In the unilateral group, the experimental side (Group 2-2) had reduced di-mensions for al mandible measurements compared with the control side (Group 2-1), suggesting a local effect of BTX-A on mandible growth, likely due to muscle reduction. Conclusions:Localized BTX-A injection induced a change in craniofacial growth, and the skeletal effect was unilateral despite both sides of the mandible functioning as one unit.%通过诱导肌肉功能衰退,评估 A 型肉毒毒素(BTX-A)对下颌骨生长发育的影响。

  1. Best Clinical Practice in Botulinum Toxin Treatment for Children with Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Walter Strobl

    2015-05-01

    Full Text Available Botulinum toxin A (BoNT-A is considered a safe and effective therapy for children with cerebral palsy (CP, especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS of IV and the risks are substantial for level V. Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age.

  2. Clinical resistance to three types of botulinum toxin type A in aesthetic medicine.

    Science.gov (United States)

    Stephan, Farid; Habre, Maya; Tomb, Roland

    2014-12-01

    Botulinum toxin injections have become the most frequent noninvasive cosmetic procedure carried out worldwide. Botulinum toxin has also multiple other indications in different medical fields. However, with the repetition of injections, a new concern has emerged: clinical resistance and loss of effectiveness of the treatment. After reporting a case of primary nonresponsiveness to three types of botulinum toxin type A injections, we conducted a review about all factors leading to the primary or secondary nonresponsiveness, as well as the factors affecting the immunogenicity of this neurotoxin. Most of the reports and studies focused on secondary resistance to botulinum toxin (BT) and the neurotoxin immunogenicity; primary nonresponsiveness was rarely reported. Factors leading to primary or secondary resistance to BT injections were numerous. In the majority of the studies, development of neutralizing antibodies to botulinum toxin was considered responsible of the induced clinical resistance. Patients should be aware of this rising concern as well as clinicians who should learn how to minimize the risk of resistance development, sparing the patients more invasive treatment modalities. Further studies related to botulinum toxin resistance are needed.

  3. 脑血管病康复中肉毒毒素应用策略%Application strategy of botox injection into patients with cerebrovascular disease during rehabilitation

    Institute of Scientific and Technical Information of China (English)

    许光旭

    2013-01-01

    Clinical application of botulinum toxin,a milestone in neuroscience,has definite mechanism and clinical efficacy.The optimal treatment for muscle spasm induced by cerebrovascular disease is botox injection.However,there exists misunderstanding in the selection of target muscles,injection dose,roote of injection and functional concept.The clinical rehabilitation and functional recovery are the main goals of botulinum toxin injection.%肉毒毒素临床应用在神经科学中具有划时代意义,其作用机制与临床效果明确.脑血管病引发的肌肉痉挛,其最佳治疗为肉毒毒素注射.临床康复中,存在靶肌肉选择、注射剂量、注射方式、功能理念的误区,注射肉毒毒素后可促进康复训练、功能恢复.

  4. Reabilitação funcional e analgesia com uso de toxina botulínica A na síndrome dolorosa regional complexa tipo I do membro superior: relato de casos Rehabilitación funcional y analgesia con uso de toxina botulínica A en el síndrome doloroso regional compleja tipo I del miembro superior: relato de casos Functional rehabilitation and analgesia with botulinum toxin A in upper limb complex regional pain syndrome type I: case reports

    Directory of Open Access Journals (Sweden)

    Gabriela Rocha Lauretti

    2005-04-01

    acometido. Se relatan dos casos de SDRC donde la aplicación de toxina botulínica-A como fármaco coadyuvante contribuyó en la recuperación funcional motora del miembro acometido. RELATO DE LOS CASOS: Dos pacientes portadoras de SDRC tipo I fueron inicialmente evaluadas para control del dolor en miembro superior derecho. Ambas presentaban incapacidad para abrir la mano y dolor por la escala analógica numérica (EAN de 10 en reposo o cuando la mano o los dedos eran pasivamente manejados. Se inició secuencia de 5 bloqueos, del ganglio estrellado ipsilateral a intervalos semanales, con clonidina y lidocaína. Simultáneamente, durante la realización del tercer bloqueo del ganglio estrellado, fue administrado 75 UI de toxina botulínica A en los músculos flexores de las falanges y de la articulación del puño. Una semana después de aplicación de la toxina botulínica A, las pacientes presentaban relajamiento de las falanges y del puño, relataban facilidad para la ejecución de la fisioterapia pasiva y el dolor clasificado fue como 2 (EAN a la manipulación pasiva. Al término de la realización de la secuencia de bloqueos del ganglio estrellado, las pacientes fueron sometidas a 3 sesiones semanales de administración por vía venosa regional de clonidina, lidocaína y parecoxib. Después de 8 meses de evaluación las pacientes presentaron 70% y 80% de recuperación motora y funcional del miembro acometido. CONCLUSIONES: La aplicación por vía muscular de toxina botulínica A resultó en mejora del movimiento del miembro acometido, analgesia auxiliando en su recuperación funcional.BACKGROUND AND OBJECTIVES: Functional inability of the affected limb is often added to alodynia and hyperalgesia in Complex Regional Pain Syndrome (CRPS type I. Two CRPS cases are reported in which botulinum toxin A as coadjuvant drug has contributed to motor and functional recovery of the affected limb. CASE REPORTS: Two CRPS type I patients were initially evaluated for upper limb pain

  5. Botulinum toxin type A injection on different positions of the bladder in female bladder pain syndrome/interstitial cystitis%A型肉毒毒素膀胱内不同部位注射治疗女性膀胱疼痛综合征/间质性膀胱炎的临床研究

    Institute of Scientific and Technical Information of China (English)

    李杰荣; 刘国庆; 王剑锋; 朵永福; 张世林; 李春景

    2016-01-01

    Objectives To compare the different effects caused by different injection sites in bladder,in cases of female bladder pain syndrome/interstitial cystitis (BPS/IC) cured by botulinum toxin type A injection.Methods 60 cases were randomly divided into two groups.Cases of group A accepted botulinum toxin type A injection only on detrusor.Cases of group B accepted botulinum toxin type A injection on detrusor and trigone of urinary bladder.The following parameters were recorded to evaluate the effects after 8 weeks:average urination frequency,Maximum voiding,PUF scores and QOL scores.Results These parameters of two groups had no statistical differences before accepting treament.Efficacy in both groups obviously improved after treatment.Efficacy of group B improved more obviously than group A.Conclusions Botulinum toxintype A injection on bladder is a new effective method for female interstitial cystitis.Injection on detrusor and trigone of urinary bladder is better than injection only on detrusor.%目的 比较A型肉毒毒素膀胱内逼尿肌注射以及逼尿肌联合三角区注射两种不同注射方法治疗女性膀胱疼痛综合征/间质性膀胱炎的疗效以及安全性.方法 60例入选病例,随机分为两组:逼尿肌注射组(A组)、逼尿肌联合三角区注射组(B组),评估两组患者治疗前及治疗后8周的平均每日排尿次数、最大排尿量、残余尿量、PUF评分、QOL评分.结果 A组及B组治疗后平均每日排尿次数减少,最大排尿量增加,PUF及QOL评分降低,残余尿量无明显增加,B组治疗后与A组治疗后相比,平均每日排尿次数、最大排尿量及PUF评分改善更明显,残余尿量与QOL评分无明显区别.结论 A型肉毒毒素膀胱内注射治疗女性膀胱疼痛综合征/间质性膀胱炎疗效好,生活质量提高,采用逼尿肌联合三角区部位的注射,症状缓解更为明显,副作用无明显增加,值得进一步研究及推广.

  6. Clinical effects of botulinum toxin type A injection and acupuncture on periorbital wrinkles%毫针刺法和A型肉毒毒素注射治疗眶周动力性皱纹的临床效果

    Institute of Scientific and Technical Information of China (English)

    马涛; 翁瑞; 郑永生

    2016-01-01

    Objective To investigate the therapeutic effects of botulinum toxin type A injection and acupuncture on periorbital wrinkles.Methods From May to September in 2015,24 patents were randomly divided into experimental and control group according to random number table:the patients in experimental group were treated with disposable acupuncture needles,20 min for each treatment,once a day,five times each course for courses,2 days interval between the two courses;the patients in control group were treated with 20 units of hotulinum toxin type A injection.The therapeutic results were observed 2 weeks after the treatment by the third-party doctor according to skin wrinkles grading.Results The periorbital wrinkles in both groups improved remarkably,and the wrinkle grading in control group was significantly lower than that in the experimental group (0.67±0.67 vs 1.33±0.61,P<0.05).The skin quality and facial expression sensation in the experimental group improved significantly when compared with those in the control group.Conclusions Acupuncture can be used as a complementary treatment of periorbital wrinkles,and it improves the skin quality in terms of elasticity and color and keeps the natural facial expression sensation.%目的 探讨毫针刺法和A型肉毒毒素注射治疗眶周动力性皱纹的临床效果.方法 将2015年5-9月对24例眶周年轻化(除皱)的美容就医者分为毫针刺法组(针刺组)和A型肉毒毒素注射组(注射组),各12例.针刺组采用一次性针灸针,针刺穴位保留20 min,1次/d,5次为1个疗程,疗程间隙2 d,治疗2个疗程.注射组采用A型肉毒毒素20U8点注射,2周后采用皱纹评价标准评价两组眉间纹及眼角鱼尾纹的变化情况.根据治疗前后相片评价两组皮肤质地和面部表情异样感觉情况.结果 针刺组和注射组治疗后眶周皱纹明显改善;注射组(0.67±0.67)分除皱效果明显优于针刺组(1.33±0.61)分(P<0.05);针刺组的皮肤质量改善和表情

  7. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection

    Directory of Open Access Journals (Sweden)

    Jia-Fong Jhang

    2015-06-01

    Full Text Available Chronic pelvic pain (CPP is defined as pain in the pelvic organs and related structures of at least 6 months’ duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A, known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.

  8. Beneficial effects of botulinum toxin type A in trigeminal neuralgia Beneficio de la toxina botulínica tipo A en neuralgia del trigemino

    OpenAIRE

    Carlos Zúñiga; Sergio Díaz; Fabián Piedimonte; Federico Micheli

    2008-01-01

    Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Vis...

  9. Can Botox Injections Relieve Arthritis Pain?

    Science.gov (United States)

    ... References Hameed F, et al. Injectable medications for osteoarthritis. PM&R. 2012;4(suppl):S75. Singh JA, et al. Botulinum toxin for shoulder pain. Cochrane Database of Systematic Reviews. http://onlinelibrary. ...

  10. Clinical studies of small amount of botulinum toxin type a local injection in patients with upper facial wrinkles%局部注射少量A型肉毒毒素治疗上半面部皱纹的临床研究

    Institute of Scientific and Technical Information of China (English)

    尚晓旭; 吴景东

    2011-01-01

    目的:观察局部注射少量A型肉毒毒素(BTXA)去除上半面部皱纹的临床疗效.方法:应用A型肉毒毒素的198例患者,其中眉间纹65例,鱼尾纹80例,额纹20例,鼻背部皱纹33例.所有患者行局部多点注射A型肉毒毒素,浓度为4U/0.1ml,并根据不同的患者调整剂量和浓度.记录患者疗效、维持时间与不良反应.结果:A型肉毒毒素治疗面部上三分之一皱纹有效率为100%,显效率94.4%.肌肉麻痹的效果通常持续3~6个月不等,不良反应主要为4例上睑下垂,3例局部水肿和4例青紫,各占2.0%、1.5%和2.0%.上述症状于3~10内自行完全消失.结论:A型肉毒毒素局部注射治疗面部上三分之一皱纹起效迅速、无创伤、简便易行.%Objective To observe the clinical effect of small amount of botulinum toxin type A (BTXA) local injection to remove half of the clinical effect of facial wrinkles. Methods 198 botulinum toxin type A patients, including 65 cases of frown lines, 80 cases of crow's feet, 20 cases of the wrinkles on the forehead, 33 cases of wrinkles of nasal back. All patients underwent local multi-point injection of botulinum toxin type A, the concentration is 4U/0.1ml, and adjusted the dose according to different patient and concentration. We recorded the outcomes, effective duration and adverse reactions. Results The effective rate of botulinum toxin type A in treatment with facial wrinkles was 100%, the obvious rate was 94.4%,and the effective duration lasts 3-6 months. The adverse effects of treatment were four cases of ptosis, 3 and 4 cases with local edema and bruising,taking account 2.0%, 1.5% and 2.0%, respectively. The symptoms disappeared on their own way. Conclusion A local injection of botulinum toxin type A treatment of upper a third facial wrinkles was rapid onset, non-invasive, non-traumatic and simple.

  11. Efficacy of Ultrasound and Water Capsule-guided Local Injection of Botulinum Toxin Type A Treatment on Patients with Facial Spasm%彩超水囊引导下A型肉毒毒素注射治疗面肌痉挛的临床疗效

    Institute of Scientific and Technical Information of China (English)

    洪艳; 丁旭东; 肖红琼; 陈华先; 高荣萍; 汪伟; 张贵斌

    2012-01-01

    Objective:To study the efficacy of ultrasound and water capsule-guided local injection of botulinum toxin type A (BTX-A) treatment on patients with facial spasm. Methods: Ninety-six cases of facial spasm were randomly divided into oral drug treatment group (A group) (48 cases) and ultrasound and water capsule-guided local injection of botulinum toxin type A treatment group (B group) (48 cases). Cohen, Acbert spasms strength grade scores in each cases with facial spasm were recorded. Therapeutic effect, duration, significant efficiency and muscle spasms strength were compared before and 6 months after treatment. Results:The muscle spasms strength showed no significant change in A group after the treatment. However, the muscle spasms strength was decreased significantly in B group after treatment (Pinjection of botulinum toxin type A treatment is a safe, effective, and simple treatment for patients with facial spasm.%目的:探讨彩超水囊引导下肉毒毒素注射治疗面肌痉挛的疗效.方法:面肌痉挛患者96例,随机分为A、B组各48例,A组给予口服药物6个月,B组给予彩超水囊引导下局部注射A型肉毒毒素(BTX-A).治疗前后分别采用Cohen、Acbert痉挛强度分级评估疗效,观察2组疗效、持续时间、显效率和治疗前后肌痉挛强度及变化情况.结果:A组治疗后肌痉挛强度变化无统计学差异,B组治疗后肌痉挛强度变化有显著性差异(P<0.01),且显效率高于A组(P<0.01).结论:彩超水囊引导下BTX-A注射治疗能显著降低面肌痉挛的肌张力,且安全、简单易行.

  12. Conjugative botulinum neurotoxin-encoding plasmids in Clostridium botulinum.

    Directory of Open Access Journals (Sweden)

    Kristin M Marshall

    Full Text Available BACKGROUND: Clostridium botulinum produces seven distinct serotypes of botulinum neurotoxins (BoNTs. The genes encoding different subtype neurotoxins of serotypes A, B, F and several dual neurotoxin-producing strains have been shown to reside on plasmids, suggesting that intra- and interspecies transfer of BoNT-encoding plasmids may occur. The objective of the present study was to determine whether these C. botulinum BoNT-encoding plasmids are conjugative. METHODOLOGY/PRINCIPAL FINDINGS: C. botulinum BoNT-encoding plasmids pBotCDC-A3 (strain CDC-A3, pCLJ (strain 657Ba and pCLL (strain Eklund 17B were tagged with the erythromycin resistance marker (Erm using the ClosTron mutagenesis system by inserting a group II intron into the neurotoxin genes carried on these plasmids. Transfer of the tagged plasmids from the donor strains CDC-A3, 657Ba and Eklund 17B to tetracycline-resistant recipient C. botulinum strains was evaluated in mating experiments. Erythromycin and tetracycline resistant transconjugants were isolated from donor:recipient mating pairs tested. Transfer of the plasmids to the transconjugants was confirmed by pulsed-field gel electrophoresis (PFGE and Southern hybridizations. Transfer required cell-to-cell contact and was DNase resistant. This indicates that transfer of these plasmids occurs via a conjugation mechanism. CONCLUSIONS/SIGNIFICANCE: This is the first evidence supporting conjugal transfer of native botulinum neurotoxin-encoding plasmids in C. botulinum, and provides a probable mechanism for the lateral distribution of BoNT-encoding plasmids to other C. botulinum strains. The potential transfer of C. botulinum BoNT-encoding plasmids to other bacterial hosts in the environment or within the human intestine is of great concern for human pathogenicity and necessitates further characterization of these plasmids.

  13. Use of Botulinum Neurotoxin in Ophthalmology

    Directory of Open Access Journals (Sweden)

    Emel Başar

    2016-12-01

    Full Text Available Botulinum neurotoxin (BoNT is the first biological toxin used in the treatment of ophthalmic diseases and to decrease skin wrinkles as an aesthetic agent. When used appropriately, it weakens the force of muscular contraction and/or inhibits glandular secretion. The most common areas for botulinum toxin treatment are the upper face, including the glabella, forehead, brows, and lateral canthal lines or crow’s feet. By relaxing the muscles causing wrinkles, non-permanent results may be achieved with its use. BoNT has gained widespread use in a variety of ophthalmic diseases. The effect of BoNT is temporary, but the therapeutic benefit is usually maintained even after repeated injections. Treatment is usually well tolerated. Complications and side effects associated with the treatment are rare and temporary. Complications occur due to weakness (chemodenervation of adjacent muscle groups, immunological mechanisms and injection technique. Current therapeutic indications, doses, complications and contraindications of BoNT use in the following disorders related to ophthalmology were investigated: aesthetic use, strabismus, blepharospasm, hemifacial spasm, eyelid retraction, entropion, lacrimal hypersecretion syndrome, and facial paralysis.

  14. Use of Botulinum Neurotoxin in Ophthalmology

    Science.gov (United States)

    Başar, Emel; Arıcı, Ceyhun

    2016-01-01

    Botulinum neurotoxin (BoNT) is the first biological toxin used in the treatment of ophthalmic diseases and to decrease skin wrinkles as an aesthetic agent. When used appropriately, it weakens the force of muscular contraction and/or inhibits glandular secretion. The most common areas for botulinum toxin treatment are the upper face, including the glabella, forehead, brows, and lateral canthal lines, or crow’s feet. By relaxing the muscles causing wrinkles, non-permanent results may be achieved with its use. BoNT has gained widespread use in a variety of ophthalmic diseases. The effect of BoNT is temporary, but the therapeutic benefit is usually maintained even after repeated injections. Treatment is usually well tolerated. Complications and side effects associated with the treatment are rare and temporary. Complications occur due to weakness (chemodenervation) of adjacent muscle groups, immunological mechanisms and injection technique. Current therapeutic indications, doses, complications and contraindications of BoNT use in the following disorders related to ophthalmology were investigated: aesthetic use, strabismus, blepharospasm, hemifacial spasm, eyelid retraction, entropion, lacrimal hypersecretion syndrome, and facial paralysis. PMID:28050326

  15. Susceptibility of Skeletal Muscle to Coxsackie A2 Virus Infection: Effects of Botulinum Toxin and Denervation

    Science.gov (United States)

    Andrew, Clifford G.; Drachman, Daniel B.; Pestronk, Alan; Narayan, Opendra

    1984-02-01

    Coxsackie A viruses can infect denervated but not innervated mature skeletal muscles. The role of synaptic transmission in preventing susceptibility to Coxsackievirus infection was studied by surgically denervating leg muscles of mice or injecting the muscles with botulinum toxin to block quantal release of acetylcholine. Control muscles were injected with heat-inactivated toxin. Subsequent injection of Coxsackie A2 virus resulted in extensive virus replication and tissue destruction in the denervated and botulinum toxin-treated muscles, while the control muscles showed only minimal changes. This suggests that the susceptibility of skeletal muscle to Coxsackievirus infection is regulated by synaptic transmission.

  16. Botulinum toxin: bioweapon & magic drug.

    Science.gov (United States)

    Dhaked, Ram Kumar; Singh, Manglesh Kumar; Singh, Padma; Gupta, Pallavi

    2010-11-01

    Botulinum neurotoxins, causative agents of botulism in humans, are produced by Clostridium botulinum, an anaerobic spore-former Gram positive bacillus. Botulinum neurotoxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons. A single gram of crystalline toxin, evenly dispersed and inhaled, can kill more than one million people. The basis of the phenomenal potency of botulinum toxin is enzymatic; the toxin is a zinc proteinase that cleaves neuronal vesicle associated proteins responsible for acetylcholine release into the neuromuscular junction. As a military or terrorist weapon, botulinum toxin could be disseminated via aerosol or by contamination of water or food supplies, causing widespread casualties. A fascinating aspect of botulinum toxin research in recent years has been development of the most potent toxin into a molecule of significant therapeutic utility . It is the first biological toxin which is licensed for treatment of human diseases. In the late 1980s, Canada approved use of the toxin to treat strabismus, in 2001 in the removal of facial wrinkles and in 2002, the FDA in the United States followed suit. The present review focuses on both warfare potential and medical uses of botulinum neurotoxin.

  17. Polyclonal neural cell adhesion molecule antibody prolongs the effective duration time of botulinum toxin in decreasing muscle strength.

    Science.gov (United States)

    Guo, Yan; Pan, Lizhen; Liu, Wuchao; Pan, Yougui; Nie, Zhiyu; Jin, Lingjing

    2015-11-01

    This study aimed to investigate if the effective duration time of botulinum toxin A (Btx-A) could be prolonged by polyclonal neural cell adhesion molecule antibody (P-NCAM-Ab). 175 male SD rats were randomly divided into three major groups: control group (n = 25), Btx-A group (n = 25), and P-NCAM-Ab groups. P-NCAM-Ab groups were composed of five sub-groups, with 25 rats each in the dose-response study. Muscle strength of rat lower limbs was determined using a survey system. The expressions of muscle-specific receptor tyrosine kinase (MuSK) and neural cell adhesion molecule (NCAM) were determined by real-time polymerase chain reactions (RT-PCR) and western blotting (WB). The muscle strength was significantly decreased by Btx-A in Btx-A/P-NCAM-Ab groups compared with normal control group. Besides, the muscle strength of P-NCAM-Ab group was significantly decreased compared with the Btx-A group. The recovery time of muscle strength in P-NCAM-Ab group was significantly longer compared with Btx-A group. RT-PCR and WB assay showed that PNCAM-Ab delayed the increase of MuSK and NCAM after Btx-A injection. P-NCAM-Ab prolongs the effective duration time of Btx-A in decreasing muscle strength, which could provide a novel enhancement in clinical application.

  18. Evaluation of a quail embryo model for the detection of botulinum toxin type A activity

    Science.gov (United States)

    The quail embryo was evaluated for use as a bioassay to detect biologically active botulinum toxin serotype A (BoNT/A). Day 15 of incubation embryos were injected with decreasing dosages of BoNT/A from 250 to 0.5 ng of toxin. At 1 day post-injection, embryos receiving 20 ng of BoNT or higher had m...

  19. A型肉毒毒素联合Lux1540-非剥脱点阵激光治疗额部皱纹的临床疗效和安全性观察%CLINICAL EFFECT AND SAFETY OBSERBATION OF BOTULINUM TOXIN TYPE A INJECTION COMBINED WITH LUX 1540 FRACTIONAL LASER ON WRINKLES

    Institute of Scientific and Technical Information of China (English)

    苏雪莲

    2015-01-01

    Objective To evaluate the effectiveness and safety of botulinum toxin type A injection andLux1540fractional laser on treatment of eye wrinkles.Methods Sixty patients with wrinkles,aged from 27 to65,were divided into three groups randomly.They were treated with botulinum toxin type A,Lux1540 fractional laser,or the combined therapy.Pictures were taken for each patient before treatment and immediate,at 7 daysand 1,3,6months after treatment,with which the results were evaluated.ResultsAt 3 to 7days after treatment,the dynamic wrinkles of patients treated with botnlinum toxin type A injection were alleviated. The static wrinkles of patients treated with Lux1540 fractional laser with or without botulinum toxin type A injection were alleviated right after the treatment.The dynamic wrinkles of those who treated with the combined therapy got better long—term effect.Conclusion It is effective and safe to treat eye wrinkles by using botulinum toxin type A injection and Lux1540 fractional laser combined therapy.%目的:探讨A型肉毒毒素联合Lux1540-非剥脱点阵激光:点阵激光治疗额头皱纹的临床疗效和安全性。方法将年龄27~65岁且寻求改善额头皱纹的门诊患者60例,随机平均分为3组,分别给予A型肉毒毒素注射,Lux1540-非剥脱点阵激光治疗,A型肉毒毒素注射联合Lux1540-非剥脱点阵激光治疗。每例患者在治疗前,治疗后即刻,治疗后7 d、1、3、6个月进行随访评价。结果单纯接受肉毒毒素注射的患者,在治疗后3~7 d开始出现动态皱纹的改善;接受Lux1540-非剥脱点阵激光以及A型肉毒毒素注射联合Lux1540-非剥脱点阵激光治疗的患者,术后即刻可观察到静态皱纹的改善,且肉毒毒素注射联合Lux1540-非剥脱点阵激光的患者,其动态皱纹的远期效果改善更加明显。结论 A型肉毒毒素联合Lux1540-非剥脱点阵激光,治疗可同时改善额部的动态皱纹和静态皱纹,并有

  20. Effect of intramuscular injection of botulinum toxin type A and triamcinolone to the masseter muscle on the development of mandible: an experimental study%咬肌内注射A型肉毒毒素和曲安奈德对大鼠下颌骨发育影响的实验研究

    Institute of Scientific and Technical Information of China (English)

    黄进军; 王晋煌; 柳大烈; 陈伯华; 陈兵

    2011-01-01

    Objective To evaluate the effect of intramuscular injection of botulinum toxin type A and triamcinolone to the masseter muscle on the development of mandible. Methods Thirty 28-days-old Wistar rats were divided into four groups: botulinum toxin type A group ( B group, 8 rats) , triamcinolone group (T group,8 rats) , botulinum toxin type A and triamcinolone group ( BT group, 8 rats) . control group ( C group, 6 rats) .The right side of masseter muscle was injected with the drugs corresponding to its group and the left side of masseter muscle was injected with saline. The control group was only anaesthetised. CT scan and 3D reconstruction were taken when the rats were 75 days old. Seven cephalometric points were digitized and selected 7 linear distances were measured. The rats were killed with an overdose of 10% chloral hydrate after CT scan. Masseter muscles of each side were obtained and weighted immediately. Results Significant atrophy of masseter muscles were observed in the B group and BT group. Mandibular length Ⅲ ( Go-Iia) . mandibular height Ⅱ ( Cor-GoT)on the right side was less than that on the left side in B group. Mandibular height Ⅱ on the right side was less than that on the left side in BT group. The variances of mandibular height Ⅱ and mandibular height Ⅲ ( ConGoT) on the right side between 4 groups were significant. Conclusion Changes on mandibular height after intramuscular injection of botulinum toxin type A to the masseter muscle were seen. But alterations of mandibular length and bigonial width were not found. Cephalometric changes were not obvious on the triamcinolone group.%目的 探讨咬肌内注射A型肉毒毒素和曲安奈德对大鼠下颌骨发育的影响.方法 取28日龄雄性Wistar大鼠为实验对象,随机分为4组:A型肉毒毒素组(B组,n=8)、曲安奈德组(T组,n=8)、A型肉毒毒素+曲安奈德组(BT组,n=8)、对照组(C组,n=6),每组大鼠取右侧咬肌并向肌内注射相应的药物,左侧注射等

  1. The change of substance P in neuropathic pain rats injected subcutaneous-ly by botulinum toxin type A%A型肉毒毒素对神经病理性疼痛模型大鼠P物质含量的影响

    Institute of Scientific and Technical Information of China (English)

    张晓英; 杨国栋; 潘万龙

    2015-01-01

    目的::研究A型肉毒毒素(botulinum toxin type A,BTX-A)对神经病理性疼痛模型大鼠P物质(substance P,SP)含量的影响。方法:5%福尔马林50μL皮下注射于大鼠额区及颞区,建立疼痛模型。 BTX-A组局部皮下注射10 U/kg BTX-A,同时设立生理盐水组及空白对照组,放射免疫法测定SP 含量。结果:生理盐水组SP 含量高于空白对照组( P<0.05), BTX-A组低于生理盐水组(P<0.05)。结论: BTX-A可能通过抑制感觉通路神经肽-SP的释放减轻神经病理性疼痛症状。%Objective:To detect the change of substance P in neuropathic pain rats injected subcutaneously by botulinum toxin type A. Methods:Besides control group,neuropathic pain rats triggered by 5 % formalin subcutaneously injected into frontal and tem-poral areas,then they had been respectively treated with 0. 9 % NaCl (n=10)and 10 U/kg BTX-A (n=10) for 6 days. All of groups were detected the content of substance P(SP) by radioimmunoassay. Results:The content of SP increased significantly in saline group than that in control group (P<0. 05),but decreased significantly in BTX-A groups than in saline group(P<0. 05). Conclusion:BTX-A could inhibit SP releasing from sensory pathways to relieve the symptoms of neuropathic pain.

  2. Potential therapeutic effect of intravesical botulinum toxin type A on bladder pain syndrome/interstitial cystitis.

    Science.gov (United States)

    Jhang, Jia-Fong; Jiang, Yuan-Hong; Kuo, Hann-Chorng

    2014-04-01

    Bladder pain syndrome/interstitial cystitis is characterized by bladder pain associated with urgency, frequency, nocturia, dysuria and sterile urine. Recent studies have shown that these bladder dysfunctions could originate from chronic inflammation or urothelial insult and proceed to a cascade of tissue reactions, which finally ascends to the central nervous system. Pilot studies of intravesical injection of botulinum toxin type A for bladder pain syndrome/interstitial cystitis had been introduced since 2005 with a promising result. Recent evidence suggests that botulinum toxin type A could significantly improve symptoms such as daytime frequency, nocturia, pain, quality of life and bladder capacity in bladder pain syndrome/interstitial cystitis patients. Single injection of botulinum toxin could not achieve long-term successful therapeutic result, and repeat injections could provide a better long-term success rate. However, patients with ulcer type bladder pain syndrome/interstitial cystitis might not gain a benefit from botulinum toxin type A injection. Laboratory evidence showed that botulinum toxin type A for bladder pain syndrome/interstitial cystitis injection could induce peripheral desensitization, reduces bladder chronic inflammation and decreases apoptotic signal molecules in the urothelium. The present article reviewed the recent advances of botulinum toxin type A on bladder pain syndrome/interstitial cystitis.

  3. Botox® after Botox® - a new approach to treat diplopia secondary to cosmetic botulinic toxin use: case reports

    Directory of Open Access Journals (Sweden)

    Cassiano Rodrigues Isaac

    2012-06-01

    Full Text Available A new technique for the treatment of diplopia secondary to cosmetic botulinum toxin A use is described. In this interventional case reports, two consecutive patients who developed diplopia after periocular cosmetic use of botulinum toxin A were treated with intramuscular botulinum toxin A injection into the antagonist extraocular muscle. Diplopia resolved in both patients in less than 1 week with no side effects or complications. In conclusion, the injection of intramuscular botulinum toxin A is an encouraging option for treatment of diplopia secondary to botulinum toxin A use for facial lifting.

  4. Clinical analysis of injecting A botulinum toxin in the treatment of upper lip twitching after gummy smile%A型肉毒毒素治疗露龈笑致上唇抽搐的临床体会

    Institute of Scientific and Technical Information of China (English)

    张芳; 王俊河; 朱彦凯

    2016-01-01

    Objective To introduce 2 cases using type-A botulinum toxin to cure upper lip twitching after gummy smile and brielfy analyse the reasons that may appear.MethodsThe author reviewed the medical history,treatment and postoperative conditions of two patients using type- A botulinum toxin to treat upper lip twitching after gummy smile and being operated from 2014 to 2015.Then we discussed the causes. ResultsThe muscle spasm caused by type-A botulinum toxin was occasional complications,which may be related to the injury of local acupuncture. Conclusion Botulinum toxin has a good effect with small trauma,and occasionally adverse reactions in the treatment of muscle spasm and gummy smile.It requires physicians be familiar with anatomy, avoid injury and notice follow-ups.%目的:介绍A型肉毒毒素注射治疗露龈笑后出现上唇抽搐的病例,并对其出现原因进行简要分析。方法:笔者对2014年-2015年治疗的2例A型肉毒毒素注射治疗露龈笑后出现上唇抽搐患者的病史、治疗经过及术后并发症进行回顾分析,探讨原因。结果:A型肉毒毒素致肌肉抽搐为偶见并发症,可能与局部针刺损伤有关。结论:肉毒毒素治疗肌肉痉挛及露龈笑效果好、创伤小,偶有不良反应,特别是作为美容用途时,要求医师熟悉解剖、避免损伤、注意随访。

  5. A Beautician's Dystonia: Long-Lasting Effect of Botulinum Toxin

    Science.gov (United States)

    Di Martino, Siria; Dalise, Stefania; Lamola, Giuseppe; Venturi, Martina; Rossi, Bruno; Chisari, Carmelo

    2014-01-01

    Treatment options for dystonia are not curative but symptomatic; the treatment of choice for focal dystonias is repeated botulinum toxin injections. Here, we present the case of a 46-year-old beautician with focal dystonia in her left hand that affected her ability to work. Pharmacological treatment with clonazepam and gabapentin failed to resolve her symptoms and was discontinued due to side effects (sleepiness, gastrointestinal disorders). Intramuscular injection of botulinum toxin (incobotulinumtoxinA, Xeomin) into the extensor digitorum communis (35 U), flexor carpi radialis (35 U), and flexor digitorum superficialis (30 U) muscles resulted in complete resolution of symptoms at clinical assessments at 1, 3, 6, and 10 months after the injections, confirmed by the results of surface electromyography 10 months after treatment. The patient was able to work again 1 month after treatment. No reinjection has been necessary at the last evaluation (12 months after treatment). In conclusion, botulinum toxin is an effective treatment for focal dystonia that can have long-lasting effects and can improve patients' ability to work and quality of life. PMID:25143844

  6. [Botulinum toxin A and physical therapy in gait in cerebral palsy].

    Science.gov (United States)

    García-Sánchez, Sandra Fabiola; Gómez-Galindo, María Teresa; Guzmán-Pantoja, Jaime Eduardo

    2017-01-01

    Introducción: La parálisis cerebral (PCI) es la principal causa de discapacidad en la infancia. La toxina botulínica tipo A (TBA) es un tratamiento para mejorar la función y patrón en la marcha, aunque con pocos estudios que cuantifiquen la mejoría. Métodos: Se realizó un estudio cuasiexperimental, de mayo de 2010 a septiembre de 2011, en un centro de rehabilitación integral, participaron 36 pacientes con PCI espástica. Se evaluó: funcionalidad de la marcha por la escala de Koman, velocidad de desplazamiento de la marcha, tono con escala de Ashworth y arcos de movilidad pasivas. Se les aplicó TBA y se les envió a 10 sesiones de terapia física, con mediciones antes, al mes 1 y 4. Resultados: 30 pacientes terminaron el estudio, con edades entre 2 y 12 años, la mayoría tuvieron mejoría en la funcionalidad de la marcha, tono, dorsiflexión y abducción de tobillos al mes, que se mantuvo a los 4 meses. Conclusiones: La toxina botulínica es un tratamiento eficaz para aumentar los arcos de movilidad y la funcionalidad de la marcha en los pacientes con hemiparesia y paraparesia espástica.

  7. Botulinum toxin: yesterday, today, tomorrow

    Directory of Open Access Journals (Sweden)

    A. R. Artemenko

    2013-01-01

    Full Text Available Botulinum toxin (BoNT is a bacterial neurotoxin presented with seven serotypes that inhibit neurotransmitter release from nerve endings. The serotypes of BoNT are antigenically dissimilar, act via different, but interconnected mechanisms, and are not interchangeable. The activity of BoNT is associated with impaired neuroexocytosis occurring in several steps: from the binding of BoNT to its specific receptor on the axon terminal membrane to the proteolytic enzymatic cleavage of SNARE substrate. The effect of BoNT is considered to be restricted to the peripheral nervous system, but when given in particularly high doses, it has been recently shown to affect individual brain structures. In addition, by modulating peripheral afferentation, BoNT may influence the excitability of central neuronal structures at both spinal and cortical levels. Only BoNT serotypes A and B are used in clinical practice and aesthetic medicine. The type A has gained the widest acceptance as a therapeutic agent for more than 100 abnormalities manifesting themselves as muscular hyperactivity, hyperfunction of endocrine gland, and chronic pain. The effect of BoNT preparations shows itself 2-5 days after injection, lasts 3 months or more, and gradually decreases with as a result of pharmacokinetic and intracellular reparative processes. Biotechnology advances and potentialities allow purposefully modification of the protein molecular structure of BoNT, which expands the use and efficiency of performed therapy with neurotoxins. Recombinant technologies provide a combination of major therapeutic properties of each used BoNT serotype and expand indications for recombinant chimeric toxins.

  8. Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients.

    Science.gov (United States)

    van Esch, Babette F; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

    2017-02-01

    Objective The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid myotomy, thyroplasty, selective laryngeal adductor denervation-reinnervation, laryngeal nerve crush, and recurrent laryngeal nerve resection. Here, we present the first systematic review comparing the effect of botulinum toxin with surgical treatment among patients diagnosed with AdSD. Data Sources MEDLINE (PubMed), EMBASE, and the Cochrane Library. Methods Articles were reviewed by 2 independent authors, and data were compiled in tables for analysis of the objective outcome (voice expert evaluation after voice recording), the subjective outcome (patient self-assessment scores), and voice-related quality of life (Voice Health Index scores). Results No clinical trials comparing both treatment modalities were identified. Single-armed studies evaluated either the effect of botulinum toxin or surgical treatment. Thirteen studies reported outcomes after botulinum toxin treatment (n = 419), and 9 studies reported outcomes after surgical treatment (n = 585 patients). A positive effect of bilateral botulinum toxin injections was found for the objective voice outcome, subjective voice outcome, and quality of life. The duration of the beneficial effect ranged from 15 to 18 weeks. Surgical treatment had an overall positive effect on objective voice improvement, subjective voice improvement, and quality of live. Conclusion No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.

  9. Botulinum Toxin; Bioterror and Biomedicinal Agent

    Directory of Open Access Journals (Sweden)

    Jiri Patocka

    2006-04-01

    Full Text Available Botulinum toxin is a group of seven homologous, highly poisonous proteins isolated fromfermentation of the anaerobic bacterium Clostridium botulinum, which naturally occurs in soiland can grow on many meats and vegetables. Botulinum toxin causes neuromuscular disordercalled botulism, which is a potentially lethal disease. There are three types of botulism: Food,wound, and infant botulism. It can lead to death unless appropriate therapy is done. Due to theseverity and potency of botulinum toxin, its importance as a biological weapon is of majorconcern to public health officials. Nevertheless, botulinum toxin is also medicament.

  10. Reconstituting botulinum toxin drugs: shaking, stirring or what?

    Science.gov (United States)

    Dressler, Dirk; Bigalke, Hans

    2016-05-01

    Most botulinum toxin (BT) drugs are stored as powders which need to be reconstituted with normal saline before clinical use. As botulinum neurotoxin (BNT), the therapeutically active ingredient, is a large double-stranded protein the process of reconstitution should be performed with special attention to mechanical stress applied. We wanted to test the mechanical stability of BNT during the reconstitution process. For this, 100 MU onabotulinumtoxinA (Botox(®), Irvine, CA, USA) was reconstituted with 2.0 ml of NaCl/H2O. Gentle reconstitution (GR) was performed with a 5 ml syringe, a 0.90 × 70 mm injection needle, one cycle of injection-aspiration-injection and two gentle shakes of the vial. Aggressive reconstitution (AR) was performed with a 5 ml syringe, a 0.40 × 40 mm injection needle, ten injection-aspiration-injection cycles and 30 s of continuous shaking of the vial. AR increased the time to paralysis in the mouse hemidiaphragm assay (HDA) from 72.0 ± 4.6 to 106.0 ± 16.0 min (*p = 0.002, two-tailed t test after Kolmogorov-Smirnova test with Lilliefors correction for normal distribution). Construction of a calibration curve revealed that the increase in the time to paralysis was correlated with a loss of potency of from 100 to 58 MU (-42 %). BT users should use large diameter injection needles for reconstitution, apply two or three injection-aspiration-injection cycles and, maybe, shake the vials a few times to rinse the entire glass wall. Aggressive reconstitution with small diameter needles, prolonged injection-aspiration-injection and violent shaking should be avoided.

  11. Cells transformed by PLC-gamma 1 overexpression are highly sensitive to clostridium difficile toxin A-induced apoptosis and mitotic inhibition.

    Science.gov (United States)

    Nam, Hyo Jung; Kang, Jin Ku; Chang, Jong Soo; Lee, Min Soo; Nam, Seung Taek; Jung, Hyun Woo; Kim, Sung-Kuk; Ha, Eun-Mi; Seok, Heon; Son, Seung Woo; Park, Young Joo; Kim, Ho

    2012-01-01

    Phospholipase C-γl (PLC-γl) expression is associated with cellular transformation. Notably, PLC-gamma is up-regulated in colorectal cancer tissue and breast carcinoma. Because exotoxins released by Clostridium botulinum have been shown to induce apoptosis and promote growth arrest in various cancer cell lines, we examined here the potential of Clostridium difficile toxin A to selectively induce apoptosis in cells transformed by PLC-γl overexpression. We found that PLC-γl-transformed cells, but not vectortransformed (control) cells, were highly sensitive to C. difficile toxin A-induced apoptosis and mitotic inhibition. Moreover, expression of the proapoptotic Bcl2 family member, Bim, and activation of caspase-3 were significantly up-regulated by toxin A in PLC-γl-transformed cells. Toxin A-induced cell rounding and paxillin dephosphorylation were also significantly higher in PLC-γl-transformed cells than in control cells. These findings suggest that C. difficile toxin A may have potential as an anticancer agent against colorectal cancers and breast carcinomas in which PLC-γl is highly up-regulated.

  12. Improvement of chronic facial pain and facial dyskinesia with the help of botulinum toxin application

    Directory of Open Access Journals (Sweden)

    Ellies Maik

    2007-08-01

    Full Text Available Abstract Background Facial pain syndromes can be very heterogeneous and need individual diagnosis and treatment. This report describes an interesting case of facial pain associated with eczema and an isolated dyskinesia of the lower facial muscles following dental surgery. Different aspects of the pain, spasms and the eczema will be discussed. Case presentation In this patient, persistent intense pain arose in the lower part of her face following a dental operation. The patient also exhibited dyskinesia of her caudal mimic musculature that was triggered by specific movements. Several attempts at therapy had been unsuccessful. We performed local injections of botulinum toxin type A (BTX-A into the affected region of the patient's face. Pain relief was immediate following each set of botulinum toxin injections. The follow up time amounts 62 weeks. Conclusion Botulinum toxin type A (BTX-A can be a safe and effective therapy for certain forms of facial pain syndromes.

  13. Neutralizing antibodies to botulinum neurotoxin type A in aesthetic medicine: five case reports

    Directory of Open Access Journals (Sweden)

    Torres S

    2013-12-01

    Full Text Available Sebastian Torres,1 Mark Hamilton,2 Elena Sanches,4 Polina Starovatova,3 Elena Gubanova,3 Tatiana Reshetnikova51Di Stefano Velona Clinic, Catania, Italy; 2Hamilton Face Clinic, Dublin, Ireland; 3Preventive Medicine Clinic "Vallex M", Moscow, Russia; 4EKLAN Co Ltd Medical Center for Aesthetic Correction, Moscow, Russia; 5Department of Dermatovenereology and Cosmetology, State Medical University, Novosibirsk, RussiaAbstract: Botulinum neurotoxin injections are a valuable treatment modality for many therapeutic indications as well as in the aesthetic field for facial rejuvenation. As successful treatment requires repeated injections over a long period of time, secondary resistance to botulinum toxin preparations after repeated injections is an ongoing concern. We report five case studies in which neutralizing antibodies to botulinum toxin type A developed after injection for aesthetic use and resulted in secondary treatment failure. These results add to the growing number of reports in the literature for secondary treatment failure associated with high titers of neutralizing antibodies in the aesthetic field. Clinicians should be aware of this risk and implement injection protocols that minimize resistance development.Keywords: aesthetic medicine, botulinum neurotoxin type A, neutralizing antibody, secondary treatment failure

  14. Botulinum Toxin for the Treatment of Tremor and Tics.

    Science.gov (United States)

    Lotia, Mitesh; Jankovic, Joseph

    2016-02-01

    The therapeutic applications of botulinum toxin (BoNT) have grown manifold since its initial approval in 1989 by the U.S. Food and Drug Administration for the treatment of strabismus, blepharospasm, and other facial spasms. Although it is the most potent biologic toxin known to man, long-term studies have established its safety in the treatment of a variety of neurologic and nonneurologic disorders. Despite a paucity of randomized controlled trials, BoNT has been found to be beneficial in treating a variety of tremors and tics when used by clinicians skilled in the administration of the drug for these hyperkinetic movement disorders. Botulinum toxin injections can provide meaningful improvement in patients with localized tremors and tics; in some cases, they may be an alternative to other treatments with more undesirable adverse effects.

  15. Botulinum toxin and its clinical aspects: An overview

    Directory of Open Access Journals (Sweden)

    Shatavisa Mukherjee

    2015-01-01

    Full Text Available Botulinum toxin (BTX, a potent neurotoxin which is produced by the bacterium Clostridium botulinum, consists of eight distinct neurotoxin serotypes referred to as (BTX type-A [BTX-A], B, C, D, E, F, G, H all of which inhibit acetylcholine release at the neuromuscular junction. BTX-A, by blocking acetylcholine release at neuromuscular junctions, accounts for its therapeutic action to relieve dystonia, spasticity, and related disorders. A wide variety of medical conditions such as bruxism, hyperhidrosis, achalasia, focal dystonia, upper motor neuron syndrome, blepharospasm, and chronic migraine are now treated with BTX. The cosmetological applications include correction of lines, creases, and wrinkling all over the face, chin, neck, and chest. Side effects are generally rare and minimal. Injections with BTX-A are well-tolerated. Discovery of further newer indications of this neurotoxin can enlighten the path of research in the field of neuroscience.

  16. 面部小面积瘢痕手术切口早期应用A型肉毒毒素注射联合强脉冲光照射的临床效果%Effect of incision early combined botulinum toxin type A injections and intense pulsed light treatment for facial small area scar surgery

    Institute of Scientific and Technical Information of China (English)

    王小玉; 王小琴; 刘琰; 王晓斌; 谭磊; 牟艳萍

    2013-01-01

    目的探讨面部小面积瘢痕切除术后切口早期应用A型肉毒毒素注射联合强脉冲光治疗的临床价值。方法将我院行面部小面积瘢痕切除术的228例患者随机等分为试验组和对照组,行常规切除改形术后,两组除均按时换药拆线、外用硅凝胶制剂等抗瘢痕增生的措施治疗外,试验组于拆线时切口内一次性注射A型肉毒毒素,术后1、2、3个月每月给予强脉冲光照射治疗1次。结果试验组切口红肿时间缩短、瘢痕增生程度较轻,色素沉着较少,没有明显的瘢痕疙瘩形成;而对照组切口红肿时间较长、瘢痕增生程度较重,色素沉着较多,3例在下颌部位发生瘢痕疙瘩;试验组术后1年的治愈率和有效率分别为91.22%、98.25%,对照组的术后1年治愈率和有效率分别为63.16%和92.98%,两组的治愈率之间差别具有统计学意义(P<0.05)。结论术后切口早期应用A型肉毒毒素注射联合强脉冲光治疗面部小面积瘢痕,可显著提高手术治愈率,且具有简单易行、不良反应低的特点。%Objective To explore the clinical value of combined botulinum toxin type A injections and intense pulsed light therapy on facial scar resection of early incision. Methods 228 patients of our hospital for facial small area scar excision were randomly divided into experimental and control groups, all of them in accordance with the principle of routine removal of orthopedic reshaping surgery ifrstly, in addition to the two groups were given time after dressing stitches, then anti-scar treatment of topical silicone gel preparations were done, experimental group also in stitches incision disposable injection of botulinum toxin type A, three times intense pulsed light irradiation were given after 1, 2,3 month. Results Experimental group wound swelling time was shortened, scar a lesser extent, less pigmentation, there was no obvious keloid formation, while the control

  17. Regional diffusion of botulinum toxin in facial muscles: a randomised double-blind study and a consideration for clinical studies with split-face design.

    Science.gov (United States)

    Punga, Anna Rostedt; Eriksson, Annika; Alimohammadi, Mohammad

    2015-11-01

    Despite the extensive use of botulinum toxin A (BoNTA) in medical and cosmetic treatments, the potential spreading of BoNTA to surrounding tissues remains unknown. A patient with hemifacial paralysis upon blepharospasm treatment with low dose of BoNTA, prompted us to investigate the spreading effect. A randomised, double-blind study was conducted in which 5 healthy women (33-52 years) were treated with different doses of onabotulinum toxin unilaterally in the corrugator muscle. Parameters of efficacy and diffusion (CMAP; EMG and jitter analysis) in both glabellar and frontalis muscles were assessed at baseline, 2 and 4 weeks following BoNTA injection. CMAP of the treated glabellar muscles was reduced to approximately 40% in all dose groups. Additionally, contralateral CMAP reduction was observed in 3 of 5 subjects. These data confirm regional diffusion of BoNTA in facial muscle application, which raises question on the reliability of split-face models in BoNTA studies.

  18. Influence of botulinum toxin on rabbit jaw muscle activity and anatomy

    NARCIS (Netherlands)

    Korfage, J.A.M.; Wang, J.; Lie, S.H.J.T.J.; Langenbach, G.E.J.

    2012-01-01

    Introduction: Muscles can adapt their fiber properties to accommodate to new conditions. We investigated the extent to which a decrease in muscle activation can cause an adaptation of fiber properties in synergistic and antagonistic jaw muscles. Methods: Three months after the injection of botulinum

  19. Botulinum therapy for poststroke spasticity of the lower extremity (clinical cases

    Directory of Open Access Journals (Sweden)

    L. V. Krylova

    2014-01-01

    Full Text Available The paper deals with the topical problem – the medical rehabilitation of patients with poststroke spasticity. It describes clinical cases of patients with poststroke spasticity of the upper and lower extremities who have received combined therapy using botulinum toxin type A (Botox injections.

  20. Botulinum toxin effect on salivary flow rate in children with cerebral palsy.

    NARCIS (Netherlands)

    Jongerius, P.H.; Rotteveel, J.J.; Limbeek, J. van; Gabreëls, F.J.M.; Hulst, K. van; Hoogen, F.J.A. van den

    2004-01-01

    OBJECTIVE: To investigate the effectiveness of botulinum neurotoxin (BoNT) type A in reducing salivary flow rate in children with cerebral palsy (CP) with severe drooling. METHODS: During a controlled clinical trial, single-dose BoNT injections into the submandibular salivary glands were compared wi

  1. 自体脂肪移植联合A型肉毒毒素注射在面部年轻化治疗中的应用%Minimally invasive facial rejuvenation via autologous fat graft and botulinum toxin type A injection

    Institute of Scientific and Technical Information of China (English)

    王忠志; 杨盼

    2014-01-01

    Objective To explore the surgical method and curative effect of facial rejuvenation via autologous fat graft combined with botulinum toxin type A (BTX-A)injection.Methods Fat granule were transplanted at fore-head,temporal,lacrimal groove or nasolabial region as soft tissue filler.While BTX-A was injected at frontal wrinkle,frown lines,radix nasi cross grain,crow′s feet and creases around the mouth for rhytidectomy,and in massester for lower facial recontour,at one week after fat graft.Results Totally 150 patients were treated by the operation mentioned above,and satisfactory outcome were obtained.Conclusion Autologous fat graft combined with BTX-A injection is safe and effective and it is an ideal cosmetic surgery for facial rejuvenation.%目的:探讨自体脂肪移植联合 A 型肉毒毒素注射在面部年轻化治疗中的应用。方法将获取的自体脂肪颗粒填充于额部、颞部凹陷及泪沟、鼻唇沟畸形,术后1周行 A 型肉毒毒素注射治疗额横纹、眉间纹、鼻根横纹、鱼尾纹、口周细纹等,麻痹肥大的咬肌以修饰下面部轮廓。结果共对150例求美者进行治疗,疗效满意。结论自体脂肪移植联合 A 型肉毒毒素注射安全、可靠,是一种理想的面部年轻化美容方法。

  2. Lateral epicondylitis: review of injection therapies.

    Science.gov (United States)

    Judson, Christopher H; Wolf, Jennifer Moriatis

    2013-10-01

    Lateral epicondylitis has several different treatment methods, with no single agreed upon therapy. This article summarizes the current literature on injection therapies for lateral epicondylitis. Glucocorticoid, botulinum toxin, autologous blood, platelet-rich plasma, hyaluronic acid, polidocanol, glycosaminoglycan, and prolotherapy injections are discussed.

  3. The identification of responsible muscle group for writer's cramp and the therapeutic effectiveness of Botulinum toxin injection%书写痉挛责任肌群的认定及肉毒毒素治疗的疗效观察

    Institute of Scientific and Technical Information of China (English)

    林建

    2004-01-01

    目的寻找引起患者书写痉挛(writer's cramp)并导致字迹抖动不清的主要责任肌群,并同时观察局部注射肉毒毒素-A(botulinum toxin-A,BTX-A)对书写痉挛病症的治疗效果及副反应发生情况.方法通过对前臂肌群的选择性运动,判断各肌群对书写痉挛症状的影响,并初步认定责任肌群,然后用维库溴铵对初步确定的责任肌群进行选择性注射,以进一步确定引起书写痉挛的主要责任肌群,最后对已确定的主要责任肌群进行BTX-A多点注射,观察其疗效及副反应发生情况.结果本研究发现,当前臂旋转肌群运动时会加重书写痉挛症状,对该群肌肉注射维库溴铵后可消除痉挛症状.当对旋转肌群进行BTX-A注射后,受试的3例患者(共5侧患肢)症状全部得到改善,无一例发生可察觉的握力减退及垂腕等副反应.结论前臂旋转肌群是导致书写痉挛并致使字迹抖动不清的主要责任肌群,对其进行BTX-A选择性多点注射可获得满意疗效,同时还可避免握力减退及垂腕等副反应的发生.

  4. Onabotulinum toxin a (botox®) in the treatment of neurogenic bladder overactivity

    DEFF Research Database (Denmark)

    Rohrsted, Malene; Nordsten, Cecilie Bagi; Bagi, Per

    2012-01-01

    Botulinum toxin (BT) is a potent presynaptic neuromuscular blocking agent which induces selective, reversible muscle weakness for months when injected intramuscularly. During recent years BT has revolutionized the treatment of previously intractable symptoms of detrusor overactivity. Based...... techniques and dosages were described. The onset of the effect usually appeared before 2 weeks, and reached a peak within 2-6 weeks, with the clinical effect being maintained for approximately 6-8 months, or even longer. Depending on the dose, a number of patients developed high residual volume and clean...

  5. Botulinum neurotoxin type A versus punctal plug insertion in the management of dry eye disease

    Directory of Open Access Journals (Sweden)

    Amal A Bukhari

    2014-01-01

    Full Text Available Purpose: To compare the efficacies of punctal plug insertion and Botulinum toxin injection in dry eye disease not responding to topical medications. Materials and Methods: A non-controlled randomized clinical trial of two parallel groups of 60 dry eye patients seen in the clinic not responding to topical medications were divided into two groups. One group received punctal plugs and the other group received Botulinum toxin injections to prevent lacrimal tear drainage. Results: Of a total of 36 patients with a mean age of 44.5 years who received punctal plugs, 50% of them experienced improvements in the clinical manifestations of their disease. 12/36 (33.3% developed plug extrusion, and 6/36 (16.7% patients developed conjunctival erosions with irritation that necessitated plug removal within one week of insertion. A total of 24 patients with a mean age of 47.5 years received injections of Botulinum toxin. Of these, 83.3% had improvement in all of the clinical manifestations of dry eye. 4/24 (16.7% had no improvement in the degrees to which they experienced foreign body sensations, 33.3% reported shampoo entering the eye while showering. All of the patients who received Botulinum toxin injections were satisfied with the results of their treatment, whereas only 72.3% of the patients who received punctal plugs were satisfied with their results. Conclusion: Botulinum neurotoxin A injections can be a very good alternative to punctal plugs in improving the clinical manifestations of dry eye disease They are associated with the development of fewer and milder complications and with higher levels of patient satisfaction.

  6. Application of botulinum toxin in pain management.

    Science.gov (United States)

    Sim, Woo Seog

    2011-03-01

    Botulinum toxin has been used for the treatment of many clinical disorders by producing temporary skeletal muscle relaxation. In pain management, botulinum toxin has demonstrated an analgesic effect by reducing muscular hyperactivity, but recent studies suggest this neurotoxin could have direct analgesic mechanisms different from its neuromuscular actions. At the moment, botulinum toxin is widely investigated and used in many painful diseases such as myofascial syndrome, headaches, arthritis, and neuropathic pain. Further studies are needed to understand the exact analgesic mechanisms, efficacy and complications of botulinum toxin in chronic pain disorders.

  7. Treating benign prostatic hyperplasia with botulinum neurotoxin.

    Science.gov (United States)

    Brisinda, G; Vanella, S; Marniga, G; Crocco, A; Maria, G

    2011-01-01

    Botulinum toxin (BoNT) has been increasingly used in the interventional treatment of several disorders; the use of this agent has extended to a plethora of conditions including focal dystonia, spasticity, inappropriate contraction in most gastrointestinal sphincters, eye movement disorders, hyperhidrosis, genitourinary disorders and aesthetically undesirable hyperfunctional facial lines. In addition, BoNT is being investigated for the control of pain, and for the management of tension or migraine headaches and myofascial pain syndrome. Benign prostatic hyperplasia (BPH) is a common condition in ageing men; the goal of therapy is to reduce the lower urinary tract symptoms (LUTS) associated with BPH and to improve the quality of life. However, medical treatment, including drugs that relax smooth muscle within the prostate and drugs that shrink the gland are not totally effective or without complications. The standard surgical treatment for BPH is progressively changing to minimally invasive therapies, but none of them has provided clear results. The use of BoNT-A to inhibit the autonomic efferent effects on prostate growth and contraction, and inhibit the abnormal afferent effects on prostate sensation, might be an alternative treatment for BPH. BoNT injections have several advantages over drugs and surgical therapies in the management of intractable or chronic disease; systemic pharmacologic effects are rare, permanent destruction of tissue does not occur, and graded degrees of relaxation may be achieved by varying the dose injected. In this paper, clinical experience over the last years with BoNT in BPH impaired patients will be illustrated.

  8. Botulinum toxin type A treatment of cerebral palsy: an integrated approach

    OpenAIRE

    Molenaers, Guy; Desloovere, Kaat; Eyssen, M; De Cat, Josse; Jonkers, Ilse; De Cock, Paul

    1999-01-01

    We have applied a multilevel approach no the management of spasticity associated with cerebral palsy (CP). All of the following factors are important in forming an integrated strategy for botulinum toxin type A (BTX-A) therapy: the timing of injections, patient selection, multilevel BTS-A treatment, optimal dosage and injection technique, follow-up treatment and objective measurements of functional outcome. Data on all these factors are presented here. CP patients had a mean age of 6.5 years ...

  9. Botulinum toxin in the management of sialorrhoea in acquired brain injury

    LENUS (Irish Health Repository)

    Carroll, A

    2016-06-01

    Sialorrhoea as a consequence of severe acquired brain injury can significantly negatively impact on quality of life. Medications used in its management have many side effects which can cause problems in the severely disabled. Botulinum toxin is an effective treatment of sialorrhoea in a number of neurological conditions but may also have a role to play in the management of sialorrhoea following severe ABI. We report on 4 cases of sialorrhoea following acquired brain injury causing a variety of problems, whose parotid glands were injected with Botulinum toxin type A (Dysport) 50mu each, under ultrasound guidance. All cases had a clinically and statistically significant reduction in drooling as measured by the teacher drooling scale (p=0.005) and carers Visual Analogue Scale (p=0.012). There were no side effects reported. Botulinum toxin is an effective treatment for sialorrhoea associated with acquired brain injury.

  10. Clinical research on injection of botulinum toxin type A by ultrasound combined with electrical stimulation guided for treatment of spasticity to early stroke patients%超声联合电刺激引导下A型肉毒毒素注射对卒中早期患者肌痉挛的临床研究

    Institute of Scientific and Technical Information of China (English)

    张大伟; 陈庆梅

    2016-01-01

    Objective To observe the effect of ultrasound combined with electrical stimulation guided injection of botulinum toxin type A(BTX-A)for the treatment of spasticity in early cerebral vascular accident patients.Methods Forty-six early cerebral vascular accident patients with lower limb spasticity were divided randomly into two groups:treatment group(23 patients)and control group (23 patients).Patients in control group got routine rehabilitation training,and those in treatment group were given ultrasound combined with electrical stimulation guided inj ection of botulinum toxin type A additionally.The functions of two groups were evaluated by using the modified Ashworth scale (MAS),Fugl-Meyer assessment (FMA ),intergrated electromyography (iEMG ),WHO Quality of Life-BREF (WHOQOL-BREF)before and six weeks after treatment.Results After six weeks of treatment,the treatment group improved much better than the control group.The average MAS,FMA,WHOQOL-BREF,iEMG score in treatment group were significantly higher than those of control group (P <0.05 ).Conclusion Ultrasound combined with electrical stimulation guided inj ection of botulinum toxin type A for the treatment of spasticity in early cerebral vascular accident patients is effective,accurate and safe.%目的:观察超声联合电刺激引导下 A型肉毒毒素(BTX-A)注射对早期脑血管意外患者肌痉挛的影响。方法选取早期脑血管意外后小腿肌痉挛患者46例,随机分为治疗组(23例)及对照组(23例)。对照组给予常规康复训练,治疗组在常规康复训练基础上辅以超声联合电刺激引导下BTX-A注射治疗。于治疗前和治疗6周后分别采用改良 Ashworth量表(MAS)、简化 Fugl-Meyer量表(FMA)、世界卫生组织生存质量量表简表(WHOQOL-BREF)、表面肌电积分值(iEMG)对2组功能进行评定。结果经6周治疗后,治疗组较对照组改善,治疗组 MAS、FMA、WHOQOL-BREF、iEMG评分显著高于对照组(P<0.05)。结论

  11. Presence of Cleaved Synaptosomal-Associated Protein-25 and Decrease of Purinergic Receptors P2X3 in the Bladder Urothelium Influence Efficacy of Botulinum Toxin Treatment for Overactive Bladder Syndrome.

    Directory of Open Access Journals (Sweden)

    Hsin-Tzu Liu

    Full Text Available To evaluate whether botulinum toxin A (BoNT-A injection and Lipotoxin (liposomes with 200 U of BoNT-A instillation target different proteins, including P2X3, synaptic vesicle glycoprotein 2A, and SNAP-25, in the bladder mucosa, leading to different treatment outcomes.This was a retrospective study performed in a tertiary teaching hospital. We evaluated the clinical results of 27 OAB patients treated with intravesical BoNT-A injection (n = 16 or Lipotoxin instillation (n = 11. Seven controls were treated with saline. Patients were injected with 100 U of BoNT-A or Lipotoxinin a single intravesical instillation. The patients enrolled in this study all had bladder biopsies performed at baseline and one month after BoNT-A therapy. Treatment outcome was measured by the decreases in urgency and frequency episodes at 1 month. The functional protein expressions in the urothelium were measured at baseline and after 1 month. The Wilcoxon signed-rank test and ordinal logistic regression were used to compare the treatment outcomes.Both BoNT-A injection and Lipotoxin instillation treatments effectively decreased the frequency of urgency episodes in OAB patients. Lipotoxin instillation did not increase post-void residual volume. BoNT-A injection effectively cleaved SNAP-25 (p < 0.01. Liposome encapsulated BoNT-A decreased urothelial P2X3 expression in the five responders (p = 0.04, while SNAP-25 was not significantly cleaved.The results of this study provide a possible mechanism for the therapeutic effects of BoNT-A for the treatment of OAB via different treatment forms. BoNT-A and Lipotoxin treatments effectively decreased the frequency of urgency episodes in patients with OAB.

  12. Improvement effect of botulinum toxin A injection treatment on spasticity of triceps surae and walking ability of patients with stroke%A型肉毒毒素局部注射对脑卒中患者下肢肌痉挛和步行能力的改善作用

    Institute of Scientific and Technical Information of China (English)

    陈晓伟; 程士欢; 李贺; 张春生; 衣爱枝; 李贞兰

    2016-01-01

    目的:采用A型肉毒毒素局部注射脑卒中患者偏瘫侧小腿三头肌,观察其对下肢肌痉挛和步行能力的影响,探讨肌张力变化与下肢运动功能的关系,研究其在社区康复中应用的可行性.方法:选取脑卒中小腿三头肌痉挛患者30例,按照患者意愿分为治疗组(n=15)和对照组(n=15).治疗组患者小腿三头肌局部注射A型肉毒毒素后进行常规康复治疗,对照组患者仅进行常规康复治疗.常规康复训练包括偏瘫侧下肢肌肉牵伸、肌力训练、平衡训练和步行训练.治疗前后进行康复评定并于治疗后3个月随访评定.肌张力评定采用改良Ashworth痉挛量表(MAS),下肢运动功能评定采用Fugl Meyer (FM)量表中的下肢部分,步行能力评定采用10米步行测试(10MWT)时间.结果:组内比较,治疗组患者治疗后和治疗后3个月MAS评分低于治疗前(P<0.05);对照组患者治疗前后MAS评分比较差异无统计学意义(P>0.05),治疗后3个月MAS随访评分低于治疗前(P<0.05).2组患者治疗后和治疗后3个月随访FMA评分、10MWT时间均高于治疗前(P<0.05).组间比较,治疗组患者治疗后和3个月随访MAS评分低于对照组(P<0.05),而FMA评分、10MWT时间明显高于对照组(P<0.05).结论:A型肉毒毒素局部注射可快速而持久降低肌张力,结合康复训练可有效改善下肢痉挛状态,提高患者的运动功能和步行能力,适合在社区康复中推广应用.

  13. Molecular diversity of Clostridium botulinum and phenotypically similar strains.

    Science.gov (United States)

    Grenda, T; Kukier, E; Sieradzki, Z; Goldsztejn, M; Kwiatek, K

    2016-12-01

    This study was undertaken to examine phenotypic and genetic features of strains preliminary classified as Clostridium botulinum species. The phenotypic characteristics were assessed with different culture media and biochemical tests. The genetic characterization included detection of botulinum toxin genes by PCR and macrorestriction analysis with SmaI, XhoI and SacII by PFGE (Pulsed-field Gel Electrophoresis). Despite similar biochemical properties of all analysed strains, only 47% of them contained genes determining toxicity specific to C. botulinum species. The most valuable differentiation of C. botulinum and C. botulinum-like strains was obtained after SmaI digestion. The highest affinity was observed among C. botulinum type B profiles which was even up to 100%. It was found 100% of affinity between C. botulinum and C. botulinum-like strains, however, the similarity among C. botulinum and C. botulinum-like was generally lower than 80%.

  14. Botulinum toxin — therapeutic effect in cosmetology

    Directory of Open Access Journals (Sweden)

    Morrison A.V.

    2016-09-01

    Full Text Available This review presents the data from published literatures and the research works conducted by the authors about mechanisms of action of botulinum toxin and its use in the practical medicine (particularly in dermatology and cosmetology. Indications and contraindications of botulinum toxin use in cosmetology are also considered in this work.

  15. Voorkomen van Clostridium botulinum op melkveebedrijven

    NARCIS (Netherlands)

    Notermans SHW; Havelaar AH; Dufrenne JB; Oosterom J

    1984-01-01

    Op melkveebedrijven wordt C.botulinum regelmatig aangetroffen. De aantallen C.botulinum type B, aanwezig in monsters grond afkomstig van weilanden, varieren van 10-300 kiemen per 100 gram grond. Op bedrijven, die regelmatig weilanden met zuiveringsslib bemesten, blijkt de besmetting met C.botuli

  16. 研究应用A型肉毒毒素进行面部除皱的临床疗效%Clinical Efficacy of Application of Botulinum Toxin Type A on Facial Wrinkles

    Institute of Scientific and Technical Information of China (English)

    郜泽誉; 朱艳; 张志磊; 赵鹏

    2014-01-01

    目的:探讨和研究应用A型肉毒毒素进行面部除皱的临床治疗效果。方法:选取新疆医科大学第五附属医院2012年12月~2013年12月间接收的48例进行面部除皱的患者作为观察对象,对患者使用A型肉毒毒素进行注射治疗,每次使用A型肉毒毒素的总剂量不超过100U。结果:48例患者通过使用A型肉毒毒素注射之后,达到了很好的治疗效果,其中有46例患者的治疗效果显著有效,显著有效率为95.65%,治疗有效的为3例患者,有效率为6.25%,总有效率达到了100%。结论:使用A型肉毒毒素来去除面部的皱纹,其疗效非常显著,见效时间短,副作用小,患者的痛苦较少,是一种非常安全和有效的除皱方式,值得在临床上推广及应用。%Objective:To investigate the application and research of botulinum toxin type A in clinical treatment of facial wrinkles. Method:48 cases with facial wrinkles in the Fifth Affiliated Hospital of Xinjiang Medical University from December,2012 to December,2013 were regarded as research object. They were treated with botulinum toxin A injection. The total dose per use of botulinum toxin type A does not exceed 100U. Result:48 patients through the use of botulinum toxin type A injection achieved good therapeutic effect. The treatment effect of 46 cases was significantly effective,and the significant efficiency was 95.65%. 3 patients had effective treatment,the effective rate was 6.25%,the total effective rate was 100%. Conclusion:The effect of botulinum toxin type A is significant,the effective time is short,the side effect is little, and the pain of patients is less. So it is a very safe and effective anti wrinkle method,and worth application in clinical practice.

  17. A型肉毒毒素注射配合康复功能训练对痉挛型偏瘫脑瘫患儿上肢运动功能疗效观察%Effect of Botulinum Toxin Type A Injection Combined with Rehabilitation Functional Training on Upper Extremity Motor Function in Children with Spastic Hemiplegic Cerebral Palsy

    Institute of Scientific and Technical Information of China (English)

    颜华; 张惠佳; 阳伟红; 王益梅; 郭春光; 胡继红; 周平秋; 何金华; 段华林

    2012-01-01

    目的 观察A型肉毒毒素(BTX-A)注射治疗配合康复功能训练对痉挛型偏瘫脑瘫患儿上肢功能障碍的疗效.方法 60例痉挛型偏瘫型脑瘫患儿均接受BTX-A注射治疗,治疗后进行强制性诱导运动训练、物理疗法、肌电生物反馈治疗、作业治疗及家庭训练.在治疗前与治疗3个月后,分别用改良Ashworth痉挛量表(MAS)评定患侧上肢肌张力、关节量角器法测量患侧腕关节主动背伸角度、Peabody运动发育量表(PDMS-II)进行患侧手精细运动商(FMQ)的评估、日常生活活动能力(ADL)量表评估ADL能力以比较观察疗效.结果 治疗后患儿上述指标均较治疗前显著改善(P<0.001).结论 BTX-A注射治疗配合康复功能训练能明显降低痉挛型偏瘫型脑瘫患儿的上肢肌张力,改善关节活动范围,明显提高上肢运动功能.%Objective To observe the effect of Botulinum toxin type A (BTX-A) injection combined with rehabilitation functional training on upper extremity motor function in children with spastic hemiplegic cerebral palsy (CP). Methods 60 spastic hemiplegic CP children were treated with constraint-induced movement therapy (CIMT), physical therapy, electromyographic biofeedback stimulation therapy, occupational therapy, family-based training and so on after injected with BTX-A. The muscle tension of the hemiplegic upper extremity accessed by Modified Ashworth Scale (MAS), the wrist angle of active dorsiextention motion by orthrometer, fine movement quotient (FMQ) by Pea-body developmental motor scale (PDMS- II), and activities of daily living (ADL) were performed to evaluate the effects before and 3 months after treatment. Results These outcomes were improved significantly after treatment (P<0.001). Conclusion BTX-A injection combined with rehabilitation functional training could rapidly reduce spasticity of the upper extremity, increase the range of motion, improve motor function of upper extremity in children with spastic

  18. Clinical Efficacy of Ultrasound-guided Botulinum Toxin Type A Injection and Muscle Electricity Biofeedback Treatment for Patients with Spasticity in Lower Limb Muscles%彩超引导下肉毒毒素注射和肌电生物反馈治疗下肢肌肉痉挛的疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈华先; 丁旭东; 张贵斌; 黄瓅; 宋金辉; 洪艳; 王汉

    2012-01-01

    Objective: To evaluate the clinical effect of ultrasound-guided botulinum toxin type A (BTX-A) injection and muscle electricity biofeedback treatment for patients with spastici-ty in the lower limb muscles after cerebral infarction. Methods: Thirty-six patients with lower limb muscle Spasms after cerebral infarction were randomly divided into control group and the treatment group with 18 cases in the each group. The ultrasound-guided BTX-A injection was applied to the both groups whereas muscle electricity biofeedback treatment was performed additional to those in the treatment group after 24 hours. The outcome was assessed by modified Ash-worth scale (MAS). Results: The recovery of Muscle spasms in the electricity biofeedback treatment group was better than that in the control group. Conclusion: The ultrasound guided BTX-A injection and muscle electricity biofeedback treatment are effective for treatingt patients with lower limb muscle spasticity after cerebral infarction.%目的:观察采用彩超引导下注射A型肉毒毒素(BTX-A)和肌电生物反馈治疗脑梗死后下肢肌肉痉挛的临床疗效.方法:选择36例脑梗死偏瘫后下肢肌肉痉挛患者,随机分成治疗组及对照组各18例.2组均对下肢痉挛肌群进行分点注射BTX-A,治疗组24 h后给予肌电生物反馈治疗6周,采用改良Ashworth评分(MAS)、步长、步速评估2组疗效.结果:治疗组治疗6周后MAS评分、步长、步速优于对照组(P<0.05).结论:采用彩超引导下多位点注射BTX-A结合肌电生物反馈治疗脑梗死后下肢肌肉痉挛有明显疗效.

  19. A randomized trial of upper limb botulimun toxin versus placebo injection, combined with physiotherapy, in children with hemiplegia.

    Science.gov (United States)

    Ferrari, Adriano; Maoret, Anna Rosa; Muzzini, Simonetta; Alboresi, Silvia; Lombardi, Francesco; Sgandurra, Giuseppina; Paolicelli, Paola Bruna; Sicola, Elisa; Cioni, Giovanni

    2014-10-01

    The main goal of this study was to investigate the efficacy of Botulinum Toxin A (BoNT-A), combined with an individualized intensive physiotherapy/orthoses treatment, in improving upper limb activity and competence in daily activity in children with hemiplegia, and to compare its effectiveness with that of non-pharmacological instruments. It was a Randomized Clinical Trial of 27 children with spastic hemiplegic cerebral palsy, outpatients of two high speciality Centres for child rehabilitation. Each child was assigned by simple randomization to experimental group (BoNT-A) or control group (placebo). Assisting Hand Assessment (AHA) was chosen as primary outcome measure; other measures were selected according to ICF dimensions. Participants were assessed at baseline (T0), at T1, T2, T3 (1-3-6 months after injection, respectively). Every patient was given a specific physiotherapeutic treatment, consisting of individualized goal directed exercises, task oriented activities, daily stretching manoeuvres, functional and/or static orthoses. BoNT-A group showed a significant increase of AHA raw scores at T2, compared to control group (T2-T0: p=.025) and functional goals achievement (GAS) was also slightly better in the same group (p=.033). Other measures indicated some improvement in both groups, without significant intergroup differences. Children with intermediate severity of hand function at House scale for upper limb impairment seem to have a better benefit from BoNT-A protocol. BoNT-A was effective in improving manipulation in the activity domain, in association with individualized goal-directed physiotherapy and orthoses; the combined treatment is recommended. The study brings more evidence for the efficacy of a combined treatment botulinum toxin injection-physiotherapy-orthoses, and it gives some suggestions for candidate selection and individualized treatment.

  20. Rapid Generation of a Nanocrystal-Labeled Peptide Library for Specific Identification of the Bacterium Clostrium Botulinum

    Energy Technology Data Exchange (ETDEWEB)

    Tok, J B

    2004-11-11

    Several peptide libraries containing up to 2 million unique peptide ligands have been synthesized. The peptides are attached onto a 80 micron resin and the length of these peptide ligands ranges from 5 to 9 amino acid residues. Using a novel calorimetric assay, the libraries were screened for binding to the ganglioside-binding domain of Clostridium Tetanus Toxin, a structural similar analog of the Clostridium Botulinum toxin. Several binding peptide sequences were identified, in which the detailed binding kinetics are currently underway using the Surface Plasmon Resonance (SPR) technique.

  1. Factors Associated with Therapeutic Efficacy of Intravesical OnabotulinumtoxinA Injection for Overactive Bladder Syndrome.

    Directory of Open Access Journals (Sweden)

    Sheng-Mou Hsiao

    Full Text Available To analyze the predictors of therapeutic efficacy after intravesical botulinum toxin A injection for overactive bladder syndrome (OAB refractory to antimuscarinic therapy.All consecutively OAB patients, who visited the urologic outpatient clinics of a medical center and refractory to antimuscarinic treatment, were prospectively enrolled. All enrolled patients received intravesical injection of 100 U onabotulinumtoxinA (Botox. The Global Response Assessment (GRA score ≥ 2 at 3 months after Botox injection was defined as a successful treatment, otherwise failed.Overall, 89 patients received intravesical injection. Eighty patients, including 42 men and 38 women, had received follow-up at 3 months. The overall success rate was 63.8%. The global response assessment, urgency severity score, urgency, urgency urinary incontinence and frequency episodes, and functional bladder capacity improved after treatment. However, post-void residual volume (PVR increased, and voiding efficiency (VE decreased after treatment. Female gender (odds ratio = 3.75 was the only independent factor associated with the success. Female gender (coefficient = 0.74, low baseline overactive bladder symptoms score (coefficient = -0.12 and the presence of OAB-wet (coefficient = 0.79 were independent factors associated with therapeutic efficacy (i.e., GRA score. VE (odds ratio = 0.062 was the only predictor for a large PVR at 3 months. The optimum cutoff value of VE was <87% with the area under the ROC curve being 0.64 (sensitivity = 63.8%, specificity = 57.1%.The therapeutic effects of Botox can persist till 6 months after treatment. Female gender, low overactive bladder symptoms score and OAB-wet are associated better therapeutic efficacy, and low baseline VE is associated with large PVR. These findings can serve as an initial guide or assist in consultation regarding the treatment of OAB patients with Botox injection.ClinicalTrials.gov NCT01657409.

  2. Treatment of Raynaud's phenomenon with botulinum toxin type A.

    Science.gov (United States)

    Zhang, Xiaolong; Hu, Yong; Nie, Zhiyu; Song, Ye; Pan, Yougui; Liu, Ying; Jin, Lingjing

    2015-07-01

    Raynaud's phenomenon (RP), an episodic vasospasm of the peripheral arteries, is quite common in general population. The current therapies of RP are limited by efficacy, side effects, and polypharmacy concerns. Botulinum toxin type A (BTX-A) local injections have been reported for the treatment of RP, but the injection sites, concentration and dose of BTX-A were different from each other in previous trials. In addition, so far, there have been no reports concerning local injection of BTX-A in Asian RP patients. Ten patients with RP in China were included in this retrospective study. All the patients had intractable pain and were non-responsive to conservative and/or medical therapy. A patterned BTX-A injection was performed in RP patients, guided by ultrasonography. BTX-A was injected as 20 u/ml devoid of preservatives. Outcomes were measured by ultrasonography, surface temperature, visual analog scale (VAS) for clinical symptoms (pain, numbness, stiffness and swelling), and changes in ulcers or gangrene. Overall, a great improvement in artery flow velocity (P < 0.01), surface temperature (P < 0.01), ulcer and VAS for clinical symptoms, was observed after BTX-A local injection. Complications were very rarely found, and no patients complained of hand weakness and bruise. BTX-A patterned injection guided by ultrasonography might be a useful therapeutic tool in the management of intractable RP.

  3. [Botulinum toxin as a biological weapon].

    Science.gov (United States)

    Rossow, Heidi; Kinnunen, Paula M; Nikkari, Simo

    2012-01-01

    Botulism is caused by botulinum neurotoxin produced by the bacterium Clostridium botulinum. It is a flaccid paralysis in which consciousness and nociception are preserved. Natural botulism typically results from ingestion of inadequately heated or unheated vacuum-packed foods. In addition, botulinum toxin is one of the most feared biological weapons. In the diagnosis and treatment of botulism early suspicion is essential. Several coinciding or local clusters without a typical connecting source, or an uncommon type of toxin may indicate an intentionally caused epidemic.

  4. The effects of botulinum toxin type A guided by electromyography combined conventional rehabilitation training to observed for the treatment of muscle spasm after stroke%肌电引导下A型肉毒毒素联合常规康复训练治疗脑卒中后肌痉挛的效果观察

    Institute of Scientific and Technical Information of China (English)

    张霞

    2014-01-01

    Objectiveto observe clinical effect of myoelectricity guided percutaneous injection of botulinum toxin a combined with rehabilitation training in the treatment of muscle spasm after stroke.Methods 72 patients with muscle spasm after stroke were randomly divided into observation group and control group. the observation group patients were treated with small dose injection of botulinum toxin a in many sites on muscle spasm part guided by electromyography combined with rehabilitation training. The control group patients were given only rehabilitation training. The modiifed Ashworth scale (MAS) classiifcation method was used to observe the therapeutic effect of two groups patients before treatment and treatment after 1 week、1 month、2 momth and 3 months.Results The modiifed Ashworth scale (MAS) classiifcations in two groups patients after treatment were obviously enhanced. There was statistical signiifcance between two groups of patients before and after treatment (P < 0.01). The observation group patients showed more signiifcant effect than that of the control group, with statistically significance (P < 0.05).Conclusion Botulinum toxin a injection guided by electromyography combined with routine rehabilitation therapy can effectively change the muscle spasm after stroke and improve the activity of daily living of patients.%目的:观察肌电引导下注射a型肉毒毒素联合康复训练治疗脑卒中后肌痉挛的临床效果。方法选取72例脑卒中后肌痉挛患者随机分为观察组和对照组,观察组在肌电引导下对脑卒中后肌痉挛部位进行多位点小剂量注射a型肉毒毒素,并辅以康复训练。对照组给予康复训练。采用改良ashworth量表(Mas)分级的方法,观察两组患者在治疗前、治疗后1周、1个月、2个月及3个月的治疗效果。结果两组患者在治疗后改良ashworth量表(Mas)分级有明显提高,经统计分析,两组患者在治疗前后具有统计学意义(P<0.01

  5. Effects of botulinum toxin type A on upper limb function in children with cerebral palsy: a systematic review.

    NARCIS (Netherlands)

    Reeuwijk, A.; Schie, P.E. van; Becher, J.G.; Kwakkel, G.

    2006-01-01

    OBJECTIVE: To evaluate whether botulinum toxin type A injections improve upper limb function in children with cerebral palsy. METHODS: An extensive search was carried out in PUBMED, CINAHL, PICARTA, EMBASE, PEDRO and the Cochrane Controlled Trials Register. Controlled and uncontrolled studies were i

  6. Long-term effects and safety of botulinum toxin type A in facial beauty%A型肉毒毒素在面部美容中的远期效果及安全性

    Institute of Scientific and Technical Information of China (English)

    曾东; 林泉; 余文林; 吴燕虹; 李勤

    2016-01-01

    statistically significant difference were observed between the two groups (P>0.05);in the observation group,average appearance age was 7.3 years younger than the control group,and the facial shape improved significantly.Conclusions Long-term and repeated application of botulinum toxin A is able to remove crow's feet and decrease the masseter and so the injection is safe with high satisfaction to beauty-seekers.

  7. Clinical and image improvement of Raynaud's phenomenon after botulinum toxin type A treatment.

    Science.gov (United States)

    Zhao, HongMei; Lian, YaJun

    2015-08-01

    Raynaud's phenomenon is often accompanied by pain, digital ulceration and compromised daily activities. Pharmacological therapy or sympathectomies have been administered to diminish these symptoms but existing treatments are not invariably efficacious. A recent case series has described the use of botulinum toxin type A in the treatment of Raynaud's phenomenon. We report two patients with severe or mild Raynaud's phenomenon who were injected with BTX-A; both of whom experienced clinical and image improvement after treatment.

  8. Jaw-opening oromandibular dystonia secondary to Wilson's Disease treated with botulinum toxin type A

    Directory of Open Access Journals (Sweden)

    Hélio A.G. Teive

    2012-06-01

    Full Text Available We have reported a case series of five patients with jaw-opening oromandibular dystonia secondary to Wilson's disease (WD, in which the patients were treated with botulinum toxin type A (BTX-A. In all cases, dystonia score was partially reduced three weeks after injections. The most common side effect was transient mild dysphagia. This preliminary study showed that jaw-opening oromandibular dystonia in WD may be partially responsive to the use of BTX-A.

  9. A Beautician’s Dystonia: Long-Lasting Effect of Botulinum Toxin

    Directory of Open Access Journals (Sweden)

    Siria Di Martino

    2014-01-01

    Full Text Available Treatment options for dystonia are not curative but symptomatic; the treatment of choice for focal dystonias is repeated botulinum toxin injections. Here, we present the case of a 46-year-old beautician with focal dystonia in her left hand that affected her ability to work. Pharmacological treatment with clonazepam and gabapentin failed to resolve her symptoms and was discontinued due to side effects (sleepiness, gastrointestinal disorders. Intramuscular injection of botulinum toxin (incobotulinumtoxinA, Xeomin into the extensor digitorum communis (35 U, flexor carpi radialis (35 U, and flexor digitorum superficialis (30 U muscles resulted in complete resolution of symptoms at clinical assessments at 1, 3, 6, and 10 months after the injections, confirmed by the results of surface electromyography 10 months after treatment. The patient was able to work again 1 month after treatment. No reinjection has been necessary at the last evaluation (12 months after treatment. In conclusion, botulinum toxin is an effective treatment for focal dystonia that can have long-lasting effects and can improve patients’ ability to work and quality of life.

  10. Expression, purification and development of neutralizing antibodies from synthetic BoNT/B LC and its application in detection of botulinum toxin serotype B.

    Science.gov (United States)

    Ponmariappan, S; Jain, Swati; Sijoria, Richa; Tomar, Arvind; Kumar, Om

    2012-03-01

    Botulism is a neuroparalytic disease caused by Clostridium botulinum, which produces seven (A-G) neurotoxins (BoNTs). The mouse bioassay is the gold standard for the detection of botulinum neurotoxins, however it requires at least 3-4 days for completion. Most of the studies were carried out in botulinum toxin A and less on type B. Attempts have been made to develop an ELISA based detection system, which is potentially an easier and more rapid method of botulinum neurotoxin detection. In the present study, the synthetic BoNT/B LC gene was constructed using PCR overlapping primers, cloned in a pET28a+ vector and expressed in E. coli BL21DE3. The maximum yield of recombinant proteins was optimized after 16 hrs of post induction at 21°C and purified the recombinant protein in soluble form. Antibodies were raised in Mice and Rabbit. The IgG antibody titer in the case of Mice was 1: 1,024,000 and Rabbit was 1: 512,000 with alum as adjuvant via intramascular route. The biological activity of the recombinant protein was confirmed by in-vitro studies using PC12 cells by the synaptobrevin cleavage, the rBoNT/B LC protein showed the maximum blockage of acetylcholine release at a concentration of 150nM rBoNT/B LC in comparison to the control cells. When the cells were incubated with rBoNT/B LC neutralized by the antisera raised against it, the acetylcholine release was equivalent to the control. IgG specific to rBoNT/B LC was purified from raised antibodies. The results showed that the developed antibody against rBoNT/B LC protein were able to detect botulinum toxin type B approximately up to 1 ng/ml. These developed high titer antibodies may prove useful for the detection of botulinum neurotoxins in food and clinical samples.

  11. Influence of Botulinum Toxin Therapy on Postural Control and Lower Limb Intersegmental Coordination in Children with Spastic Cerebral Palsy

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    Bernard Dan

    2013-01-01

    Full Text Available Botulinum toxin injections may significantly improve lower limb kinematics in gait of children with spastic forms of cerebral palsy. Here we aimed to analyze the effect of lower limb botulinum toxin injections on trunk postural control and lower limb intralimb (intersegmental coordination in children with spastic diplegia or spastic hemiplegia (GMFCS I or II. We recorded tridimensional trunk kinematics and thigh, shank and foot elevation angles in fourteen 3–12 year-old children with spastic diplegia and 14 with spastic hemiplegia while walking either barefoot or with ankle-foot orthoses (AFO before and after botulinum toxin infiltration according to a management protocol. We found significantly greater trunk excursions in the transverse plane (barefoot condition and in the frontal plane (AFO condition. Intralimb coordination showed significant differences only in the barefoot condition, suggesting that reducing the degrees of freedom may limit the emergence of selective coordination. Minimal relative phase analysis showed differences between the groups (diplegia and hemiplegia but there were no significant alterations unless the children wore AFO. We conclude that botulinum toxin injection in lower limb spastic muscles leads to changes in motor planning, including through interference with trunk stability, but a combination of therapies (orthoses and physical therapy is needed in order to learn new motor strategies.

  12. Botulinum Toxin for Neuropathic Pain: A Review of the Literature

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    Hyun-Mi Oh

    2015-08-01

    Full Text Available Botulinum neurotoxin (BoNT, derived from Clostridium botulinum, has been used therapeutically for focal dystonia, spasticity, and chronic migraine. Its spectrum as a potential treatment for neuropathic pain has grown. Recent opinions on the mechanism behind the antinociceptive effects of BoNT suggest that it inhibits the release of peripheral neurotransmitters and inflammatory mediators from sensory nerves. There is some evidence showing the axonal transport of BoNT, but it remains controversial. The aim of this review is to summarize the experimental and clinical evidence of the antinociceptive effects, mechanisms, and therapeutic applications of BoNT for neuropathic pain conditions, including postherpetic neuralgia, complex regional pain syndrome, and trigeminal neuralgia. The PubMed and OvidSP databases were searched from 1966 to May 2015. We assessed levels of evidence according to the American Academy of Neurology guidelines. Recent studies have suggested that BoNT injection is an effective treatment for postherpetic neuralgia and is likely efficient for trigeminal neuralgia and post-traumatic neuralgia. BoNT could also be effective as a treatment for diabetic neuropathy. It has not been proven to be an effective treatment for occipital neuralgia or complex regional pain syndrome.

  13. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review

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    Cotchett Matthew P

    2010-09-01

    Full Text Available Abstract Background Plantar heel pain (plantar fasciitis is one of the most common musculoskeletal pathologies of the foot. Plantar heel pain can be managed with dry needling and/or injection of myofascial trigger points (MTrPs however the evidence for its effectiveness is uncertain. Therefore, we aimed to systematically review the current evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain. Methods We searched specific electronic databases (MEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus and AMI in April 2010 to identify randomised and non-randomised trials. We included trials where participants diagnosed with plantar heel pain were treated with dry needling and/or injections (local anaesthetics, steroids, Botulinum toxin A and saline alone or in combination with acupuncture. Outcome measures that focussed on pain and function were extracted from the data. Trials were assessed for quality using the Quality Index tool. Results Three quasi-experimental trials matched the inclusion criteria: two trials found a reduction in pain for the use of trigger point dry needling when combined with acupuncture and the third found a reduction in pain using 1% lidocaine injections when combined with physical therapy. However, the methodological quality of the three trials was poor, with Quality Index scores ranging form 7 to 12 out of a possible score of 27. A meta-analysis was not conducted because substantial heterogeneity was present between trials. Conclusions There is limited evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain. However, the poor quality and heterogeneous nature of the included studies precludes definitive conclusions being made. Importantly, this review highlights the need for future trials to use rigorous randomised controlled methodology with measures such as blinding to reduce bias. We also recommend that such trials adhere to the

  14. Efficacy of Onabotulinum Toxin A (Botox versus Abobotulinum Toxin A (Dysport Using a Conversion Factor (1 : 2.5 in Treatment of Primary Palmar Hyperhidrosis

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    Hanan Mohamed El Kahky

    2013-01-01

    Full Text Available Background. Two preparations of botulinum A toxin (BTX-A are commercially available for the treatment of palmar hyperhidrosis (PPH: Botox (Allergan; 100 U/vial and Dysport (Ipsen Limited; 500 U/vial, which are not bioequivalent. Results regarding an appropriate conversion factor between them are controversial. Objectives. This paper aims to compare the efficacy of Botox and Dysport in PPH using a conversion factor of 1 : 2.5. Methods. Eight patients with severe PPH received intradermal injections of Botox in one palm and Dysport in the other in the same session. Clinical assessment was performed at baseline and posttreatment for 8 months using Minor’s iodine starch test, Hyperhidrosis Disease Severity Scale (HDSS, and Dermatology Life Quality Index (DLQI test. Results. At 3 weeks, a significant decrease in sweating for both preparations was noted which was more pronounced with Dysport compared with Botox. At 8 weeks, this difference turned insignificant. Continued evaluation showed similar improvement in both palms with a nonsignificant difference. Patients with longer disease duration were more liable to relapse. Conclusion. The efficacy and safety of Botox and Dysport injections were similar using a conversion factor of 1 : 2.5. There was a trend towards a more rapid action after Dysport treatment but without significant importance.

  15. Treatment of muscular contraction deformities with botulinum toxin type A after latissimus dorsi flap and sub-pectoral implant breast reconstruction.

    Science.gov (United States)

    Figus, Andrea; Mazzocchi, Marco; Dessy, Luca Andrea; Curinga, Giuseppe; Scuderi, Nicolò

    2009-07-01

    Unusual and probably underestimated complications following breast reconstruction with a latissimus dorsi (LD) flap and sub-pectoral implant are the LD muscle twitching and the breast contour deformities from pectoralis major (PM) muscle contraction. Surgical muscle denervation is usually indicated for these complications. Botulinum toxin A (BTX-A) infiltration has been described in reducing breast contour deformity in sub-pectoral implant after breast augmentation or reconstruction. Between January 2002 and April 2006, 71 consecutive patients underwent delayed unilateral breast reconstructions with LD flap and sub-pectoral implant after mastectomy. All patients reporting discomforting signs and symptoms from muscle contraction in the reconstructed breast were included in this prospective study. Thirteen patients (18.3%) were selected and treated with BTX-A percutaneous local injections. Signs and symptoms were evaluated, after 4, 8 and 12 months, by the patients and by a panel of three physicians not involved in the study, using a five-point scale. During the study period all patients reported a decrease or disappearance of the signs and symptoms. After 12 months, 11 patients received three BTX-A infiltrations, demonstrating considerable improvements compared to the pre-treatment status. Wilcoxon matched pairs rank sum test showed a statistical difference between pre-treatment and post-treatment scores after 14 days (P<0.01) and 12 months (P<0.001). Our experience shows that muscular contraction deformities after breast reconstruction with a LD flap plus implant are not uncommon complications. The use of BTX-A infiltrations is an effective, not surgical, low cost and low risk procedure to treat these complications. It is an easy procedure to be performed on an outpatient basis with a temporary effect but safely repeatable and reproducible; it avoids hospitalisation or further surgical procedures and demonstrates tolerable latency with satisfactory outcomes.

  16. Historical Perspectives and Guidelines for Botulinum Neurotoxin Subtype Nomenclature

    Science.gov (United States)

    2016-08-26

    20National Institute for Biological Standards and Control, a centre of Medicines and Healthcare Products Regulatory Agency, Hertfordshire UK. 21Botulinum...The technology resulting in the production of monoclonal antibodies provided a new way of evaluating these toxins serologically. Monoclonal...botulinum neurotoxin-producing strains representing three clostridial species illustrate the mobility and diversity of botulinum neurotoxin genes, Infect

  17. Altered cortical activation from the hand after facial botulinum toxin treatment.

    Science.gov (United States)

    Haenzi, Sara; Stefanics, Gabor; Lanaras, Tatjana; Calcagni, Maurizio; Ghosh, Arko

    2014-01-01

    Plastic interactions between face and hand cortical tactile circuits occur after severe injuries that affect the hand such as in amputation or spinal cord injury. However, whether loss of facial movements alters the cortical circuits involved in processing tactile inputs from the hand remains unknown. In this prospective observational study we used electroencephalography (EEG) to measure cortical activity evoked by tactile stimulation of the hands before and after botulinum toxin-A-induced facial paralysis. We found a reduction in the tactile event-related potentials (ERPs) 6 weeks after the treatment. This suggests that the limited paralysis of facial muscles induced during cosmetic interventions designed to smooth lines and wrinkles on the face is sufficient to alter the cortical processing of tactile inputs from the hand.

  18. Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations

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    Amanda Lezanski Gujda

    2015-01-01

    Full Text Available Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians.

  19. 局部注射A型肉毒毒素后远隔部位运动神经元功能状态的改变%Changes of motoneuronal function on remote site after local injection of botulinum toxin type-A

    Institute of Scientific and Technical Information of China (English)

    卢祖能; 肖哲曼; 余绍祖; 董红娟; 初红

    2005-01-01

    背景:注射A型肉毒毒素后,不仅影响注射局部神经肌肉接头的功能,也可导致远隔部位的改变;F波由运动神经元逆向兴奋引起,故有可能间接评价运动神经元的功能状态.目的:探讨局部注射A型肉毒毒素后远隔部位F波改变及其可能机制.设计:以运动障碍性疾病患者为研究对象的自身对照观察性研究.单位:一所大学医院神经科门诊.对象:2002-09/2003-07就诊于武汉大学人民医院神经科门诊的未接受过A型肉毒毒素局部注射治疗的运动障碍性疾病患者26例,其中19例为偏侧面肌痉挛、5例为Meige综合征、2例为痉挛性斜颈.干预:对26例患者行A型肉毒毒素注射,并在注射前、注射后1周及注射后12~24周,分别检测其尺神经及胫神经F波.主要观察指标:注射A型肉毒毒素前、后F波最短潜伏期、平均潜伏期、负峰波幅、时限、出现率和弥散时值;M波潜伏期及波幅变化.结果:注射1周后3例共5条尺神经未引出肯定波形.与注射前比较,尺、胫神经F波平均潜伏期及尺神经F波时限在注射后1周显著延长,且这种改变与注射剂量无关;注射后12~24周上述两参数与注射前比较,差异均无显著性意义.结论:F波平均潜伏期和时限为评价A型肉毒毒素远隔效应的敏感指标;A型肉毒毒素的远隔效应似与注射部位的距离有关,而与注射剂量无关.%BACKGROUND: After local injection of Botulinum toxin type-A (BoTX-A), not only the function of the neuromuscular conjunction was affected, but also the changes occurred remote from the injected site. F-waves result from the back fire of the motoneuron activation, which may indirectly reflect the functional state of the motoneurons.OBJECTIVE: To evaluate the remote effect of local BoTX-A injection by F-wave test.DESIGN: Self-control study based on patients with movement disorders.SETTING: Neruologic clinic in a university hospital.PARTICIPANTS: Twenty

  20. Análise estrutural da laringofaringe e suas implicações na miotomia do cricofaríngeo, na injeção de toxina botulínica e na dilatação por balão Laryngopharyngeal structural analysis and its morphofunctional correlation with cricopharyngeal myotomy, botulinum toxin injection and balloon dilation

    Directory of Open Access Journals (Sweden)

    Milton Melciades Barbosa Costa

    2003-06-01

    characteristics and relationships on 24 pieces obtained from adults' corpses of both sexes fixed in 10% formaldehyde solution. RESULTS: The cricopharyngeal muscle presenting its anterior-lateral insertion, with a C-shaped outline, on the posterior-lateral edge of the cricoid cartilage. This kind of morphology blocks the possibility to generate a predominant anterior and posterior high pressure during its contraction like that we find at the pharyngoesophageal transition. The observation of this kind of pressure has its explanation in a tweezers-like relationship exerted on one side by the vertebral body and on the other side by the posterior contour of the cricoid cartilage. CONCLUSIONS: The muscular organization of the laryngopharyngeal segment allowed us to sustain that a large myotomy of the pharyngoesophageal transition, that takes more than just the cricopharyngeal transversal fasciculus, hinders the ejection function in a region where the dimension do not need any parietal sectioning. Myotomy that encompasses only the transversal fasciculus can contribute to improve the pharyngoesophageal flux by a decrease of the local resistance. The efficiency of this myotomy depends mostly on some residual pharyngeal ejection force and also on a slight hyolaryngeal displacement. The transversal fasciculus of the cricopharyngeal muscle is a narrow strip of muscular mass to be injected by percutaneous way with solution of botulinum toxin; maybe endoscopically. For this reason, dose, dilution and injection sites have an important meaning in the cricopharyngeal therapeutics using botulinum toxin. The efficiency of this procedure, like myotomy, depends on some residual pharyngeal ejection force and on, at least, some hyolaryngeal displacement. The dilation of the pharyngoesophageal transition with pneumatic balloon does not seem to be an adequate procedure for a region that does not present a narrow lumen determined by fibrosis. For anatomical characteristics of the TFE region, mean pressure

  1. Botulinum Toxin Treatment for Limb Spasticity in Childhood Cerebral Palsy

    Science.gov (United States)

    Pavone, Vito; Testa, Gianluca; Restivo, Domenico A.; Cannavò, Luca; Condorelli, Giuseppe; Portinaro, Nicola M.; Sessa, Giuseppe

    2016-01-01

    CP is the most common cause of chronic disability in childhood occurring in 2–2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX) has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects, and possible resistance as well as specific use in the upper and lower limbs muscles. PMID:26924985

  2. Botulinum Toxin in Secondarily Nonresponsive Patients with Spasmodic Dysphonia.

    Science.gov (United States)

    Mor, Niv; Tang, Christopher; Blitzer, Andrew

    2016-09-01

    Chemodenervation with botulinum toxin (BoNT) has been effective and well tolerated for all types of dystonia for >30 years. We reviewed outcomes of our patients treated with BoNT serotype A (BoNT-A) for spasmodic dysphonia (SD) who became secondarily nonresponsive. We found that 8 of 1400 patients became nonresponsive to BoNT-A (0.57%), which is lower than the secondary nonresponse rate in other dystonias. After a cessation period, 4 of our patients resumed BoNT-A injections, and recurrence of immunoresistance was not seen in any of them. When compared with patients with other dystonias, patients with SD receive extremely low doses of BoNT. Small antigen challenge may explain the lower rate of immunoresistance and long-lasting efficacy after BoNT-A is restarted among secondary nonresponsive patients with SD.

  3. Botulinum toxin treatment for limb spasticity in childhood cerebral palsy

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    Vito ePavone

    2016-02-01

    Full Text Available CP is the most common cause of chronic disability in childhood occurring in 2 to 2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects and possible resistance as well as specific use in the upper and lower limbs muscles

  4. Classification of Posture in Poststroke Upper Limb Spasticity: A Potential Decision Tool for Botulinum Toxin A Treatment?

    Science.gov (United States)

    Hefter, Harald; Jost, Wolfgang H.; Reissig, Andrea; Zakine, Benjamin; Bakheit, Abdel Magid; Wissel, Jorg

    2012-01-01

    A significant percentage of patients suffering from a stroke involving motor-relevant central nervous system regions will develop a spastic movement disorder. Hyperactivity of different muscle combinations forces the limbs affected into abnormal postures or movement patterns. As muscular hyperactivity can effectively and safely be treated with…

  5. Botulinum Toxin as a Novel Addition to Anti-Arthritis Armamentarium

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    Hamid Namazi

    2005-01-01

    Full Text Available Osteoarthritis is the most common joint disease and is among the most frequent health problems for middle aged and older people. There is strong evidence that proinflammatory cytokines contribute to cartilage degradation in osteoarthritis. Interleukin-1 is the prototypical proinflammatory cytokine implicated in the pathogenesis of cartilage matrix degeneration. Results from studies in animal models provide stronger evidence implicating a role for interleukin-1 in the pathogenesis of matrix loss in osteoarthritis. These include the induction of proteoglycan loss by intraarticular injection of interleukin-1 and the capacity of the inhibitor of interleukin-1, interleukin-1 receptor antagonist (IL-1 ra, to slow the progression of cartilage loss in animal models of osteoarthritis. The botulinum toxin has been used in many clinical situations such as: cerebral palsy, headache, cosmesis and etc. Moreover, there is evidence that botulinum toxin specifically inhibits Rho GTPase by ADP-ribosylation of aminoacid ASn-41. Rho GTPase is necessary for activation of interleukin-1 inflammation pathway. Based on previously mentioned evidence we suggest, intraarticular injection of the botulinum toxin may be a useful therapy in osteoarthritis.

  6. Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

    Science.gov (United States)

    Contarino, Maria Fiorella; Van Den Dool, Joost; Balash, Yacov; Bhatia, Kailash; Giladi, Nir; Koelman, Johannes H.; Lokkegaard, Annemette; Marti, Maria J.; Postma, Miranda; Relja, Maja; Skorvanek, Matej; Speelman, Johannes D.; Zoons, Evelien; Ferreira, Joaquim J.; Vidailhet, Marie; Albanese, Alberto; Tijssen, Marina A. J.

    2017-01-01

    Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored. PMID:28286494

  7. Effect of botulinum toxin type A injection on hypertrophic scar in rabbit ear model%A型肉毒毒素局部应用对兔耳增生性瘢痕创面愈合和瘢痕增生的影响

    Institute of Scientific and Technical Information of China (English)

    王琳; 邰宁正; 范志宏

    2009-01-01

    目的 研究A型肉毒毒素对兔耳增生性瘢痕组织的影响.方法 8只日本大耳白兔,体重3 kg,建立兔耳增生性瘢痕模型.将兔耳创面分为A型肉毒毒素治疗组(T组)和瘢痕组(S组),每组48个创面.大体观察创面愈合时间和瘢痕增生情况.术后28 d,同法另取4只兔子的兔耳腹面健康皮肤为空白组(B组),收集标本.测量S、T组标本HE切片的瘢痕增生指数HI,流式细胞仪分析2组标本中成纤维细胞的细胞周期,western-blot检测S、T、B组标本中Ⅰ、Ⅲ型胶原的蛋白表达.结果 ①T组标本的瘢痕增生指数HI较S组显著降低,P<0.01;②蛋白水平上,T组的胶原Ⅰ、Ⅲ蛋白表达和胶原Ⅰ/Ⅲ比值均较s组显著降低,P<0.01;③S组分布于G2-M期和S期的成纤维细胞较T组显著增多,而静止期G0-G1的细胞则显著减少,P<0.05.结论 A型肉毒毒素局部应用能抑制兔耳增生瘢痕的形成.抑制成纤维细胞的增殖活性,减少瘢痕组织中Ⅰ、Ⅲ型胶原的合成,降低胶原Ⅰ/Ⅲ比值,为其治疗增生性瘢痕的临床应用提供了一定的理论依据.%Objective To investigate the effect of botulinum toxin type A (Botox A) injection on hypertrophic scar in rabbit ear model. Methods The hypertrophic scar model was established in 16 Japanese rabbits' ears. These wounds were divided into two groups as group T(treated with Botox A, n =48) and group S (not treated, n = 48). The wounds healing times and scar hypertrophy were observed with 8 specimen of normal skin at the rabbit ears as sham group B. HE stain was used to assess the hypertrophic index(HI). The expression of collagen Ⅰ and Ⅲ was tested by western-blot. The cell cycle of fibroblasts was studied by flow cytometry. Results The [] was significantly lower in group T than in group S(P < 0.01). The expression of collagen Ⅰ and Ⅲ, as well as the ratio of Ⅰ to Ⅲ, was markedly stronger in group S than in group T(P < 0.01). Compared with group T, more

  8. Characterization of Clostridium sp. RKD producing botulinum-like neurotoxin.

    Science.gov (United States)

    Dixit, Aparna; Dhaked, Ram Kumar; Alam, Syed Imteyaz; Singh, Lokendra

    2005-07-01

    A Gram positive, motile, rod-shaped, strictly anaerobic bacterium isolated from intestine of decaying fish was identified as Clostridium sp. RKD and produced a botulinum type B-like neurotoxin as suggested by mouse bioassay and protection with anti botulinum antibodies. The neurotoxicity was functionally characterized by the phrenic nerve hemi-diaphragm assay. Phylogenetic analysis based on 16S rDNA sequence, placed it at a different position from the reported strains of Clostridium botulinum. The strain exhibited differences from both Clostridium botulinum and Clostridium tetani with respect to morphological, biochemical and chemotaxonomic characteristics. Botulinum group specific and serotype specific primers amplified the DNA fragments of 260 and 727 bp, respectively, indicating presence of botulinum type 'B' toxin gene. Sequence of nearly 700 bp amplified using primers specific for botulinum neurotoxin type B gene, did not show any significant match in the database when subjected to BLAST search.

  9. Physical Characterization of Clostridium Botulinum Neurotoxin Genes

    Science.gov (United States)

    1993-10-01

    Clostridium tetani (Welloner, 1982). They differ in that whereas BoNT acts at the nerve periphery, TeTx blocks the release of inhibitory amino acids...AD-A27 2 939 GRANT NO: DAMDl7-90-Z-0033 TITLE: PHYSICAL CHARACTERIZATION OF CLOSTRIDIUM BOTULINUM NEUROTOXIN GENES PRINCIPAL INVESTIGATOR: Nigel P...Characterization of Clostridium Grant No. Botulinum. Neurotoxin Genes DAMD 17-90- Z-0033 6. AUTHOR(S) Nigel P. Minton, Ph.D. 7. PERFORMING ORGANIZATION NAME(S

  10. 不同剂量A型肉毒毒素注射治疗上面部动力性皱纹疗效观察%Effect observation on different doses of Botulinum toxin type A in treatment of upper facial wrinkles

    Institute of Scientific and Technical Information of China (English)

    陶冶; 周水勇; 张瑱; 王剑

    2015-01-01

    Objective To investigate the clinical application and safety dose of injection of botulinum toxin A on upper facial wrinkles. Methods 105 cases of upper facial wrinkles patients as the research object,were treated with botulinum toxin type A injection.According to their intention were divided into low dose group (group A,n=58) and high dose group (B group,n=47 group).Compared clinical treatment efficiency,the incidence of adverse reactions and satisfaction evaluation of two groups,followed-up for 6 months,analyzed the onset time,duration and other indexes. Results ①The onset time and the duration in A group than was significantly shorter than in group B,(P0.05);but satisfaction rate in group B was significantly higher than group A (P<0.05);③The incidence rate of adverse reaction in group B was 23.4%,was obviously higher than group A of 3.4% (P<0.05). Conclusion The curative effect of Botulinum toxin A injection in treatment of the upper facial wrinkles is satisfactory,the choice of dosage and concentration can be adjusted according to the physical differences of patients and differences in tolerance to low dose,initial treatment should give low dosage to ensure safety.%目的:探讨不同剂量A型肉毒毒素注射在上面部动力性皱纹中的临床应用价值及安全剂量。方法:选取105例上面部动力性皱纹患者为研究对象,均予以A型肉毒毒素注射治疗。根据其意愿分成低剂量组(A组,n=58)和高剂量组(B组,n=47)两组。比对两组患者临床治疗有效率、不良反应发生率及满意度评估情况,行为期6个月随访,分析起效时间、维持时间等治疗指标差异。结果:①A组起效时间较B组长且持续时间显著短于B组,(P<0.05);②两组患者在临床疗效对比上无统计学意义(P>0.05);但B组满意率明显高于A组(P<0.05);③B组不良反应发生率为23.4%,明显高于A组的5.2%(P<0.05)。结论:对上面部动力

  11. Clinical research on botulinum toxin type A combining rehabilitation training for the treatment of children cerebral palsy%肉毒杆菌毒素A辅助复健训练治疗儿童痉挛型脑瘫的疗效观察

    Institute of Scientific and Technical Information of China (English)

    吴素英

    2011-01-01

    AIM: To observe the clinical effect of botulinum toxin type A combining rehabilita-tion for the treatment of children cerebral palsy METHODS: Thirty-two cases of children cere-bral palsy admitted to hospital from March 2009 to March 2011 were randomly divided into two groups, control group (n= 16) and treatment group (n= 16). The control group was given conventional rehabilitation training; the treatment group was also given injection of botulinum toxin A. The clinical effects in 2 groups were observed and compared. RESULTS: After treatment, the GMFM score in the treatment group was significantly higher than that in the control group (P<0. 05). The Ashworth score in the treatment group was significantly lower thanthat in the control group (P<0. 05); and the popliteal fossa angle, foot disaffection angle and abduction angle in the treatment group were superior to those in the control group (P<0. 05). CONCLUSION- There is a significant clinical effect of botulinum toxin type A combining rehabilitation for the treatment of children cerebral palsy.%目的:探讨采用肉毒杆菌毒素A辅助复健训练治疗儿童痉挛型脑瘫的临床疗效.方法:将本院2009年3月-2011年3月收治的32例脑性瘫痪患儿随机分成2组:对照组16例,试验组16例.其中,对照组给予常规的复健训练治疗,试验组则给予注射肉毒杆菌毒素A辅助复健训练治疗.结果:经过治疗后,试验组的粗大运动(GMFM)功能评分显著高于对照组(P<0.05);试验组的肌张力改良Ashworth评分相比对照组显著性降低(P<0.05);试验组的腘窝角、足背屈角、足外展角的活动范围相比对照组均有显著性改善(P<0.05).结论:采用肉毒杆菌毒素A辅助复健训练治疗儿童脑瘫的临床疗效显著.

  12. 胰岛素样生长因子-1抗体对注射A型肉毒毒素后运动终板功能恢复的影响%Effect of insulin-like growth factor 1 antibody on motor endplate function after botulinum toxin injection

    Institute of Scientific and Technical Information of China (English)

    潘丽珍; 靳令经; 潘有贵; 郑玉果; 管强; 郭艳; 聂志余

    2016-01-01

    目的 探讨胰岛素样生长因子-1抗体(IGF-1Ab)对大鼠腓肠肌肌注A型肉毒毒素(Btx-A)后运动终板功能的影响. 方法 90只SD大鼠按随机数字表法分为4组,第1组为对照组,第2组为Btx-A组,第3、4组为抗体组(Ab 2 μg、Ab 20 μg组).第2、3、4组于大鼠右侧腓肠肌局部注射Btx-A 0.5 U(0.1 mL),第3天时第3、4组分别在同一位点注射IGF-1Ab 2 μg、20 μg(0.1 mL),动态测量大鼠腓肠肌肌力及乙酰胆碱酯酶染色阳性区平均吸光度值变化. 结果 注射Btx-A后,Btx-A组大鼠腓肠肌肌力由注射前12.34±0.16g降至7.70±0.90 g,其他各组肌力亦较注射前减退;第14、28、42、56、70天,IGF-1 Ab组(第3、4组)肌力较Btx-A组均减小,差异有统计学意义(P<0.05),且第42~70天第4组肌力低于第3组,差异有统计学意义(P<0.05);注射部位运动终板染色平均吸光度值演变呈相同趋势. 结论 IGF-1Ab可抑制Btx-A肌注后大鼠腓肠肌运动终板功能的恢复.%Objective To investigate the effect of insulin-like growth factor 1 antibody (IGF-1Ab) on motor endplate function after injection ofbotulinum toxin A (Btx-A).Methods The total 90 male SD rats were randomly divided into 4 groups:control group,Btx-A group and 2 ug and 20 ug IGF-1Ab groups.In Btx-A and IGF-1Ab groups,a volume of 0.5 U (0.1 mL) Btx-A was intramuscularly injected into a site in the fight gastrocnemius muscle;on day 3,equal volumes (0.1 mL) of IGF-1Ab with a dosage of 2 ug and 20 ug were injected to the 2 ug and 20 ug IGF-1Ab groups respectively at the same site.The gastrocnemius muscle strength and the mean optical density (MOI) value of the positive reaction zone of acetylcholine esterase staining were evaluated at different time points.Results The gastrocnemius muscle strength increased from 12.34±0.16 g before injection to 7.70±0.90 g after injection in the Btx-A group;the gastrocnemius muscle strength decreased in other groups after injection of Btx-A;on day 14

  13. Botulinum Toxin in the Treatment of Pediatric Upper Limb Spasticity

    Science.gov (United States)

    Schwabe, Aloysia L.

    2016-01-01

    Botulinum neurotoxin (BoNT) is one of the mainstays in the treatment of pediatric spasticity and dystonia. When considering initiation of BoNT treatment for spasticity, treatment goals and responses to prior conservative measures such as passive range of motion exercises, splinting, and other medication trials should be reviewed. As a general rule, children should be engaged in therapy services around the time of the injections and have a robust home program in place. When managing spasticity in children with BoNT injections, the practitioner should be well versed in functional anatomy with specialized training in injection techniques. Localization techniques in addition to anatomical landmarks are recommended for improved efficacy and include limited electromyography, electrical stimulation, and/or ultrasound guidance. A follow-up visit for the purpose of reassessment during the peak effect of the drug is advised. It is known that BoNT is effective at reducing spasticity and improving range of motion, but it remains to be determined to what degree this translates into improved function, activity, and participation. PMID:26869860

  14. 膀胱内注射肉毒毒素对膀胱疼痛综合征疼痛程度影响的Meta分析%Effect of Intravesical Botulinum Toxin Injection on Pain of Bladder Pain Syndrome:A Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    张杰; 王强; 王增春; 任自刚; 熊巍; 刘海泉; 王俊杰; 范婷婷

    2016-01-01

    Objective To systemically evaluate the effect of intravesical Botulinum toxin on pain of patientspain syndrom. Methods The following databases as Cochrane Library, PubMed, Web of Science, Embase, Springer, Wiley, Science Direct, OVID were searched to col-lect the randomized controlled trials (RCTs) with the treatment of intravesical Botulinum toxin vs. 0.9%sodium chloride for patients with bladder pain syndrome. Two reviewers screened the trials according to the inclusion and exclusion criterias, extracted the data, assessed the quality, and the changes of Visual Analogue Scales (VAS) before and after treatment were used to conduct Meta analysis with RevMan5.2 software. Results Five studies were included with a total of 218 patients, there were 127 cases in intravesical Botulinum toxin group and 91 cases in 0.9%sodium chloride group. Meta analysis showed that the pain relief effect of intravesical Botulinum toxin was better than that of 0.9%sodium chloride. Conclusion Intravesical Botulinum toxin can relieve the pain of patients with bladder pain syndrome.%目的:系统评价膀胱内注射肉毒毒素对膀胱疼痛综合征疼痛程度的影响。方法检索Cochrane图书馆、PubMed、Web of Science、Embase、Springer、Wiley、Science Direct、OVID数据库,搜集膀胱内注射肉毒毒素治疗膀胱疼痛综合征的随机对照试验。由两位研究者根据纳入与排除标准筛选试验,提取资料并进行质量评价后,取治疗前、后视觉模拟评分值,利用Rev-Man 5.2软件进行Meta分析。结果最终筛选出5篇符合条件的文献,共纳入218例患者,其中对照组91例,膀胱内注射肉毒毒素组127例。Meta分析结果显示膀胱内注射肉毒毒素组对疼痛的缓解程度优于对照组。结论膀胱内注射肉毒毒素能够缓解膀胱疼痛综合征的疼痛程度。

  15. Alterations in CNS Activity Induced by Botulinum Toxin Treatment in Spasmodic Dysphonia: An H[subscript 2][superscript 15]O PET Study

    Science.gov (United States)

    Ali, S. Omar; Thomassen, Michael; Schulz, Geralyn M.; Hosey, Lara A.; Varga, Mary; Ludlow, Christy L.; Braun, Allen R.

    2006-01-01

    Speech-related changes in regional cerebral blood flow (rCBF) were measured using H[subscript 2][superscript 15]O positron-emission tomography in 9 adults with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (BTX) injection and 10 age- and gender-matched volunteers without neurological disorders. Scans were acquired at rest…

  16. Tyrosine Phosphorylation of Botulinum Neurotoxin Protease Domains

    Science.gov (United States)

    2012-06-01

    from SNAP-25 cleavage by botulinum neurotoxin E inhibits vesicle docking. FEBS Lett. 435, 84–88. Foran, P., Shone, C. C., and Dolly , J. O. (1994...R., and Dolly , J. O. (2003). Evaluation of the therapeutic usefulness of bot- ulinum neurotoxin B, C1, E, and F compared with the long lasting type A

  17. The use of botulinum toxin in ophthalmology.

    Science.gov (United States)

    Denniston, A; Reuser, T

    2001-08-01

    As the diversity of clinical applications for the botulinum neurotoxin continues to grow, exciting developments are occurring in its use around the eye, where indeed its benefits were first recognized. These include use to treat strabismus, eyelid disorders and a number of other ocular conditions.

  18. Noncosmetic periocular therapeutic applications of botulinum toxin

    Directory of Open Access Journals (Sweden)

    Kaynak-Hekimhan Pelin

    2010-01-01

    Full Text Available Botulinum toxin blocks acetylcholine release at the neuromuscular junction. The drug which was initially found to be useful in the treatment of strabismus has been extremely effective in the treatment of variety of conditions, both cosmetic and noncosmetic. Some of the noncosmetic uses of botulinum toxin applications include treatment of spastic facial dystonias, temporary treatment of idiopathic or thyroid dysfunction-induced upper eyelid retraction, suppression of undesired hyperlacrimation, induction of temporary ptosis by chemodenervation in facial paralysis, and correction of lower eyelid spastic entropion. Additional periocular uses include control of synchronic eyelid and extraocular muscle movements after aberrant regeneration of cranial nerve palsies. Cosmetic effects of botulinum toxin were discovered accidentally during treatments of facial dystonias. Some of the emerging nonperiocular application for the drug includes treatment of hyperhidrosis, migraine, tension-type headaches, and paralytic spasticity. Some of the undesired side effects of periocular applications of botulinum toxin inlcude ecchymosis, rash, hematoma, headache, flu-like symptoms, nausea, dizziness, loss of facial expression, lower eyelid laxity, dermatochalasis, ectropion, epiphora, eyebrow and eyelid ptosis, lagophthalmos, keratitis sicca, and diplopia.

  19. Neutralization of Botulinum Neurotoxin Type E by a Humanized Antibody

    Directory of Open Access Journals (Sweden)

    Yağmur Derman

    2016-09-01

    Full Text Available Botulinum neurotoxins (BoNTs cause botulism and are the deadliest naturally-occurring substances known to humans. BoNTs have been classified as one of the category A agents by the Centers for Disease Control and Prevention, indicating their potential use as bioweapons. To counter bio-threat and naturally-occurring botulism cases, well-tolerated antibodies by humans that neutralize BoNTs are relevant. In our previous work, we showed the neutralizing potential of macaque (Macaca fascicularis-derived scFv-Fc (scFv-Fc ELC18 by in vitro endopeptidase immunoassay and ex vivo mouse phrenic nerve-hemidiaphragm assay by targeting the light chain of the botulinum neurotoxin type E (BoNT/E. In the present study, we germline-humanized scFv-Fc ELC18 into a full IgG hu8ELC18 to increase its immunotolerance by humans. We demonstrated the protection and prophylaxis capacity of hu8ELC18 against BoNT/E in a mouse model. A concentration of 2.5 ng/mouse of hu8ELC18 protected against 5 mouse lethal dose (MLD in a mouse protection assay and complete neutralization of 1 LD50 of pure BoNT/E toxin was achieved with 8 ng of hu8ELC18 in mouse paralysis assay. Furthermore, hu8ELC18 protected mice from 5 MLD if injected up to 14 days prior to intraperitoneal BoNT/E administration. This newly-developed humanized IgG is expected to have high tolerance in humans.

  20. Neutralization of Botulinum Neurotoxin Type E by a Humanized Antibody

    Science.gov (United States)

    Derman, Yağmur; Selby, Katja; Miethe, Sebastian; Frenzel, André; Liu, Yvonne; Rasetti-Escargueil, Christine; Avril, Arnaud; Pelat, Thibaut; Urbain, Remi; Fontayne, Alexandre; Thullier, Philippe; Sesardic, Dorothea; Lindström, Miia; Hust, Michael; Korkeala, Hannu

    2016-01-01

    Botulinum neurotoxins (BoNTs) cause botulism and are the deadliest naturally-occurring substances known to humans. BoNTs have been classified as one of the category A agents by the Centers for Disease Control and Prevention, indicating their potential use as bioweapons. To counter bio-threat and naturally-occurring botulism cases, well-tolerated antibodies by humans that neutralize BoNTs are relevant. In our previous work, we showed the neutralizing potential of macaque (Macaca fascicularis)-derived scFv-Fc (scFv-Fc ELC18) by in vitro endopeptidase immunoassay and ex vivo mouse phrenic nerve-hemidiaphragm assay by targeting the light chain of the botulinum neurotoxin type E (BoNT/E). In the present study, we germline-humanized scFv-Fc ELC18 into a full IgG hu8ELC18 to increase its immunotolerance by humans. We demonstrated the protection and prophylaxis capacity of hu8ELC18 against BoNT/E in a mouse model. A concentration of 2.5 ng/mouse of hu8ELC18 protected against 5 mouse lethal dose (MLD) in a mouse protection assay and complete neutralization of 1 LD50 of pure BoNT/E toxin was achieved with 8 ng of hu8ELC18 in mouse paralysis assay. Furthermore, hu8ELC18 protected mice from 5 MLD if injected up to 14 days prior to intraperitoneal BoNT/E administration. This newly-developed humanized IgG is expected to have high tolerance in humans. PMID:27626446

  1. 踝足矫形器联合肉毒毒素治疗痉挛型脑性瘫痪儿童尖足畸形的疗效观察%Ankle-foot orthosis combined with botulinum toxin type A injection in treating tip foot deformity in children with cerebral palsy

    Institute of Scientific and Technical Information of China (English)

    周陶成; 童光磊; 张敏; 李司南; 易昕; 陈露露; 温祖芳; 康倩倩; 陈婧

    2015-01-01

    目的 观察踝足矫形器(A FO)联合A型肉毒毒素(BTX-A)肌肉注射治疗痉挛型脑瘫患儿尖足的疗效.方法 痉挛型脑瘫患儿尖足畸形50例,采用随机数字表法将其分为对照组和观察组,每组25例,对照组患儿采用BTX-A肌肉注射与运动康复训练,观察组在对照组基础上加用AFO训练,与其运动康复训练同步.分别于治疗前、治疗后1、3和6个月,使用量角器测量踝关节的被动背屈角(APROM),改良Ashworth量表的评分(MAS)以及粗大运动功能量表(GMFM-88)的D区(站立)和E区(走跑跳)评分.结果 治疗前,观察组APROM、MAS和GMFM(D、E)分别为(109.25±12.38)°、(3.12±0.56)分和(55.32±11.23)分,与对照组[(107.11±13.44)°、(3.05±0.66)分和(56.21±10.81)分]比较,差异均无统计学意义(P>0.05).2组患儿的APROM、MAS和GMFM评分在治疗后1、3和6个月时与组内与治疗前比较,差异均有统计学意义(P<0.05);治疗后,观察组APROM、MAS和GMFM评分分别与对照组治疗比较,差异亦均有统计学意义(P<0.05).2组治疗后各时间点之间的评估指标比较,观察组差异均有统计学意义;对照组治疗后1个月与治疗后3个月比较,差异有统计学意义(P<0.05),治疗后3个月和治疗后6个月比较,差异无统计学意义(P>0.05).结论 AFO联合BTX-A疗法能进一步缓解痉挛型脑瘫患儿的下肢痉挛程度,减轻尖足异常姿势,维持时间更持久.%Objective To observe the clinical efficacy of ankle-foot orthosis (AFO) combined with botulinum toxin type A (BTX-A) injection in treating tip foot deformity in children with cerebral palsy (CP).Methods Fifty CP children with tip foot deformity were selected and randomly divided into a control group and an observation group according to a random number table.Both groups were given BTX-A injection, and the observation group was additionally treated with AFO.All children were assessed before, 1 month, 3 months and 6 months after the treatment

  2. Impact of Endoscopic Gastric Wall Injection of Botulinum Toxin Type A on Appetite-related Hormones in Patients with Simple Obesity%内镜下胃壁注射A型肉毒杆菌毒素对单纯性肥胖患者食欲相关激素的影响

    Institute of Scientific and Technical Information of China (English)

    李莉; 刘庆森; 刘文徽; 窦艳; 彭丽华; 杨云生; 孟科

    2012-01-01

    Background: Obesity has become one of the major public health problems in China and developed countries. Botulinum toxin type A (BTX-A) can induce muscle paralysis by blocking the release of acetylcholine at neuromuscular junction. Aims: To investigate the impact of endoscopic gastric wall injection of BTX-A on weight loss and peripheral appetite-related hormones in patients with simple obesity. Methods: Twenty simple obesity patients were randomized into two groups and received endoscopic gastric wall injection of BTX-A 200 U and 300 U, respectively. Twenty puncture sites were selected at gastric antrum, body and fundus in each subject. Body weight and body mass index (BMI), as well as fasting serum insulin, leptin and plasma motilin, peplide YY (PYY) , ghrelin levels were measured before and 4, 12 weeks after treatment. Results; Nineteen patients completed the 12 weeks follow up. After treatment, the body weight and BMI decreased significantly ( P < 0. 05), while no significant changes were found in serum insulin, leptin and plasma motilin levels. Significant decrease was found in plasma level of ghrelin 4 weeks after treatment and in plasma level of PYY 12 weeks after treatment (P<0.05). There were no significant differences in weight loss and 5 appetite-related hormones between the two treatment groups. No clinically significant side effects were observed. Conclusions: Endoscopic gastric wall injection of BTX-A is a safe and effective choice for weight loss in patients with simple obesity. Effect of BTX-A on weight loss might be related to the inhibition of ghrelin secretion in gastric fundus.%肥胖已成为我国以及发达国家面临的严重公共健康问题之一.A型肉毒杆菌毒素( BTX-A)可阻断神经肌肉接头处的胆碱能传递,使肌肉松弛.目的:探讨内镜下胃壁注射BTX-A治疗单纯性肥胖的减重效果及其对外周血食欲相关激素的影响.方法:20例单纯性肥胖患者随机分为两组,分别内镜

  3. DEVELOPMENT OF ENZYME-LINKAGE IMMUNOSORBENT ASSAY AGAINST TYPE B OF CLOSTRIDIUM BOTULINUM: A PRELIMINARY STUDY

    Directory of Open Access Journals (Sweden)

    S. N. Depamede

    2011-12-01

    Full Text Available Clostridium botulinum neurotoxin (BoNTs is one of the causes of economic loss in the livestock industry. This economic loss would be as a direct result when animals poisoned by BoNTs or indirectly when the livestock products are contaminated by BoNTs, which end up with the products are banned by authority. Therefore a routine surveillance of BoNTs in the farm and in livestock product processing industry is urgently needed. One of the most relatively quick and accurate methods to perform a routine detection of the presence of BoNTs is enzyme-linkage immunosorbant assay (ELISA. In this article we describe the results of the development of ELISA, using polyclonal antibodies against BoNTs-B produced locally. Antibodies were generated from six Balb/c mice with standard immunological methods. Mice were immunized three times for a period of 8 weeks with a commercial type B Clostridium botulinum toxoid at a dose of 100 ng per mouse per injection. The resulting antibody was purified by a combination of ammonium sulfate precipitation 50% (w/v technique and a protein A column method. The results of this preliminary study indicated that the developed ELISA method capable of detecting type B Clostridium botulinum toxin up to 1.0 ng/ml.

  4. Attempts to identify Clostridium botulinum toxin in milk from three experimentally intoxicated Holstein cows

    Science.gov (United States)

    Moeller, R.B.; Puschner, B.; Walker, R.L.; Rocke, T.E.; Smith, S.R.; Cullor, J.S.; Ardans, A.A.

    2009-01-01

    Three adult lactating Holstein cows were injected in the subcutaneous abdominal vein with 175 ng/kg of body weight of Clostridium botulinum type C toxin (451 cow median toxic doses) to determine if this botulinum toxin crosses the blood-milk barrier. Whole blood (in sodium heparin) and clotted blood serum samples were taken at 0 min, 10 min, and 3, 6, 9, and 12 h postinoculation. Milk samples were taken at 0 min and at 3, 6, 9 and 12 h postinoculation. All samples were tested for the presence of the toxin using the mouse bioassay and immunostick ELISA test. The immunostick ELISA identified the toxin in whole blood and the mouse bioassay identified the toxin in serum at all times examined in all 3 animals. Toxin was not identified by either detection method in milk samples collected from the 3 animals. From these results, it appears that Clostridium botulinum type C toxin does not cross from the blood to the milk in detectable concentrations. ?? American Dairy Science Association, 2009.

  5. Historical and current perspectives on Clostridium botulinum diversity.

    Science.gov (United States)

    Smith, Theresa J; Hill, Karen K; Raphael, Brian H

    2015-05-01

    For nearly one hundred years, researchers have attempted to categorize botulinum neurotoxin-producing clostridia and the toxins that they produce according to biochemical characterizations, serological comparisons, and genetic analyses. Throughout this period the bacteria and their toxins have defied such attempts at categorization. Below is a description of both historic and current Clostridium botulinum strain and neurotoxin information that illustrates how each new finding has significantly added to the knowledge of the botulinum neurotoxin-containing clostridia and their diversity.

  6. Rational Design of Therapeutic and Diagnostic Against Botulinum Neurotoxin

    Science.gov (United States)

    2006-12-01

    Gram-positive bacilli bacterium, Clostridium botulinum, which can be found worldwide in soil. Clostridium tetani is a similar bacterium to C...B: Biological Sciences, 354, 259-268. 6. Nantel, A.J. (1999). Clostridium Botulinum. WHO international programme on chemical safety poisons...of Clostridium botulinum C1 neurotoxin. Nucleic Acids Research, 18, 4924. 20. Binz, T., Kurazono, H., Popoff, M.R., Eklund, M.W., Sakaguchi, G

  7. Human Monoclonal Antibodies as a Countermeasure Against Botulinum Toxins

    Science.gov (United States)

    2012-11-30

    REPORT Human monoclonal antibodies as a countermeasure against Botulinum toxins 14. ABSTRACT 16. SECURITY CLASSIFICATION OF: In this report, we...Prescribed by ANSI Std. Z39.18 - 31-Aug-2012 Human monoclonal antibodies as a countermeasure against Botulinum toxins Report Title ABSTRACT In this report...DTRA Final Report: Human monoclonal antibodies as a countermeasure against Botulinum toxins   Page 1 of 22 DTRA Final Report: Human monoclonal

  8. Literature Review and Comparison of Two Statistical Methods to Evaluate the Effect of Botulinum Toxin Treatment on Gait in Children with Cerebral Palsy

    Science.gov (United States)

    Nieuwenhuys, Angela; Papageorgiou, Eirini; Pataky, Todd; De Laet, Tinne; Molenaers, Guy; Desloovere, Kaat

    2016-01-01

    Aim This study aimed at comparing two statistical approaches to analyze the effect of Botulinum Toxin A (BTX-A) treatment on gait in children with a diagnosis of spastic cerebral palsy (CP), based on three-dimensional gait analysis (3DGA) data. Through a literature review, the available expert knowledge on gait changes after BTX-A treatment in children with CP is summarized. Methods Part 1—Intervention studies on BTX-A treatment in children with CP between 4–18 years that used 3DGA data as an outcome measure and were written in English, were identified through a broad systematic literature search. Reported kinematic and kinetic gait features were extracted from the identified studies. Part 2—A retrospective sample of 53 children with CP (6.1 ± 2.3years, GMFCS I-III) received 3DGA before and after multilevel BTX-A injections. The effect of BTX-A on gait was interpreted by comparing the results of paired samples t-tests on the kinematic gait features that were identified from literature to the results of statistical parametric mapping analysis on the kinematic waveforms of the lower limb joints. Results Part 1–53 kinematic and 33 kinetic features were described in literature. Overall, there is no consensus on which features should be evaluated after BTX-A treatment as 49 features were reported only once or twice. Part 2—Post-BTX-A, both statistical approaches found increased ankle dorsiflexion throughout the gait cycle. Statistical parametric mapping analyses additionally found increased knee extension during terminal stance. In turn, feature analyses found increased outtoeing during stance after BTX-A. Conclusion This study confirms that BTX-A injections are a valuable treatment option to improve gait function in children with CP. However, different statistical approaches may lead to different interpretations of treatment outcome. We suggest that a clear, definite hypothesis should be stated a priori and a commensurate statistical approach should

  9. Literature Review and Comparison of Two Statistical Methods to Evaluate the Effect of Botulinum Toxin Treatment on Gait in Children with Cerebral Palsy.

    Directory of Open Access Journals (Sweden)

    Angela Nieuwenhuys

    Full Text Available This study aimed at comparing two statistical approaches to analyze the effect of Botulinum Toxin A (BTX-A treatment on gait in children with a diagnosis of spastic cerebral palsy (CP, based on three-dimensional gait analysis (3DGA data. Through a literature review, the available expert knowledge on gait changes after BTX-A treatment in children with CP is summarized.Part 1--Intervention studies on BTX-A treatment in children with CP between 4-18 years that used 3DGA data as an outcome measure and were written in English, were identified through a broad systematic literature search. Reported kinematic and kinetic gait features were extracted from the identified studies. Part 2--A retrospective sample of 53 children with CP (6.1 ± 2.3years, GMFCS I-III received 3DGA before and after multilevel BTX-A injections. The effect of BTX-A on gait was interpreted by comparing the results of paired samples t-tests on the kinematic gait features that were identified from literature to the results of statistical parametric mapping analysis on the kinematic waveforms of the lower limb joints.Part 1-53 kinematic and 33 kinetic features were described in literature. Overall, there is no consensus on which features should be evaluated after BTX-A treatment as 49 features were reported only once or twice. Part 2--Post-BTX-A, both statistical approaches found increased ankle dorsiflexion throughout the gait cycle. Statistical parametric mapping analyses additionally found increased knee extension during terminal stance. In turn, feature analyses found increased outtoeing during stance after BTX-A.This study confirms that BTX-A injections are a valuable treatment option to improve gait function in children with CP. However, different statistical approaches may lead to different interpretations of treatment outcome. We suggest that a clear, definite hypothesis should be stated a priori and a commensurate statistical approach should accompany this hypothesis.

  10. Treatment diary for botulinum toxin spasticity treatment: a pilot study.

    Science.gov (United States)

    Biering-Sørensen, Bo; Iversen, Helle K; Frederiksen, Inge M S; Vilhelmsen, Jeanet R; Biering-Sørensen, Fin

    2017-02-20

    The aim of this study is to develop a treatment diary for patients receiving spasticity treatment including botulinum toxin injection and physiotherapy and/or occupational therapy. The diary focuses on problems triggered by skeletal muscle overactivity; agreed goals for treatment and the patient's self-evaluation of achievement on the Goal Attainment Scale; which skeletal muscles were injected; physiotherapists' and occupational therapists' evaluation of the patients' achievement of objectives on the Goal Attainment Scale; and proposals for optimization of treatment and changing goals. The evaluation included a satisfaction questionnaire and the WHO-QoL BREF and WHO-5 well-being score. Overall, 10 patients were enrolled in the pilot study. The patients were generally satisfied with the diary, found that it involved them more in their treatment and made it easier to set personal goals, and found it worth the time spent using it. However, no clear advantage in relation to their quality of life (WHO-QoL BREF and WHO-5 well-being score) was reported.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.

  11. BotR/A and TetR are alternative RNA polymerase sigma factors controlling the expression of the neurotoxin and associated protein genes in Clostridium botulinum type A and Clostridium tetani.

    Science.gov (United States)

    Raffestin, Stéphanie; Dupuy, Bruno; Marvaud, Jean Christophe; Popoff, Michel R

    2005-01-01

    Clostridium botulinum and Clostridium tetani, respectively, produce potent toxins, botulinum neurotoxin (BoNT) and tetanus neurotoxin (TeTx), which are responsible for severe diseases, botulism and tetanus. Neurotoxin synthesis is a regulated process in Clostridium. The genes botR/A in C. botulinum A and tetR in C. tetani positively regulate expression of BoNT/A and associated non-toxic proteins (ANTPs), as well as TeTx respectively. The botR/A gene lies in close vicinity of the two operons which contain bont/A and antps genes in C. botulinum A, and tetR immediately precedes the tetX gene in C. tetani. We show that BotR/A and TetR function as specific alternative sigma factors rather than positive regulators based on the following results: (i) BotR/A and TetR associated with target DNAs only in the presence of the RNA polymerase core enzyme (Core), (ii) BotR/A and TetR directly bound with the core enzyme, (iii) BotR/A-Core recognized -35 and -10 regions of ntnh-bont/A promoter and (iv) BotR/A and TetR triggered in vitro transcription from the target promoters. In C. botulinum A, bont/A and antps genes are transcribed as bi- and tricistronic operons controlled by BotR/A. BotR/A and TetR are seemingly related to a new subgroup of the sigma70 family that includes TcdR and UviA, which, respectively, regulate production of toxins A and B in C. difficile and bacteriocin in C. perfringens. Sequences of -35 region are highly conserved in the promoter of target toxin genes in C. botulinum, C. tetani, C. difficile and C. perfringens. Overall, a common regulation mechanism probably controls toxin gene expression in these four toxigenic clostridial species.

  12. Comparison of pneumatic dilation with pneumatic dilation plus botulinum toxin for treatment of achalasia.

    Science.gov (United States)

    Bakhshipour, Alireza; Rabbani, Romina; Shirani, Shapoor; Soleimani, Hosein A S L; Mikaeli, Javad

    2010-01-01

    Among the therapeutic options for achalasia are pneumatic dilatation (PD), an appropriate long-term therapy, and botulinum toxin injection (BT) that is a relatively short-term therapy. This study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injection and pneumatic dilation) in a group of achalasia patients who are low responder to two initial pneumatic dilations. Thirty-four patients with documented primary achalasia that had low response to two times PD (pneumatic dilation (n=18) or botulinum toxin injection and pneumatic dilation by four weeks interval (n=16), PD and BT+PD groups respectively. Symptom scores were evaluated before and at 1, 6 and 12 months after treatment. Clinical remission was defined as a decrease in symptom score > or = 50% of baseline. There were no significant differences between the two groups in gender, age and achalasia type. Remission rate of patients in BT-PD group in comparison with PD group were 87.5% vs. 67.1% (P = 0.7), 87.5% vs. 61.1% (P = 0.59) and 87.5% vs. 55.5% (P = 0.53) at 1, 6 and 12 months respectively .There were no major complications in either group. The mean symptom score decreased by 62.71% in the BT-PD group (P first year. Despite a better response rate in BT+PD group, a difference was not statistically significant. A difference may be meaningful if a large numbers of patients are included in the study.

  13. Comparison of Pneumatic Dilation with Pneumatic Dilation Plus Botulinum Toxin for Treatment of Achalasia

    Directory of Open Access Journals (Sweden)

    Alireza Bakhshipour

    2010-03-01

    Full Text Available Among the therapeutic options for achalasia are pneumatic dilatation (PD, an appropriate long-term therapy, and botulinum toxin injection (BT that is a relatively short-term therapy. This study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injection and pneumatic dilation in a group of achalasia patients who are low responder to two initial pneumatic dilations. Thirty- four patients with documented primary achalasia that had low response to two times PD (<50% decrease in symptom score and barium height at 5 minute in timed esophagogram after 3month of late PD were randomized to receive pneumatic dilation (n=18 or botulinum toxin injection and pneumatic dilation by four weeks interval (n=16, PD and BT+PD groups respectively. Symptom scores were evaluated before and at 1, 6 and 12 months after treatment. Clinical remission was defined as a decrease in symptom score ≥ 50% of baseline. There were no significant differences between the two groups in gender, age and achalasia type. Remission rate of patients in BT-PD group in comparison with PD group were 87.5% vs. 67.1% (P = 0.7, 87.5% vs. 61.1% (P = 0.59 and 87.5% vs. 55.5% (P = 0.53 at 1, 6 and 12 months respectively .There were no major complications in either group. The mean symptom score decreased by 62.71% in the BT-PD group (P < 0.002 and 50.77% in the PD group (P < 0.01 at the end of the first year. Despite a better response rate in BT+PD group, a difference was not statistically significant. A difference may be meaningful if a large numbers of patients are included in the study.

  14. Effect of botulinum toxin type A injection on the expression of substance P, TGF-β1 and α-SMA in rabbit ear model of hypertrophic scar%A型肉毒毒素对兔耳增生性瘢痕组织中P物质、β1转移生长因子、α平滑肌肌动蛋白的影响

    Institute of Scientific and Technical Information of China (English)

    王琳; 邰宁正; 范志宏

    2009-01-01

    Objective To investigate the effect of botulinum toxin type A injection on the expres-sion of substance P, TGF-β1 and α-SMA in rabbit ear model of hypertrophic scar. Methods The hyper-trophic sear model was established in 24 Japanese rabbits'ears. The wounds in ventral surface of ear were divided in Group I (lateral wounds) and Group S (medial wounds), 3 wounds each side per ear, totally 72 wounds each group. The wound-healing time and the growth of scar were observed and recorded. On post-wounding day 28, the wounds were created in another 6 rabbits in the same way and the normal skin were harvested as Group C. Likewise, the scar samples in Groups I and S were harvested. The mRNA expression of substance P, TGF-β1 and α-SMA were detected quantitatively by using real-time PCR and α-SMA was also detected with Western blot. Results No difference between the ratio of healed or infec-tious wounds on post-wounding day 14. The mRNA expression of SP, TGF-β1 and α-SMA in Group I was significantly lower than Group S, but higher than those in Group C (PI组>C组.结论 BTA注射不延迟创面愈合,并减少了兔耳增生瘢痕中SP、TGF-β1和α-SMA的mRNA表达,为其治疗增生性瘢痕的临床应用提供了一定的理论依据.

  15. Effect of Botulinum Toxin on Disabling Neuropathic Pain: A Case Presentation Suggesting a New Therapeutic Strategy.

    Science.gov (United States)

    Buonocore, Michelangelo; Demartini, Laura; Mandrini, Silvia; Dall'Angelo, Anna; Dalla Toffola, Elena

    2017-02-01

    This case presentation describes a 47-year-old woman who developed complex regional pain syndrome type II with severe neuropathic pain following iatrogenic transection of the tibial nerve at the ankle. The pain and disability progressively worsened over time, markedly impaired ambulation, and were not relieved despite various analgesic treatments. After injection of botulinum toxin (abobotulinumtoxinA, BoNT-A) in the leg muscles the tendons of which pass through the tarsal tunnel (together with the tibial nerve), her pain decreased and her walking capacity improved. This case suggests a new therapeutic role for botulin toxin in treating peripheral neuropathic pain caused by movement-evoked ectopic potentials.

  16. Positive regulation of botulinum neurotoxin gene expression by CodY in Clostridium botulinum ATCC 3502.

    Science.gov (United States)

    Zhang, Zhen; Dahlsten, Elias; Korkeala, Hannu; Lindström, Miia

    2014-12-01

    Botulinum neurotoxin, produced mainly by the spore-forming bacterium Clostridium botulinum, is the most poisonous biological substance known. Here, we show that CodY, a global regulator conserved in low-G+C Gram-positive bacteria, positively regulates the botulinum neurotoxin gene expression. Inactivation of codY resulted in decreased expression of botA, encoding the neurotoxin, as well as in reduced neurotoxin synthesis. Complementation of the codY mutation in trans rescued neurotoxin synthesis, and overexpression of codY in trans caused elevated neurotoxin production. Recombinant CodY was found to bind to a 30-bp region containing the botA transcription start site, suggesting regulation of the neurotoxin gene transcription through direct interaction. GTP enhanced the binding affinity of CodY to the botA promoter, suggesting that CodY-dependent neurotoxin regulation is associated with nutritional status.

  17. Clinically and electrophysiologically diagnosed botulinum intoxication.

    Science.gov (United States)

    Kotan, Dilcan; Aygul, Recep; Ceylan, Mustafa; Yilikoglu, Yalcin

    2013-01-03

    In this case report, clinical and electrophysiological findings of 43-year-old female patient who developed Clostridium botulinum intoxication after consumption of home-made canned food are presented. Following the sudden onset of severe nausea and vomiting, diplopia, blurred vision, bilateral ptosis, weakness, speech and swallowing difficulties have developed and the patient declared that she has just tasted the canned beans after she had rinsed them several times. The case, where serological tests cannot be performed, was diagnosed clinically and treated with antitoxin immediately. During follow-up, consecutive nerve stimulation was performed and significant incremental response was observed. There was an improvement in symptoms within 2 weeks, and in 5 or 6 weeks the symptoms had disappeared completely. Electrodiagnostic studies revealed that the findings turned to normal. The case showed that immediate antitoxin treatment is life-saving even the diagnosis of botulinum intoxication is based on clinical findings.

  18. Research progress of botulinum toxin type A in treatment of spastic cerebral palsy%A型肉毒毒素治疗痉挛型脑瘫的研究进展

    Institute of Scientific and Technical Information of China (English)

    刘春明(综述); 刘芸(审校)

    2015-01-01

    脑瘫是指出生前到出生后1个月内各种原因所引起的脑损伤或发育缺陷所致的运动障碍及姿势异常。小儿脑瘫临床上分为痉挛型,不随意运动型,共济失调型,肌张力低下型及混合型5种,其中,痉挛型占60%~70%,是造成儿童肢体残疾的最主要脑瘫类型。脑瘫一旦确诊多采用综合的治疗方法包括功能训练,物理疗法,中医针刺,按摩,药物治疗等。近年来,临床上开始广泛使用毒杆菌毒素 A(botuli-num toxin A,BTX-A)局部注射治疗痉挛型脑瘫儿童,大量临床研究结果显示该药安全、有效,但在治疗过程中应该严格掌握使用该药的适应证,禁忌证,而剂量的选择和靶肌的准确定位是影响治疗效果的关键因素。%Cerebral palsy refers to brain injury caused by various reasons from before birth to 1 month after birth or movement disorders and abnormal posture caused by brain developmental defects. Children cerebral palsy is divided into 5 kinds in the clinic:spastic type, dyskinetic type, ataxia type, muscle hypotonia type and mixed type. Among them, the spastic type accounts for 60% ~70% , and is the main type which causes children physical disabilities. Once diagnosed, the comprehensive treatment method is ap-plied, including functional training, physical therapy, acupuncture, massage, medicine treatment, and so on. In recent years, the lo-cal injection of botulinum toxin A is used for treating the children with spastic cerebral palsy. A large number of clinical studies show that the drug is safe and effective; however, in the course of treatment, it should strictly control the drug indications and contraindica-tions. Especially, the dosage choice and the accurate localization of target muscle is the key factor to influence the treatment effect.

  19. Regulation of toxin synthesis in Clostridium botulinum and Clostridium tetani.

    Science.gov (United States)

    Connan, Chloé; Denève, Cécile; Mazuet, Christelle; Popoff, Michel R

    2013-12-01

    Botulinum and tetanus neurotoxins are structurally and functionally related proteins that are potent inhibitors of neuroexocytosis. Botulinum neurotoxin (BoNT) associates with non-toxic proteins (ANTPs) to form complexes of various sizes, whereas tetanus toxin (TeNT) does not form any complex. The BoNT and ANTP genes are clustered in a DNA segment called the botulinum locus, which has different genomic localization (chromosome, plasmid, phage) in the various Clostridium botulinum types and subtypes. The botulinum locus genes are organized in two polycistronic operons (ntnh-bont and ha/orfX operons) transcribed in opposite orientations. A gene called botR lying between the two operons in C. botulinum type A encodes an alternative sigma factor which regulates positively the synthesis of BoNT and ANTPs at the late exponential growth phase and beginning of the stationary phase. In Clostridium tetani, the gene located immediately upstream of tent encodes a positive regulatory protein, TetR, which is related to BotR. C. botulinum and C. tetani genomes contain several two-component systems and predicted regulatory orphan genes. In C. botulinum type A, four two-component systems have been found that positively or negatively regulate the synthesis of BoNT and ANTPs independently of BotR/A. The synthesis of neurotoxin in Clostridia seems to be under the control of complex network of regulation.

  20. Experience with different botulinum toxins for the treatment of refractory neurogenic detrusor overactivity

    Directory of Open Access Journals (Sweden)

    Cristiano M. Gomes

    2010-02-01

    Full Text Available PURPOSE: To report our experience with the use of the botulinum toxin-A (BoNT/A formulations Botox® and Prosigne® in the treatment of neurogenic detrusor overactivity (NDO. MATERIALS AND METHODS: At a single institution, 45 consecutive patients with refractory urinary incontinence due to NDO received a single intradetrusor (excluding the trigone treatment with botulinum toxin type A 200 or 300 units. Botox was used for the first 22 patients, and Prosigne for the subsequent 23 patients. Evaluations at baseline and week 12 included assessment of continence and urodynamics. Safety evaluations included monitoring of vital signs, hematuria during the procedure, hospital stay, and spontaneous adverse event reports. RESULTS: A total of 42 patients were evaluated (74% male; mean age, 34.8 years. Significant improvements from baseline in maximum cystometric capacity (MCC, maximum detrusor pressure during bladder contraction, and compliance were observed in both groups (P < 0.05. Improvement in MCC was significantly greater with Botox versus Prosigne (+103.3% vs. +42.2%; P = 0.019. Continence was achieved by week 12 in 16 Botox recipients (76.2% and 10 Prosigne recipients (47.6%; P = 0.057. No severe adverse events were observed. Mild adverse events included 2 cases of transient hematuria on the first postoperative day (no specific treatment required, and 3 cases of afebrile urinary tract infection. CONCLUSIONS: Botox and Prosigne produce distinct effects in patients with NDO, with a greater increase in MCC with Botox. Further evaluation will be required to assess differences between these formulations.

  1. THE PROPERTIES AND LONGITUDINAL EXPERIENCE OF CHINESE TYPE A BOTULINUM TOXIN FOR THE TREATMENT OF FOCAL DYSTONIA AND HEMIFACIAL SPASM

    Institute of Scientific and Technical Information of China (English)

    万新华; 汤晓芙; 王荫椿

    2003-01-01

    Objective. To introduce the properties of Chinese type A botulinum toxin (CBTXA, made by Lanzhou Institute of Biological Products), and its long-term effect for focal dystonia and hemifacial spasm. Method. The purity and recovery of crude and crystalline toxin were tested. Long-term data from 305 patients with hemifacial spasm (HFS), blepharospasm (BS) and cervical dystonia (CD) were evaluated and subgroups of patients received CBTXA injections between 1994 and 2000 in at least six separate treatment sessions, with follow up for 2-8 years. The therapeutic results of the last session CBTXA injections were analyzed in comparison with the first session. Result. CBTXA purity was high[(2.55~2.60)×107D50/mgPr, A260/A280 ≤0.55, high molecular substance accounted for 99.2% of total proteins]. Long term treatment with CBTXA in patients with focal dystonia and HFS was not associated with any decline in benefit, and efficacy may improve slightly with repeat treatments. CBTXA is an excellent long-term treatment of HFS, BS and CD. Conchusion. We conclude that Chinese type A botulinum toxin is of botulinum toxin therapy quality standard according to results obtained from the basic study and long-term clinical applications. The reinjection of CBTXA significantly improves the quality of life of most patients and is a safe, effective and comparatively economical treatment for patients with focal dystonia and HFS.

  2. Botulinum toxin type A and B improve quality of life in patients with axillary and palmar hyperhidrosis.

    Science.gov (United States)

    Rosell, Karolina; Hymnelius, Kristina; Swartling, Carl

    2013-05-01

    Hyperhidrosis is a common disorder that may have a severe impact on quality of life. The aim of this study was to investigate the clinical effect of two novel botulinum toxins, Xeomin®, a type A botulinum toxin, and Neuro-bloc®, a type B botulinum toxin, in the treatment of axillary and palmar hyperhidrosis. A total of 84 patients, 58 with axillary and 26 with palmar hyperhidrosis, were included in this open study. Axillae were injected with 107 ± 22 U Xeomin® and palms were injected with 213 ± 19 U Xeomin® and 264 ± 60 U Neurobloc® over the thenar eminences to avoid muscle weakness. At follow-up 3 weeks post-treatment, all patients treated for axillary hyperhidrosis reported satisfaction in self-ranking, evaporation decreased > 40%, and Dermatology Life Quality Index (DLQI) score improved from 12.0 to 1.7 (p 50% and DLQI score improved from 10.3 to 1.2 (p hyperhidrosis and in combination with Neurobloc® on palmar hyperhidrosis. Neurobloc® may be an option for use in the treatment of palmar hyperhidrosis in order to minimize muscular side-effects.

  3. Genetic diversity within Clostridium botulinum serotypes, botulinum neurotoxin gene clusters and toxin subtypes.

    Science.gov (United States)

    Hill, Karen K; Smith, Theresa J

    2013-01-01

    Clostridium botulinum is a species of spore-forming anaerobic bacteria defined by the expression of any one or two of seven serologically distinct botulinum neurotoxins (BoNTs) designated BoNT/A-G. This Gram-positive bacterium was first identified in 1897 and since then the paralyzing and lethal effects of its toxin have resulted in the recognition of different forms of the intoxication known as food-borne, infant, or wound botulism. Early microbiological and biochemical characterization of C. botulinum isolates revealed that the bacteria within the species had different characteristics and expressed different toxin types. To organize the variable bacterial traits within the species, Group I-IV designations were created. Interestingly, it was observed that isolates within different Groups could express the same toxin type and conversely a single Group could express different toxin types. This discordant phylogeny between the toxin and the host bacteria indicated that horizontal gene transfer of the toxin was responsible for the variation observed within the species. The recent availability of multiple C. botulinum genomic sequences has offered the ability to bioinformatically analyze the locations of the bont genes, the composition of their toxin gene clusters, and the genes flanking these regions to understand their variation. Comparison of the genomic sequences representing multiple serotypes indicates that the bont genes are not in random locations. Instead the analyses revealed specific regions where the toxin genes occur within the genomes representing serotype A, B, C, E, and F C. botulinum strains and C. butyricum type E strains. The genomic analyses have provided evidence of horizontal gene transfer, site-specific insertion, and recombination events. These events have contributed to the variation observed among the neurotoxins, the toxin gene clusters and the bacteria that contain them, and has supported the historical microbiological, and biochemical

  4. AB206. Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity

    Science.gov (United States)

    Chen, Hui; Xie, Keji; Jiang, Chonghe; Tang, Ping; Ou, Rubiao; Zeng, Jianweng; Deng, Xiangrong; Zhou, Liling; Huang, Maping; Li, Qingqing; Liu, Qiuling; Huang, Jiebing; Huang, Tanghai

    2016-01-01

    Objective To evaluate the effect and safety of trigonal injection of botulinum toxin A (BTX-A) for patients with neurological detrusor overactivity (NDO) with incontinence. Methods A prospective, multicenter, single-blind and randomized controlled trial (RCT) was conducted between June 2011 and June 2014. Spinal cord injury patients with urinary incontinence secondary to NDO were recruited. At a 1:1 ratio, patients randomly received 200 U BTX-A intradetrusor injections excluding the trigone (control group) or 160 U intradetrusor and 40 U intratrigonal injections (experimental group). Patients were evaluated at baseline, and 4, 12 weeks after injection. The efficacy and safety outcomes included I-QoL, voiding volume, urinary incontinence episodes, complete dryness, maximum detrusor pressure (Pdetmax), volume at first involuntary detrusor contraction (VFIDC). Vesicoureteral reflux (VUR) and other adverse events were recorded. Results Ninety-six patients were recruited and 91 of them completed the trial. Among the 91 patients, 47 were randomized to experimental group and 44 to the control group. There were no significant differences in baseline evaluation items (gender, age, duration of spinal cord injury, level of neurological injury, AIS scores) between the two groups. At 12 weeks, the improvement was significantly better in the experimental group than in the control group for I-QoL (26.01 vs. 18.75, P=0.01), mean urinary incontinence episodes (−5.22/d vs. −4.68/d, P=0.01), complete dryness (13 vs. 5, P=0.03), mean voiding volume (159.72 vs. 139.07 mL, P=0.02), Pdetmax (−33.34 vs. −28.02 cmH2O, P=0.04), and VFIDC (106.81 vs. 97.86 mL, P=0.02), duration of first detrusor contraction (−41.54 vs. −18.65 s, P=0.03) and the number of patients with detrusor contraction (−20 vs. −9, P=0.02). In both of two groups, no patients developed VUR. Conclusions BTX-A intradetrusor and intratrigonal injections are more effective than those excluding the trigone for

  5. A mixed treatment comparison to compare the efficacy and safety of botulinum toxin treatments for cervical dystonia.

    Science.gov (United States)

    Han, Yi; Stevens, Andrea L; Dashtipour, Khashayar; Hauser, Robert A; Mari, Zoltan

    2016-04-01

    A systematic pair-wise comparison of all available botulinum toxin serotype A and B treatments for cervical dystonia (CD) was conducted, as direct head-to-head clinical trial comparisons are lacking. Five botulinum toxin products: Dysport(®) (abobotulinumtoxinA), Botox(®) (onabotulinumtoxinA), Xeomin(®) (incobotulinumtoxinA), Prosigne(®) (Chinese botulinum toxin serotype A) and Myobloc(®) (rimabotulinumtoxinB) have demonstrated efficacy for managing CD. A pair-wise efficacy and safety comparison was performed for all toxins based on literature-reported clinical outcomes. Multi-armed randomized controlled trials (RCTs) were identified for inclusion using a systematic literature review, and assessed for comparability based on patient population and efficacy outcome measures. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was selected as the efficacy outcome measurement for assessment. A mixed treatment comparison (MTC) was conducted using a Bayesian hierarchical model allowing indirect comparison of the interventions. Due to the limitation of available clinical data, this study only investigated the main effect of toxin treatments without explicitly considering potential confounding factors such as gender and formulation differences. There was reasonable agreement between the number of unconstrained data points, residual deviance and pair-wise results. This research suggests that all botulinum toxin serotype A and serotype B treatments were effective compared to placebo in treating CD, with the exception of Prosigne. Based on this MTC analysis, there is no significant efficacy difference between Dysport, Botox, Xeomin and Myobloc at week four post injection. Of the adverse events measured, neither dysphagia nor injection site pain was significantly greater in the treatment or placebo groups.

  6. Botulinum toxins: Pharmacology and its current therapeutic evidence for use

    Directory of Open Access Journals (Sweden)

    Muthane U

    2003-10-01

    Full Text Available Botulinum toxins are, as a group, among the most potent neuromuscular toxins known, yet they are clinically useful in the management of conditions associated with muscular and glandular over-activity. Botulinum toxins act by preventing release of acetylcholine into the neuromuscular junction. While botulinum toxin type A is commonly available, different manufacturers produce specific products, which are not directly interchangeable and should not be considered as generically equivalent formulations. Type B is also available in the market. Each formulation of botulinum toxin is unique with distinct dosing, efficacy and safety profiles for each use to which it is applied. Botulinum toxin type A is the treatment of choice based on its depth of evidence in dystonias and most other conditions. Botulinum toxin type A is established as useful in the management of spasticity, tremors, headache prophylaxis and several other neurological conditions. Active research is underway to determine the parameters for which the type B toxin can be used in these conditions, as covered in this review. Botulinum toxin use has spread to several fields of medicine.

  7. Genomic characterization of Italian Clostridium botulinum group I strains.

    Science.gov (United States)

    Giordani, Francesco; Fillo, Silvia; Anselmo, Anna; Palozzi, Anna Maria; Fortunato, Antonella; Gentile, Bernardina; Azarnia Tehran, Domenico; Ciammaruconi, Andrea; Spagnolo, Ferdinando; Pittiglio, Valentina; Anniballi, Fabrizio; Auricchio, Bruna; De Medici, Dario; Lista, Florigio

    2015-12-01

    Clostridium botulinum is a gram-positive bacterium capable of producing the botulinum neurotoxin, a powerful poison that causes botulism, a severe neuroparalytic disease. Its genome has been sequenced entirely and its gene content has been analyzed. To date, 19 full genomes and 64 draft genomes are available. The geographical origin of these genomes is predominantly from the US. In the present study, 10 Italian genomes of C. botulinum group I were analyzed and compared with previously sequenced group I genomes, in order to genetically characterize the Italian population of C. botulinum group I and to investigate the phylogenetic relationships among different lineages. Using the suites of software ClonalFrame and ClonalOrigin to perform genomic analysis, we demonstrated that Italian C. botulinum group I population is phylogenetically heterogeneous encompassing different and distant lineages including overseas strains, too. Moreover, a high recombination rate was demonstrated in the evolution of C. botulinum group I species. Finally, genome sequencing of the strain 357 led us to identify a novel botulinum neurotoxin subtype, F8.

  8. Botulinum Toxin Physiology in Focal Hand and Cranial Dystonia

    Directory of Open Access Journals (Sweden)

    Barbara Illowsky Karp

    2012-11-01

    Full Text Available The safety and efficacy of botulinum toxin for the treatment of focal hand and cranial dystonias are well-established. Studies of these adult-onset focal dystonias reveal both shared features, such as the dystonic phenotype of muscle hyperactivity and overflow muscle contraction and divergent features, such as task specificity in focal hand dystonia which is not a common feature of cranial dystonia. The physiologic effects of botulinum toxin in these 2 disorders also show both similarities and differences. This paper compares and contrasts the physiology of focal hand and cranial dystonias and of botulinum toxin in the management of these disorders.

  9. Cosmetic Effect of Botulinum Toxin In Focal Hyperhydrosis

    Directory of Open Access Journals (Sweden)

    Jain S

    2005-01-01

    Full Text Available Hyperhydrosis of axillae, palm and sole is not a very uncommon problem. It leads to great embarrassment and considerable emotional stress to the individuals. Botulinum toxins prevent the release of acetylcholine at nerve terminals, therefore, reduces sweat secretion. Six patients of axillary and 4 patients of palmer and planter hyperhydrosis were treated with botulinum toxin. All patients experienced relatively satisfactory reduction of hyperhydrosis for period ranging between 4-7 months. No adverse effects were observed. Botulinum toxin therefore can be considered as an effective treatment in focal hyperhydrosis.

  10. Botulinum toxin physiology in focal hand and cranial dystonia.

    Science.gov (United States)

    Karp, Barbara Illowsky

    2012-11-20

    The safety and efficacy of botulinum toxin for the treatment of focal hand and cranial dystonias are well-established. Studies of these adult-onset focal dystonias reveal both shared features, such as the dystonic phenotype of muscle hyperactivity and overflow muscle contraction and divergent features, such as task specificity in focal hand dystonia which is not a common feature of cranial dystonia. The physiologic effects of botulinum toxin in these 2 disorders also show both similarities and differences. This paper compares and contrasts the physiology of focal hand and cranial dystonias and of botulinum toxin in the management of these disorders.

  11. Botulinum toxin for treatment of glandular hypersecretory disorders.

    LENUS (Irish Health Repository)

    Laing, T A

    2012-02-03

    SUMMARY: The use of botulinum toxin to treat disorders of the salivary glands is increasing in popularity in recent years. Recent reports of the use of botulinum toxin in glandular hypersecretion suggest overall favourable results with minimal side-effects. However, few randomised clinical trials means that data are limited with respect to candidate suitability, treatment dosages, frequency and duration of treatment. We report a selection of such cases from our own department managed with botulinum toxin and review the current data on use of the toxin to treat salivary gland disorders such as Frey\\'s syndrome, excessive salivation (sialorrhoea), focal and general hyperhidrosis, excessive lacrimation and chronic rhinitis.

  12. Effects of Botulinum Toxin on Jaw Motor Events during Sleep in Sleep Bruxism Patients: A Polysomnographic Evaluation

    Science.gov (United States)

    Shim, Young Joo; Lee, Moon Kyu; Kato, Takafumi; Park, Hyung Uk; Heo, Kyoung; Kim, Seong Taek

    2014-01-01

    Study Objectives: To investigate the effects of botulinum toxin type A (BoNT-A) injection on jaw motor episodes during sleep in patients with or without orofacial pain who did not respond to oral splint treatment. Methods: Twenty subjects with a clinical diagnosis of SB completed this study. Ten subjects received bilateral BoNT-A injections (25 U per muscle) into the masseter muscles only (group A), and the other 10 received the injections into both the masseter and temporalis muscles (group B). Video-polysomnographic (vPSG) recordings were made before and at 4 weeks after injection. Rhythmic masticatory muscle activity (RMMA) and orofacial activity (OFA) were scored and analyzed for several parameters (e.g., frequency of episodes, bursts per episode, episode duration). The peak amplitude of electromyographic (EMG) activity in the two muscles was also measured. Results: BoNT-A injection did not reduce the frequency, number of bursts, or duration for RMMA episodes in the two groups. The injection decreased the peak amplitude of EMG burst of RMMA episodes in the injected muscles (p < 0.001, repeated measure ANOVA) in both groups. At 4 weeks after injection, 9 subjects self-reported reduction of tooth grinding and 18 subjects self-reported reduction of morning jaw stiffness. Conclusions: A single BoNT-A injection is an effective strategy for controlling SB for at least a month. It reduces the intensity rather than the generation of the contraction in jaw-closing muscles. Future investigations on the efficacy and safety in larger samples over a longer follow-up period are needed before establishing management strategies for SB with BoNT-A. Citation: Shim YJ; Lee MK; Kato T; Park HU; Heo K; Kim ST. Effects of botulinum toxin on jaw motor events during sleep in sleep bruxism patients: a polysomnographic evaluation. J Clin Sleep Med 2014;10(3):291-298. PMID:24634627

  13. Genomes, neurotoxins and biology of Clostridium botulinum Group I and Group II.

    Science.gov (United States)

    Carter, Andrew T; Peck, Michael W

    2015-05-01

    Recent developments in whole genome sequencing have made a substantial contribution to understanding the genomes, neurotoxins and biology of Clostridium botulinum Group I (proteolytic C. botulinum) and C. botulinum Group II (non-proteolytic C. botulinum). Two different approaches are used to study genomics in these bacteria; comparative whole genome microarrays and direct comparison of complete genome DNA sequences. The properties of the different types of neurotoxin formed, and different neurotoxin gene clusters found in C. botulinum Groups I and II are explored. Specific examples of botulinum neurotoxin genes are chosen for an in-depth discussion of neurotoxin gene evolution. The most recent cases of foodborne botulism are summarised.

  14. Beneficial effects of botulinum toxin type A in trigeminal neuralgia Beneficio de la toxina botulínica tipo A en neuralgia del trigemino

    Directory of Open Access Journals (Sweden)

    Carlos Zúñiga

    2008-09-01

    Full Text Available Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Visual Analogic Scale for pain. Ten of our patients reported a significant benefit from botulinum toxin injections, with reduction or even disappearance of pain, and remained pain free for as long as 60 days. Our findings suggest that botulinum toxin may represent a useful therapeutic tool in the management of patients with this entity.La toxina botulínica ha sido estudiada en forma exhaustiva como una potencial herramienta en el tratamiento de múltiples síndromes dolorosos. Por lo tanto, evaluamos los efectos clínicos de la aplicación de toxina botulínica tipo A en 12 sujetos con neuralgia trigeminal idiopática resistente a manejo farmacológico. Se aplicaron en dichos sujetos entre 20 y 50 unidades de toxina botulínica tipo A en las zonas gatillo. Además se infiltró el músculo masetero en aquellos que presentaban involucro mandibular. Los sujetos fueron evaluados semanalmente con una escala visual análoga para dolor. Diez de los sujetos reportaron un beneficio significativo con el uso de toxina botulínica, con reducción e incluso desaparición del dolor, permaneciendo libres de dolor por un periodo de hasta 60 días. Nuestros hallazgos sugieren que la toxina botulínica puede representar una herramienta terapéutica útil en el manejo de pacientes con esta entidad.

  15. An in vivo analysis of facial muscle change treated with botulinum toxin type A using digital image speckle correlation

    Science.gov (United States)

    Xu, Yan; Palmaccio, Samantha Palmaccio; Bui, Duc; Dagum, Alexander; Rafailovich, Miriam

    Been famous for clinical use from early 1980s, the neuromuscular blocking agent Botulinum toxin type A (BTX-A), has been used to reduce wrinkles for a long time. Only little research has been done to quantify the change of muscle contraction before and after injection and most research paper depend on subjective evaluation from both patients and surgeons. In our research, Digital Image Speckle Correlation (DISC) was employed to study the mechanical properties of skin, contraction mode of muscles (injected) and reaction of neighbor muscle group (un-injected).At the same time, displacement patterns (vector maps)generated by DISC can predict injection locus for surgeons who normally handle it depending only on visual observation.

  16. Historical Perspectives and Guidelines for Botulinum Neurotoxin Subtype Nomenclature

    Science.gov (United States)

    Peck, Michael W.; Smith, Theresa J.; Anniballi, Fabrizio; Austin, John W.; Bano, Luca; Bradshaw, Marite; Cuervo, Paula; Cheng, Luisa W.; Derman, Yagmur; Dorner, Brigitte G.; Fisher, Audrey; Hill, Karen K.; Kalb, Suzanne R.; Korkeala, Hannu; Lindström, Miia; Lista, Florigio; Lúquez, Carolina; Mazuet, Christelle; Pirazzini, Marco; Popoff, Michel R.; Rossetto, Ornella; Rummel, Andreas; Sesardic, Dorothea; Singh, Bal Ram; Stringer, Sandra C.

    2017-01-01

    Botulinum neurotoxins are diverse proteins. They are currently represented by at least seven serotypes and more than 40 subtypes. New clostridial strains that produce novel neurotoxin variants are being identified with increasing frequency, which presents challenges when organizing the nomenclature surrounding these neurotoxins. Worldwide, researchers are faced with the possibility that toxins having identical sequences may be given different designations or novel toxins having unique sequences may be given the same designations on publication. In order to minimize these problems, an ad hoc committee consisting of over 20 researchers in the field of botulinum neurotoxin research was convened to discuss the clarification of the issues involved in botulinum neurotoxin nomenclature. This publication presents a historical overview of the issues and provides guidelines for botulinum neurotoxin subtype nomenclature in the future. PMID:28106761

  17. Historical Perspectives and Guidelines for Botulinum Neurotoxin Subtype Nomenclature

    Directory of Open Access Journals (Sweden)

    Michael W. Peck

    2017-01-01

    Full Text Available Botulinum neurotoxins are diverse proteins. They are currently represented by at least seven serotypes and more than 40 subtypes. New clostridial strains that produce novel neurotoxin variants are being identified with increasing frequency, which presents challenges when organizing the nomenclature surrounding these neurotoxins. Worldwide, researchers are faced with the possibility that toxins having identical sequences may be given different designations or novel toxins having unique sequences may be given the same designations on publication. In order to minimize these problems, an ad hoc committee consisting of over 20 researchers in the field of botulinum neurotoxin research was convened to discuss the clarification of the issues involved in botulinum neurotoxin nomenclature. This publication presents a historical overview of the issues and provides guidelines for botulinum neurotoxin subtype nomenclature in the future.

  18. Effects of Transgenic Expression of Botulinum Toxins in Drosophila

    OpenAIRE

    Backhaus, Philipp

    2017-01-01

    Clostridial neurotoxins (botulinum toxins and tetanus toxin) disrupt neurotransmitter release by cleaving neuronal SNARE proteins. We generated transgenic flies allowing for conditional expression of different botulinum toxins and evaluated their potential as tools for the analysis of synaptic and neuronal network function in Drosophila melanogaster by applying biochemical assays and behavioral analysis. On the biochemical level, cleavage assays in cultured Drosophila S2 cells were performed ...

  19. Botulinum toxin the poison that heals: A brief review.

    Science.gov (United States)

    Dutta, Shubha Ranjan; Passi, Deepak; Singh, Mahinder; Singh, Purnima; Sharma, Sarang; Sharma, Abhimanyu

    2016-01-01

    Botulinum neurotoxins, causative agents of botulism in humans, are produced by Clostridium botulinum, an anaerobic spore-former Gram-positive bacillus. Botulinum neurotoxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons. This paper aims at discussing botulinum neurotoxin, its structure, mechanism of action, pharmacology, its serotypes and the reasons for wide use of type A, the various indications and contraindications of the use of botulinum neurotoxin and finally the precautions taken when botulinum neurotoxin is used as a treatment approach. We have searched relevant articles on this subject in various medical databases including Google Scholar, PubMed Central, ScienceDirect, Wiley Online Library, Scopus, and Copernicus. The search resulted in more than 2669 articles, out of which a total of 187 were reviewed. However, the review has been further constricted into only 54 articles as has been presented in this manuscript keeping in mind the page limitation and the limitation to the number of references. A single gram of crystalline toxin, evenly dispersed and inhaled, can kill more than one million people. The basis of the phenomenal potency of botulinum toxin (BT) is enzymatic; the toxin is a zinc proteinase that cleaves neuronal vesicle-associated proteins responsible for acetylcholine release into the neuromuscular junction. A fascinating aspect of BT research in recent years has been the development of the most potent toxin into a molecule of significant therapeutic utility. It is the first biological toxin which is licensed for the treatment of human diseases. The present review focuses on both warfare potential as well as medical uses of botulinum neurotoxin.

  20. Host Response to Botulinum Neurotoxins for Developing Diagnostics and Antidotes

    Science.gov (United States)

    2009-09-18

    difficile 630, Clostridium perfringens ATCC13124, Clostridium perfringens str. 13, Clostridium tetani E88, Clostridium thermocellum ATCC27405. The...proteins produced by Clostridium botulinum in seven immunologically distinct serotypes named A to G. BoNTs being the causative agents of the most...8 Sequence Analysis of P-250 protein Based on the N-terminal sequence of P-250, we used the codon usage table of Clostridium botulinum Hall-A

  1. Toxina botulínica y su empleo en la patología oral y maxilofacial Botulinum toxin and its use in oral and maxillofacial pathology

    Directory of Open Access Journals (Sweden)

    D. Martínez-Pérez

    2004-06-01

    Full Text Available Resumen: Las toxinas botulínicas son exotoxinas de la bacteria formadora de esporas Clostridim botulinum y los agentes causantes del botulismo. Cuando se inyecta en el músculo produce una parálisis flácida. El efecto clínico está directamente relacionado con la dosis y debe ajustarse para cada caso concreto. La Toxina botulínica ha demostrado en los más de veinte años en que se está utilizando que es un fármaco seguro. Las indicaciones de la toxina botulínica en la actualidad incluyen todas aquellas patologías que resultan de la hiperfunción muscular y la disfunción autonómica.Abstract: Botilinum toxins are exotoxins of the bacteria that form the Clostridium botulinum spores and the causative agents of botulism. When injected into the muscle flaccid paralysis is produced. The clinical effect is directly related with the dose and is should be adjusted for each particular case. over the last twenty years that it has been in use, the botulinum toxin has shown itself to be a reliable drug. Current indications for the use of botulinum toxin include all those pathologies which are the results of muscle hyperfunction and autonomic dysfunction.

  2. Cellular and Matrix Response of the Mandibular Condylar Cartilage to Botulinum Toxin

    Science.gov (United States)

    Dutra, Eliane H.; O’ Brien, Mara H.; Lima, Alexandro; Kalajzic, Zana; Tadinada, Aditya; Nanda, Ravindra; Yadav, Sumit

    2016-01-01

    Objectives To evaluate the cellular and matrix effects of botulinum toxin type A (Botox) on mandibular condylar cartilage (MCC) and subchondral bone. Materials and Methods Botox (0.3 unit) was injected into the right masseter of 5-week-old transgenic mice (Col10a1-RFPcherry) at day 1. Left side masseter was used as intra-animal control. The following bone labels were intraperitoneally injected: calcein at day 7, alizarin red at day 14 and calcein at day 21. In addition, EdU was injected 48 and 24 hours before sacrifice. Mice were sacrificed 30 days after Botox injection. Experimental and control side mandibles were dissected and examined by x-ray imaging and micro-CT. Subsequently, MCC along with the subchondral bone was sectioned and stained with tartrate resistant acid phosphatase (TRAP), EdU, TUNEL, alkaline phosphatase, toluidine blue and safranin O. In addition, we performed immunohistochemistry for pSMAD and VEGF. Results Bone volume fraction, tissue density and trabecular thickness were significantly decreased on the right side of the subchondral bone and mineralized cartilage (Botox was injected) when compared to the left side. There was no significant difference in the mandibular length and condylar head length; however, the condylar width was significantly decreased after Botox injection. Our histology showed decreased numbers of Col10a1 expressing cells, decreased cell proliferation and increased cell apoptosis in the subchondral bone and mandibular condylar cartilage, decreased TRAP activity and mineralization of Botox injected side cartilage and subchondral bone. Furthermore, we observed reduced proteoglycan and glycosaminoglycan distribution and decreased expression of pSMAD 1/5/8 and VEGF in the MCC of the Botox injected side in comparison to control side. Conclusion Injection of Botox in masseter muscle leads to decreased mineralization and matrix deposition, reduced chondrocyte proliferation and differentiation and increased cell apoptosis in the

  3. Adenosine Deaminase Inhibition Prevents Clostridium difficile Toxin A-Induced Enteritis in Mice ▿

    Science.gov (United States)

    de Araújo Junqueira, Ana Flávia Torquato; Dias, Adriana Abalen Martins; Vale, Mariana Lima; Spilborghs, Graziela Machado Gruner Turco; Bossa, Aline Siqueira; Lima, Bruno Bezerra; Carvalho, Alex Fiorini; Guerrant, Richard Littleton; Ribeiro, Ronaldo Albuquerque; Brito, Gerly Anne

    2011-01-01

    Toxin A (TxA) is able to induce most of the classical features of Clostridium difficile-associated disease in animal models. The objective of this study was to determine the effect of an inhibitor of adenosine deaminase, EHNA [erythro-9-(2-hydroxy-3-nonyl)-adenine], on TxA-induced enteritis in C57BL6 mice and on the gene expression of adenosine receptors. EHNA (90 μmol/kg) or phosphate-buffered saline (PBS) was injected intraperitoneally (i.p.) 30 min prior to TxA (50 μg) or PBS injection into the ileal loop. A2A adenosine receptor agonist (ATL313; 5 nM) was injected in the ileal loop immediately before TxA (50 μg) in mice pretreated with EHNA. The animals were euthanized 3 h later. The changes in the tissue were assessed by the evaluation of ileal loop weight/length and secretion volume/length ratios, histological analysis, myeloperoxidase assay (MPO), the local expression of inducible nitric oxide synthase (NOS2), pentraxin 3 (PTX3), NF-κB, tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β) by immunohistochemistry and/or quantitative reverse transcription-PCR (qRT-PCR). The gene expression profiles of A1, A2A, A2B, and A3 adenosine receptors also were evaluated by qRT-PCR. Adenosine deaminase inhibition, by EHNA, reduced tissue injury, neutrophil infiltration, and the levels of proinflammatory cytokines (TNF-α and IL-1β) as well as the expression of NOS2, NF-κB, and PTX3 in the ileum of mice injected with TxA. ATL313 had no additional effect on EHNA action. TxA increased the gene expression of A1 and A2A adenosine receptors. Our findings show that the inhibition of adenosine deaminase by EHNA can prevent Clostridium difficile TxA-induced damage and inflammation possibly through the A2A adenosine receptor, suggesting that the modulation of adenosine/adenosine deaminase represents an important tool in the management of C. difficile-induced disease. PMID:21115723

  4. Molecular Dynamics Simulation of Cholera Toxin A-1 Polypeptide

    Directory of Open Access Journals (Sweden)

    Badshah Syed Lal

    2016-01-01

    Full Text Available A molecular dynamics (MD simulation study of the enzymatic portion of cholera toxin; cholera toxin A-1 polypeptide (CTA1 was performed at 283, 310 and 323 K. From total energy analysis it was observed that this toxin is stable thermodynamically and these outcomes were likewise confirmed by root mean square deviations (RMSD investigations. The Cα root mean square fluctuation (RMSF examinations revealed that there are a number of residues inside CTA1, which can be used as target for designing and synthesizing inhibitory drugs, in order to inactivate cholera toxin inside the human body. The fluctuations in the radius of gyration and hydrogen bonding in CTA1 proved that protein unfolding and refolding were normal routine phenomena in its structure at all temperatures. Solvent accessible surface area study identified the hydrophilic nature of the CTA1, and due to this property it can be a potential biological weapon. The structural identification (STRIDE algorithm for proteins was successfully used to determine the partially disordered secondary structure of CTA1. On account of this partially disordered secondary structure, it can easily deceive the proteolytic enzymes of the endoplasmic reticulum of host cells.

  5. Ouabain exacerbates botulinum neurotoxin-induced muscle paralysis via progression of muscle atrophy in mice.

    Science.gov (United States)

    Fujikawa, Ryu; Muroi, Yoshikage; Unno, Toshihiro; Ishii, Toshiaki

    2010-12-01

    Botulinum neurotoxin serotype A (BoNT/A) inhibits acetylcholine release at the neuromuscular junction in isolated muscles, and ouabain can partially block its effect. However, it is not clear whether ouabain attenuates BoNT/A-induced neuromuscular paralysis in vivo. In this work, we investigated the effects of ouabain on BoNT/A-induced neuromuscular paralysis in mice. Ouabain was administered to mice intraperitoneally immediately after a single injection of BoNT/A into skeletal muscle. The effects of ouabain on BoNT/A-induced muscle paralysis were assessed by quantitative monitoring of muscle tension and digit abduction via the digit abduction scoring (DAS) assay. A single administration of ouabain significantly prolonged BoNT/A-induced neuromuscular paralysis. Moreover, consecutive daily injection of ouabain exacerbated BoNT/A-induced neuromuscular paralysis, and led to a significant decrease in both twitch and tetanic forces as assayed in isolated BoNT/A-injected muscles. We next looked at the effects of ouabain on BoNT/A-induced muscle atrophy. Administration of ouabain led to a decrease in the myofibrillar cross-sectional area (CSAs) by 14 post-BoNT/A injection. In addition, repeated administration of ouabain increased mRNA expression levels of ubiquitin ligases, which are markers of muscle atrophy, in BoNT/A-injected muscle. These results suggest that ouabain exacerbates BoNT/A-induced neuromuscular paralysis via a marked progression of BoNT/A-induced muscle atrophy.

  6. Botulinum Toxin as an Alternative to Treat the Spasm of the Near Reflex.

    Science.gov (United States)

    Laria, Carlos; Merino-Suárez, María L; Piñero, David P; Gómez-Hurtado, Arantxa; Pérez-Cambrodí, Rafael J

    2015-01-01

    We describe the case of an eight-year-old girl with complaints of headaches and blurred vision (uncorrected visual acuity: 0.1 decimal) that showed on examination miotic pupils, pseudomyopia, no ocular motility restrictions, and no associated neurological disease. After initial treatment with cyclopentolate for two months, pseudomyopia persisted with an intermittent and variable esotropia. Spectacles of +1 both eyes and atropine 1% one drop daily were then prescribed. The situation improved and remained stable for several weeks, with pseudomyopia and esotropia reappearing later. Finally, botulinum toxin (2.5 iu Botox) was injected in the medial rectus muscle on two occasions and a visual therapy program based on the stimulation of fusional divergence, diplopia, and stereopsis consciousness was recommended. This prescription was combined with the use of atropine during the first few weeks. Orthotropia and corrected distance visual acuity of 1.0 were found three months after treatment. The evolution and clinical results of this case report suggest that botulinum toxin in combination with other therapeutic alternatives may be useful in the treatment of spasm of the near reflex.

  7. Clinical efficacy of two concentrations of diluted botulism toxin A for blepharospasm%两种不同浓度的A型肉毒素注射治疗眼睑痉挛的观察对比

    Institute of Scientific and Technical Information of China (English)

    赵敏; 孙重

    2016-01-01

    28.51 ±3.42U,the differences were statistically significant( P0.05 ). Sixteen cases had ptosis in different levels in the high concentration group, and 2 in the low concentration group, the differences were statistically significant ( P<0.01).There were no serious complications such as intoxication, drug allergy in both groups.Ptosis relieved after using naphcon-A and disappeared in 2-3 wk.?CONCLUSION: The efficacy of local injection with two concentrations of diluted botulinum toxin A for blepharospasm was positive. Considering the high incidence of ptosis in high concentration group, we recommended the 25U/mL botulism toxin A for blepharospasm.

  8. Botulinum toxin drugs: brief history and outlook.

    Science.gov (United States)

    Dressler, D

    2016-03-01

    The global botulinum toxin (BT) market is currently undergoing rapid changes: this may be the time to review the history and the future of BT drug development. Since the early 1990s Botox(®) and Dysport(®) dominated the international BT market. Later, Myobloc(®)/NeuroBloc(®), a liquid BT type B drug, came out, but failed. Xeomin(®) is the latest major BT drug. It features removal of complexing proteins and improved neurotoxin purity. Several new BT drugs are coming out of Korea, China and Russia. Scientific challenges for BT drug development include modification of BT's duration of action, its transdermal transport and the design of BT hybrid drugs for specific target tissues. The increased competition will change the global BT market fundamentally and a re-organisation according to large indication groups, such as therapeutic and cosmetic applications, might occur.

  9. Botulinum Toxin to Treat Neurogenic Bladder.

    Science.gov (United States)

    Smith, Christopher P; Chancellor, Michael B

    2016-02-01

    Alteration in neural control from suprapontine areas to the nerves innervating the bladder can lead to bladder dysfunction and the development of a neurogenic bladder (NGB). Patients with NGB often suffer from urinary incontinence, which can lead to adverse events such as urinary tract infections and decubiti, in addition to creating a large care burden for family members or healthcare providers and significantly impairing patient quality of life. The common failure of anticholinergic medications has spurned the development of second-line treatments, including the use of botulinum toxin. OnabotulinumtoxinA (onaBoNT-A; BOTOX, Allergan, Inc.) was approved by the U.S. Food and Drug Administration (FDA) in 2011 to treat neurogenic detrusor overactivity in patients with urinary incontinence resulting from a NGB. In this review the authors summarize pertinent results from key trials leading to FDA approval of onaBoNT-A as well as more recent long-term data.

  10. First report of an infant botulism case due to Clostridium botulinum type Af.

    Science.gov (United States)

    de Jong, Laura I T; Fernández, Rafael A; Pareja, Virtudes; Giaroli, Gabriel; Guidarelli, Sergio R; Dykes, Janet K; Lúquez, Carolina

    2015-02-01

    Most infant botulism cases worldwide are due to botulinum toxin types A and B. Rarely, Clostridium botulinum strains that produce two serotypes (Ab, Ba, and Bf) have also been isolated from infant botulism cases. This is the first reported case of infant botulism due to C. botulinum type Af worldwide.

  11. Development of a quail embryo model for the detection of botulinum toxin type A activity

    Science.gov (United States)

    Clostridium botulinum is a ubiquitous microorganism which under certain anaerobic conditions can produce botulinum toxins. Due to concerns in regards to both food-borne illness and the potential use of botulinum toxin as a biological weapon, the capability to assess the amount of toxin in a food or...

  12. An aptamer beacon responsive to botulinum toxins.

    Science.gov (United States)

    Bruno, John G; Richarte, Alicia M; Carrillo, Maria P; Edge, Allison

    2012-01-15

    Sixty candidate DNA aptamers were developed against botulinum neurotoxin (BoNT) type A light chain (LC) from ten rounds of selection, resulting in several identical sequences. Secondary structures of the identical aptamers were compared to structures of previously reported BoNT A DNA aptamers. A series of ten candidate loop structures were selected from this comparison as potential binding pockets and aptamer beacons. These candidate beacons were synthesized with 5'-TYE 665 and 3'-Iowa Black quencher labels for comparison of fluorescence levels as a function of BoNT A LC concentration. Only three of the ten candidates exhibited any fluorescence response to increasing levels of BoNT A LC. However, of the two most responsive candidates, one represented a subset loop of the larger more intensely fluorescent double-looped structure, designated Beacon 10. This beacon yielded a lower limit of detection of 1 ng/mL in buffer using a spectrofluorometer and a portable handheld fluorometer, but also responded substantially to BoNT A, B, E holotoxins and heavy or light chain components even in a dilute soil suspension, but not in 50% human serum. Beacon 10 did not respond strongly to a variety of other divergent peptides, suggesting that it is relatively specific to the level of botulinum toxins and is only useful for environmental testing. Beacon 10 also shared short sequence segments with other published BoNT aptamer DNA sequences, suggesting that these may be points of physical contact between the aptamers and BoNTs.

  13. [Botulinum toxin for the treatment of pain syndromes].

    Science.gov (United States)

    Ferreira, Joaquim J; Couto, Marina; Costa, João; Coelho, Miguel; Rosa, Mário M; Sampaio, Cristina

    2006-01-01

    Although botulinum toxin (BoNT) is being used for therapeutic purposes for more than 20 years, the list of potential new indications continues to increase and includes various pain syndromes. The pain relief experienced by patients with dystonia and spasticity from intramuscular BoNT injections suggested that other chronic skeletal-muscles pain conditions may also benefit. BoNT inhibits the release of acetylcholine at the neuromuscular junction thereby reducing striatal muscle contractions and the proposed analgesic property was initially attributed to muscular relaxation. A specific analgesic BoNT effect is difficult to conclude from studies where pain is conditioned by other associated symptoms like dystonia, muscle contraction or spasticity. One alternative is to critically appraise clinical trials where BoNT was studied as the active intervention and pain evaluated as an outcome. From this analysis there is convincing evidence for the effectiveness of BoNT in the treatment of pain associated with cervical dystonia. For all other pain syndromes there have been relatively few, small sized, placebo-controlled studies (myofascial pain syndrome, chronic neck and low back pain, piriformis syndrome and fibromyalgia) and the results of these studies have been contradictory or non conclusive. To establish the analgesic properties of BoNT there is a need for appropriately designed, exploratory randomized controlled studies in well accepted human models of nociceptive or neuropathic pain. This does not exclude the subsequent need to conduct pragmatic trials to evaluate the effectiveness of BoNT in conditions where the improvement of pain or any associated clinical sign or symptom may be of clinical relevance.

  14. Pentamidine Injection

    Science.gov (United States)

    Pentamidine injection is used to treat pneumonia caused by a fungus called Pneumocystis carinii. It is in ... Pentamidine injection comes as powder to be mixed with liquid to be injected intramuscularly (into a muscle) ...

  15. Striving for more good days: patient perspectives on botulinum toxin for the treatment of cervical dystonia

    Directory of Open Access Journals (Sweden)

    Poliziani M

    2016-08-01

    Full Text Available Michele Poliziani,1 Marco Koch,2 Xierong Liu1 1Opinion Health, London, UK; 2Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany Background: The recommended reinjection interval for botulinum neurotoxin (BoNT formulations in the treatment of cervical dystonia (CD is generally ≥12 weeks, though intervals ≥10 weeks are approved for incobotulinumtoxinA in Europe. However, recurring symptoms can occur before the end of this period. Using qualitative research, we sought a greater understanding of disease burden, unmet patient needs, and barriers to treatment. Methods: We conducted online semistructured, focus-group discussions, and online forum follow-up discussions among patients with CD, focusing on disease burden, patient needs, injection cycle preferences, and relationships with health care professionals. A subset of patients was also questioned in telephone interviews about individual experiences of CD and BoNT treatment. All participants were UK residents who had received onabotulinumtoxinA or abobotulinumtoxinA for CD for ≥1 year. Results: Thirty-one patients (81% female; mean duration of CD 16.4 [range 4–31] years; mean BoNT injection cycle length 12.8 weeks participated in the online focus-group and forum follow-up discussions. Of these, seven patients participated in telephone interviews. All had recurring symptoms between treatments, which substantially impacted on their work, family, and social life. Symptom severity fluctuated throughout an injection cycle and differed between patients and across injection cycles. Participants’ relationships with health care professionals and treatment satisfaction varied greatly. Many participants wanted longer-lasting and/or more stable symptom relief with shorter and/or more flexible injection intervals, according to individual needs. Lack of health care resources, long journeys to treatment centers, and immunogenicity/side-effect concerns were perceived as the main barriers to more

  16. An Open Study of Botulinum-A Toxin Treatment of Idiopathic Trigeminal Neuralgia

    Directory of Open Access Journals (Sweden)

    Karim Nikkhah

    2015-07-01

    Full Text Available Introduction: Trigeminal Neuralgia (TN is a unilateral, recurrent, sharp facial pain disorder that is limited to the distribution of divisions of the trigeminal nerve. The aim of this study was to evaluate the efficacy of Botulinum neurotoxin type A (BTX-A for alleviating the frequency and severity of TN pain. Materials and Methods: This trial was performed as a before and after study. We treated 31 patients (15 male and 16 female with mean age of 52 year old that their diagnosis was made at least 4.5 years before. We injected BTX-A in various parts of face and particularly in the origin of mandibular and maxillary branches of trigeminal nerve. Injection volume was determined by the necessity and pain intensity measured with visual analog scale up to 100U. Patients were evaluated before and after the injection and were followed after week, and each month, for a three months period. Other related variables were recorded such as: toxin complications, pain status variations by brushing, chewing, cold weather and patient’s satisfaction with their therapy. Results: showed that after injection, pain intensity and frequency decreased after tooth brushing, chewing and cold weather (P

  17. CLINICAL APPLICATION OF BOTULINUM TOXIN TYPE B IN MOVEMENT DISORDERS AND AUTONOMIC SYMPTOMS

    Institute of Scientific and Technical Information of China (English)

    Xin-hua Wan; Kevin Dat Vuong; Joseph Jankovic

    2005-01-01

    Objective To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disorders such as sialorrhea and hyperhidrosis.Methods A retrospective study of BTX-B injections in treatment of 58 patients with various neurological disorders was performed. The mean follow-up time was 0.9 ± 0.8 years. Results of the first and last treatment of patients with at least 3injection sessions were compared.Results The response of 58 patients to a total of 157 BTX-B treatment sessions was analyzed. Of the 157 treatment sessions, 120 sessions (76.4%) resulted in moderate or marked improvement while 17 sessions (10.8%) had no response.The clinical benefits after BTX-B treatment lasted an average of 14 weeks. Of the 41 patients with at least 3 injection sessions (mean 10 ± 8.6), most patients needed increased dosage upon the last session compared to the first session. Nineteen patients (32.8%) with 27 sessions (17.2%) reported adverse effects with BTX-B treatment.Conclusios Though most patients require increased dosage to maintain effective response after repeated injections,BTX-B is an effective and safe treatment drug for a variety of movement disorders, as well as drooling and hyperhidrosis.

  18. Use of botulinum toxin type A in symptomatic accessory soleus muscle: first five cases.

    Science.gov (United States)

    Isner-Horobeti, M-E; Muff, G; Lonsdorfer-Wolf, E; Deffinis, C; Masat, J; Favret, F; Dufour, S P; Lecocq, J

    2016-11-01

    Symptomatic accessory soleus muscle (ASM) can cause exercise-induced leg pain due to local nerve/vascular compression, muscle spasm, or local compartment syndrome. As intramuscular injections of botulinum toxin type A (BTX-A) can reduce muscle tone and mass, we investigated whether local BTX-A injections relieve the pain associated with symptomatic ASM. We describe five patients presenting peri/retromalleolar exertional pain and a contractile muscle mass in the painful region. Com-pression neuropathy was ruled out by electromyo-graphic analysis of the lower limb muscles. Doppler ultrasonography was normal, excluding a local vascular compression. ASM was confirmed by magnetic resonance imaging. After a treadmill stress test, abnormal intramuscular pressure values in the ASM, confirmed the diagnosis of compartment syndrome only in one patient. All five patients received BTX-A injections in two points of the ASM. The treatment efficacy was evaluated based on the disappearance of exercise-induced pain and the resumption of normal physical and sports activities. After BTX-A injection, exertional pain disappeared and all five patients resumed their normal level of physical and sports performances. Neither side effects nor motor deficits were observed. BTX-A is well tolerated in patients with ASM and could be used as a new conservative therapeutic strategy for the treatment of symptomatic ASM before surgery.

  19. Botulinum Neurotoxin A for Parotid Enlargement in Cystic Fibrosis: The First Case Report.

    Science.gov (United States)

    El Khoury, Joseph; Habre, Samer; Nasr, Marwan; Hokayem, Nabil

    2016-09-01

    Cystic fibrosis (CF) is the most common lethal autosomal recessive genetic disease associated with exocrine gland dysfunction. Salivary gland involvement is a common finding. The literature on submaxillary gland involvement has failed to address the parotid gland and any specific treatment of salivary gland manifestations of CF. Treatment is mainly symptomatic, consisting of analgesics, gustatory stimulation, and massage. Salivary secretion has clearly been linked to parasympathetic and sympathetic signals through intracellular calcium release. CF alters salivary composition with increased calcium and phosphorus concentrations and causes histologic changes (duct enlargement, dilation of acini, and abnormal mucous plugs). This study investigated whether botulinum toxin injected into the parotid gland during an acute exacerbation of CF-associated salivary gland disease could alleviate pain and control future exacerbations.

  20. A Case of Painful Hemimasticatory Spasm with Masseter Muscle Hypertrophy Responsive to Botulinum Toxin

    Directory of Open Access Journals (Sweden)

    Jin-Hyuck Kim

    2009-10-01

    Full Text Available Hemimasticatory spasm (HMS is a rare disorder of the trigeminal nerve characterized by paroxysmal involuntary contractions of the unilateral jaw-closing muscles. HMS has been frequently described in association with facial hemiatrophy or localized scleroderma. A 42-year-old female presented with involuntary paroxysmal spasms of the left face, of 6 months duration. Her lower face on the left was markedly hypertrophied without skin lesions. An electrophysiological study indicated that the masseter reflexes and masseteric silent period were attenuated on the affected side. Surface electromyography demonstrated irregular bursts of motor unit potentials at high frequencies up to 200 Hz. Magnetic resonance imaging of the head showed marked hypertrophy of the left masseter muscle. Biopsy of the hypertrophied masseter muscle was normal. Repeated local injections of botulinum toxin noticeably reduced the size of the hypertrophied muscle as well as improved the patient’s symptoms.

  1. Detection limit of Clostridium botulinum spores in dried mushroom samples sourced from China.

    Science.gov (United States)

    Malakar, Pradeep K; Plowman, June; Aldus, Clare F; Xing, Zengtao; Zhao, Yong; Peck, Michael W

    2013-08-16

    A survey of dried mushrooms (Lentinula edodes (Shiitake) and Auricularia auricula (Wood Ear)) sourced from China was carried out to determine the natural contamination of these mushrooms with spores of proteolytic Clostridium botulinum and non-proteolytic C. botulinum. The mushrooms were collected from supermarkets and retailers in 21 cities in China during October 2008. Spore loads of C. botulinum in mushrooms have a degree of uncertainty and variability and this study contributes valuable data for determining prevalence of spores of C. botulinum in mushrooms. An optimized detection protocol that combined selective enrichment culture with multiplex PCR was used to test for spores of proteolytic and non-proteolytic C. botulinum. Detection limits were calculated, using a maximum likelihood protocol, from mushroom samples inoculated with defined numbers of spores of proteolytic C. botulinum or non-proteolytic C. botulinum. Based on the maximum likelihood detection limit, it is estimated that dried mushroom A. auricula contained <550spores/kg of proteolytic C. botulinum, and <350spores/kg of non-proteolytic C. botulinum. Dried L. edodes contained <1500spores/kg of proteolytic C. botulinum and it was not possible to determine reliable detection limits for spores of non-proteolytic C. botulinum using the current detection protocol.

  2. Botulinum toxin type A products are not interchangeable: a review of the evidence

    Directory of Open Access Journals (Sweden)

    Brin MF

    2014-10-01

    Full Text Available Mitchell F Brin,1,2 Charmaine James,3 John Maltman1 1Allergan, Inc., Irvine, CA, USA; 2Department of Neurology, University of California, Irvine, CA, USA; 3Allergan, Marlow, UKAbstract: Botulinum toxin type A (BoNTA products are injectable biologic medications derived from Clostridium botulinum bacteria. Several different BoNTA products are marketed in various countries, and they are not interchangeable. Differences between products include manufacturing processes, formulations, and the assay methods used to determine units of biological activity. These differences result in a specific set of interactions between each BoNTA product and the tissue injected. Consequently, the products show differences in their in vivo profiles, including preclinical dose response curves and clinical dosing, efficacy, duration, and safety/adverse events. Most, but not all, published studies document these differences, suggesting that individual BoNTA products act differently depending on experimental and clinical conditions, and these differences may not always be predictable. Differentiation through regulatory approvals provides a measure of confidence in safety and efficacy at the specified doses for each approved indication. Moreover, the products differ in the amount of study to which they have been subjected, as evidenced by the number of publications in the peer-reviewed literature and the quantity and quality of clinical studies. Given that BoNTAs are potent biological products that meet important clinical needs, it is critical to recognize that their dosing and product performance are not interchangeable and each product should be used according to manufacturer guidelines.Keywords: onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, glabellar lines, non-interchangeability

  3. Effective local anesthesia for onabotulinumtoxin A injections to treat hyperhidrosis associated with traumatic amputation

    OpenAIRE

    Shi, Lucy L; Sargen, Michael R.; Chen, Suephy C.; Arbiser, Jack L.; Pollack, Brian P.

    2016-01-01

    Background: Botulinum toxin type A (BTX-A) injections are an effective treatment for controlling hyperhidrosis at sites of amputation. Hyperesthesia associated with amputated limbs is a major barrier to performing this procedure under local anesthesia. Objective: To present a novel method for improving local anesthesia with BTX-A injections. Methods & Results: A 29-year-old military veteran with a below-the-knee amputation of his right leg was suf...

  4. Occurrence of human pathogenic Clostridium botulinum among healthy dairy animals: an emerging public health hazard.

    Science.gov (United States)

    Abdel-Moein, Khaled A; Hamza, Dalia A

    2016-01-01

    The current study was conducted to investigate the occurrence of human pathogenic Clostridium botulinum in the feces of dairy animals. Fecal samples were collected from 203 apparently healthy dairy animals (50 cattle, 50 buffaloes, 52 sheep, 51 goats). Samples were cultured to recover C. botulinum while human pathogenic C. botulinum strains were identified after screening of all C. botulinum isolates for the presence of genes that encode toxins type A, B, E, F. The overall prevalence of C. botulinum was 18.7% whereas human pathogenic C. botulinum strains (only type A) were isolated from six animals at the rates of 2, 2, 5.8, and 2% for cattle, buffaloes, sheep, and goats, respectively. High fecal carriage rates of C. botulinum among apparently healthy dairy animals especially type A alarm both veterinary and public health communities for a potential role which may be played by dairy animals in the epidemiology of such pathogen.

  5. NQO1-Knockout Mice Are Highly Sensitive to Clostridium Difficile Toxin A-Induced Enteritis.

    Science.gov (United States)

    Nam, Seung Taek; Hwang, Jung Hwan; Kim, Dae Hong; Lu, Li Fang; Hong, Ji; Zhang, Peng; Yoon, I Na; Hwang, Jae Sam; Chung, Hyo Kyun; Shong, Minho; Lee, Chul-Ho; Kim, Ho

    2016-08-28

    Clostridium difficile toxin A causes acute gut inflammation in animals and humans. It is known to downregulate the tight junctions between colonic epithelial cells, allowing luminal contents to access body tissues and trigger acute immune responses. However, it is not yet known whether this loss of the barrier function is a critical factor in the progression of toxin A-induced pseudomembranous colitis. We previously showed that NADH:quinone oxidoreductase 1 (NQO1) KO (knockout) mice spontaneously display weak gut inflammation and a marked loss of colonic epithelial tight junctions. Moreover, NQO1 KO mice exhibited highly increased inflammatory responses compared with NQO1 WT (wild-type) control mice when subjected to DSS-induced experimental colitis. Here, we tested whether toxin A could also trigger more severe inflammatory responses in NQO1 KO mice compared with NQO1 WT mice. Indeed, our results show that C. difficile toxin A-mediated enteritis is significantly enhanced in NQO1 KO mice compared with NQO1 WT mice. The levels of fluid secretion, villus disruption, and epithelial cell apoptosis were also higher in toxin A-treated NQO1 KO mice compared with WT mice. The previous and present results collectively show that NQO1 is involved in the formation of tight junctions in the small intestine, and that defects in NQO1 enhance C. difficile toxin A-induced acute inflammatory responses, presumably via the loss of epithelial cell tight junctions.

  6. Two-component systems and toxinogenesis regulation in Clostridium botulinum.

    Science.gov (United States)

    Connan, Chloé; Popoff, Michel R

    2015-05-01

    Botulinum neurotoxins (BoNTs) are the most potent toxins ever known. They are mostly produced by Clostridium botulinum but also by other clostridia. BoNTs associate with non-toxic proteins (ANTPs) to form complexes of various sizes. Toxin production is highly regulated through complex networks of regulatory systems involving an alternative sigma factor, BotR, and at least 6 recently described two-component systems (TCSs). TCSs allow bacteria to sense environmental changes and to respond to various stimuli by regulating the expression of specific genes at a transcriptional level. Several environmental stimuli have been identified to positively or negatively regulate toxin synthesis; however, the link between environmental stimuli and TCSs is still elusive. This review aims to highlight the role of TCSs as a central point in the regulation of toxin production in C. botulinum.

  7. The history of Botulinum toxin: from poison to beauty.

    Science.gov (United States)

    França, Katlein; Kumar, Anagha; Fioranelli, Massimo; Lotti, Torello; Tirant, Michael; Roccia, Maria Grazia

    2017-03-15

    Botulinum toxin, also called the "miracle toxin," is a neurotoxin produced by the bacteria Clostridium botulinum. It is known to block nerve signals that contract muscles resulting in a temporary paralysis of the muscles. Toxins type A and B have been extensively studied and utilized in the realm of beauty and cosmetology. Initially, the toxin gained popularity as a disease-causing "poison". It was only later that it found its way to becoming a must have in modern aesthetic practice. Today, this wonder toxin has proven to be an apt and convenient option in the field of anti-aging medicine.

  8. Genomics of Clostridium botulinum group III strains.

    Science.gov (United States)

    Sakaguchi, Yoshihiko; Suzuki, Tomonori; Yamamoto, Yumiko; Nishikawa, Atsushi; Oguma, Keiji

    2015-05-01

    In Clostridium botulinum, the characteristics of type C and D strains are quite different from other types, and they are classified as group III. They produce C2 binary toxin and C3 exoenzyme in addition to type C and D neurotoxins. Two different phages and many plasmids are identified in the organisms. The genes of neurotoxin and C3 exoenzyme are converted from toxigenic strains to non-toxigenic strains by the specific bacteriophages (phages), whereas, the C2 toxin gene is carried by large or small plasmids. Classification of type C and D strains has been in confusion because 1) antigenicity of type C and D neurotoxins is complex, 2) the cells produce two types of toxins, neurotoxin and C2 toxin, and 3) some non-toxigenic strains can be converted to produce C or D neurotoxin by the infection with phages. Until now, entire nucleotide sequences of cell chromosomes, phages, and plasmids have been determined. Since both genetic and protein-chemical analyses have been clarifying the above confusions, these data are reviewed historically.

  9. Endoscopic botox injections in therapy of refractorygastroparesis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Gastroparesis (GP) is a common disease seen in gastroenterologypractice particularly in western countries,and it may be underdiagnosed. The available drugtherapies for this condition are quite disappointing.Botulinum toxin type A (BT) has been found to be effectivetherapy in various spastic disorders of smoothmuscle of gastrointestinal tract. However, the benefitsof BT injections in GP have been unclear. Severalretrospective and open label studies have shown clinicaladvantages of intrapyloric Botulinum toxin type Ainjections, while two small randomized trials did notshow positive results. Therefore, the available publishedstudies yielded conflicting results leading to fading outof botox therapy for GP. We recognize possible clinicalbenefit of BT injections without any disadvantages of thistreatment.We are calling for revisiting the endoscopyguided botox therapy in refractory GP. In this reviewwe discuss important features of these studies pointingout differences in results among them. Differences inpatient selection, doses and method of administrationof botox toxin in the prior studies may be the cause ofconflicting results. The mechanism of action, indications,efficacy and side-effects of BT are reviewed. Finally, werecognize limited evidence to recommend BT in GP andcalling attention for future research in this field since noadvances in drug management had been made in thelast two decades.

  10. Doxycycline Injection

    Science.gov (United States)

    Doxycycline injection is used to treat or prevent bacterial infections, including pneumonia and other respiratory tract infections. ... certain skin, genital, intestine, and urinary system infections. Doxycycline injection may be used to treat or prevent ...

  11. Pembrolizumab Injection

    Science.gov (United States)

    Pembrolizumab injection is used to treat melanoma (a type of skin cancer) that cannot be treated with ... who have a specific type of melanoma tumor. Pembrolizumab injection is also used to treat a certain ...

  12. Lacosamide Injection

    Science.gov (United States)

    ... injection is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in ... older (about 1 in 500 people) who took anticonvulsants like lacosamide injection to treat various conditions during ...

  13. Paclitaxel Injection

    Science.gov (United States)

    ... with other medications. Paclitaxel injection manufactured with polyoxyethylated castor oil is used to treat ovarian cancer (cancer that ... cancer, and lung cancer. Paclitaxel injection with polyoxyethylated castor oil is also used to treat Kaposi's sarcoma (a ...

  14. Obinutuzumab Injection

    Science.gov (United States)

    Obinutuzumab injection is used with chlorambucil (Leukeran) to treat chronic lymphocytic leukemia (CLL; a type of cancer of the white blood cells). Obinutuzumab injection is in a class of medications called ...

  15. Moxifloxacin Injection

    Science.gov (United States)

    ... Moxifloxacin injection may also be used to treat bronchitis or sinus infections but should not be used for these conditions if there are other treatment options available.Moxifloxacin injection is in a class ...

  16. Temozolomide Injection

    Science.gov (United States)

    Temozolomide is used to treat certain types of brain tumors. Temozolomide is in a class of medications called alkylating ... Temozolomide injection comes as a powder to be added to fluid and injected over 90 minutes intravenously ( ...

  17. Midazolam Injection

    Science.gov (United States)

    ... injection is in a class of medications called benzodiazepines. It works by slowing activity in the brain ... breast-feeding.talk to your doctor about the risks and benefits of receiving midazolam injection if you ...

  18. Methotrexate Injection

    Science.gov (United States)

    Methotrexate injection is used alone or in combination with other medications to treat gestational trophoblastic tumors (a ... in bones) after surgery to remove the tumor. Methotrexate injection is also used to treat severe psoriasis ( ...

  19. Doripenem Injection

    Science.gov (United States)

    ... injection is in a class of medications called carbapenem antibiotics. It works by killing bacteria.Antibiotics such ... if you are allergic to doripenem injection; other carbapenem antibiotics such as imipenem/cilastatin (Primaxin) or meropenem ( ...

  20. Cefotaxime Injection

    Science.gov (United States)

    Cefotaxime injection is used to treat certain infections caused by bacteria including pneumonia and other lower respiratory ... skin, blood, bone, joint, and urinary tract infections. Cefotaxime injection may also be used before surgery, and ...

  1. Bendamustine Injection

    Science.gov (United States)

    Bendamustine injection is used to treat chronic lymphocytic leukemia (CLL; a type of cancer of the white ... injection. You should use birth control to prevent pregnancy in yourself or your partner during your treatment ...

  2. Caspofungin Injection

    Science.gov (United States)

    Caspofungin injection is used in adults and children 3 months of age and older to treat yeast ... people with a weakened ability to fight infection. Caspofungin injection is in a class of antifungal medications ...

  3. Estrogen Injection

    Science.gov (United States)

    The estradiol cypionate and estradiol valerate forms of estrogen injection are used to treat hot flushes (hot ... should consider a different treatment. These forms of estrogen injection are also sometimes used to treat the ...

  4. Spasmodic dysphonia follow-up with videolaryngoscopy and voice spectrography during treatment with botulinum toxin.

    Science.gov (United States)

    Esposito, Marcello; Dubbioso, R; Apisa, P; Allocca, R; Santoro, L; Cesari, U

    2015-09-01

    Spasmodic dysphonia (SD) is a focal dystonia of laryngeal muscles seriously impairing quality of voice. Adductor SD (ADSD) is the most common presentation of this disorder that can be identified by specialized phoniatricians and neurologists firstly on a clinical evaluation and then confirmed by videolaryngoscopy (VL). Botulinum toxin (BTX) injection with electromyographic guidance in muscles around vocal cords is the most effective treatment. Voice Handicap Index (VHI) questionnaire is the main tool to assess dysphonia and response to treatment. Objective of this study is to perform VL and voice spectrography (VS) to confirm the efficacy of BTX injections over time. 13 patients with ADSD were studied with VHI, VL and VS before and after 4 consecutive treatment with onobotulinumtoxin-A. For each treatment vocal improvement was proved by a significant reduction of VHI score and increase of maximum time phonation and harmonic-to-noise ratio while VL showed the absence of spasm in most of patients. No change of the response to BTX was found between injections. This study supports the efficacy of the treatment of SD with BTX with objective measurements and suggests that the efficacy of recurring treatments is stable over time.

  5. A Pilot Study of Botulinum Toxin for Jerky, Position-Specific, Upper Limb Action Tremor

    Science.gov (United States)

    Saifee, Tabish A.; Teodoro, Tiago; Erro, Roberto; Edwards, Mark J.; Cordivari, Carla

    2016-01-01

    Background We aimed to investigate the efficacy and safety of botulinum toxin (BT) injections for jerky action tremor of the upper limb. Methods We performed an uncontrolled, prospective study of electromyography (EMG)-guided BT injections for jerky, position-specific, upper limb action tremor. The primary outcome was clinical global impression at 3–6 weeks after baseline. Results Eight patients with jerky, position-specific action tremor involving the upper limb were consecutively recruited. After a median follow-up of 4.4 weeks (interquartile range [IQR] 3.6–6 weeks), four of them rated themselves as “improved” and two as “much improved.” Five of these six subjects reported improvements in specific activities of daily living (bringing liquids to mouth, feeding, shaving, and dressing). Upper limb subscore of the Fahn–Tolosa–Marin Tremor Rating Scale (FTM) significantly decreased from 4.5 (4–6) to 3 (2–5) (p = 0.01). Discussion This pilot, prospective cohort study suggests that EMG-guided BT injections may improve jerky, position-specific, upper limb action tremor. Placebo-controlled studies evaluating larger samples of patients are warranted to confirm these findings. PMID:27818844

  6. Evaluation of voice quality in adductor spasmodic dysphonia before and after botulinum toxin treatment.

    Science.gov (United States)

    Langeveld, T P; van Rossum, M; Houtman, E H; Zwinderman, A H; Briaire, J J; Baatenburg de Jong, R J

    2001-07-01

    In this prospective study, the efficacy of botulinum toxin (Botox) injections in patients with adductor spasmodic dysphonia (AdSD) was assessed by 3 different modalities: perceptual and acoustic analyses and subjective self-assessment. This was done by comparing AdSD patients' pretreatment and posttreatment values and comparing these values with those of normal control speakers. In contrast to most other studies, the posttreatment status was defined as the optimal voice quality as judged by the patient. The aim of the study was to assess to what extent Botox injections actually improve voice quality and function. The AdSD subjects rated a significantly improved voice quality and function after Botox treatment. However, the results were never within normal limits. Perceptually, the characteristic and severely impaired AdSD voice improved, but another "type" of pathological voice was detected after Botox treatment. Acoustic analyses demonstrated a significant improvement, as well. Nevertheless, the "optimally" treated AdSD voice still remained significantly deviant as compared to normal voice production. Currently, Botox injection is the therapy of first choice for AdSD. Although significant improvement could be measured in our study perceptually, acoustically, and subjectively, the optimal voice that was achieved never fully matched normal voice quality or function.

  7. Combinatorial Strategies and Hypothesis-Based Drug Design in Drug Discovery Targeted to the Protease and Channel Activities of Botulinum Toxin A

    Science.gov (United States)

    2000-02-01

    endoproteases produced by bacteria of the genus 11 Present address: Centro de Biologia Molecular y Celular, Universi- Clostridium, because they...Present address: Centro de Biologia Molecular y Celular, Universidad chem (La Jolla, CA) or Peninsula Laboratories (Belmont, CA). Sol- Miguel Herndndez... Biologia Molecular y Celular. Universidad Miguel Hernmndez. 03206 Elche. Spain. (2)Instituto de Neurociencias. Universidad Miguel Hern~ndez. 03206

  8. Safety and efficacy of botox injection in alleviating post-operative pain and improving quality of life in lower extremity limb lengthening and deformity correction

    Directory of Open Access Journals (Sweden)

    Finley Allen

    2007-09-01

    Full Text Available Abstract Background Distraction osteogenesis is the standard treatment for the management of lower limb length discrepancy of more than 3 cm and bone loss secondary to congenital anomalies, trauma or infection. This technique consists of an osteotomy of the bone to be lengthened, application of an external fixator, followed by gradual and controlled distraction of the bone ends. Although limb lengthening using the Ilizarov distraction osteogenesis principle yields excellent results in most cases, the technique has numerous problems and is not well tolerated by many children. The objective of the current study is to determine if Botulinum Toxin A (BTX-A, which is known to possess both analgesic and paralytic actions, can be used to alleviate post-operative pain and improve the functional outcome of children undergoing distraction osteogenesis. Methods/Design The study design consists of a multi centre, randomized, double-blinded, placebo-controlled trial. Patients between ages 5–21 years requiring limb lengthening or deformity correction using distraction will be recruited from 6 different sites (Shriners Hospital for Children in Montreal, Honolulu, Philadelphia and Portland as well as DuPont Hospital for Children in Wilmington, Delaware and Hospital for Sick Children in Toronto, Ont. Approximately 150 subjects will be recruited over 2 years and will be randomized to either receive 10 units per Kg of BTX-A or normal saline (control group intraoperatively following the surgery. Functional outcome effects will be assessed using pain scores, medication dosages, range of motion, flexibility, strength, mobility function and quality of life of the patient. IRB approval was obtained from all sites and adverse reactions will be monitored vigorously and reported to IRB, FDA and Health Canada. Discussion BTX-A injection has been widely used world wide with no major side effects reported. However, to the best of our knowledge, this is the first time BTX

  9. Organization and regulation of the neurotoxin genes in Clostridium botulinum and Clostridium tetani.

    Science.gov (United States)

    Raffestin, Stéphanie; Marvaud, Jean Christophe; Cerrato, Rosario; Dupuy, Bruno; Popoff, Michel R

    2004-04-01

    Botulinum and tetanus neurotoxins are structurally and functionally related 150 kDa proteins that are potent inhibitors of neuroexocytosis. Botulinum neurotoxin associates with non-toxic proteins to form complexes of various sizes. The botulinum neurotoxin and non-toxic protein genes are clustered in a DNA segment called the botulinum locus. This locus is probably located on a mobile or degenerate mobile element, which accounts for the various genomic localizations (chromosome, plasmid, phage) in different Clostridium botulinum types. The botulinum neurotoxin and non-toxic protein genes are organized in two polycistronic operons (ntnh-bont and ha operons) transcribed in opposite orientations. The gene that separates the two operons of the botulinum locus in C. botulinum A encodes a 21 kDa protein BotR/A, which is a positive regulator of the expression of the botulinum locus genes. Similarly, in Clostridium tetani, the gene located immediately upstream of the tetanus toxin gene, encodes a positive regulatory protein, TetR. BotR and TetR are possibly alternative sigma factors related to TxeR and UviA, which regulate C. difficile toxin and C. perfringens bacteriocin production, respectively. TxeR and UviA define a new sub-group of the sigma(70) family of RNA polymerase initiation factors. In addition, the C. botulinum genome contains predicted two-component system genes, some of which are possibly involved in regulation of toxinogenesis.

  10. Ranitidine Injection

    Science.gov (United States)

    Ranitidine injection comes as a solution (liquid) to be mixed with another fluid and injected intravenously (into a vein) over 5 to 20 minutes. Ranitidine may also be injected into a muscle. It is usually given every 6 to 8 hours, but may also be given ...

  11. Ustekinumab Injection

    Science.gov (United States)

    ... Do not inject into an area where the skin is tender, bruised, red, or hard or where you have scars or stretch marks.Your doctor or pharmacist will ... injection.you should know that ustekinumab injection may decrease your ability ... new or changing skin lesions, minor infections (such as open cuts or ...

  12. Holotoxin Activity of Botulinum Neurotoxin Subtype A4 Originating from a Nontoxigenic Clostridium botulinum Expression System.

    Science.gov (United States)

    Bradshaw, Marite; Tepp, William H; Whitemarsh, Regina C M; Pellett, Sabine; Johnson, Eric A

    2014-12-01

    Clostridium botulinum subtype A4 neurotoxin (BoNT/A4) is naturally expressed in the dual-toxin-producing C. botulinum strain 657Ba at 100× lower titers than BoNT/B. In this study, we describe purification of recombinant BoNT/A4 (rBoNT/A4) expressed in a nonsporulating and nontoxigenic C. botulinum expression host strain. The rBoNT/A4 copurified with nontoxic toxin complex components provided in trans by the expression host and was proteolytically cleaved to the active dichain form. Activity of the recombinant BoNT/A4 in mice and in human neuronal cells was about 1,000-fold lower than that of BoNT/A1, and the recombinant BoNT/A4 was effectively neutralized by botulism heptavalent antitoxin. A previous report using recombinant truncated BoNT/A4 light chain (LC) expressed in Escherichia coli has indicated reduced stability and activity of BoNT/A4 LC compared to BoNT/A1 LC, which was surmounted by introduction of a single-amino-acid substitution, I264R. In order to determine whether this mutation would also affect the holotoxin activity of BoNT/A4, a recombinant full-length BoNT/A4 carrying this mutation as well as a second mutation predicted to increase solubility (L260F) was produced in the clostridial expression system. Comparative analyses of the in vitro, cellular, and in vivo activities of rBoNT/A4 and rBoNT/A4-L260F I264R showed 1,000-fold-lower activity than BoNT/A1 in both the mutated and nonmutated BoNT/A4. This indicates that these mutations do not alter the activity of BoNT/A4 holotoxin. In summary, a recombinant BoNT from a dual-toxin-producing strain was expressed and purified in an endogenous clostridial expression system, allowing analysis of this toxin.

  13. Genetic Diversity Among Botulinum Neurotoxin-Producing Clostridial Strains

    Science.gov (United States)

    2007-02-01

    fragment length polymorphism analysis of Norwegian Bacillus cereus and Bacillus thuringiensis soil isolates. Appl. Environ. Microbiol. 67:4863–4873...isolation and purification. Individual bacterial colonies of each of the C. botulinum strains were removed from anaerobic CDC blood agar plates and

  14. Calf muscle volume estimates: Implications for Botulinum toxin treatment?

    DEFF Research Database (Denmark)

    Bandholm, Thomas Quaade; Sonne-Holm, Stig; Thomsen, Carsten;

    2007-01-01

    An optimal botulinum toxin dose may be related to the volume of the targeted muscle. We investigated the suitability of using ultrasound and anthropometry to estimate gastrocnemius and soleus muscle volume. Gastrocnemius and soleus muscle thickness was measured in 11 cadaveric human legs, using u...

  15. Botulinum toxins: mechanisms of action, antinociception and clinical applications.

    Science.gov (United States)

    Wheeler, Anthony; Smith, Howard S

    2013-04-05

    Botulinum toxin (BoNT) is a potent neurotoxin that is produced by the gram-positive, spore-forming, anaerobic bacterium, Clostridum botulinum. There are 7 known immunologically distinct serotypes of BoNT: types A, B, C1, D, E, F, and G. Clostridum neurotoxins are produced as a single inactive polypeptide chain of 150kDa, which is cleaved by tissue proteinases into an active di-chain molecule: a heavy chain (H) of ∼100 kDa and a light chain (L) of ∼50 kDa held together by a single disulfide bond. Each serotype demonstrates its own varied mechanisms of action and duration of effect. The heavy chain of each BoNT serotype binds to its specific neuronal ecto-acceptor, whereby, membrane translocation and endocytosis by intracellular synaptic vesicles occurs. The light chain acts to cleave SNAP-25, which inhibits synaptic exocytosis, and therefore, disables neural transmission. The action of BoNT to block the release of acetylcholine botulinum toxin at the neuromuscular junction is best understood, however, most experts acknowledge that this effect alone appears inadequate to explain the entirety of the neurotoxin's apparent analgesic activity. Consequently, scientific and clinical evidence has emerged that suggests multiple antinociceptive mechanisms for botulinum toxins in a variety of painful disorders, including: chronic musculoskeletal, neurological, pelvic, perineal, osteoarticular, and some headache conditions.

  16. Biosynthesis of a thiamin antivitamin in Clostridium botulinum.

    Science.gov (United States)

    Cooper, Lisa E; O'Leary, Seán E; Begley, Tadhg P

    2014-04-15

    Bacimethrin-derived 2'-methoxythiamin pyrophosphate inhibits microbial growth by disrupting metabolic pathways dependent on thiamin-utilizing enzymes. This study describes the discovery of the bacimethrin biosynthetic gene cluster of Clostridium botulinum A ATCC 19397 and in vitro reconstitution of bacimethrin biosynthesis from cytidine 5'-monophosphate.

  17. CRYSTAL STRUCTURE OF CLOSTRIDIUM BOTULINUM NEUROTOXIN SEROTYPE B.

    Energy Technology Data Exchange (ETDEWEB)

    SWAMINATHAN,S.; ESWARAMOORTHY,S.

    2001-11-19

    The toxigenic strains of Clostridium botulinum produce seven serologically distinct types of neurotoxins labeled A - G (EC 3.4.24.69), while Clostridium tetani produces tetanus neurotoxin (EC 3.4.24.68). Botulinum and tetanus neurotoxins (BoNTs and TeNT) are produced as single inactive chains of molecular mass of approximately 150 kDa. Most of these neurotoxins are released after being cleaved into two chains, a heavy chain (HI) of 100 kDa and a light chain (L) of 50 kDa held together by an interchain disulfide bond, by tissue proteinases. BoNT/E is released as a single chain but cleaved by host proteinases [1]. Clostvidium botulinum neurotoxins are extremely poisonous proteins with their LD{sub 50} for humans in the range of 0.1 - 1 ng kg{sup -1} [2]. Botulinum neurotoxins are responsible for neuroparalytic syndromes of botulism characterized by serious neurological disorders and flaccid paralysis. BoNTs block the release of acetylcholine at the neuromuscular junction causing flaccid paralysis while TeNT blocks the release of neurotransmitters like glycine and {gamma}-aminobutyric acid (GABA) in the inhibitory interneurons of the spinal cord resulting in spastic paralysis. In spite of different clinical symptoms, their aetiological agents intoxicate neuronal cells in the same way and these toxins have similar structural organization [3].

  18. Centrifugal microfluidic platform for ultrasensitive detection of Botulinum Toxin

    Science.gov (United States)

    Botulinum neurotoxin – a global public health threat and category A bioterrorism agent - is the most toxic substance known and one of the most challenging toxins to detect due to its lethality at extremely low concentrations. Hence the live-mouse bioassay because of its superior sensitivity, remains...

  19. Botulinum Neurotoxin Serotypes Detected by Electrochemical Impedance Spectroscopy

    Science.gov (United States)

    Savage, Alison C.; Buckley, Nicholas; Halliwell, Jennifer; Gwenin, Christopher

    2015-01-01

    Botulinum neurotoxin is one of the deadliest biological toxins known to mankind and is able to cause the debilitating disease botulism. The rapid detection of the different serotypes of botulinum neurotoxin is essential for both diagnosis of botulism and identifying the presence of toxin in potential cases of terrorism and food contamination. The modes of action of botulinum neurotoxins are well-established in literature and differ for each serotype. The toxins are known to specifically cleave portions of the SNARE proteins SNAP-25 or VAMP; an interaction that can be monitored by electrochemical impedance spectroscopy. This study presents a SNAP-25 and a VAMP biosensors for detecting the activity of five botulinum neurotoxin serotypes (A–E) using electrochemical impedance spectroscopy. The biosensors are able to detect concentrations of toxins as low as 25 fg/mL, in a short time-frame compared with the current standard methods of detection. Both biosensors show greater specificity for their compatible serotypes compared with incompatible serotypes and denatured toxins. PMID:25954998

  20. Botulinum Neurotoxin Serotypes Detected by Electrochemical Impedance Spectroscopy

    Directory of Open Access Journals (Sweden)

    Alison C. Savage

    2015-05-01

    Full Text Available Botulinum neurotoxin is one of the deadliest biological toxins known to mankind and is able to cause the debilitating disease botulism. The rapid detection of the different serotypes of botulinum neurotoxin is essential for both diagnosis of botulism and identifying the presence of toxin in potential cases of terrorism and food contamination. The modes of action of botulinum neurotoxins are well-established in literature and differ for each serotype. The toxins are known to specifically cleave portions of the SNARE proteins SNAP-25 or VAMP; an interaction that can be monitored by electrochemical impedance spectroscopy. This study presents a SNAP-25 and a VAMP biosensors for detecting the activity of five botulinum neurotoxin serotypes (A–E using electrochemical impedance spectroscopy. The biosensors are able to detect concentrations of toxins as low as 25 fg/mL, in a short time-frame compared with the current standard methods of detection. Both biosensors show greater specificity for their compatible serotypes compared with incompatible serotypes and denatured toxins.

  1. Efficacy and safety of botulinum toxin in treatment of anismus: A systematic review

    Institute of Scientific and Technical Information of China (English)

    Sameh Hany Emile; Hossam Ayman Elfeki; Hosam Ghazy Elbanna; Mohamed Youssef; Waleed Thabet; Tito M Abd El-Hamed; Basem Said; Ahmed Lotfy

    2016-01-01

    AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases including: Pub Med/MEDLINE, and Cochrane Central Register of Control ed Trials, also an internet-based search using "Google Scholar" service was conducted. Both comparative and observational studies were included. We excluded irrelevant articles, editorials, case reports, reviews, and meta-analyses. The studies that followed the patients less than 6 mo were excluded. Variables collected were demographic data of the patients, technique of BTX-A injection and number of sessions, short-term and longterm clinical improvement, post-injection changes in electromyography(EMG), defecography, manometry, and balloon expulsion test, and complications recorded after BTX-A injection.RESULTS: Seven studies comprising 189 patients were included in the review. The median age of the patients was 41.2 years and female-to-male ratio was 1.3:1. The median dose of BTX-A injected per procedure was 100 IU(range, 20-100 IU). Lateral injection was done in five trails and combined lateral and posterior injections in two trials. Three studies used endorectal ultrasonographyguided technique, one study used EMG-guided technique,whereas the remaining three studies used manual palpation with the index finger. The median percentage of patients who reported initial improvement of symptoms was 77.4%(range 37.5%-86.7%), this percentage declined to a median of 46%(range 25%-100%) at 4 mo after injection of BTX-A. Rates of improvement evaluated by balloon expulsion test, EMG, and defecography ranged between(37.5%-80%),(54%-86.7%), and(25%-86.6%), respectively. Fourteen(7.4%) patients developed complications after injection of BTX-A. Complication rates across the studies ranged from 0% to 22.6%. CONCLUSION: Initial satisfactory improvement of symptoms after BTX-A injection remarkably

  2. Structures of Clostridium Botulinum Neurotoxin Serotype A Light Chain Complexed with Small-Molecule Inhibitors Highlight Active-Site Flexibility

    Energy Technology Data Exchange (ETDEWEB)

    Silvaggi,N.; Boldt, G.; Hixon, M.; Kennedy, J.; Tzipori, S.; Janda, K.; Allen, K.

    2007-01-01

    The potential for the use of Clostridial neurotoxins as bioweapons makes the development of small-molecule inhibitors of these deadly toxins a top priority. Recently, screening of a random hydroxamate library identified a small-molecule inhibitor of C. botulinum Neurotoxin Serotype A Light Chain (BoNT/A-LC), 4-chlorocinnamic hydroxamate, a derivative of which has been shown to have in vivo efficacy in mice and no toxicity. We describe the X-ray crystal structures of BoNT/A-LC in complexes with two potent small-molecule inhibitors. The structures of the enzyme with 4-chlorocinnamic hydroxamate or 2,4-dichlorocinnamic hydroxamate bound are compared to the structure of the enzyme complexed with L-arginine hydroxamate, an inhibitor with modest affinity. Taken together, this suite of structures provides surprising insights into the BoNT/A-LC active site, including unexpected conformational flexibility at the S1' site that changes the electrostatic environment of the binding pocket. Information gained from these structures will inform the design and optimization of more effective small-molecule inhibitors of BoNT/A-LC.

  3. EGA Protects Mammalian Cells from Clostridium difficile CDT, Clostridium perfringens Iota Toxin and Clostridium botulinum C2 Toxin.

    Science.gov (United States)

    Schnell, Leonie; Mittler, Ann-Katrin; Sadi, Mirko; Popoff, Michel R; Schwan, Carsten; Aktories, Klaus; Mattarei, Andrea; Azarnia Tehran, Domenico; Montecucco, Cesare; Barth, Holger

    2016-04-01

    The pathogenic bacteria Clostridium difficile, Clostridium perfringens and Clostridium botulinum produce the binary actin ADP-ribosylating toxins CDT, iota and C2, respectively. These toxins are composed of a transport component (B) and a separate enzyme component (A). When both components assemble on the surface of mammalian target cells, the B components mediate the entry of the A components via endosomes into the cytosol. Here, the A components ADP-ribosylate G-actin, resulting in depolymerization of F-actin, cell-rounding and eventually death. In the present study, we demonstrate that 4-bromobenzaldehyde N-(2,6-dimethylphenyl)semicarbazone (EGA), a compound that protects cells from multiple toxins and viruses, also protects different mammalian epithelial cells from all three binary actin ADP-ribosylating toxins. In contrast, EGA did not inhibit the intoxication of cells with Clostridium difficile toxins A and B, indicating a possible different entry route for this toxin. EGA does not affect either the binding of the C2 toxin to the cells surface or the enzyme activity of the A components of CDT, iota and C2, suggesting that this compound interferes with cellular uptake of the toxins. Moreover, for C2 toxin, we demonstrated that EGA inhibits the pH-dependent transport of the A component across cell membranes. EGA is not cytotoxic, and therefore, we propose it as a lead compound for the development of novel pharmacological inhibitors against clostridial binary actin ADP-ribosylating toxins.

  4. Universal and specific quantitative detection of botulinum neurotoxin genes

    Directory of Open Access Journals (Sweden)

    Arnon Stephen S

    2010-10-01

    Full Text Available Abstract Background Clostridium botulinum, an obligate anaerobic spore-forming bacterium, produces seven antigenic variants of botulinum toxin that are distinguished serologically and termed "serotypes". Botulinum toxin blocks the release of acetylcholine at neuromuscular junctions resulting in flaccid paralysis. The potential lethality of the disease warrants a fast and accurate means of diagnosing suspected instances of food contamination or human intoxication. Currently, the Food and Drug Administration (FDA-accepted assay to detect and type botulinum neurotoxins (BoNTs is the mouse protection bioassay. While specific and sensitive, this assay requires the use of laboratory animals, may take up to four days to achieve a diagnosis, and is unsuitable for high-throughput analysis. We report here a two-step PCR assay that identifies all toxin types, that achieves the specificity of the mouse bioassay while surpassing it in equivalent sensitivity, that has capability for high-throughput analysis, and that provides quantitative results within hours. The first step of our assay consists of a conventional PCR that detects the presence of C. botulinum regardless of the neurotoxin type. The second step uses quantitative PCR (qPCR technology to determine the specific serotype of the neurotoxin. Results We assayed purified C. botulinum DNA and crude toxin preparations, as well as food and stool from healthy individuals spiked with purified BoNT DNA, and one stool sample from a case of infant botulism for the presence of the NTNH gene, which is part of the BoNT gene cluster, and for the presence of serotype-specific BoNT genes. The PCR surpassed the mouse bioassay both in specificity and sensitivity, detecting positive signals in BoNT preparations containing well below the 1 LD50 required for detection via the mouse bioassay. These results were type-specific and we were reliably able to quantify as few as 10 genomic copies. Conclusions While other studies

  5. Botulinum Toxin Type a as a Therapeutic Agent against Headache and Related Disorders.

    Science.gov (United States)

    Luvisetto, Siro; Gazerani, Parisa; Cianchetti, Carlo; Pavone, Flaminia

    2015-09-01

    Botulinum neurotoxin A (BoNT/A) is a toxin produced by the naturally-occurring Clostridium botulinum that causes botulism. The potential of BoNT/A as a useful medical intervention was discovered by scientists developing a vaccine to protect against botulism. They found that, when injected into a muscle, BoNT/A causes a flaccid paralysis. Following this discovery, BoNT/A has been used for many years in the treatment of conditions of pathological muscle hyperactivity, like dystonias and spasticities. In parallel, the toxin has become a "glamour" drug due to its power to ward off facial wrinkles, particularly frontal, due to the activity of the mimic muscles. After the discovery that the drug also appeared to have a preventive effect on headache, scientists spent many efforts to study the potentially-therapeutic action of BoNT/A against pain. BoNT/A is effective at reducing pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain and bladder pain. In 2010, regulatory approval for the treatment of chronic migraine with BoNT/A was given, notwithstanding the fact that the mechanism of action is still not completely elucidated. In the present review, we summarize experimental evidence that may help to clarify the mechanisms of action of BoNT/A in relation to the alleviation of headache pain, with particular emphasis on preclinical studies, both in animals and humans. Moreover, we summarize the latest clinical trials that show evidence on headache conditions that may obtain benefits from therapy with BoNT/A.

  6. Journal of Tissue Engineering and Reconstructive Surgery%Botulinum Toxin Type A for Lower Facial Rejuvenation

    Institute of Scientific and Technical Information of China (English)

    潘本耘(综述); 王丹茹(审校)

    2016-01-01

    维持下面部的紧致轮廓,是东方女性面部年轻化的重点诉求,多数人倾向于选择微创、低风险的治疗方式。近20年来,无创注射A型肉毒毒素,因相对微创、保守及可逆化而广受青睐,被广泛用于上、中面部的年轻化。而为了追求整体面部轮廓的协调,A型肉毒毒素在下面部年轻化中的应用更是受到广泛关注。我们就A型肉毒毒素在下面部年轻化中的应用进展进行综述。%[Summary] How to keep the firm lower facial contour along with the gradually aging process is the major point that Asian women focus on. They are seeking for an minimally invasive and less risky approach, compared with the traditional surgery. The past two decades has seen the botulinum toxin type A (BTX-A) injection as a relatively noninvasive, conservative, and reversible preferred method for women who seek for beauty. The application of BTX-A in upper and mid face has been widely accepted. The use of BTX-A in the lower face has been attracting more and more attention for harmonious lineament. In this paper, the research progress of Botulinum toxin type A for lower facial rejuvenation was reviewed.

  7. Botulinum Toxin Type A as a Therapeutic Agent against Headache and Related Disorders

    Directory of Open Access Journals (Sweden)

    Siro Luvisetto

    2015-09-01

    Full Text Available Botulinum neurotoxin A (BoNT/A is a toxin produced by the naturally-occurring Clostridium botulinum that causes botulism. The potential of BoNT/A as a useful medical intervention was discovered by scientists developing a vaccine to protect against botulism. They found that, when injected into a muscle, BoNT/A causes a flaccid paralysis. Following this discovery, BoNT/A has been used for many years in the treatment of conditions of pathological muscle hyperactivity, like dystonias and spasticities. In parallel, the toxin has become a “glamour” drug due to its power to ward off facial wrinkles, particularly frontal, due to the activity of the mimic muscles. After the discovery that the drug also appeared to have a preventive effect on headache, scientists spent many efforts to study the potentially-therapeutic action of BoNT/A against pain. BoNT/A is effective at reducing pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain and bladder pain. In 2010, regulatory approval for the treatment of chronic migraine with BoNT/A was given, notwithstanding the fact that the mechanism of action is still not completely elucidated. In the present review, we summarize experimental evidence that may help to clarify the mechanisms of action of BoNT/A in relation to the alleviation of headache pain, with particular emphasis on preclinical studies, both in animals and humans. Moreover, we summarize the latest clinical trials that show evidence on headache conditions that may obtain benefits from therapy with BoNT/A.

  8. Glucosylation Drives the Innate Inflammatory Response to Clostridium difficile Toxin A.

    Science.gov (United States)

    Cowardin, Carrie A; Jackman, Brianna M; Noor, Zannatun; Burgess, Stacey L; Feig, Andrew L; Petri, William A

    2016-08-01

    Clostridium difficile is a major, life-threatening hospital-acquired pathogen that causes mild to severe colitis in infected individuals. The tissue destruction and inflammation which characterize C. difficile infection (CDI) are primarily due to the Rho-glucosylating toxins A and B. These toxins cause epithelial cell death and induce robust inflammatory signaling by activating the transcription factor NF-κB, leading to chemokine and cytokine secretion. The toxins also activate the inflammasome complex, which leads to secretion of the pyrogenic cytokine IL-1β. In this study, we utilized glucosylation-deficient toxin A to show that activation of the inflammasome by this toxin is dependent on Rho glucosylation, confirming similar findings reported for toxin B. We also demonstrated that tissue destruction and in vivo inflammatory cytokine production are critically dependent on the enzymatic activity of toxin A, suggesting that inhibiting toxin glucosyltransferase activity may be effective in combating this refractory disease.

  9. Hemagglutinin gene shuffling among Clostridium botulinum serotypes C and D yields distinct sugar recognition of the botulinum toxin complex.

    Science.gov (United States)

    Miyata, Keita; Suzuki, Tomonori; Hayashi, Shintaro; Miyashita, Shin-Ichiro; Ohyama, Tohru; Niwa, Koichi; Watanabe, Toshihiro; Sagane, Yoshimasa

    2015-10-01

    Clostridium botulinum strains produce a large-sized toxin complex (TC) that is composed of botulinum neurotoxin (BoNT), non-toxic non-hemagglutinin and three different hemagglutinins (HA-70, HA-33 and HA-17). HA components enhance toxin delivery across the intestinal cell wall in a sugar chain-dependent manner. Here we characterized the sugar recognition of serotype D strain 1873 (D-1873) botulinum L-TC. Most L-TCs produced by serotype C and D strains bind to cells via interactions between HA-33 and cell surface sialo-oligosaccharides. However, like the previously reported L-TC produced by serotype C strain Yoichi (C-Yoichi), D-1873 L-TC binds only to cells that have been treated with neuraminidase, indicating that they recognize asialo-oligosaccharides. The D-1873 HA-33 amino acid sequence is similar to that of C-Yoichi, but had lower similarity to the majority of serotype C and D HA-33s. A comparison of TC component primary structures for 12 serotype C and D strains suggested that at least three types of HA-33 genes exist, and these are shuffled among the serotype C and D strains independently of BoNT serotype. This shuffling produces the distinct sugar recognition of serotype C and D botulinum TCs.

  10. Presence of Clostridium botulinum and botulinum toxin in milk and udder tissue of dairy cows with suspected botulism.

    Science.gov (United States)

    Böhnel, H; Gessler, F

    2013-04-13

    Clostridium botulinum is an anaerobic spore-forming bacterium prevalent in the environment, and causes botulism in man and animals via toxins. Dairy cattle may be contaminated or infected by feed, water or other environmental factors. Milk may also carry the pathogen. Hence, milk and udder samples need to be tested. The number of clinical cases of bovine botulism in Germany has been increasing since the mid-1990s. Besides routine samples, additional 99 milk samples from 37 farms, and 51 udder samples from 51 farms from sick animals presumably affected by botulism were tested microbiologically by the mouse bioassay. Milk from three farms (8.1 per cent) contained botulinum toxin, and from two (5.4 per cent) bacterial states of C botulinum. Ten udder samples (19.6 per cent) contained toxin, and 7 (13.7 per cent) bacterial forms, including one case where both toxin and bacteria were found. The findings are discussed. Positive milk samples containing botulinum toxin or bacteria raise concern of food safety for the human consumer. Pathological udder samples may show either infection prior to, or contamination after death.

  11. Characterization of rabbit ileal receptors for Clostridium difficile toxin A. Evidence for a receptor-coupled G protein

    Energy Technology Data Exchange (ETDEWEB)

    Pothoulakis, C.; LaMont, J.T.; Eglow, R.; Gao, N.; Rubins, J.B.; Theoharides, T.C.; Dickey, B.F. (Boston Univ. School of Medicine, MA (USA))

    1991-07-01

    The purpose of this study was to characterize the surface receptor for toxin A, the enterotoxin from Clostridium difficile, on rabbit intestinal brush borders (BB) and on rat basophilic leukemia (RBL) cells. Purified toxin A was radiolabeled using a modified Bolton-Hunter method to sp act 2 microCi/micrograms, with retention of full biologic activity. 3H-Toxin A bound specifically to a single class of receptors on rabbit BB and on RBL cells with dissociation constants of 5.4 x 10(-8) and 3.5 x 10(-8) M, respectively. RBL cells were highly sensitive to toxin A (cell rounding) and had 180,000 specific binding sites per cell, whereas IMR-90 fibroblasts were far less sensitive to toxin A and lacked detectable specific binding sites. Exposure of BB to trypsin or chymotrypsin significantly reduced 3H-toxin A specific binding. Preincubation of BB with Bandeirea simplicifolia (BS-1) lectin also reduced specific binding, and CHAPS-solubilized receptors could be immobilized with WGA-agarose. The addition of 100 nM toxin A accelerated the association of 35S-GTP gamma S with rabbit ileal BB, and preincubation of BB with the GTP analogues GTP gamma S or Gpp(NH)p, significantly reduced 3H-toxin A specific binding. Our data indicate that the membrane receptor for toxin A is a galactose and N-acetyl-glucosamine-containing glycoprotein which appears to be coupled to a G protein.

  12. Diversity of the Germination Apparatus in Clostridium botulinum Groups I, II, III, and IV

    Science.gov (United States)

    Brunt, Jason; van Vliet, Arnoud H. M.; van den Bos, Fédor; Carter, Andrew T.; Peck, Michael W.

    2016-01-01

    Clostridium botulinum is a highly dangerous pathogen that forms very resistant endospores that are ubiquitous in the environment, and which, under favorable conditions germinate to produce vegetative cells that multiply and form the exceptionally potent botulinum neurotoxin. To improve the control of botulinum neurotoxin-forming clostridia, it is important to understand the mechanisms involved in spore germination. Here we present models for spore germination in C. botulinum based on comparative genomics analyses, with C. botulinum Groups I and III sharing similar pathways, which differ from those proposed for C. botulinum Groups II and IV. All spores germinate in response to amino acids interacting with a germinant receptor, with four types of germinant receptor identified [encoded by various combinations of gerA, gerB, and gerC genes (gerX)]. There are three gene clusters with an ABC-like configuration; ABC [gerX1], ABABCB [gerX2] and ACxBBB [gerX4], and a single CA-B [gerX3] gene cluster. Subtypes have been identified for most germinant receptor types, and the individual GerX subunits of each cluster show similar grouping in phylogenetic trees. C. botulinum Group I contained the largest variety of gerX subtypes, with three gerX1, three gerX2, and one gerX3 subtypes, while C. botulinum Group III contained two gerX1 types and one gerX4. C. botulinum Groups II and IV contained a single germinant receptor, gerX3 and gerX1, respectively. It is likely that all four C. botulinum Groups include a SpoVA channel involved in dipicolinic acid release. The cortex-lytic enzymes present in C. botulinum Groups I and III appear to be CwlJ and SleB, while in C. botulinum Groups II and IV, SleC appears to be important. PMID:27840626

  13. Diversity of the Germination Apparatus in Clostridium botulinum Groups I, II, III and IV

    Directory of Open Access Journals (Sweden)

    Jason Brunt

    2016-10-01

    Full Text Available Clostridium botulinum is a highly dangerous pathogen that forms very resistant endospores that are ubiquitous in the environment, and which, under favourable conditions germinate to produce vegetative cells that multiply and form the exceptionally potent botulinum neurotoxin. To improve the control of botulinum neurotoxin-forming clostridia, it is important to understand the mechanisms involved in spore germination. Here we present models for spore germination in C. botulinum based on comparative genomics analyses, with C. botulinum Groups I and III sharing similar pathways, which differ from those proposed for C. botulinum Groups II and IV. All spores germinate in response to amino acids interacting with a germinant receptor, with four types of germinant receptor identified (encoded by various combinations of gerA, gerB and gerC genes (gerX. There are three gene clusters with an ABC-like configuration; ABC gerX1, ABABCB gerX2 and ACxBBB gerX4, and a single CA-B gerX3 gene cluster. Subtypes have been identified for most germinant receptors types, and the individual GerX subunits of each cluster show similar grouping in phylogenetic trees. C. botulinum Group I contained the largest variety of gerX subtypes, with three gerX1, three gerX2 and one gerX3 subtypes, while C. botulinum Group III contained two gerX1 types and one gerX4. C. botulinum Groups II and IV contained a single germinant receptor, gerX3 and gerX1, respectively. It is likely that all four C. botulinum Groups include a SpoVA channel involved in DPA release. The cortex lytic enzymes present in C. botulinum Groups I and III appear to be CwlJ and SleB, while in C. botulinum Groups II and IV, SleC appears to be important.

  14. Structural Studies on Intact Clostridium Botulinum Neurotoxins Complexed with Inhibitors Leading to Drug Design

    Science.gov (United States)

    2006-02-01

    structure1. Introduction Tetanus neurotoxin (TeNT) produced by Clostridium tetani and the seven antigenically distinct botulinum neurotoxins (BoNT/A-G...2-0011 TITLE: Structural Studies on Intact Clostridium Botulinum Neurotoxins Complexed with Inhibitors Leading to Drug...DATES COVERED (From - To) 28 Jan 2005 – 27 Jan 2006 4. TITLE AND SUBTITLE Structural Studies on Intact Clostridium Botulinum Neurotoxins Complexed

  15. Evidence that plasmid-borne botulinum neurotoxin type B genes are widespread among Clostridium botulinum serotype B strains.

    Directory of Open Access Journals (Sweden)

    Giovanna Franciosa

    Full Text Available BACKGROUND: Plasmids that encode certain subtypes of the botulinum neurotoxin type B have recently been detected in some Clostridium botulinum strains. The objective of the present study was to investigate the frequency with which plasmid carriage of the botulinum neurotoxin type B gene (bont/B occurs in strains of C. botulinum type B, Ab, and A(B, and whether plasmid carriage is bont/B subtype-related. METHODOLOGY/PRINCIPAL FINDINGS: PCR-Restriction fragment length polymorphism was employed to identify subtypes of the bont/B gene. Pulsed-field gel electrophoresis and Southern blot hybridization with specific probes were performed to analyze the genomic location of the bont/B subtype genes. All five known bont/B subtype genes were detected among the strains; the most frequently detected subtype genes were bont/B1 and /B2. Surprisingly, the bont/B subtype gene was shown to be plasmid-borne in >50% of the total strains. The same bont/B subtype gene was associated with the chromosome in some strains, whereas it was associated with a plasmid in others. All five known bont/B subtype genes were in some cases found to reside on plasmids, though with varying frequency (e.g., most of the bont/B1 subtype genes were located on plasmids, whereas all but one of the bont/B2 subtypes were chromosomally-located. Three bivalent isolates carried both bont/A and /B genes on the same plasmid. The plasmids carrying the bont gene were five different sizes, ranging from approximately 55 kb to approximately 245 kb. CONCLUSIONS/SIGNIFICANCE: The unexpected finding of the widespread distribution of plasmids harboring the bont/B gene among C. botulinum serotype B strains provides a chance to examine their contribution to the dissemination of the bont genes among heterogeneous clostridia, with potential implications on issues related to pathogenesis and food safety.

  16. Subcutaneous Injections

    DEFF Research Database (Denmark)

    Thomsen, Maria

    This thesis is about visualization and characterization of the tissue-device interaction during subcutaneous injection. The tissue pressure build-up during subcutaneous injections was measured in humans. The insulin pen FlexTouchr (Novo Nordisk A/S) was used for the measurements and the pressure...... build-up was evaluated indirectly from the changes in the flow rate between subcutaneous injections and air injections. This method enabled the tissue counter pressure to be evaluated without a formal clinical study approval. The measurements were coupled to a model for the pressure evolution...

  17. Brain Metabolic Changes of Cervical Dystonia with Spinocerebellar Ataxia Type 1 after Botulinum Toxin Therapy.

    Science.gov (United States)

    Kikuchi, Akio; Takeda, Atsushi; Sugeno, Naoto; Miura, Emiko; Kato, Kazuhiro; Hasegawa, Takafumi; Baba, Toru; Konno, Masatoshi; Oshima, Ryuji; Watanuki, Shoichi; Hiraoka, Kotaro; Tashiro, Manabu; Aoki, Masashi

    2016-01-01

    We occasionally observe long-term remission of cervical dystonia after several botulinum toxin treatments. However, botulinum toxin transiently acts on neuromuscular junctions. We herein report that a cervical dystonia patient with spinocerebellar ataxia type 1 could have long-term remission as a result of the depression of hypermetabolism in the bilateral putamen and primary sensorimotor cortex after botulinum toxin therapy. We suggest that botulinum toxin impacts the central nervous system, causing prolonged improvement through the normalization of basal ganglia circuits in addition to its effects at neuromuscular junctions.

  18. Efficacy and Safety of a New Botulinum Toxin Type A Free of Complexing Proteins

    Directory of Open Access Journals (Sweden)

    Hyun-Mi Oh

    2015-12-01

    Full Text Available MT10107 is botulinum neurotoxin type A derived drug which utilizes the 150 kDa portion without complexing proteins and human serum albumin contents. To evaluate the efficacy and the safety of MT10107, it was compared with onabotulinumtoxinA in this double-blind, randomized controlled trial. Twenty-five healthy males received a randomly selected dose of MT10107 into the extensor digitorum brevis (EDB muscle of one foot, and an equivalent dose of onabotulinumtoxinA (BOTOX was injected into the contralateral EDB muscle. While efficacy of the administered substance was determined by measuring paretic effects on the EDB, the local spread of toxin effects was evaluated by the paretic effects on the nearby abductor hallucis (AH and abductor digiti quinti (ADQ muscles. Paretic effects were defined as the percentage of reduction of the compound muscle action potential (CMAP amplitudes, measured at 14, 30, 90 days after the injection, compared to the baseline value. Intergroup (MT10107 and onabotulinumtoxinA differences were not significant in the percentage reduction of the amplitudes in the EDB muscles. In this study, there was no significant difference in efficacy and safety between the two test drugs. MT10107 may be effective and safe as much as onabotulinumtoxinA to produce the desired paretic effect.

  19. Unique use of botulinum toxin to decrease adductor tone and allow surgical excision of vulvar carcinoma.

    Science.gov (United States)

    Guo, Y; Shin, K

    2004-01-01

    Here, we present the case of an 86-year-old woman with vulvar carcinoma requiring surgical resection and with Parkinson's disease with severe spasticity and contractures of the lower extremities. Because of the patient's severe contractures and spasticity (her knees could only be separated by 2 cm with sustained abducting force), surgical positioning and access to the vulva were impossible. The patient was admitted, intending to undergo surgery after injection with botulinum toxin (BTX) to hip adductors and intensive physical therapy. After confirmed healed hip arthroplasty, the patient underwent BTX injection (400 U) to her bilateral adductor brevis, adductor longus, adductor magnus, and semimembranosus and semitendinosus muscles on day 2 of her hospital stay. On day 3, a physical therapist began a twice-a-day stretching program. An adjustable abduction brace was custom-made to provide sustained stretching. On day 9, the patient underwent wide local excision of vulvar carcinoma with the abductor brace in place. The patient tolerated the surgery well and was discharged home on day 11 with continuous physical therapy. Upon discharge, the distance between the patient's knees was 14 cm. This unique case demonstrated a new indication for BTX treatment in the preoperative setting to allow surgical positioning and access.

  20. Antibody-induced secondary treatment failure in a patient treated with botulinum toxin type A for glabellar frown lines

    Directory of Open Access Journals (Sweden)

    Stengel G

    2011-11-01

    Full Text Available Gabriele Stengel, Eva Kristina Bee Hautarztpraxis Stengel and Bee, Münster, Germany Abstract: Botulinum toxin type A (BTX-A preparations are widely used nonsurgical treatments for facial wrinkles. Higher doses of BTX-A are also used for therapeutic purposes in the treatment of conditions involving increased muscle tone, such as cervical dystonia. The phenomenon of antibody-induced treatment failure is well known in the therapeutic setting, but reports are also emerging following cosmetic use of BTX-A. We describe the case of a 41-year-old female nurse who developed secondary treatment failure during 6 years of BTX-A treatment for glabellar lines. After a good response to the first BTX-A injection, the intensity and duration of effect decreased after subsequent treatments. Antibody tests revealed a high titer of neutralizing anti-BTX-A antibodies. This case shows secondary treatment failure due to the production of neutralizing antibodies following administration of BTX-A formulations for cosmetic purposes and demonstrates that immunogenicity of BTX-A preparations is an important consideration, even in the cosmetic setting. Keywords: botulinum toxin type A, neutralizing antibodies, antibody-induced treatment failure

  1. Injection MD

    CERN Document Server

    Bartmann, W; Bracco, C; Drosdal, L; Gianfelice, E; Goddard, B; Kain, V; Papaphilippou, Y; Vanbavinckhove, G

    2012-01-01

    This note summarizes the results obtained at injection during the 2nd MD block and the floating MD block in July. Highlights are presented for injection in the LHC with the Q20 SPS optics, influence of the supercycle and injection with 25 ns bunch spacing. Beams were successfully injected into the LHC using the Q20 optics [1, 3]. Small corrections were needed to steer the beam in the transfer lines. Dispersion measurements were conducted for both beams. The horizontal normalized dispersion in TI2 was a factor 2 smaller for Q20 with respect to Q26, for TI8 on the other hand the opposite was observed. The results for injection loss dependency on super cycle composition show only a small increase in losses for beam 2. The losses observed must therefore mainly come from other sources such as shot-by-shot stability or quality of scraping. For the injection with 25 ns bunch spacing bunches were injected for both beams. For B1 up to the maximum of 288 bunches. For B2 on the other only up to 144 bunches were injected...

  2. Clostridium botulinum group I strain genotyping by 15-locus multilocus variable-number tandem-repeat analysis

    NARCIS (Netherlands)

    Fillo, S.; Giordani, F.; Anniballi, F.; Gorgé, O.; Ramisse, V.; Vergnaud, G.; Riehm, J.M.; Scholz, H.C.; Splettstoesser, W.D.; Kieboom, J.; Olsen, J.-S.; Fenicia, L.; Lista, F.

    2011-01-01

    Clostridium botulinum is a taxonomic designation that encompasses a broad variety of spore-forming, Gram-positive bacteria producing the botulinum neurotoxin (BoNT). C. botulinum is the etiologic agent of botulism, a rare but severe neuroparalytic disease. Fine-resolution genetic characterization of

  3. Immunoprecipitation of native botulinum neurotoxin complexes from Clostridium botulinum subtype A strains.

    Science.gov (United States)

    Lin, Guangyun; Tepp, William H; Bradshaw, Marite; Fredrick, Chase M; Johnson, Eric A

    2015-01-01

    Botulinum neurotoxins (BoNTs) naturally exist as components of protein complexes containing nontoxic proteins. The nontoxic proteins impart stability of BoNTs in the gastrointestinal tract and during purification and handling. The two primary neurotoxin complexes (TCs) are (i) TC1, consisting of BoNT, nontoxin-nonhemagglutinin (NTNH), and hemagglutinins (HAs), and (ii) TC2, consisting of BoNT and NTNH (and possibly OrfX proteins). In this study, BoNT/A subtypes A1, A2, A3, and A5 were examined for the compositions of their TCs in culture extracts using immunoprecipitation (IP). IP analyses showed that BoNT/A1 and BoNT/A5 form TC1s, while BoNT/A2 and BoNT/A3 form TC2s. A Clostridium botulinum host strain expressing recombinant BoNT/A4 (normally present as a TC2) from an extrachromosomal plasmid formed a TC1 with complexing proteins from the host strain, indicating that the HAs and NTNH encoded on the chromosome associated with the plasmid-encoded BoNT/A4. Strain NCTC 2916 (A1/silent B1), which carries both an ha silent bont/b cluster and an orfX bont/a1 cluster, was also examined. IP analysis revealed that NCTC 2916 formed only a TC2 containing BoNT/A1 and its associated NTNH. No association between BoNT/A1 and the nontoxic proteins from the silent bont/b cluster was detected, although the HAs were expressed as determined by Western blotting analysis. Additionally, NTNH and HAs from the silent bont/b cluster did not form a complex in NCTC 2916. The stabilities of the two types of TC differed at various pHs and with addition of KCl and NaCl. TC1 complexes were more stable than TC2 complexes. Mouse serum stabilized TC2, while TC1 was unaffected.

  4. A survey of clostridium botulinum in food poisoning in Iran

    Directory of Open Access Journals (Sweden)

    Modarres Sh

    1997-09-01

    Full Text Available Food-borne botulism is one of the dangerous food poisonings in human in the world. The specimens of 115 patients (serum and stool with clinical symptoms of botulism, who were inpatient and outpatient were collected at some medical centers in Tehran and other areas of Iran, between April 1984 to August 1994. In this survey, specimens of 73 patients showed the toxin and spore of C.botulinum. Clostridium botulinum type E, was the most common causative agent in food-borne botulism, being responsible for 71.24% of all specimens; other etiologic types, in order of frequency were types A (16.43% and B (12.33%. The results of this study indicate, that the various kinds of fish, salted fish, smoked fish and canned fish, also cans of greenbeans and cucumber were causative of food-borne botulism in patients.

  5. Botulinum Neurotoxin Is Shielded by NTNHA in an Interlocked Complex

    Energy Technology Data Exchange (ETDEWEB)

    Gu, Shenyan; Rumpel, Sophie; Zhou, Jie; Strotmeier, Jasmin; Bigalke, Hans; Perry, Kay; Shoemaker, Charles B.; Rummel, Andreas; Jin, Rongsheng (Cornell); (Tufts); (Hannover-MED); (Sanford-Burnham)

    2012-03-28

    Botulinum neurotoxins (BoNTs) are highly poisonous substances that are also effective medicines. Accidental BoNT poisoning often occurs through ingestion of Clostridium botulinum-contaminated food. Here, we present the crystal structure of a BoNT in complex with a clostridial nontoxic nonhemagglutinin (NTNHA) protein at 2.7 angstroms. Biochemical and functional studies show that NTNHA provides large and multivalent binding interfaces to protect BoNT from gastrointestinal degradation. Moreover, the structure highlights key residues in BoNT that regulate complex assembly in a pH-dependent manner. Collectively, our findings define the molecular mechanisms by which NTNHA shields BoNT in the hostile gastrointestinal environment and releases it upon entry into the circulation. These results will assist in the design of small molecules for inhibiting oral BoNT intoxication and of delivery vehicles for oral administration of biologics.

  6. Interaction of Botulinum Toxin with the Epithelial Barrier

    Directory of Open Access Journals (Sweden)

    Yukako Fujinaga

    2010-01-01

    Full Text Available Botulinum neurotoxin (BoNT is a protein toxin (~150 kDa, which possesses a metalloprotease activity. Food-borne botulism is manifested when BoNT is absorbed from the digestive tract to the blood stream and enters the peripheral nerves, where the toxin cleaves core proteins of the neuroexocytosis apparatus and elicits the inhibition of neurotransmitter release. The initial obstacle to orally ingested BoNT entering the body is the epithelial barrier of the digestive tract. Recent cell biology and molecular biology studies are beginning to elucidate the mechanism by which this large protein toxin crosses the epithelial barrier. In this review, we provide an overview of the structural features of botulinum toxins (BoNT and BoNT complex and the interaction of these toxins with the epithelial barrier.

  7. Computer-Assisted Communication Device for Botulinum-Intoxicated Patients

    Science.gov (United States)

    2008-01-01

    1997; Sobel, 2005; Adler et al., 2007). The clinical manifestations of botulism consist of blurred vision, diplopia, dizziness, dry mouth, dysphasia...questions regarding diagnostic procedures or the need to adjust body position (Table 1). Many of these issues are applicable to botulism cases in general...Monma, C. and Kitamura, M. (2003) ‘A botulism case of a 12-year-old girl caused by intestinal colonization of Clostridium botulinum type Ab’, Jpn. J