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Sample records for botulinum toxin-a injections

  1. The Difference of Treatment Results between Botulinum Toxin A Split Injection Sites and Botulinum Toxin A Non-Split Injection Sites for Hemifacial Spasm.

    Science.gov (United States)

    Prutthipongsit, Anuwat; Aui-aree, Nipat

    2015-11-01

    To compare hemifacial spasm treatment results between Botulinum toxin A split injection sites and Botulinum toxin A non-split injection sites. Thirty-one hemifacial spasm patients were randomly assigned into the non-split injection sites group (injecting Botulinum toxin A to the zygomaticus major and risorius each) or split injection sites group with the same amount of Botulinum toxin A as the first method (injection Botulinum toxin A to the zygomaticus major and minor and risorius two injections each) The main outcomes are onset of improvement and effective duration of treatment. Fifteen patients were assigned to non-split injection sites group and 16 patients were assigned to split injection sites group. The median onset of improvement in non-split injection sites group and split injection sites group was 4.0 and 4.5 days, respectively (p = 0.984). The effective duration of treatment in the non-split injection sites group was 60.0 days and in the split injection sites group was 54.5 days (p = 0.582). The splitting of injection sites did not signicantly improve the efficacy of Botulinum toxin A in the treatment of hemifacial spasm.

  2. Sustained improvement of reading symptoms following botulinum toxin A injection for convergence insufficiency

    DEFF Research Database (Denmark)

    Saunte, Jon Peiter; Holmes, Jonathan M

    2014-01-01

    INTRODUCTION: We evaluated the use of botulinum toxin A in adults with convergence insufficiency in whom prior treatment had failed. METHODS: We studied 8 patients (median age 36 years, range 17 to 77 years) with reading symptoms due to convergence insufficiency defined as an exodeviation greater...... pharmacological effect. Botulinum toxin injection may be useful in management of adult convergence insufficiency, although repeat injections may be needed....

  3. Botulinum toxin a injection of the obturator internus muscle for chronic perineal pain.

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    Gajraj, Noor M

    2005-05-01

    Chronic perineal pain is often a difficult condition to manage. Current treatments include pudendal nerve injections and pudendal nerve release surgery. The obturator internus muscle has a close relationship to the pudendal nerve and might be a potential target for therapeutic intervention. A case is presented of refractory perineal pain that was successfully treated by injecting the obturator internus muscle with botulinum toxin A.

  4. Achalasia in Pregnancy: Botulinum Toxin A Injection of Lower Esophageal Sphincter

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    Nicole Hooft

    2015-01-01

    Full Text Available Background. Achalasia, a rare esophageal motility disorder that may cause malnutrition during pregnancy, can result in fetal and maternal morbidity and mortality. Many medical treatment regimens are contraindicated or not tolerated during pregnancy, and surgery is generally avoided due to potential risks to the fetus. Case Report. Severe, medically refractory achalasia in a 23-year-old pregnant woman that caused malnutrition was successfully managed by administering a botulinum toxin A injection to the lower esophageal sphincter. The injection was performed at approximately 14 weeks’ gestation and the patient reported clinically significant relief from dysphagia. She gained weight and ultimately delivered a healthy baby girl at term, but her symptoms returned a few months postpartum. She underwent a second treatment of botulinum toxin A injection, but it offered only one month of relief. Roughly eight months after delivery, the patient underwent a laparoscopic extended Heller myotomy and Dor fundoplication. The patient resumed a normal diet one week postoperatively, and her baby has had no complications. Conclusion. This is only the second reported case of botulinum toxin A injection being used to treat achalasia in pregnancy. This treatment proved to be a safe temporary alternative without the risks of surgery and anesthesia during pregnancy.

  5. 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.

  6. Long-term efficacy and safety of botulinum toxin A injections to treat blepharospasm and hemifacial spasm.

    Science.gov (United States)

    Ababneh, Osama H; Cetinkaya, Altug; Kulwin, Dwight R

    2014-04-01

    To evaluate efficacy and safety of botulinum toxin A injections after more than 10 consecutive years of treatment for benign essential blepharospasm and hemifacial spasm. Retrospective chart review at university-affiliated hospital. Study consisted of 64 patients treated with botulinum toxin A injections between October 2005 and May 2006. Inclusion criteria included patients treated with at least one annual botulinum toxin-A injection for more than 10 consecutive years. Data collected included diagnoses and patient characteristics, injection dates, doses administered at each visit, response scores, duration of effect, and adverse events. Included changes in doses, response scores, duration of effects, and adverse events between the first and last botulinum toxin A injections. Thirty-two of 64 patients (mean age at first injection, 57.2 ± 12.4 years; 25 women) met the inclusion criteria. The mean duration of follow up was 14.1 ± 3.1 years (range 10-20 years; mean total visits 44.4 ± 19). A higher mean injection dose per visit was administered during the last year compared with the first year (26.8 ± 10.3 vs. 22.5 ± 7.5 units, respectively) (P = 0.003). The mean durations of effect during the first and last years were 12.4 ± 7.1 and 14.6 ± 7.0 weeks, respectively (P = 0.076). There were no significant differences between genders or between benign essential blepharospasm and hemifacial spasm subgroups. The most common adverse events were ptosis, lagophthalmos and dry eye. Botulinum toxin A is an effective, safe, long-term treatment for patients with benign essential blepharospasm and hemifacial spasm. Sustained treatment efficacy required higher doses; however, fewer adverse reactions developed. © 2013 Royal Australian and New Zealand College of Ophthalmologists.

  7. Long lasting benefits following the combination of static night upper extremity splinting with botulinum toxin A injections in cerebral palsy children.

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    Kanellopoulos, A D; Mavrogenis, A F; Mitsiokapa, E A; Panagopoulos, D; Skouteli, H; Vrettos, S G; Tzanos, G; Papagelopoulos, P J

    2009-12-01

    Botulinum toxin A injections and orthotics have been used to manage upper extremity spasticity in hemiplegic children. The authors performed a study to evaluate the necessity and effectiveness of a static night splint following outpatient botulinum toxin A treatment in children with upper limb spastic cerebral palsy. Twenty children with upper limb spastic cerebral palsy were treated with botulinum toxin A injections. A static night splint was applied in half of them. Objective assessment of upper limb function was performed at baseline, at 2 and 6 months after botulinum toxin A injection using the Quality of Upper Extremity Skills Test. After botulinum toxin A treatment, both groups showed an improvement on their previous functional level of the injected upper extremity. At 2 months, children in group A showed a 15.4% improvement, whereas children in group B improved by 12.2% from baseline; these were not statistically significant (P=0.326). At 6 months, group A still maintained a 15.9% improvement in function compared to group B which differed only by 4.2% from prebotulinum toxin A baseline; these differences were statistically significant (P=0.000). Complications related to the botulinum toxin A injection were not observed. The static Static night splinting following botulinum toxin A injections has shown a definite treatment effect in reducing spasticity and improving function in children with upper limb spastic cerebral palsy.

  8. Intragastric injection of botulinum toxin A for the treatment of obesity.

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    Mittermair, Reinhard; Keller, Christian; Geibel, John

    2007-06-01

    Botulinum toxin A (BTX-A) is a powerful and long-acting inhibitor of muscular contractions in both striated and smooth muscles. Hypothetically, BTX-A should inhibit the acetylcholine-mediated peristalsis, which is mainly responsible for gastric motility, and thereby induce slowed gastric emptying, earlier satiety and weight loss. The aim of this study was to observe the effects of endoscopic intragastric injections of BTX-A in obese patients. After approval by the University Ethics Committee, 10 female patients with class I obesity (body mass index 30-35) were double-blind randomized into 2 groups (BTX-A and 0.9% Saline). In Group 1, 200 U BTX-A were injected endoscopically into the antrum and the distal gastric body. In Group 2, 0.9% saline was injected endoscopically into the antrum and the distal gastric body. Body weight and feeling of satiety were recorded monthly over a period of 6 months. Both groups (BTX-A and 0.9% Saline) showed no significant weight reduction (P>0.05). One patient in Group 1 and two patients in Group 2 reported a feeling of early satiety. No adverse effects related to BTX-A or complications resulting from the endoscopic procedure were observed. Intragastric injection of BTX-A for the treatment of obesity does not seem to reduce body weight.

  9. The Change of Intrinsic Stiffness in Gastrocnemius after Intensive Rehabilitation with Botulinum Toxin A Injection in Spastic Diplegic Cerebral Palsy

    OpenAIRE

    Kwon, Dong Rak; Park, Gi Young; Kwon, Jung Gu

    2012-01-01

    A recent study claimed that botulinum toxin A (BTX-A) injection into the calf muscle of cerebral palsy (CP) children did not change the intrinsic stiffness. Contrary to this recent report, in our case, decreased muscle spasticity, which was measured using a modified Ashworth scale, and increased Gross Motor Function Measure score were demonstrated at 4 weeks after intensive rehabilitation treatment (IRT) with BTX-A injection to the medial gastrocnemius muscle in a child with spastic CP. Addit...

  10. 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

  11. Rehabilitation therapies after botulinum toxin-A injection to manage limb spasticity: a systematic review.

    Science.gov (United States)

    Kinnear, Bianca Z; Lannin, Natasha A; Cusick, Anne; Harvey, Lisa A; Rawicki, Barry

    2014-11-01

    Botulinum toxin A (BoNT-A) injections are increasingly used to treat muscle spasticity and are often complemented by adjunctive rehabilitation therapies; however, little is known about the effect of therapy after injection. The aim of this study was to identify and summarize evidence on rehabilitation therapies used after BoNT-A injections to improve motor function in adults with neurological impairments. Searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, National Research Register, metaRegistry of Controlled Trials, PEDro, and OTseeker. Randomized and quasi-randomized controlled trials were considered for inclusion. Participants with neurological impairments received BoNT-A to treat focal spasticity in limbs, with rehabilitation interventions provided to experimental groups only. Primary outcome measures were joint mobility, function of the affected limb, and spasticity. Eleven studies with 234 participants, most of whom had stroke, were included in the review. Two reviewers extracted study details and data. Methodological quality was rated using the PEDro scale. Both fixed-effects and random-effects models were used to calculate effect size. Studies were of variable quality: 3 were poor (PEDro score 1 to 4), and 8 were moderate (PEDro score 6 to 7). No study investigated effects for longer than 24 weeks (6 months). Included trials presented 9 therapy types, including ergometer cycling, electrical stimulation, stretch (casting, splinting, taping, or manual or exercise-induced stretch), constraint-induced movement therapy, task-specific motor training, and exercise programs. Statistical findings suggest that combined therapy and BoNT-A is slightly more effective than BoNT-A alone. Evidence relating to impact of adjunct therapy is available, but the heterogeneity of studies limits the opportunity to demonstrate overall impact. Researchers need to consider the benefits of greater consistency in study

  12. Intravesical botulinum toxin a injections do not benefit patients with ulcer type interstitial cystitis.

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    Lee, Cheng-Ling; Kuo, Hann-Chorng

    2013-01-01

    Ulcer type and non-ulcer type interstitial cystitis/bladder pain syndromes (IC/BPS) are considered different disease entities. Thus, intravesical botulinum toxin A (BoNT-A) treatment outcomes could differ for each entity. To evaluate and compare the treatment outcomes of BoNT-A injections for treatment of each IC/BPS type. Prospective interventional study. Tertiary medical center affiliated with Buddhist Tzu Chi General Hospital and Tzu Chi University, Taiwan. Forty-four consecutive patients with IC/BPS for whom conventional treatments failed were prospectively enrolled in this study. Patients were classified as having ulcer (n = 10) or non-ulcer (n = 30) IC/BPS based on their previous cystoscopic findings. All patients received 4 sets of intravesical BoNT-A injections (100 U in 40 suburothelial injections) every 6 months. The primary end-point was the global response assessment (GRA) 6 months after the fourth set of BoNT-A injections. Secondary end-points included the O'Leary-Sant score (OSS) including symptom indexes (ICSI) and problem indexes (ICPI), visual analog scale (VAS) pain score, voiding diary, and urodynamics variables. After 4 sets of BoNT-A injections, 15 patients with non-ulcer IC/BPS had GRA scores >= 2, while the other 15 had GRA scores ulcer IC/BPS had GRA scores ulcer IC/BPS had significantly higher daytime frequency, nocturia, smaller functional bladder capacity, smaller voided volume, greater VAS, smaller maximal bladder capacity, and greater glomerulation grade than did patients with non-ulcer IC/BPS. After 4 sets of BoNT-A injections, patients with non-ulcer IC/BPS and GRA scores >= 2 or ulcer IC/BPS showed no significant change in any clinical or urodynamic variable. After failure of repeated BoNT-A injections, all 10 patients with ulcer IC/BPS underwent transurethral electrocauterization of their ulcers, which resulted in immediate pain relief. Lack of a control arm in this study. Repeated intravesical BoNT-A injections provided effective

  13. The change of intrinsic stiffness in gastrocnemius after intensive rehabilitation with botulinum toxin a injection in spastic diplegic cerebral palsy.

    Science.gov (United States)

    Kwon, Dong Rak; Park, Gi Young; Kwon, Jung Gu

    2012-06-01

    A recent study claimed that botulinum toxin A (BTX-A) injection into the calf muscle of cerebral palsy (CP) children did not change the intrinsic stiffness. Contrary to this recent report, in our case, decreased muscle spasticity, which was measured using a modified Ashworth scale, and increased Gross Motor Function Measure score were demonstrated at 4 weeks after intensive rehabilitation treatment (IRT) with BTX-A injection to the medial gastrocnemius muscle in a child with spastic CP. Additionally, we indentified decreased muscle stiffness which was demonstrated by a decrease in the color-coded scale and shear velocity, and an increase in the strain ratio using dynamic sonoelastography.

  14. 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.

  15. The Changes in Corneal Astigmatism after Botulinum Toxin-A Injection in Patients with Blepharospasm

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    Moon, Nam Ju; Lee, Hyeon Il

    2006-01-01

    To determine if the involuntary contractions of eyelids may have any effects on the development of corneal astigmatism, we performed this prospective study which includes 19 patients with either essential blepharospasm or hemifacial spasm. In hemifacial spasm, the degree of corneal astigmatism was evaluated between two eyes. Then the topographic changes were checked using vector analysis technique before and after passively opening the eyelids. They were also measured before and at 1 and 6 months after the injection of Botulinum toxin. Resultantly, 20 eyes had the with-the-rule (group1) and 9 eyes against-the-rule (group2) astigmatism. In hemifacial spasm, significantly more astigmatism was found at spastic eyes. The corneal topographic changes after passively opening the eyelids showed 10 eyes with the astigmatic shift to the with-the-rule, while the remaining 19 to the against-the-rule. At 1 month after injection of Botulinum toxin, group 1 showed reduced average corneal astigmatism, whereas group 2 showed increased astigmatism. The astigmatic change vector showed significantly more against-the-rule. In the contrary, 6 months after treatment, corneal astigmatism again increased in group 1 and decreased in group 2. So they took on the appearance of pretreatment astigmatic status eventually. Conclusively eyelids may play an important role in corneal curvature. PMID:16479079

  16. The use of Botulinum toxin-a injection for facial wrinkles: a histological and immunohistochemical evaluation.

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    El-Domyati, Moetaz; Attia, Sameh K; El-Sawy, Ashraf E; Moftah, Noha H; Nasif, Ghada A; Medhat, Walid; Marwan, Belkais

    2015-06-01

    Botulinum toxin (BTX)-A has been used for years in the reduction of facial wrinkles; however, histological and immunohistochemical changes after its use were not previously investigated. To evaluate histological and immunohistochemical changes after BTX-A injection for facial wrinkles, sixteen volunteers, with wrinkles on the upper third of the face, were subjected to single injection of BTX-A. Skin biopsy specimens were obtained from peri-orbital wrinkle site (crow's feet area) before and after 3 months of BTX-A injection. Using histological and immunohistochemical evaluation coupled with computerized morphometric analysis, measurement of epidermal thickness, wrinkle depth and width as well as quantitative evaluation of collagen types I and III and elastin was performed for skin biopsies. After BTX-A injections, there were significant increase in wrinkle width and granular layer thickness (P 0.05). However, collagen fibers showed better organization and orientation after BTX-A injection. The histological changes observed after BTX-A injection for facial wrinkles may help in better understanding of its mechanism of action. © 2015 Wiley Periodicals, Inc.

  17. Multilevel Botulinum Toxin A (Abobotulinum Toxin A Injections in Spastic Forms of Cerebral Palsy: Retrospective Analysis of 8 Russian Centers Experience

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    O. A. Klochkova

    2016-01-01

    Full Text Available Background: The contemporary application of Botulinum toxin A (BTA in cerebral palsy (CP implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months. Multilevel BTA injections were indicated for the majority (n = 634, 87.6% of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U, the repeated injections doses up to 45 U/kg (1000 U (in most centers. The median intervals between the repeated injections were 180–200 days in 484 (66.9% patients and 140–180 days in 157 (24.7% patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.

  18. The role of the injection botulinum toxin A in cases of blepharospasm syndrome, hemifacial spasm and Meige's syndrome.

    Science.gov (United States)

    Bastola, P; Chaudhary, M; Agrawal, J P; Shah, D N

    2010-01-01

    . Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal.

  19. Botulinum toxin A injections and occupational therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial.

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    Lidman, Git; Nachemson, Ann; Peny-Dahlstrand, Marie; Himmelmann, Kate

    2015-08-01

    To investigate the effects of repeated botulinum toxin A (BoNT-A) injections combined with occupational therapy, including a splint, compared with occupational therapy alone on hand function in children with unilateral spastic cerebral palsy (USCP), in all International Classification of Functioning, Disability and Health (ICF) domains. This was a randomized controlled study, population-based and evaluator-blinded for primary outcome (October 2004 to September 2010). Twenty children (14 males; median age 3y 1mo) with USCP, recruited at a rehabilitation centre in Sweden, were assigned to one of two parallel groups using concealed allocation. In the course of one year, 10 children received occupational therapy, while 10 received repeated BoNT-A plus occupational therapy (BoNT-A/OT). Primary outcome (Assisting Hand Assessment [AHA]), and secondary outcome measures (range of movement [ROM], and Canadian Occupational Performance Measure), were measured at baseline, 3, 6, 9, and 12 months. AHA revealed a superior effect in the BoNT-A/OT group at 12 months: 6 out of 10 improved compared with 1 out of 10 in the occupational therapy group (poccupational therapy alone for bimanual performance in young children with USCP. Active ROM and goal performance improved in both groups. © 2015 Mac Keith Press.

  20. 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.

  1. 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

    STUDY DESIGN: A prospective, randomized triple-blinded cross-over design treating with either botulinum toxin A (BXT) or Saline (NaCl). OBJECTIVE: To examine the efficacy of BTX treatment in cerebral palsy scoliosis (CPS). SUMMARY OF BACKGROUND DATA: Intramuscular injections with BTX have been used...... or BTX in selected spine muscles with 6 months intervals (block randomization, sealed envelope). X-rays of the spine and clinical follow-up were captured before and 6 weeks after each injection. Primary outcome parameter was radiological change in Cobb's angle, where a seven degree change was regarded...

  2. Physical therapies as an adjunct to Botulinum toxin-A injection of the upper or lower limb in adults following neurological impairment

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    Kinnear Bianca Z

    2012-06-01

    Full Text Available Abstract Background Spasticity of muscles is a common consequence of central nervous system impairment. Traditionally, neurological rehabilitation for spasticity has involved occupational and physical therapy; however, increasingly Botulinum toxin–A injections may be provided. Injection effects are temporary. Consequently, understanding the effect of adjunct physical therapies will help inform multimodal rehabilitation decisions. Presently, these effects are not known. This systematic review will identify and summarize evidence on physical therapies used after Botulinum toxin-A injection to improve motor function in adults with neurological impairments. Method Systematic searching of seven electronic databases will occur to identify relevant randomized trials. Available trial data will be extracted into a list of pre-defined primary outcomes, including range of movement, spasticity and functional limb use. Pre-defined secondary outcomes will also be reviewed where trials have these data available for reporting. Effects will be expressed as mean differences or standardized mean differences with 95% confidence intervals (CI. Where possible, comparable results will be meta-analyzed, and a summary of the available pool of evidence produced. All randomized controlled trials will be rated using the PEDro methodological quality scale. Where possible, study data will be meta-analyzed using RevMan 5 Software. The protocol was registered in PROSPERO international prosepective register of systematic reviews (PROSPERO 2011:CRD42011001491. Discussion Review results will be the most comprehensive answer available to the following question: Are physical therapies clinically effective after Botulinum toxin-A injections in adults with neurological spasticity? Results will inform healthcare providers and managers who determine who gets access to and provision of Botulinum toxin-A injection and whether this is done with or without physical therapies. Results

  3. Evaluation of the cost per patient per injection of botulinum toxin A in upper limb spasticity: comparison of two preparations in 19 countries

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    Valentine W

    2012-11-01

    Full Text Available Stéphane Roze,1 Hannah Kurth,2 Barnaby Hunt,3 William Valentine,3 Rémi Marty11HEVA, Lyon, France; 2Ipsen Pharma, Boulogne-Billancourt, France; 3Ossian Health Economics and Communications, Basel, SwitzerlandBackground: Botulinum toxin A injections are indicated for the management of movement disorders, including upper limb spasticity. The aim of this study was to compare the cost per patient per injection for two botulinum toxin A preparations in 19 countries.Methods: Doses of botulinum toxin A are expressed in noninterchangeable units (U, ie, Botox® in 100 Allergan units (100 U and Dysport® in 500 Speywood units (500 U. Recommended dosages were derived from country-specific summaries of product characteristics or prescribing information. Cost analysis was based on official list prices and expressed in 2011 Euros. The cost per patient per injection was calculated using the recommended dosage in upper limb spasticity combined with price per vial in each country.Results: For upper limb spasticity, the recommended dosage for Dysport in the summary of product characteristics is 1000 U per patient, whereas for Botox the recommended dosage when recommendations were made is 300 U. Allowing for different prices per vial in each country, the cost per patient per injection for upper limb spasticity was less for Dysport than for Botox in 18 (95% of the 19 countries (mean 17% less across countries. The difference was 20% or higher in nearly half (47% of the countries. Sensitivity analyses considering available "real-world" dosing showed consistent results, with Dysport being less costly than Botox in all 19 countries.Conclusion: Considering costs per patient per injection based on analysis of recommended dosages in the summary of product characteristics, Dysport remains cheaper than Botox in most countries. Thus, when extrapolated to a national level, substantial savings could be realized by using Dysport in the treatment of upper limb spasticity

  4. Increasing the area and varying the dosage of Botulinum toxin a injections for effective treatment of hemifacial spasm.

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    Choe, Won Joo; Kim, Jin

    2016-09-01

    Wider-area botulinum toxin (BT) injection with the dosage depending on specific pathology is a promising approach for the treatment of hemifacial spasm (HFS), resulting in effective and long-lasting control of HFS with fewer side-effects. The aim of this study was to develop a BT injection strategy that minimizes complications by considering the causes, duration, and electrophysiologic features of the disease, as well as the patient's age. From July 2011 to July 2015, 26 patients were included in the strategy. The mean age was 61.8 ± 14.6. In the case of essential HFS, 2 units/injection site was the standard dosage. If a patient was aged over 60 and had a reduced electromyogram (EMG) amplitude, the dosage was reduced by 0.5 units/site. In the case of post-paralytic and tumor-induced HFS, 1.5 units/site was the standard dosage. All cases were managed by alternating injections of Botox and Dysport with no physical therapy. Most HFS patients treated with the injection strategy had complete remission of HFS within 1 week. The average number of BT injection sites was 22.6 ± 6.7. The mean total BT dosage on the affected side was 28.6 ± 4.9 units. The mean duration of BT efficacy was 28.6 ± 7.7 weeks.

  5. GRIN: “GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial”: study protocol

    Science.gov (United States)

    2014-01-01

    Background Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years. Methods/Design An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child’s occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health. Discussion This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised

  6. GRIN: "GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial": study protocol.

    Science.gov (United States)

    Thomas, Rachel E; Johnston, Leanne M; Boyd, Roslyn N; Sakzewski, Leanne; Kentish, Megan J

    2014-02-07

    Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years. An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child's occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health. This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised comparison trial comparing group versus

  7. Intra-articular injection of Botulinum toxin A reduces neurogenic inflammation in CFA-induced arthritic rat model.

    Science.gov (United States)

    Wang, Lin; Wang, Kaile; Chu, Xiao; Li, Tieshan; Shen, Nana; Fan, Chenglei; Niu, Zhenyuan; Zhang, Xiaochen; Hu, Luoman

    2017-02-01

    Currently, administration of Botulinum toxin Type A (BoNT/A) to treat arthritic pain has promising efficacy in clinical research. However, the mechanisms underlying anti-neurogenic inflammation mediated by BoNT/A remains unclear. The aim of this study was to demonstrate the effectiveness in macro and micro levels and to explore the causal mechanism of BoNT/A. Wistar rats (n = 60) were injected with 50ul complete Freund's adjuvant (CFA) in the left ankle joint capsule to establish a model of chronic monoarthritis. Pain behaviour (Evoked pain assessment) and infrared thermal imaging testing were performed at the macroscopic level to assess the effectiveness of analgesia and anti-inflammation. Western blotting and immunofluorescence staining were used at the microscopic level in an attempt to determine the mechanisms of anti-nociceptive or anti-inflammatory effects of BoNT/A. Additionally, hematoxylin-eosin staining was also used to visualise the cartilage and the synovial degenerative conditions of arthritis. By comparing the outcome of the evoked pain test and immunofluorescence staining, there was a significant improvement in BoNT/A compared with the normal saline (NS) injected control group. In addition, thermal variations showed that the temperature of ipsilateral ankle joint increased between 1 and 2 weeks following injection of CFA, but decreased after 3 weeks (still above the contralateral side). However, the temperature showed no difference between the BoNT/A group and NS group after treatment. The expression of IL-1β or TNF-α in the ankle synovial tissue was significantly decreased in the BoNT/A group compared to the NS group (p < 0.05). Based on the HE assessment, cartilage degeneration and infiltration of inflammatory cells in the BoNT/A group was alleviated compared to the NS group after treatment. In conclusion, we proposed the hypothesis that intra-articular BoNT/A administration does play an important role in anti-neurogenic inflammation. The

  8. The Effect of Botulinum Toxin A Injections in the Spine Muscles for Cerebral Palsy Scoliosis, Examined in a Prospective, Randomized Triple-blinded Study.

    Science.gov (United States)

    Wong, Christian; Pedersen, Søren Anker; Kristensen, Billy B; Gosvig, Kasper; Sonne-Holm, Stig

    2015-12-01

    A prospective, randomized triple-blinded cross-over design treating with either botulinum toxin A (BXT) or saline (NaCl). To examine the efficacy of BTX treatment in cerebral palsy scoliosis (CPS). Intramuscular injections with BTX have been used off label in treating CPS. 1 prospective study has been conducted, demonstrating in both radiological and clinical improvement, whereas showing no side effects or complications. Subjects (brace-treated CPS between 2 and 18 yr) were injected using ultrasonic-guidance with either NaCl or BTX in selected spine muscles with 6 mo intervals (block randomization, sealed envelope). Radiographs of the spine and clinical follow-up were captured before and 6 weeks after each injection. Primary outcome parameter was radiological change in Cobb angle, where a 7° change was regarded 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 score and systematic open questioning of the parents about the child's wellbeing. Subjects, researchers, and monitors were blinded during the trial. Appropriate permissions (2008-004584-19) and no funding were obtained. 16 cerebral palsy patients (GFMCS III-V) with CPS were consecutively included, whereas 6 patients were excluded. There were no drop-outs to follow-up, but 1 possible 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 with NaCl injections using Wilcoxon matched pair signed-rank test. No positive radiological or clinical effects were demonstrated by this treatment, except for the parent's initial subjective but positive appraisal of the effect. However, the study was terminated due to 1 possible severe adverse event and scheduled numbers needed to treat (hence power) were not reached. 1.

  9. Botulinum Toxin A for Treatment of Contact Granuloma.

    Science.gov (United States)

    Yılmaz, Taner; Kayahan, Bahar; Günaydın, Rıza Önder; Kuşçu, Oğuz; Sözen, Tevfik

    2016-11-01

    Contact granuloma has been associated with voice abuse, laryngopharyngeal reflux, and habitual throat clearing. It has a high propensity for persistence and recurrence. Treatment options included voice therapy and antireflux measures. Surgical excision has been considered in patients who do not respond to medical management. In this research, we aimed to present our experience with botulinum toxin injection only. Retrospective case series of a tertiary referral center. Our series consisted of 22 patients, who underwent botulinum toxin injection only as an office procedure to bilateral thyroarytenoid and lateral cricoarytenoid muscles in 2 × 1.25 to 2 × 2.5 U. No other treatment was applied. The cases were followed up for at least 6 months ranging between 6 and 100 months with a mean of 28. Seventeen cases (77%) were cured of their granuloma. Eleven of the cured cases had grade 2, four cases had grade 1, and two patients had grade 3 granuloma. Botulinum toxin A injection only is an efficient treatment modality in contact granuloma, especially for grade 1, 2, and 3 cases, and it can be used as a first-line treatment. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  10. Efficacy of carbamazepine combined with botulinum toxin a in the treatment of blepharospasm and hemifacial spasm.

    Science.gov (United States)

    Li, Xian Hua; Lin, Shao Chun; Hu, Yan Fei; Liu, Li Ya; Liu, Ju Bo; Hong, Yi Chun

    2012-12-01

    To observe the efficacy of the combined treatment of carbamazepine and botulinum toxin A for blepharospasm and hemifacial spasm. Fifty-eight patients with either blepharospasm or hemifacial spasm were randomly divided into treatment and control groups. In the treatment group, 30 patients were administered with local intramuscular injections of botulinum toxin A and oral carbamazepine 100 mg/time, 3 times a day for 60 days. Twenty-eight subjects in the control group underwent local intramuscular injections of botulinum toxin A only. After combined treatment, the complete remission rate was 90%, which was significantly higher than that of the of the control group (67.9%, Pbotulinum toxin A had increased efficacy in the treatment of blepharospasm or hemifacial spasm, but had no significant effect in terms of the duration of the therapeutic effect.

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

    Science.gov (United States)

    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)…

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

    Science.gov (United States)

    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

  13. Intralesional Botulinum Toxin A Injection for Recalcitrant Alopecial Totalis and Alopecia Universalis: A Randomized, Double-Blind, Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Rattapon Thuangtong

    2017-01-01

    Full Text Available Background: Alopecia totalis (AT and alopecia universalis (AU have a high rate of recurrence and are very difficult to treat. To date, no consensus has been reach among clinicians regarding the best way to treat these conditions. It was recently proposed that botulinum toxin type A (BT injection in alopecia areata may inhibit unmyelinated C fibers from releasing substance P and calcitonin-gene-related protein (CGRP, which showed a favorable clinical response in cephalalgic alopecia areata. Objective: To investigate the efficacy of botulinum toxin type A (BT in the treatment of recalcitrant AT and AU. Methods: Twenty patients with either recalcitrant AT or AU were enrolled in this study. One half of the scalp was injected with BT 50 units 2.5 ml intradermally (dilution 20 units/ml and the other half of the scalp was injected with normal saline 2.5 ml. Clinical assessments were performed using Severity of Alopecia Tool (SALT score, scalp mapping, and photography. Patients were followed up monthly for 4 months after treatment to evaluate terminal hair regrowth. Results: Based on patient results at the 4-month follow-up, no clinical improvement in either recalcitrant alopecia totalis or alopecia universalis was observed. Conclusion: Although BT has been demonstrated to improve the clinical features of cephalalgia alopecia areata, BT was not shown to improve the clinical features of recalcitrant AT or AU in this study. In order to understand and explain the differences in these two clinical outcomes using BT in alopecia, further investigation is needed.

  14. Use of botulinum toxin A in the treatment of hemifacial spasm and blepharospasm.

    Science.gov (United States)

    Chang, L B; Tsai, C P; Liao, K K; Kao, K P; Yuan, C L; Yen, D J; Lin, K P

    1999-01-01

    Hemifacial spasm and blepharospasm are both dystonic disorders. They may seriously affect individuals' lifestyle and social activities. In 1990, the Food and Drug Administration of the USA approved botulinum toxin A as a therapeutic agent in the treatment of hemifacial spasm and blepharospasm. We present a therapeutic review of botulinum toxin A in 80 patients in Taiwan. Fifty-eight patients with hemifacial spasm and 22 with blepharospasm. Botulinum toxin A was prepared and injected into the facial and eyelid muscles. Patients were monitored every two weeks and classified into four groups (excellent, moderate, mild and no improvement) according to the clinical improvement scale. Complications were also recorded. A total of 86.2% of hemifacial spasm patients and 81.8% of blepharospasm patients had excellent improvement on the spasm intensity scale, while 6.8% of hemifacial spasm and 9.0% of blepharospasm patients had moderate improvement. The complication rate was low and included transient mild facial weakness (5%), ptosis (3.8%), eyelid swelling and/or ecchymosis (3.8%), nausea/vomiting (2.5%) and transient severe facial weakness (1.3%). Botulinum toxin A is an excellent therapeutic agent to improve spasm intensity and has a low complication rate.

  15. Botulinum toxin a can positively impact first impression.

    Science.gov (United States)

    Dayan, Steven H; Lieberman, Elliot D; Thakkar, Nirav N; Larimer, Karen A; Anstead, Amy

    2008-06-01

    BACKGROUND First impression is influenced by facial appearance and improved by cosmetic surgery. OBJECTIVE We wanted to determine if treatment with botulinum toxin A (BTxnA) would improve first impression. MATERIALS AND METHODS Women received BTxnA in the forehead. Photos were taken prior to, and 1 week after, final BTxnA injection in smiling and relaxed poses. Photos were divided into books with each subject represented only once. Evaluators completed a survey rating first impression on various measures of success for each photo. RESULTS No differences were seen for social skills, financial, or relationship success scales. A significant decrease in first impression scores between treatment photos was seen for academic performance and occupational success. However, analysis of between-subject effects found that "smile/relax" accounted for the decreased score in both scales. Significant increases in first impression scores were seen for dating success, attractiveness, and athletic success scales where smile/relax and BTxnA contributed significantly to the improved scores. CONCLUSIONS BTxnA improved first impression scores for dating success, attractiveness, and athletic success scales. Academic performance and occupational success scores were not affected by BTxnA when the smile/relax variable was included. The smile/relax variable was a more important predictor for academic performance and occupational success scores.

  16. Botulinum Neurotoxin Injections

    Science.gov (United States)

    ... These are botulinum neurotoxin type A (trade names Botox, Dysport, and Xeomin) and botulinum neurotoxin type B ( ... is commercially available in the United States as Botox from Allergan, Inc, Dysport from Ipsen, Ltd, and ...

  17. Botulinum toxin A for oral cavity cancer patients: in microsurgical patients BTX injections in major salivary glands temporarily reduce salivary production and the risk of local complications related to saliva stagnation.

    Science.gov (United States)

    Corradino, Bartolo; Di Lorenzo, Sara; Moschella, Francesco

    2012-10-24

    In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid blow-out syndrome. Botulinum injections in the major salivary glands, four days before surgery, temporarily reduces salivation during the healing stage and thus could reduce the incidence of saliva-related complications. Forty three patients with oral cancer were treated with botulinum toxin A. The saliva quantitative measurement and the sialoscintigraphy were performed before and after infiltrations of botulinum toxin in the major salivary glands. In all cases there was a considerable, but temporary, reduction of salivary secretion. A lower rate of local complications was observed in the post-operative period. The salivary production returned to normal within two months, with minimal side effects and discomfort for the patients. The temporary inhibition of salivary secretion in the post-operative period could enable a reduction in saliva-related local complications, in the incidence of oro-cutaneous fistulas, and improve the outcome of the surgery as well as the quality of residual life in these patients.

  18. 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.

    Science.gov (United States)

    Hoare, Brian J; Imms, Christine; Rawicki, Hyam Barry; Carey, Leeanne

    2010-07-05

    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. 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. 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 upper limb injection of BoNT-A. The paper outlines the background

  19. 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

  20. 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

  1. Comparison of the effects of esomeprazole plus mosapride citrate and botulinum toxin A on vocal process granuloma.

    Science.gov (United States)

    Lei, Lei; Yang, Hui; Zhang, Xinsheng; Ren, Jia

    Vocal process granulomas have a high tendency for persistence despite many treatment alternatives. Anti-reflux medications or botulinum toxin A injections are the main current therapies. There are no studies that compare the effects on vocal process granuloma of proton pump inhibitors plus prokinetic agents with botulinum toxin A injections. Prospective cohort study. Adult patients reporting to our outpatient department complaining of trachyphonia and/or abnormal pharyngeal sensations who were found to have contact granulomas. Patients were divided into two groups according to the treatment: esomeprazole with mosapride citrate (n=26) or botulinum toxin A injection (n=20). The reflux symptom index and reflux finding score determined by electronic fibrolaryngoscopy were utilized to assess efficacy. Forty-six patients were recruited (43 male; 3 female). The mean age (range) was 48.3years (38-69) and the body mass index was 23.51kg/m(2) (19.13-27.89). Laryngopharyngeal reflux disease diagnosed by RSI or RFS was found in 18 and 27 patients, respectively, and 18 diagnosed without laryngopharyneal reflux disease. Twenty patients (95%) were cured in the esomeprazole with mosapride citrate group and nine (45%) in the botulinum toxin A group. Eleven (55%) patients had recurrence after botulinum toxin A injection, with an average interval of 3.1months (range 1-6). The recorded symptoms after therapy resolved within 6months with a statistically significant improvement in the esomeprazole with mosapride citrate group. Combined proton pump inhibitor plus prokinetic drug therapy plays a significant role in the treatment of vocal process granulomas or after surgery. Copyright © 2017. Published by Elsevier Inc.

  2. 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.

  3. Botulinum toxin A in the treatment of anal fissure

    Directory of Open Access Journals (Sweden)

    Stanković Nebojša

    2004-01-01

    Full Text Available Background. This paper presents our first experience in the treatment of primary anal fissure by injection of botulinum A toxin into the internal sphincter. Methods. The study group of the retrospective study included 12 outpatients (8 females and 4 males, mean age 42 (range 18-60. During the period 2000-2003, after unsuccessful conservative treatment, patients were treated with the injections of botulinum A toxin, 100 units on both sides of the anal fissure laterally into the internal anal sphincter (50 units on either side. The patients were clinically evaluated 3, 7, and 30 days, and 3 and 6 months after the treatment. Results. Three fissures had healed after a month, and seven after 3 months. Two remained unhealed, but asymptomatic. There was no incontinence of flatus or faeces after 3 months of the treatment. After temporary healing, two fissures relapsed after 6 months, and these patients had the adequate tonus of the anal sphincter muscles. Except for the temporary incontinence, there were neither other side-efects, nor serious complications. Conclusion. Injection of botulinum A toxin achieved good results in the treatment of anal fissure. The appropriate use makes this method safe as an alternative to surgical treatment of anal fissure.

  4. Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures

    DEFF Research Database (Denmark)

    Pingel, Jessica; Nielsen, Mikkel Schou; Lauridsen, Torsten

    2017-01-01

    dose intramuscular BoNT/A injections (6 UI = 60 pg) on muscle tissue. The gait pattern of the rats was significantly affected 3 weeks after BoNT/A injection. The ankle joint rotated externally, the rats became flat footed, and the stride length decreased after BoNT/A injection. Additionally...

  5. Evaluation of the therapeutic use of botulinum toxin A in the periorbital region

    Directory of Open Access Journals (Sweden)

    Ahmed Tawfik

    2015-01-01

    Full Text Available Botulinum toxin blocks acetylcholine release at the neuromuscular junction causing paralysis that is reversed within 4 months. The toxin was well known for its lethal effect when ingested with food (botulism; however, it was found to be highly effective in various disorders, both cosmetic and noncosmetic. The therapeutic uses in ophthalmology include treatment of strabismus, spastic focal facial dystonias, induction of temporary ptosis in cases of lagophthalmos (chemotarsorrhaphy, temporary correction of dysthyroid upper eyelid retraction, suppression of lacrimal gland secretion to temporarily control gustatory lacrimation, some cases of obstructive epiphora and primary hyperlacrimation, and temporary correction of lower lid entropion. In this prospective study, we evaluate the results of using botulinum toxin A (botox injection in some periorbital pathologies namely, focal facial dystonias, lower lid entropion, lagophthalmos, and epiphora. Fifty patients were treated with botox (20 patients with focal facial dystonias, nine with lagophthalmos, eight with lower lid entropion, and 13 with epiphora, different techniques were used according to the pre-existing pathology, and the following data were recorded: age and sex, total dose for each injection, onset and duration of effect, degree of improvement, and the occurrence of any adverse effects. The study results supported the high efficacy of botulinum toxin for treatment of blepharospasm, hemifacial spasm, lagophthalmos, lower lid entropion, and epiphora, with marked to moderate improvement in 99, 87.5, 55.5, 75, and 92.3% of patients, respectively. Few side effects occurred but they resolved spontaneously without residues. We concluded that botulinum toxin A is a safe and effective treatment with a temporary outcome that may be desirable in certain situations.

  6. 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

    Science.gov (United States)

    2010-01-01

    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 upper limb injection of Bo

  7. Botulinum Toxin A Injection to the Bladder Neck and Urethra for Medically Refractory Lower Urinary Tract Symptoms in Men Without Prostatic Obstruction

    Directory of Open Access Journals (Sweden)

    Jing-Liang Chen

    2009-12-01

    Conclusion: Bladder neck and urethral BoNT-A injections improved LUTS and increased Qmax in men with a small prostate. Our findings suggest that bladder neck and urethral dysfunction may play a role in LUTS in men without BPH.

  8. A Single-blind, Split-face, Randomized, Pilot Study Comparing the Effects of Intradermal and Intramuscular Injection of Two Commercially Available Botulinum Toxin A Formulas to Reduce Signs of Facial Aging.

    Science.gov (United States)

    Sapra, Priya; Demay, Shantel; Sapra, Sheetal; Khanna, Julie; Mraud, Kelli; Bonadonna, Jennifer

    2017-02-01

    Objective: To examine the effectiveness of intradermal botulinum toxin type A injection in improving skin texture and midface lift while reducing pore size and sebum production, as well as investigate the differences in effectiveness between onabotulinumtoxinA and abobotulinumtoxinA using intradermal and intramuscular injection methods. Design: A 16-week, single-blind, split-face, randomized study. Each patient served as their own control, receiving onabotulinumtoxinA and abobotulinumtoxinA randomized to either the left or right side of the face. Patients received intradermal botulinum toxin type A injections at Week 0 and intramuscular botulinum toxin type A injections at Week 2. Participants: Ten women aged 35 to 65 years who exhibited static rhytids in the glabellar and periorbital area. Measurements: The primary endpoint was efficacy of split-face treatment of intradermal and intramuscular onabotulinumtoxinA and abobotulinumtoxinA as assessed by a blinded evaluator using baseline and post-treatment photographs. The secondary endpoints included safety as assessed by adverse events and patient satisfaction measured by questionnaires completed at baseline and post-treatment. Results: Intradermal injection of botulinum toxin type A led to a statistically significant improvement in skin texture (p=0.004) while also resulting in mild midface lift (p=0.024), but did not provide a significant reduction of pore size and sebum production. There was no statistically significant difference between onabotulinumtoxinA and abobotulinumtoxinA when injected intradermally or intramuscularly. Conclusion: Intradermal injection of botulinum toxin type A appears to be a safe and effective therapy that provides an improvement in facial skin texture and midface lift. Registry: clinicaltrials.gov (ID#: NCT02907268).

  9. The effects of botulinum toxin A on ephaptic transmission in idiopathic hemifacial spasm.

    Science.gov (United States)

    Kurt, Tülay; Seçil, Yaprak; Gürgör, Nevin; Tokuçoğlu, Figen; Beckmann, Yeşim; Ertekin, Cumhur

    2009-01-01

    Lateral spreading and synkinetic responses of blink reflex are a sign of ephaptic transmission in idiopathic hemifacial spasm (HFS). The aim of this study was to evaluate the effect of botulinum toxin A (Btx A) on ephaptic transmission in idiopathic HFS. Thirty-three patients with idiopathic HFS were investigated. Btx A was injected only into the affected orbicularis oculi (OC) muscle. Electrophysiological studies were performed before and three weeks after the Btx A injection. After Btx A, the latencies of motor response and blink reflexes elicited from the OC muscle were significantly increased. The lateral spreading was not obtained in the OC muscle, while the orbicularis oris muscle response was not changed. There were no significant differences in the synkinetic responses of blink reflex. During needle EMG examination, positive sharp waves and fibrilation potentials were observed due to chemodenervation only in the OC muscle. Btx A affects only the neuromuscular junctions of the injected muscle and has no effect upon ephaptic transmission.

  10. Drooling in Parkinson's disease: A randomized controlled trial of incobotulinum toxin A and meta-analysis of Botulinum toxins.

    Science.gov (United States)

    Narayanaswami, Pushpa; Geisbush, Thomas; Tarulli, Andrew; Raynor, Elizabeth; Gautam, Shiva; Tarsy, Daniel; Gronseth, Gary

    2016-09-01

    Botulinum toxins are a therapeutic option for drooling in Parkinson's Disease (PD). The aims of this study were to: 1. evaluate the efficacy of incobotulinum toxin A for drooling in PD. 2. Perform a meta-analysis of studies of Botulinum toxins for drooling in PD. 1. Primary study: Randomized, double blind, placebo controlled, cross over trial. Incobotulinum toxin (100 units) or saline was injected into the parotid (20 units) and submandibular (30 units) glands. Subjects returned monthly for three evaluations after each injection. Outcome measures were saliva weight and Drooling Frequency and Severity Scale. 2. Systematic review of literature, followed by inverse variance meta-analyses using random effects models. 1. Primary Study: Nine of 10 subjects completed both arms. There was no significant change in the primary outcome of saliva weight one month after injection in the treatment period compared to placebo period (mean difference, gm ± SD: -0.194 ± 0.61, range: -1.28 to 0.97, 95% CI -0.71 to 0.32). Secondary outcomes also did not change. 2. Meta-analysis of six studies demonstrated significant benefit of Botulinum toxin on functional outcomes (effect size, Cohen's d: -1.32, CI -1.86 to -0.78). The other studies used a higher dose of Botulinum toxin A into the parotid glands. This study did not demonstrate efficacy of incobotulinum toxin A for drooling in PD, but lacked precision to exclude moderate benefit. The parotid/submandibular dose-ratio may have influenced results. Studies evaluating higher doses of incobotulinum toxin A into the parotid glands may be useful. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Corneal and Tear Film Changes After Botulinum Toxin-A in Blepharospasm or Hemifacial Spasm.

    Science.gov (United States)

    Gunes, Alime; Demirci, Seden; Koyuncuoglu, Hasan Rifat; Tok, Levent; Tok, Ozlem

    2015-08-01

    To investigate changes in corneal parameters and the tear film after botulinum toxin-A (BTX-A) injection in patients with blepharospasm or hemifacial spasm. Twelve patients with benign essential blepharospasm and 30 with hemifacial spasm treated with BTX-A were included in this study. Disease severity was evaluated using the Jankovic scale. Corneal parameters were measured by the Pentacam. The Schirmer test score, tear breakup time, corneal fluorescein staining value, and Ocular Surface Disease Index score were also evaluated. The BTX-A treatment relieved spasms in all of the patients. There was a statistically significant difference in disease severity between pretreatment and the third week (2.7 ± 0.8 and 1.3 ± 0.6, respectively; P hemifacial spasm. However, there were no changes in corneal parameters, except corneal astigmatism, in these patients after treatment.

  12. Role of medical thermography in treatment of Frey's syndrome with botulinum toxin A.

    Science.gov (United States)

    Green, Richard James; Endersby, Simon; Allen, John; Adams, James

    2014-01-01

    Frey syndrome classically causes gustatory sweating and facial flushing. We describe 2 cases in which medical thermography was used to investigate the symptoms. Images were taken after patients chewed a sialagogue and 2 weeks later they were given injections of botulinum toxin A. Images taken 4 weeks after treatment showed a considerable reduction in sweating and facial flushing, which was supported by the results of quality of life questionnaires completed before and after treatment. Medical thermography is much cleaner than the Minor's starch iodine test. It identifies areas of gustatory sweating, changes in temperature, and vascular changes, which potentially enable treatment to be targeted accurately. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Facial asymmetry in patients with hemifacial spasm before and after botulinum toxin A treatment.

    Science.gov (United States)

    Xiao, Libin; Pan, Yougui; Zhang, Xiaolong; Hu, Yong; Cai, Li; Nie, Zhiyu; Pan, Lizhen; Li, Bing; He, Yijing; Jin, Lingjing

    2016-11-01

    Botulinum toxin A (BoNT-A) injection is one of the most widely used methods for hemifacial spasm (HFS) with high efficacy in controlling spasm. However, it is still unknown if esthetic symmetry could be desired as the spasm was controlled by BoNT-A therapy. The purpose of this study is to clarify the facial asymmetric characteristics of HFS patients and if the asymmetry could be amended by BoNT-A injection in the abnormal side. In this prospective analysis, HFS patients were enrolled, who received hemifacial BoNT-A injection and completed follow-up at weeks 2-4. Self-reported improvement and negative influence of facial asymmetry in social life were documented. Facial asymmetry was assessed by the Sunnybrook facial grading system (SFGS) and a new scale created by our clinic-the Symmetry Scale for Hemifacial Spasm (SSHS). Thirty-eight patients were eligible for analysis. Among them, 34 patients (89 %) had marked improvement in spasm after BoNT-A injection. After BoNT-A injection, SFGS showed an improvement of synkinesis (p = 0.01). And SSHS showed an amelioration of resting symmetry in lower face after treatment (p spasm and synkinesis of HFS and improved resting symmetry in lower face, but facial symmetry of voluntary movement deteriorated after hemifacial BoNT-A injection.

  14. Effects of botulinum toxin A and/or bimanual task-oriented therapy on upper extremity activities in unilateral Cerebral Palsy: a clinical trial

    NARCIS (Netherlands)

    Speth, L.; Janssen-Potten, Y.; Rameckers, E.; Defesche, A.; Winkens, B.; Becher, J.G.; Smeets, R.; Vles, H.

    2015-01-01

    Background: This study reports on the effects of botulinum toxin A (BoNT-A) injections in the upper extremity (UE) in children with unilateral Cerebral Palsy (uCP) combined with bimanual task-oriented therapy (BITT) or either treatment modality performed separately. Bimanual activities were measured

  15. Isosorbide dinitrate ointment vs botulinum toxin A (Dysport®) as the primary treatment for chronic anal fissure: a randomized multicentre study

    NARCIS (Netherlands)

    Berkel, A.E.M.; Rosman, C.; Koop, R.; van Duijvendijk, P.; van der Palen, Jacobus Adrianus Maria; Klaase, J.M.

    2014-01-01

    Aim Nitric oxide donors, such as isosorbide dinitrate ointment (ISDN), are considered as first-choice agents in the treatment of chronic anal fissure. Injection with botulinum toxin A in the internal anal sphincter is often used as a second-line therapy, although it may give better results and fewer

  16. [Essential blepharospasm and hemifacial spasm: characteristic of the patient, botulinum toxin A treatment and literature review].

    Science.gov (United States)

    Schellini, Silvana Artioli; Matai, Olívia; Igami, Thais Zamudio; Padovani, Carlos Roberto; Padovani, Carlos Pereira

    2006-01-01

    To evaluate the characteristics of the essential blepharospasm and hemifacial spasm patients and the feasible treatment with botulinum toxin A. Thirty-four essential blepharospasm or hemifacial spasm patients were evaluated according to gender, ocular complaint, time of disease, treatment outcome and complications. Age median was 63 years and the mean was 61 years, with no difference regarding sex; 66.66% of the patients had hemifacial spasm and 33.33%, essential blepharospasm. Many patients complained of dry eye associated with involuntary spasm. Botulinum toxin A showed a positive outcome in 91.30% of the treated patients and complications observed after treatment were eyelid ptosis (8.33%) and buccal angle deviation (8.33%). Essential blepharospasm and hemifacial spasm occurred in the elderly, of both sexes. Treatment with botulinum toxin A was useful, with very low complication rates.

  17. Molecular Mechanisms of Treadmill Therapy on Neuromuscular Atrophy Induced via Botulinum Toxin A

    Science.gov (United States)

    Tsai, Sen-Wei; Chen, Hsiao-Ling

    2013-01-01

    Botulinum toxin A (BoNT-A) is a bacterial zinc-dependent endopeptidase that acts specifically on neuromuscular junctions. BoNT-A blocks the release of acetylcholine, thereby decreasing the ability of a spastic muscle to generate forceful contraction, which results in a temporal local weakness and the atrophy of targeted muscles. BoNT-A-induced temporal muscle weakness has been used to manage skeletal muscle spasticity, such as poststroke spasticity, cerebral palsy, and cervical dystonia. However, the combined effect of treadmill exercise and BoNT-A treatment is not well understood. We previously demonstrated that for rats, following BoNT-A injection in the gastrocnemius muscle, treadmill running improved the recovery of the sciatic functional index (SFI), muscle contraction strength, and compound muscle action potential (CMAP) amplitude and area. Treadmill training had no influence on gastrocnemius mass that received BoNT-A injection, but it improved the maximal contraction force of the gastrocnemius, and upregulation of GAP-43, IGF-1, Myo-D, Myf-5, myogenin, and acetylcholine receptor (AChR) subunits α and β was found following treadmill training. Taken together, these results suggest that the upregulation of genes associated with neurite and AChR regeneration following treadmill training may contribute to enhanced gastrocnemius strength recovery following BoNT-A injection. PMID:24327926

  18. Molecular Mechanisms of Treadmill Therapy on Neuromuscular Atrophy Induced via Botulinum Toxin A

    Directory of Open Access Journals (Sweden)

    Sen-Wei Tsai

    2013-01-01

    Full Text Available Botulinum toxin A (BoNT-A is a bacterial zinc-dependent endopeptidase that acts specifically on neuromuscular junctions. BoNT-A blocks the release of acetylcholine, thereby decreasing the ability of a spastic muscle to generate forceful contraction, which results in a temporal local weakness and the atrophy of targeted muscles. BoNT-A-induced temporal muscle weakness has been used to manage skeletal muscle spasticity, such as poststroke spasticity, cerebral palsy, and cervical dystonia. However, the combined effect of treadmill exercise and BoNT-A treatment is not well understood. We previously demonstrated that for rats, following BoNT-A injection in the gastrocnemius muscle, treadmill running improved the recovery of the sciatic functional index (SFI, muscle contraction strength, and compound muscle action potential (CMAP amplitude and area. Treadmill training had no influence on gastrocnemius mass that received BoNT-A injection, but it improved the maximal contraction force of the gastrocnemius, and upregulation of GAP-43, IGF-1, Myo-D, Myf-5, myogenin, and acetylcholine receptor (AChR subunits α and β was found following treadmill training. Taken together, these results suggest that the upregulation of genes associated with neurite and AChR regeneration following treadmill training may contribute to enhanced gastrocnemius strength recovery following BoNT-A injection.

  19. Effect of multilevel botulinum toxin a and comprehensive rehabilitation on gait in cerebral palsy.

    NARCIS (Netherlands)

    Scholtes, V.A.; Dallmeijer, A.J.; Knol, D.L.; Speth, L.A.; Maathuis, C.G.; Jongerius, P.H.; Becher, J.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

  20. 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.

    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

  1. 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

  2. Ultrasound-guided botulinum toxin injections

    OpenAIRE

    S. E. Khatkova; A. A. Balbert

    2016-01-01

    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 si...

  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. Drooling in Patients with Cerebral Palsy: The Effectiveness of Botulinum Toxin A Treatment

    Directory of Open Access Journals (Sweden)

    O. A. Klochkova

    2015-01-01

    Full Text Available Background. Drooling (sialorrhea is a complex medical and social problem of patients with cerebral palsy (CP. During the last decade many methods for drooling correction in CP are under active development.Aim: to evaluate the effectiveness and safety of the first and repeated injections of botulinum toxin A (BTA for correcting drooling in children with CP.Methods. 13 children (2 years — 14 years 7 months with spastic forms of CP and drooling resistant to non-drug treatment. Drooling was evaluated with the Drooling Impact Scale — DIS before, 1, 3 and 6 months after the BTA injections. Parotid and submandibular salivary glands were injected under ultrasound control with Dysport — 1 group (5 children or Botox — 2 group (8 children. The total dose of Dysport for the all glands was 120–320 U (3,8–14,5 U/kg, Botox — 30–100 U (2,5–4,5 U/kg. The median of the basic DIS index was 77 (64–90 points in the first group and 58 (53–66 points in the second group.Results. One month after the BTA injections the DIS index decreased by 20 and more points in 6 (42,2% patients, by 10–19 points in 7 (53,8% children. There were no persistent side effects and no difference in the BTA effectiveness between the two groups. The mean decrease of DIS was 30% in both groups. 3 months after the injections 2 patients (15,4% kept 20 points decrease of the DIS index, 6 patients (46,2% demonstrated 10 points decrease. 6 months after injections nearly all patients returned to the basic level of drooling. Repeated injections of the BTA demonstrated the same tendency and duration of the DIS changes. There was no significant correlation between the GMFCS level and the drooling intensity.Conclusion. BTA injections into salivary glands of children with CP was an effective and safe method of drooling correction with the maximum effect taking place 2–4 weeks after the injections and a stable effect — 3 months after the injections.

  5. Botulinum toxin A treatment for primary hemifacial spasm: a 10-year multicenter study.

    Science.gov (United States)

    Defazio, Giovanni; Abbruzzese, Giovanni; Girlanda, Paolo; Vacca, Laura; Currà, Antonio; De Salvia, Roberto; Marchese, Roberta; Raineri, Roberto; Roselli, Francesco; Livrea, Paolo; Berardelli, Alfredo

    2002-03-01

    Botulinum toxin A (BTX) is the currently preferred symptomatic treatment for primary hemifacial spasm (HFS), but its long-term efficacy and safety are not known. To assess the long-term effectiveness and safety of BTX in the treatment of primary HFS. Retrospective review of medical records of the 1st and 10th years of treatment. Outpatient clinics of 4 Italian university centers in the Italian Movement Disorders Study Group. A series of 65 patients with primary HFS who had received BTX injections regularly for at least 10 years. Mean duration of improvement and quality of the effect induced by the preceding treatment (measured using a patient self-evaluation scale) and occurrence and duration of adverse effects in the 1st and 10th years of treatment. Using a mean BTX dose per treatment session similar to that used by others, we obtained a 95% response rate and an overall mean duration of improvement of 12.6 weeks during year 1. The effectiveness of BTX in relieving the symptoms of primary HFS, as measured by the response rate and average duration of improvement, remained unchanged in the 1st and 10th years. Patients needed statistically similar BTX doses in the 1st and 10th years. The rate of local adverse effects (including upper lid ptosis, facial weakness, and diplopia) diminished significantly in the 10th year of treatment. Treatment with BTX effectively induces sustained relief from symptoms of HFS in the long term, with only minimal and transient adverse reactions.

  6. Botulinum toxin injection: a review of injection principles and protocols

    Directory of Open Access Journals (Sweden)

    David E. Rapp

    2007-04-01

    Full Text Available Despite the favorable outcomes seen using botulinum toxin (BTX for voiding dysfunction using BTX, a standardized technique and protocol for toxin injection is not defined. We reviewed the current literature on intravesical BTX injection for DO (detrusor overactivity. Specific attention was placed on defining optimal injection protocol, including dose, volume, and injection sites. In addition, we sought to describe a standard technique to BTX injection.

  7. Obesity Treatment with Botulinum Toxin-A Is Not Effective: a Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Bustamante, Fabio; Brunaldi, Vitor Ottoboni; Bernardo, Wanderley Marques; de Moura, Diogo Turiani H; de Moura, Eduardo Turiani H; Galvão, Manoel; Santo, Marco Aurélio; de Moura, Eduardo Guimarães H

    2017-10-01

    The effectiveness of gastric injections of botulinum toxin-A (BTA) as primary treatment for obesity is not well known since results in literature are discrepant. Hence, we aimed to systematically review and meta-analyze the available data to assess the real effect of BTA therapy. We searched MEDLINE, Embase, Cochrane, SCOPUS, EBSCO, LILACS, and BVS. We considered eligible only randomized controlled trials enrolling obese patients comparing BTA versus saline injections. Our initial search identified 8811 records. Six studies fulfilled eligibility criteria. After critical appraisal, two articles were excluded and we meta-analyzed the remainder. The mean difference for absolute weight loss and BMI reduction were 0.12 [CI 95%, - 1.14, 1.38] and - 0.06 [95% CI, - 0.92, 0.81], respectively. Therefore, we concluded that treatment of obesity with BTA is not effective.

  8. Using family and staff experiences of a botulinum toxin-A service to improve service quality.

    Science.gov (United States)

    Burton, K L O; Bau, K; Lewis, J; Aroyan, K R; Botha, B; Botman, A G M; Stewart, K; Waugh, M-C A; Paget, S P

    2017-11-01

    The decision for families to proceed with botulinum toxin-A (BoNT-A) injections for managing childhood conditions involving hypertonia can be complex. Family-centred care is a service model that facilitates supporting families in this decision-making process. Understanding families' experiences of services is critical to developing family-centred care. The aim of this project was therefore to increase understanding of the experiences of families of children attending a BoNT-A service in order to improve the service and its family-centred approach to care. Sixteen staff of a BoNT-A service participated in a patient journey mapping exercise. Nine families of the service participated in in-depth interviews. Interviews were audio-recorded and transcribed verbatim. Data from the staff session and interviews were analysed independently using grounded, hermeneutic thematic analysis. Staff sessions revealed 5 core themes that related to impacting on the family experience. Family interviews revealed 4 core themes, with 7 subthemes and 1 latent theme. Areas of importance identified by families relating to BoNT-A treatment included acknowledgement of individual needs, care coordination, empowerment of families and patients, consistency in service delivery, and the distressing nature of appointment and decision-making. Comparison of the data from the staff patient journey mapping and family interviews suggested that staff have a good but incomplete understanding of the factors important to families, highlighting the need for consumer engagement in establishing family-centred care. The themes identified can guide the provision of family-centred BoNT-A injection clinics. © 2017 John Wiley & Sons Ltd.

  9. Botulinum Toxin Injections Into the Lateral Cricoarytenoid Muscles for Vocal Process Granuloma.

    Science.gov (United States)

    Pham, Q; Campbell, R; Mattioni, J; Sataloff, R

    2017-08-01

    Contact granulomas are benign, exophytic inflammatory lesions of the larynx that typically arise on or near the vocal process of the arytenoid cartilage. The most common management options include voice therapy and antireflux pharmacotherapy, intralesional steroid injections, botulinum toxin injections, and surgical excision. In-office Botox injection into the lateral cricoarytenoid (LCA) muscle can be effective even for recurrent granulomas. This is a retrospective chart review and literature review. We reviewed more than 400 charts and included two patients, who underwent in-office injection with botulinum toxin A into LCA muscles bilaterally, after previously failing both conservative and surgical management. Both cases showed significant improvement of the laryngeal granulomas after 6 months and a single botulinum toxin injection. Both cases were initially grade III granuloma that improved to grade I. In-office injection of botulinum toxin A targeting the LCA muscle appears to be a safe and effective treatment modality in refractory laryngeal granuloma. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  10. Autologous blood injection and botulinum toxin for resistant plantar fasciitis accompanied by spasticity.

    Science.gov (United States)

    Logan, Lynne Romeiser; Klamar, Karl; Leon, Jerry; Fedoriw, Wladislaw

    2006-08-01

    An originally ambulatory 18-yr-old woman with spastic left hemiplegic cerebral palsy developed left plantar fasciitis with a gradual loss of function requiring use of a wheelchair. Her symptoms were resistant to physical therapy. Two hundred units of botulinum toxin A was diluted in 4 mL of saline and injected into the gastrocnemius. Three milliliters of autologous blood was injected into the plantar fascia. She reported decreased pain at 3 days postinjection. At 10 days, she had no pain on walking. Dorsiflexion increased and Ashworth and Tardieu improved. A stretching program was taught and a better-fitting night splint was obtained. At 21 days, she exhibited no pain and increased dorsiflexion. Autologous blood injection combined with botulinum toxin A may be an alternative treatment for resistant plantar fasciitis accompanied by spasticity. Our hypothesis is that chronic plantar fasciitis is a degenerative condition and thus is relieved when a mild inflammatory process is created that leads to healing.

  11. Treatment of major depressive disorder using botulinum toxin A: a 24-week randomized, double-blind, placebo-controlled study.

    Science.gov (United States)

    Magid, Michelle; Reichenberg, Jason S; Poth, Poppy E; Robertson, Henry T; LaViolette, Amanda K; Kruger, Tillmann H C; Wollmer, M Axel

    2014-08-01

    To determine whether a single treatment of botulinum toxin A in the forehead (glabellar) region can improve symptoms of depression in patients with major depressive disorder (MDD), as defined by DSM-IV criteria. Thirty participants were randomly assigned to receive either placebo or botulinum toxin A (BTA; onabotulinumtoxinA) injections in the forehead. Female participants received 29 units; male participants received 39 units. At week 12, the groups were crossed over. Participants were evaluated at weeks 0, 3, 6, 12, 15, 18, and 24 for improvement in MDD symptoms using the Patient Health Care Questionnaire-9, Beck Depression Inventory (BDI), and 21-Item Hamilton Depression Rating Scale (HDRS-21) objective measurement scales. The primary outcome was the rate of HDRS-21 response, defined as ≥ 50% score reduction from baseline. The study occurred from July 2011 to November 2012. Patients who received BTA at week 0 (BTA-first group) and at week 12 (BTA-second group) had a statistically significant reduction in MDD symptoms as compared to placebo. Improvement in MDD continued over 24 weeks in the group that received BTA first even though the cosmetic effects of BTA wore off at 12 to 16 weeks. HDRS-21 response rates were 55% (6/11) in the BTA-first group, 24% (4/17) in the BTA-second group, and 0% (0/19) in the placebo group (P < .0001). HDRS-21 remission rates (score ≤ 7) were 18% (2/11), 18% (3/17), and 0% (0/19), respectively (P = .057). HDRS-21 scores dropped -46% and -35% in the BTA-first and -second groups versus -2% in the placebo group (P < .0001). The BDI response rate (≥ 50% reduction from baseline) was 45% (5/11) in the BTA-first group, 33% (6/18) in the BTA-second group, and 5% (1/19) in the placebo group (P = .0067). BDI remission rates (score ≤ 9) were 27% (3/11), 33% (6/18), and 5% (1/19), respectively (P = .09). BDI scores dropped -42% and -35% in the BTA-first and -second groups versus -15% in the placebo group (P < .0001). Botulinum toxin A

  12. Botulinum toxin injections for blepharospasm prior to ocular surgeries

    Directory of Open Access Journals (Sweden)

    Kaydu E

    2012-05-01

    Full Text Available Seydi Okumus1, Erol Coskun1, İbrahim Erbagci1, M Gürkan Tatar2, Aysegul Comez1, Erdal Kaydu1, Ramazan Yayuspayi1, Bulent Gurler11Department of Ophthalmology, University of Gaziantep, 2Ophthalmology Clinic, Nizip State Hospital, Nizip, Gaziantep, TurkeyPurpose: The aim of this study was to show the efficiency of preoperative botulinum toxin A (Botox A in patients with benign essential blepharospasm who were to undergo ocular surgery with local anesthesia.Materials and methods: Twenty-eight benign essential blepharospasm patients who were administered unilateral Botox A prior to ocular surgery between January 2004 and May 2011 were included in this study. Eleven cases had pterygiums, ten had cataracts, and four had glaucomas, while the remaining three had aphakia. All cases’ severity of spasm (stage 0–4 and eyelid closing forces (stage 1–4 were evaluated according to the Jankovic scale prior to the injection, at 3 days, 14 days, 1 month, and 3 months after Botox A injection.Results: Of the patients enrolled in the study, 16 were female and 12 were male, with an average age of 55.52 ± 1.53 years (52–65. Average onset of the Botox injection's effect was 2.8 ± 0.9 (2–5 days. Its effect lingered for about 11.5 ± 3.6 (8–22 weeks. The severity of spasm and eyelid closing forces of all the patients enrolled were compared prior to the injection at 3 and 14 days and the first and third months after the injection. There were statistically significant differences between prior to the injection and 3 days (P = 0.001, 14 days (P < 0.001 and 1 month after the injection (P <0.001. There was no statistically significant difference between prior to the injection and 3 months after the injection (P = 0.513. Fourteen days following the injection, the surgeries were successfully performed.Conclusion: Botox A administered prior to ocular surgery will control both blepharospasm and lower the risks that can be encountered before and during surgery, thus

  13. 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. 

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

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    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.

  15. 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…

  16. Thickened saliva after effective management of drooling with botulinum toxin A.

    NARCIS (Netherlands)

    Erasmus, C.E.; Hulst, K. van; Hoogen, F.J.A. van den; Limbeek, J. van; Roeleveld, N.; Veerman, E.C.; Rotteveel, J.J.; Jongerius, P.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 3-17 y, mean age 9 y 10 mo) diagnosed with spastic (n=9) or dyskinetic (n=6)

  17. Thickened saliva after effective management of drooling with botulinum toxin A

    NARCIS (Netherlands)

    Erasmus, C.E.; van Hulst, K.; van den Hoogen, F.J.; van Limbeek, J.; Roeleveld, N.; Veerman, E.C.I.; Rotteveel, J.J.; Jongerius, P.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

  18. Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II.

    Science.gov (United States)

    Löwing, Kristina; Thews, Karin; Haglund-Åkerlind, Yvonne; Gutierrez-Farewik, Elena M

    2017-08-01

    To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP). A consecutive selection of 40 children, ages 4-12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I-II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections. A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months. The treatments' positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome.

  19. Botulinum toxin injection in laryngeal dyspnea.

    Science.gov (United States)

    Woisard, Virginie; Liu, Xuelai; Bes, Marie Christine Arné; Simonetta-Moreau, Marion

    2017-02-01

    Data, regarding the use of botulinum toxin (BT-A) in laryngeal dyspnea, are scarce, coming from some cases reports in the literature, including Vocal fold paralysis, laryngeal dystonia, vocal cord dysfunction also called paradoxical motion of the vocal fold (PMVF), and post-neuroleptic laryngeal dyskinesia. There is no consensus regarding the muscles and the doses to inject. The aim of this study is to present a retrospective review of patients treated in our ENT Department by BT-A injection in this indication. This study is a retrospective study describing patients who underwent an injection of botulinum toxin for laryngeal dyspnea in the ENT Department from 2005 to 2015 years. The inclusion criteria were a dyspnea associated with a laryngeal dysfunction, confirmed by flexible fiberoptic nasopharyngolaryngoscopy. Information concerning the causes of the dyspnea, the botulinum toxin BT-A injections procedure, post-injection follow-up, and respiratory outcome were collected for all patients included. In the group of 13 patients included, the main cause identified as principal factor linked with the short breath was: a bilateral VF paralysis (Patel et al., Otolaryngol Head Neck Surg 130:686-689, 7), laryngeal dystonia (Balkissoon and Kenn, Semin Respir Crit Care Med 33:595-605, 2), Anxiety syndrome associated with unilateral vocal fold paralysis or asthma (Marcinow et al., Laryngoscope 124:1425-1430, 3), and an isolated asthma (Zwirner et al., Eur Arch Otorhinolaryngol 254:242-245, 1). Nine out of the thirteen patients were improved by the injections. A BT-A-induced stable benefit for four patients led them to stop the injections in the follow-up. Good outcome was observed in five other patients (main cause: bilateral VP paralysis), allowing a progressive lengthening of the delay between BT-A injections. Four patients did not report a positive risk/benefit ratio after BT-A injections; two of them (with bilateral VF paralysis), because of respiratory side effects and

  20. 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.

  1. 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

    Directory of Open Access Journals (Sweden)

    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

  2. Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia.

    Science.gov (United States)

    Rodriguez-Acevedo, Omar; Elstner, Kristen E; Jacombs, Anita S W; Read, John W; Martins, Rodrigo Tomazini; Arduini, Fernando; Wehrhahm, Michael; Craft, Colette; Cosman, Peter H; Dardano, Anthony N; Ibrahim, Nabeel

    2018-02-01

    Operative management of complex ventral hernia still remains a significant challenge for surgeons. Closure of large defects in the unprepared abdomen has serious pathophysiological consequences due to chronic contraction and retraction of the lateral abdominal wall muscles. We report outcomes of 56 consecutive patients who had preoperative Botulinum toxin A (BTA) abdominal wall relaxation facilitating closure and repair. This was a prospective observational study of 56 patients who underwent ultrasound-guided BTA into the lateral abdominal oblique muscles prior to elective ventral hernia repair between November 2012 and January 2017. Serial non-contrast abdominal CT imaging was performed to evaluate changes in lateral oblique muscle length and thickness. All hernias were repaired laparoscopically, or laparoscopic-open-laparoscopic (LOL) using intraperitoneal onlay mesh. 56 patients received BTA injections at predetermined sites to the lateral oblique muscles, which were well tolerated. Mean patient age was 59.7 years, and mean BMI was 30.9 kg/m 2 (range 21.8-54.0). Maximum defect size was 24 × 27 cm. A subset of 18 patients underwent preoperative pneumoperitoneum as an adjunct procedure. A comparison of pre-BTA to post-BTA imaging demonstrated an increase in mean lateral abdominal wall length from 16.1 cm to 20.1 cm per side, a mean gain of 4.0 cm/side (range 1.0-11.7 cm/side) (p LOL primary closure was achieved in all cases, with no clinical evidence of raised intra-abdominal pressures. One patient presented with a new fascial defect 26 months post-operative. Preoperative BTA to the lateral abdominal wall muscles is a safe and effective technique for the preparation of patients prior to operative management of complex ventral hernias. BTA temporary flaccid paralysis relaxes, elongates and thins the chronically contracted abdominal musculature. This in turn reduces lateral traction forces facilitating laparoscopic repair and fascial closure of large

  3. Bilateral versus posterior injection of botulinum toxin in the internal ...

    African Journals Online (AJOL)

    Aim. Comparison of bilateral versus posterior injection of botulinum toxin into the internal anal sphincter for treatment of acute anal fissure. Methods. Forty patients with acute anal fissure were randomly divided into two equal groups. Group 1 was treated by injecting 20 units of botulinum toxin into each side of the internal ...

  4. Quality of life in hemifacial spasm patient after treatment with botulinum toxin A; a 24-week, double-blind, randomized, cross-over comparison of Dysport and Neuronox study.

    Science.gov (United States)

    Kongsengdao, Subsai; Kritalukkul, Saksit

    2012-03-01

    Hemifacial spasm (HFS) is a common movement disorder presented with unilateral, intermittent, irregular tonic or clonic contraction of facial expression muscles without any identifiable etiology. Comparison of quality of life (QoL) between Dysport and Neuronox has not been studied in HFS patients. To evaluate the QoL after treatment with botulinum toxin A (Dysport and Neuronox) injection in HFS patient. A 24-week, double-blind, randomized, cross-over comparison of QoL in HFS patients after being treated with botulinum toxin A (Dysport) and botulinum toxin A (Neuronox) was performed. Assessment of QoL composed of hemifacial spasm-30 (HFS-30), medical outcome study short form 36 items (SF-36), abnormal involuntary movement scale (AIMS) and center for epidemiologic studies-depression (CES-D) questionnaire, were performed at week 0, week 12, and week 24. The 24-hour HFS diary, recorded for 4 weeks after treatment was also evaluated. Total of 26 HFS patients were enrolled between May 2010 and January 2011. The mean HFS-30, AIMS and CES-D were reduced after treatment without any difference between the two groups. The mean SF-36 was not changed in both groups. However mean HFS-30 (p = 0.09), AIMS (p = 0.02) and CES-D (p spasm per day and duration of functional impairment per day in Dysport group were significantly lower than the Neuronox group (p botulinum toxin A injection.

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    Ana Claudia Paradella

    2016-11-01

    Full Text Available 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.

  7. Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series.

    NARCIS (Netherlands)

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

    2001-01-01

    Drooling beyond the age of 4 years is pathological, particularly if it occurs in children with neurological and developmental impairment and disability. Considering the therapeutic spectrum of botulinum toxin A and in view of the innervation of the salivary glands, we postulated that intraglandular

  8. Augmenting occupational therapy treatment of upper-extremity spasticity with botulinum toxin A: a case report of progress at discharge and 2 years later.

    Science.gov (United States)

    Denham, Susan P

    2008-01-01

    This case report summarizes occupational therapy services provided to a participant after botulinum toxin A (BTA) injections and her improvements 2 years later. The injections were performed to neutralize spasticity in the left upper extremity after a stroke. Along with BTA, the participant received occupational therapy for 12 weeks, using neurodevelopmental and biomechanical approaches and an activity-based home program. Spasticity decreased from a 4 to a 1 on the Modified Ashworth Scale (MAS) immediately after the injections. Two years after the injections, the MAS score ranged between 1 and 1+. Initially, the participant demonstrated functional limitations in areas of splint application, dressing, toileting, and bathing. Following BTA injections and occupational therapy, the participant demonstrated increased independence in all deficit areas. For this participant, BTA, combined with functional, activity-based occupational therapy interventions, was associated with neurological change and greater functional use of the spastic limb.

  9. Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen.

    Science.gov (United States)

    Zielinski, M D; Goussous, N; Schiller, H J; Jenkins, D

    2013-02-01

    Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the "chemical components separation," which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral abdominal wall musculature. This is a retrospective review of all OA patients (age ≥18) from December 2009-June 2010 who underwent BTX injection. Under ultrasound guidance, a total of 300 units of BTX were injected into the external oblique, internal oblique and transversus abdominus. A total of 18 patients were injected with a median age of 66 years (56 % male). Indications for OA treatment included questionable bowel viability (39 %), shock (33 %), loss of abdominal domain (6 %) and feculent contamination (17 %). Median ASA score was 3 with an APACHE 3 score of 85. Patients underwent a median of 4 serial abdominal explorations. The primary fascial closure rate was 83 % with a partial fascial closure rate of 6 % and planned ventral hernia rate of 11 %. Of the 9 patients injected within 24 h of their initial OA procedure, 89 % achieved primary fascial closure. Mortality was 11 %; death was unrelated to BTX injection. The overall complication rate was 67 %; specific complications rates included fascial dehiscence (11 %), enterocutaneous fistula development (0 %), intra-abdominal abscess (44 %) and deep surgical site infection (33 %). The "chemical components separation" technique described is safe and avoids the extensive dissection necessary for mechanical components separation in critically ill patients with infected/contaminated abdominal domains. While further evaluation is required, the described technique provides potential to improve delayed primary fascial closure rates in the OA setting.

  10. Evaluation of concentrations of botulinum toxin A for the treatment of hemifacial spasm: a randomized double-blind crossover trial.

    Science.gov (United States)

    Li, Y J; Huang, Y; Ding, Q; Gu, Z H; Pan, X L

    2015-02-06

    The aim of our study was to evaluate the efficacy and safety of two concentrations of botulinum toxin A (BTX-A) for the treatment of hemifacial spasm. We randomly divided 20 patients with hemifacial spasm into high- and low-concentration groups; they were administered 50 and 25 U/mL BTX-A injection, respectively. Further, we compared the curative effects and the occurrence of adverse reactions in the two groups. Our results showed that both the concentrations of BTX-A were effective and no significant difference was observed in the onset time and therapeutic efficacy between the two groups; however, the duration of efficacy was longer in the high-concentration group than in the low-concentration group. Patients in both groups had no allergic reactions and systemic toxic reactions, but those in the high-concentration group had more serious adverse reactions and they lasted for longer durations. The adverse reactions in the two groups were not specifically treated, and they resolved in a relatively short time. In conclusion, local injection of BTX-A was effective in treating hemifacial spasm and each concentration of BTX-A had advantages and disadvantages, which indicated that the concentration of BTX-A can be selected according to the clinical characteristics and willingness of the patients.

  11. Electrical Stimulation Following Botulinum Toxin A in Children With Spastic Diplegia: A Within-Participant Randomized Pilot Study.

    Science.gov (United States)

    Mudge, Anita; Harvey, Lisa A; Lancaster, Ann; Lowe, Kevin

    2015-01-01

    To determine whether electrical stimulation (ES) following botulinum toxin A (BoNT/A) injection increases passive extensibility of the hamstring muscles in children with spastic diplegia. Six children undergoing bilateral BoNT/A injections to the hamstrings participated in this within-participant single blind randomized controlled trial. One leg of each child was randomised to the experimental condition and the other to the control condition. The experimental leg received daily stretch and ES to the hamstrings for 12 weeks, while the control leg received only daily stretch. The primary outcome was passive hamstring extensibility reflected by popliteal angle measured with a standardised torque. Secondary outcomes were two goniometric measures of popliteal angle using the Modified Tardieu Scale (R1 and R2), and parents' perceptions of treatment effectiveness. Outcomes were measured at baseline, 4 weeks, 12 weeks and 6 months. The mean between-group difference (95% CI) at 4 weeks was 2° (-2 to 5) for popliteal angle measured with a standardised torque, favouring the experimental leg. Tardieu results for R1 and R2 were 0° (-4 to 3) and 7° (0 to 14), respectively. ES does not improve passive extensibility of the hamstring muscles at 4 weeks over any possible effects of BoNT/A alone.

  12. Analgesic Effect of Botulinum Toxin A in Myofascial Pain Syndrome Patients Previously Treated with Local Infiltration of Anesthetic and Steroids.

    Science.gov (United States)

    Cartagena-Sevilla, Joaquín; García-Fernández, María R; Vicente-Villena, Juan P

    2016-12-01

    The purpose of this study was to evaluate the analgesic effect of botulinum toxin A (BoNTA) injections in patients with myofascial pain syndrome (MPS) who were previously treated with the local infiltration of anesthetic and steroids (LIAS). The study included a retrospective phase and a longitudinal open-label prospective phase, which were conducted on consecutive patients with MPS previously treated with the local infiltration of anesthetic (levobupivacaíne 0.25%) and steroids (triamcinolone 40 mg). Eligible patients were treated with a single intramuscular injection of BoNTA (Botox; Allergan, Inc., Irvine, CA). The treatment efficacy was determined according to the degree of pain relief obtained. Eighty-two patients met the inclusion/exclusion criteria and were included in the study. Successful results were obtained for 32 (39.0%) and 30 (36.6%) patients, during treatment with BoNTA and LIAS, respectively. The mean (standard deviation) length of the analgesic effect was significantly longer with BoNTA (29.6 [SD = 17.7] weeks) than with LIAS (8.5 [SD = 6.4] weeks), P pain for a relatively long time.

  13. Contralateral botulinum toxin injection to improve facial asymmetry after acute facial paralysis.

    Science.gov (United States)

    Kim, Jin

    2013-02-01

    The application of botulinum toxin to the healthy side of the face in patients with long-standing facial paralysis has been shown to be a minimally invasive technique that improves facial symmetry at rest and during facial motion, but our experience using botulinum toxin therapy for facial sequelae prompted the idea that botulinum toxin might be useful in acute cases of facial paralysis, leading to improve facial asymmetry. In cases in which medical or surgical treatment options are limited because of existing medical problems or advanced age, most patients with acute facial palsy are advised to await spontaneous recovery or are informed that no effective intervention exists. The purpose of this study was to evaluate the effect of botulinum toxin treatment for facial asymmetry in 18 patients after acute facial palsy who could not be optimally treated by medical or surgical management because of severe medical or other problems. From 2009 to 2011, nine patients with Bell's palsy, 5 with herpes zoster oticus and 4 with traumatic facial palsy (10 men and 8 women; age range, 22-82 yr; mean, 50.8 yr) participated in this study. Botulinum toxin A (Botox; Allergan Incorporated, Irvine, CA, USA) was injected using a tuberculin syringe with a 27-gauge needle. The amount injected per site varied from 2.5 to 3 U, and the total dose used per patient was 32 to 68 U (mean, 47.5 +/- 8.4 U). After administration of a single dose of botulinum toxin A on the nonparalyzed side of 18 patients with acute facial paralysis, marked relief of facial asymmetry was observed in 8 patients within 1 month of injection. Decreased facial asymmetry and strengthened facial function on the paralyzed side led to an increased HB and SB grade within 6 months after injection. Use of botulinum toxin after acute facial palsy cases is of great value. Such therapy decreases the relative hyperkinesis contralateral to the paralysis, leading to greater symmetric function. Especially in patients with medical

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

    Directory of Open Access Journals (Sweden)

    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

  15. Evaluating the effects of Botulinum Toxin A on tear metrics in patients with hemifacial spasm.

    Science.gov (United States)

    Mali, Yasmin Poustchi; Schultze, Robert L; Wladis, Edward J

    2017-10-01

    Hemifacial spasm has been previously shown to result in dry eye and ocular surface diseases. This study was performed to assess the impact of chemodenervation with botulinum toxin on clinically-relevant metrics of tears. Tear osmolarity and lipid layer thickness were measured in patients with hemifacial spasm after they achieved relief from hemifacial spasm via botulinum toxin injections. Twelve eyes of 6 patients with hemifacial spasm (2 men and 4 women; mean age 55.5 years) were assessed in accordance with the Declaration of Helsinki and IRB approval. The mean tear osmolarities were 300.8 mOsm (standard deviation = 7.44 mOsm) and 293.0 mOsm (standard deviation = 7.01 mOsm) for treated and untreated eyes, respectively, and this difference was not statistically significant (p = 0.097). The mean lipid layer thicknesses of the tear film were 78.7 nm (standard deviation = 18.0 nm) and 71.5 nm (standard deviation = 25.2 nm) for treated and untreated eyes, respectively, and these values were not statistically significantly different (p = 0.671). Although previous investigations have demonstrated significant dry eye disease in patients with hemifacial spasm, successful chemodenervation with botulinum toxin appears to result in tear osmolarities and lipid layer thicknesses that were comparable in treated and untreated eyes. This finding may represent an additional benefit to treatment of hemifacial spasm.

  16. Antinociceptive effect of botulinum toxin A involves alterations in AMPA receptor expression and glutamate release in spinal dorsal horn neurons.

    Science.gov (United States)

    Hong, Bin; Yao, LingLing; Ni, Linhui; Wang, Li; Hu, XingYue

    2017-08-15

    The use of botulinum toxin A (BTX-A) for various clinical therapeutic applications is increasing. It is widely believed that peripheral therapeutic or toxic effects of BTX-A are exclusively mediated by SNAP-25 cleavage. There is growing evidence of long-distance retrograde axonal transport of BTX-A on entering the central nervous system, subsequent to a local injection of the toxin. However, the prevalence of central antinociceptive effects after BTX-A peripheral application and its underlying mechanisms are unclear. Our results show that (1) BTX-A can undergo retrograde axonal transport to the dorsal horn after peripheral application; (2) Peripheral pretreatment with BTX-A decreases the expression and function of AMPA receptors in the spinal cord dorsal horn neurons; (3) Peripheral pretreatment with BTX-A does not change basal glutamate release, but decreases the effect of formalin-evoked release of glutamate in spinal cord dorsal horn neurons. These results suggest that peripheral application of BTX-A can change AMPA receptor expression in, and glutamate release from, spinal dorsal horn neurons, which may have significance in its central antinociceptive effects. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

  17. A Randomized Controlled Trial Comparing Botulinum Toxin A Dosage in the Upper Extremity of Children with Spasticity

    Science.gov (United States)

    Kawamura, Anne; Campbell, Kent; Lam-Damji, Sophie; Fehlings, Darcy

    2007-01-01

    This study compared the effects of low and high doses of botulinum toxin A (BTX-A) to improve upper extremity function. Thirty-nine children (22 males, 17 females) with a mean age of 6 years 2 months (SD 2y 9mo) diagnosed with spastic hemiplegia or triplegia were enrolled into this double-blind, randomized controlled trial. The high-dose group…

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

    Science.gov (United States)

    Iannitti, Tommaso; Palmieri, Beniamino; Aspiro, Anna; Di Cerbo, Alessandro

    2014-01-01

    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. 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. 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). Both treatment modalities reduced sweating at 3-month follow-up, if compared with baseline (all PDelivery of lidocaine and BTX-A by JetPeel™-3 resulted in lower procedure-related pain and reduced sweating, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (all Pdelivery by jet nebulization over standard injection therapy for treatment of primary

  19. The Role of Botulinum Toxin A in Treatment of Temporomandibular Joint Disorders: A Review.

    Science.gov (United States)

    Ataran, Rana; Bahramian, Ayla; Jamali, Zahra; Pishahang, Vahid; Sadeghi Barzegani, Homayoon; Sarbakhsh, Parvin; Yazdani, Javad

    2017-09-01

    Temporomandibular joint disorders (TMDs) usually present with symptoms and signs such as pain, mandibular movement, dysfunction, or joint sounds. Botulinum toxin type A (BTX-A) is a biologic toxin which inhibits skeletal muscle through hindering the production of acetylcholine in the nerve endings. This toxin is used for the treatment of hyperactivity of lateral pterygoid muscle and TMD symptoms. This comprehensive review aimed to evaluate the effect of BTX-A injections in the lateral pterygoid muscle on treatment of TMDs symptoms. In this study, online databases including Scopus, Medline, Ebsco, Cochrane, EMBASE, and Google scholar were searched for the keywords "pterygoid muscle" and "Onabotulinumtoxin A". Twenty-four articles were eligible to be enrolled in the study. In 4 interventional studies and 20 descriptive studies, BTX-A was used for the treatment of TMDs. The dosage and number of injections were different in each study; however, the injection methods were relatively similar. Regardless of the type, number of injections, and dosage, injection of BTX-A in lateral pterygoid seems effective in reducing the click sound and other TMJ-related muscle disorders such as pain, hyperactivity, and dysfunction.

  20. Why do females use botulinum toxin injections?

    Directory of Open Access Journals (Sweden)

    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.

  1. Botulinum toxin injections for adults with overactive bladder syndrome.

    Science.gov (United States)

    Duthie, James B; Vincent, Michael; Herbison, G Peter; Wilson, David Iain; Wilson, Don

    2011-12-07

    Overactive bladder syndrome (OAB) is a common condition with a significant negative impact on quality of life characterised by urgency with or without urge incontinence, frequency and nocturia.  Intravesical botulinum toxin is being increasingly used to treat severe overactive bladder refractory to standard management.  An increasing body of literature is forming that supports this technique as effective, well tolerated, and safe.  This review is a substantial update of the 2007 review of the same title. The objective was to compare intravesical botulinum toxin with other treatments for neurogenic and idiopathic overactive bladder in adults. The hypothesis to be addressed were whether intravesical injection of botulinum toxin was better than placebo or no treatment; pharmacological and other non-pharmacological interventions; whether higher doses of botulinum toxin were better than lower doses; whether botulinum toxin in combination with other treatments was better than other treatments alone; whether one formulation of botulinum toxin is better than another; and whether one injection technique was better than another. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 23 February 2010). The Register contains trials identified from MEDLINE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), and handsearching of journals and conference proceedings. Additionally, all reference lists of selected trials and relevant review papers were searched. No limitations were placed on the searches. All randomised or quasi-randomised controlled trials of treatment for OAB in adults in which at least one management arm involved intravesical injection of botulinum toxin were included. Participants had either neurogenic OAB or idiopathic OAB with or without stress incontinence. Comparison interventions could include no intervention, placebo, lifestyle modification, bladder retraining, pharmacological treatments, surgery, bladder

  2. 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. PMID:28149474

  3. Bilateral versus posterior injection of botulinum toxin in the internal ...

    African Journals Online (AJOL)

    (Botox, Allergan Inc., Irvine, CA, USA) were diluted in saline to a concentration of 50 U/ml immediately before injection. Patients in group 1 were treated by injection of botulinum toxin into each side of the internal sphincter with a 25G needle, under direct vision and guided by digital examination. (a total of 40 U per patient).

  4. Botulinum toxin A is effective to treat tension-type headache caused by hemifacial spasm.

    Science.gov (United States)

    Mizuma, Atsushi; Nagata, Eiichiro; Yasuda, Takashi; Kouchi, Maiko; Nakayama, Taira; Honma, Kazunari; Tokuoka, Kentaro; Kitagawa, Yasuhisa; Nogawa, Shigeru; Takizawa, Shunya

    2017-10-01

    We examined the relationship between hemifacial spasm (HFS; a form of cranio-cervical dystonia) and chronic primary headache, including tension-type headache (TTH). We also examined whether botulinum toxin A (BoNT/A) therapy for HFS ameliorates concomitant TTH. Fifty-one HFS patients receiving BoNT/A therapy were recruited. Patients' characteristics (including age, gender, chronic headache history, exercise habits, stiff neck, cervical spondylolysis history), stress factors, worsening/new onset of headache associated with HFS, and dose of BoNT/A were examined. We diagnosed headache types according to The International Classification of Headache Disorders, 3rd edition, beta. Numerical Rating Scale (NRS) and Headache Impact Test-6 (HIT-6) scores for headache severity were compared between the 6-week baseline before BoNT/A therapy and 6-week follow-up after BoNT/A therapy. Of 51 patients with HFS, 17 (33.3%) reported worsening or new onset of headache (especially TTH) associated with HFS (Group-S), and 34 were not aware of headache (Group-N). Twelve patients (70.6%) in group-S reported improvement of headache after BoNT/A therapy. NRS (from 7 [5-9] to 0 [0-5], p<0.01) and HIT-6 (from 55 [54-64] to 44 [36-52], p<0.001) scores were significantly improved after BoNT/A therapy. Logistic regression analysis revealed significant interaction between TTH associated with HFS and the presence of stress factors (odds ratio 43.11: 2.95-629.39, p<0.001) and history of chronic headache (odds ratio 28.53: 2.96-275.10, p<0.001). Primary headache, especially TTH, is associated with HFS. BoNT/A therapy for HFS may also be indirectly effective for treatment of TTH. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Microcirculatory Effects of Botulinum Toxin A in the Rat: Acute and Chronic Vasodilation.

    Science.gov (United States)

    Aru, Roberto Giorgio; Songcharoen, Somjade Jay; Seals, Samantha R; Arnold, Peter B; Hester, Robert L

    2017-07-01

    Botulinum toxin-A (BTX) has numerous cosmetic and therapeutic applications. Our previous studies have found that BTX augments pedicled flap survival through both vasodilatory effects and attenuation of the inflammatory response to ischemia in the rat. This study examines the effect of chronic BTX on microcirculatory vascular tone and its response to acute topical vasodilators in muscle flaps. The spinotrapezius muscle of Sprague-Dawley rats underwent a single 2-week pretreatment of 0.2 mL saline either with (n = 5) or without (n = 5) 2u BTX. After surgical elevation, an arcade arteriole was observed using a video caliper device. Vessel diameter was measured at 30-second intervals after sequential superfusion of nitroglycerin (100 and 200 μg/mL), multiple concentrations of lidocaine, and a combination of adenosine (10 μM) and nitroprusside (10 μM) to induce maximum dilation. Baseline and dilation diameters were expressed as ratios of pharmacologically induced maximum dilation, whereas percent dilation was defined as the change in diameter over baseline diameter. We found a significant increase in resting diameter with BTX pretreatment (P = 0.0028). Compared with the control group, mean baseline diameter was 15% greater, and percent dilation was 25% less in BTX-pretreated flaps. There was no significant relationship between BTX pretreatment and dilation diameter (P = 0.2895) after adjusting for the effect of acute vasodilators. Pretreatment with BTX may induce the arteriolar resting diameter to be closer to their maximum potential diameter. Additionally, BTX does not display a synergistic effect with topical vasodilators on vasodilation.

  6. Recurrent contact granuloma: experience with excision and botulinum toxin injection.

    Science.gov (United States)

    Yilmaz, Taner; Süslü, Nilda; Atay, Gamze; Özer, Serdar; Günaydin, Riza Önder; Bajin, Münir Demir

    2013-06-01

    Contact granuloma is a difficult-to-treat laryngeal disorder associated with vocal abuse, habitual throat clearing, and laryngopharyngeal reflux. It has a high propensity for persistence and recurrence despite many treatment alternatives. To present our experience with recurrent contact granuloma treated with microlaryngoscopic excision and botulinum toxin injection. Case series. The follow-up period had a mean (range) of 41 (11-88) months. Tertiary referral university clinic. Twenty patients with recurrent, grade 3 and grade 4 contact granuloma whose lesion was excised at least once after failure of conservative treatments. Microlaryngoscopic excision and botulinum toxin type A injection into the region of the bilateral thyroarytenoid and lateral cricoarytenoid muscles. Disappearance of contact granuloma. Seventeen patients were cured of their contact granuloma. Three patients experienced recurrences: 2 received botulinum toxin injection only as outpatients and recovered. The other patient required reexcision and reinjection under general anesthesia. These 3 patients were free of granuloma at their last follow-up. After failed conservative treatment, microlaryngoscopic excision and botulinum toxin type A injection is successful in the treatment of recurrent contact granuloma. Removing recurrent granulomas can result in a low recurrence rate if botulinum toxin type A is added at the time of removal.

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

    Directory of Open Access Journals (Sweden)

    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. Comparison of the efficacies of botulinum toxin A and Johnstone pressure splints against hip adductor spasticity among patients with cerebral palsy: a randomized trial.

    Science.gov (United States)

    Hazneci, Bulent; Tan, Arif Kenan; Guncikan, Mustafa Nuri; Dincer, Kemal; Kalyon, Tunc Alp

    2006-07-01

    The goal was to compare the efficacies of botulinum toxin A (BTX) treatment and Johnstone pressure splint (JPS) treatment against hip adductor muscle spasticity among children with spastic diplegic cerebral palsy. For each patient in the BTX group, a total of 300 IU of BTX was injected into adductor and medial hamstring muscle groups. In the JPS group, long leg JPS were administered for 30 minutes 3 days per week. Bobath neurodevelopmental exercises were administered to both groups 3 days per week during the study period. All cases were assessed by using gross motor function measurements, passive hip abduction goniometric measurements, modified Ashworth Scale scores, and measurements of the distance between the knees as indicator variables. We found that there was statistically significant improvement in all indicators for both groups. BTX treatment was found to be superior to JPS treatment in terms of the indicator variables of our study.

  9. Botulinum toxin A for patients with orofacial dystonia: prospective, observational, single-centre study.

    Science.gov (United States)

    Ruiz-de-León-Hernández, G; Díaz-Sánchez, R-M; Torres-Lagares, D; Hernández-Pacheco, E; González-Martín, M; Serrera-Figallo, M-A

    2018-03-01

    The objective of this study was to demonstrate the efficacy of intramuscular botulinum toxin type A (BTX-A) as a method of controlling the symptoms of focal facial dystonia. A prospective, longitudinal, observational, pre-post (case-series) single-centre study was conducted over a period of 3 months, involving 30 patients with focal dystonia. The patients were enrolled on a first-come, first-served basis. For all patients, the abnormal movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS). The AIMS results were recorded immediately before BTX-A injection (primary predictor variable) and after 3 months (the toxin reaches its maximum effect 2 weeks after injection, and the effect is maintained for 3 months). An improvement in AIMS score was the primary outcome variable. Treatment efficacy was evaluated using the Pearson correlation index with a level of significance of P<0.05. The average age of the study subjects was 70.9±12.7years (20 female, 10 male). The mean dose of BTX-A used was 27.4±20.5U. The mean improvement in AIMS score after treatment was 5.2±4.2. A significant correlation was found between the dose applied and the reduction in AIMS score (P<0.05). BTX-A can be used in the treatment of focal dystonia and provides reproducible results. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy

    Science.gov (United States)

    Willis, Allison W; Crowner, Beth; Brunstrom, Janice E; Kissel, Abigail; Racette, Brad A

    2011-01-01

    The aim of this study was to determine the safety profile of high dose (15–25 units/kg) of botulinum toxin A (BTX-A) in children with cerebral palsy (CP) and increased lower extremity muscle tone. We performed a retrospective review of 929 patient encounters at the Movement Disorders Center at Washington University. A total of 261 patients (105 females; 156 males) were treated during these visits, ages 6 months to 21 years (mean 8y 4mo [SD 4y 8mo]). Ambulatory ability at the time of BTX-A injection was independent ambulation (36.4%, n=95), ambulation with a walker (27.6%, n=72), and non-ambulatory (31.8%, n=83). A few patients (4.2%, n=11) were able to ambulate with a cane or crutch at the time of injection. Participants were characterized according to BTX-A dose, CP etiology, motor involvement pattern, muscles injected, ambulatory ability, and use of oral tone medications. Follow-up records were searched for reported adverse events (AEs), with a mean time to AE assessment of 6.5 weeks (SD 3.38). The AE occurrence was determined for doses of 0 to 4.9 units/kg, 5 to 9.9 units/kg, 10 to 14.9 units/kg, 15 to 19.9 units/kg, and 20 to 25 units/kg. The overall AE occurrence was 4.2%. Standard doses of BTX-A had side-effect occurrences of 3.9% for 5 to 10 units/kg and 7.6% for 10 to 15 units/kg. Among higher doses (15–20 units/kg and 20–25 units/kg) the AE occurrence was 3.5% and 8.6% respectively. No patient developed botulism. AEs were randomly distributed across dosing groups, CP etiologies, clinical phenotypes, ambulatory status, and treatment duration. All doses were associated with a significant increase in passive range of motion using the Tardieu scale. We conclude that higher dose BTX-A is safe in children with a spectrum of CP phenotypes and are well tolerated over time. PMID:17979859

  11. Botulinum toxin injection of spastic finger flexors in hemiplegic patients.

    Science.gov (United States)

    Rodriquez, A A; McGinn, M; Chappell, R

    2000-01-01

    To assess the outcomes of botulinum toxin injection of spastic finger flexors followed by intensive training of finger extensors. Fourteen subjects with chronic hemiplegia spasticity of the upper limb had electromyographic-guided botulinum toxin injection into the long finger flexors. All patients presented with minimal active finger extension with the wrist flexed, sustained clonus of the finger flexors, functional proximal arm function, and absence of fixed contracture. Cadaver dissections directed selection of two injection sites: the flexor digitorum sublimis and the flexor digitorum profundus. Fifty mouse units of botulinum toxin were injected into each muscle. After injection, the subjects were instructed in a home program of stretching the long finger flexors, upper limb weight bearing with a weight-bearing splint, and exercise to improve finger extension control. Compared with preinjection measures, assessment the first week after the initial injection showed significantly reduced tone, reduced clonus, and greater active finger extension with the wrist in the neutral position. Four months later, the Ashworth scale increased to preinjection levels in the six subjects with repeated injections but was again decreased postinjection. Active finger extension with the wrist in the neutral position and clonus showed a statistically nonsignificant trend toward cumulative improvement after the second injection. The greatest change in finger extension and spasticity reduction occurred after the first injection. Continued significant improvement in finger extension was not observed.

  12. Ten Mistakes To Avoid When Injecting Botulinum Toxin.

    Science.gov (United States)

    Ruiz-Rodriguez, R; Martin-Gorgojo, A

    2015-01-01

    Injection of botulinum toxin is currently the most common cosmetic procedure in the United States, and in recent years it has become-together with dermal fillers-the mainstay of therapy for the prevention and treatment of facial aging. However, in some cases the treatment may lead to a somewhat unnatural appearance, usually caused by loss of facial expression or other telltale signs. In the present article, we review the 10 mistakes that should be avoided when injecting botulinum toxin. We also reflect on how treatment with botulinum toxin influences us through our facial expressions, both in terms of how we feel and what others perceive. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.

  13. Switch to Abobotulinum toxin A may be useful in the treatment of neurogenic detrusor overactivity when intradetrusor injections of Onabotulinum toxin A failed.

    Science.gov (United States)

    Bottet, Florie; Peyronnet, Benoit; Boissier, Romain; Reiss, Bénédicte; Previnaire, Jean G; Manunta, Andrea; Kerdraon, Jacques; Ruffion, Alain; Lenormand, Loïc; Perrouin Verbe, Brigitte; Gaillet, Sarah; Gamé, Xavier; Karsenty, Gilles

    2018-01-01

    To assess the outcomes of switching to a different brand of botulinum toxin A (BTA, from Botox® to Dysport®) in case of failure of intradetrusor injections (IDI) of Botox® in the treatment of neurogenic detrusor overactivity (NDO). The charts of all patients who underwent a switch to IDI of Dysport® after failure of an IDI of Botox® at six departments of neurourology were retrospectively reviewed. The main outcomes of interest were the bladder diary data and four urodynamic parameters: maximum cystometric capacity (MCC), maximum detrusor pressure (PDET max), and volume at first uninhibited detrusor contraction (UDC). Fifty-seven patients were included. After the first injection of Dysport®, no adverse events were reported. A significant decrease in number of urinary incontinence episodes per day was observed in 52.63% of patients (P switch from (56.14%). After a median follow up of 21 months, 87% of responders to BTA switch were still treated successfully with BTA. Most patients refractory to Botox® (56.14%) draw benefits from the switch to Dysport®. © 2017 Wiley Periodicals, Inc.

  14. Botulinum toxin uses in strabismus: A review of the injections performed during one year in a general hospital.

    Science.gov (United States)

    Jarrín, E; Arranz Márquez, E; Yebra González, L; García Gil de Bernabé, J

    2016-03-01

    To analyse the indications, dosage and efficacy of botulinum toxin A injection performed in patients in a Strabismus Department. In this prospective study, botulinum toxin A was injected into 28 patients diagnosed with strabismus. Data was obtained from the records of patients that were evaluated during 2013 in the Strabismus Unit of Rey Juan Carlos Hospital (Móstoles, Madrid, Spain) in order to assess the indications and dosage of botulinum toxin A use in strabismus, as well as its clinical effect and differences in paediatric and adult patients. The outcomes in the last visit, at least 14 months after the injections, were analysed. An analysis was performed on the data from 11 children, 6 females (54.5%), and 17 adults, 11 males (64%). The mean age was 4.42±3.48 years and 58.71±18.07 years in the children and adult groups, respectively. The majority of cases in both groups were esotropia (81.8% in children and 47.1% in adults). However the pathologies in the adult group were quite heterogeneous, including 4 patients with exotropia (26.5%), 4 with hypertropia (26.5%), and one with isolated nystagmus (5.9%). The mean number of the botulinum toxin injections in children was 1.45±0.93, although 72.7% received a single injection. In the adult group, the mean number of injections was 3.27±1.41. There was a statistically significant difference between pre- and post-injection in the tropia and phoria measurements in children and adults group (P<.05). In both groups there was a statistically significant improvement in post-injection torticollis when compared with the pre-injection measurement (P<.05). An improvement in the stereoacuity could be detected in 4 children. Two children (18.2%) and 5 adults (29.4%) required subsequent surgical intervention. Eight adult patients (49.1%) complained of diplopia in the primary position, which was resolved in 6 cases with toxin injection, whereas 2 needed surgery for diplopia correction. Botulinum toxin is a very useful tool in

  15. Long-term follow-up of bilateral botulinum toxin injections versus bilateral recessions of the medial rectus muscles for treatment of infantile esotropia.

    Science.gov (United States)

    Gursoy, Huseyin; Basmak, Hikmet; Sahin, Afsun; Yildirim, Nilgun; Aydin, Yasemin; Colak, Ertugrul

    2012-06-01

    To compare long-term outcomes of botulinum toxin A injection with incisional surgery for the management of infantile esotropia. Medical records of infants muscle recessions (surgery group) were reviewed. Minimum follow-up was 48 months, and patients with accommodative esotropia or inferior oblique muscle overaction were excluded. Success was defined as alignment with 10(Δ) of orthophoria without surgery (botulinum group) or without reoperation (surgery group) and compared by the use of an adjusted odds ratio (aOR). The record review identified a total of 51 patients, with 25 in the botulinum group and 26 in the surgery group. Median pretreatment deviation was similar in the botulinum and surgery groups (40(Δ) vs 45(Δ); P = 0.37), but median age at treatment was earlier in the botulinum group (10 vs 12.5 months; P = 0.01). The mean number of injections in successfully treated botulinum group patients was 1.4. The success rate was similar in the botulinum (68%) and surgery (77%) groups (aOR = 0.87, P = 0.87). The median follow-up time was longer in the botulinum group (84 vs 75 months; P = 0.02). Gross stereopsis was demonstrable in 10 of 15 patients in the botulinum group and 9 of 13 in the surgery group (aOR = 3.6, P = 0.46). There was no difference in binocular alignment with botulinum toxin versus surgical treatment. Botulinum toxin injection may be considered a primary treatment for infantile esotropia. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  16. 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

    Directory of Open Access Journals (Sweden)

    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

  17. Why Do Females Use Botulinum Toxin Injections?

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    Carter Singh; Amarjit Dulku; Ahmed Haq; Tayyab Bhatti; Aqib Bhatti

    2015-01-01

    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 injectio...

  18. BOTULINUM TOXIN

    Science.gov (United States)

    Nigam, P K; Nigam, Anjana

    2010-01-01

    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, C1, C2, 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. PMID:20418969

  19. 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.

  20. Rationale for using botulinum toxin A as an adjunct to upper limb rehabilitation in children with cerebral palsy.

    Science.gov (United States)

    Hoare, Brian

    2014-08-01

    Cerebral palsy describes a group of disorders of movement and posture that result from disturbances in the developing brain. Although the brain lesion is nonprogressive, the secondary physical symptoms change with time and growth. If left untreated, symptoms may result in the development of physical impairment and impede independent performance of daily tasks. Intramuscular injection of botulinum neurotoxin A is a relatively safe and effective adjunct to upper limb therapy. Botulinum neurotoxin A primarily aims to reduce muscle overactivity, thereby reducing the development of increased muscle stiffness that can lead to permanent changes. With a specific focus on the physiological action of botulinum neurotoxin A, this article describes the secondary symptoms of cerebral palsy and their different contributions. To highlight research directions and future implications for clinical practice, this article also documents the recent scientific evidence for upper limb botulinum neurotoxin A and proposes a preventive clinical model that aims to mitigate the effects of increasing upper limb impairment. © The Author(s) 2014.

  1. Temporomandibular Myofacial Pain Treated with Botulinum Toxin Injection

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    Niv Mor

    2015-07-01

    Full Text Available This article reviews the diagnoses and treatment of temporomandibular disorders (TMD and outlines of the role of botulinum toxin (BoNT in the treatment of myofacial TMD. This manuscript includes a brief history of the use of BoNT in the treatment of pain, the mechanism of action of BoNT, and the techniques for injections, adverse effects and contraindications when using BoNT to treat mayofacial pain caused by TMD.

  2. Combined therapy using botulinum toxin A and single-joint hybrid assistive limb for upper-limb disability due to spastic hemiplegia.

    Science.gov (United States)

    Saita, Kazuya; Morishita, Takashi; Hyakutake, Koichi; Fukuda, Hiroyuki; Shiota, Etsuji; Sankai, Yoshiyuki; Inoue, Tooru

    2017-02-15

    We investigated the combination of robot-assisted rehabilitation (RT) using a single-joint hybrid assistive limb (HAL-SJ) and botulinum toxin A (BTX-A) as therapy for paretic arm with spasticity in post-stroke patients. Participants were seven patients (4 females, 3 males; mean (±SD) age: 60.6±8.4years) who had spastic hemiplegia following chronic stroke. On the day following BTX-A injection, we started RT, which was performed for 20 sessions of 60min each over a two-week period. Clinical outcome measures, including Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and Disability Assessment Scale (DAS), and cortical activity were evaluated at baseline, and two weeks, and four months following BTX-A injection. Cortical activity associated with elbow joint movement of the affected arm was assessed via functional near infrared spectroscopy (fNIRS). FMA, MAL, and DAS scores significantly improved at two weeks and four months (phemiplegia due to stroke, and functional imaging study showed neuroplasticity induced by the treatment. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. 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. © 2011 John Wiley & Sons A/S.

  4. 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.

  5. Aesthetic Applications of Botulinum Toxin A in Asians: An International, Multidisciplinary, Pan-Asian Consensus

    Science.gov (United States)

    Sundaram, Hema; Huang, Po-Han; Hsu, Nai-Jen; Huh, Chang Hun; Wu, Woffles T.L.; Wu, Yan; Cassuto, Daniel; Kerscher, Martina J.

    2016-01-01

    Background: Botulinum toxin type A remains the most popular nonsurgical aesthetic treatment worldwide. Previous consensus statements have focused on Caucasians and on Koreans as generally representative of Asians. However, indications and dosages vary among different ethnic groups. This publication reports the results of a multidisciplinary, pan-Asian consensus focusing on incobotulinumtoxinA. Methods: A consensus group of plastic surgeons and dermatologists from Asia, Europe, and the United States convened for a live meeting in Asia, followed by a questionnaire-based Delphi procedure. Treatment of Asians in both their native countries and countries of migration was discussed. Results: For most items, the group achieved a majority consensus. A number of treatment indications, strategies, and dosages were identified in Asians, which are distinct to those previously described for Caucasians due to differences in facial morphotypes, anatomy, and cultural expectations. The group also formulated position statements for intradermal botulinum toxin type A (“mesotoxin”), body shaping with the calves as a paradigm, and reduction of parotid glands. While Asians have previously been considered a homogeneous group for the purposes of aesthetic treatment, this publication considers regional variations. A new classification of Asian facial morphotypes is proposed to aid treatment planning and implementation. Conclusions: This is the first pan-Asian consensus for aesthetic use of botulinum toxin type A. Its unique objective is to optimize treatment safety and efficacy for patients of complete or part-Asian ancestry in all regions. The recommendations for incobotulinumtoxinA may be extended with care to other botulinum toxin formulations. PMID:28293488

  6. Safety and efficacy of botulinum toxin A for the treatment of spasticity in amyotrophic lateral sclerosis: results of a pilot study.

    Science.gov (United States)

    Vázquez-Costa, Juan F; Máñez, Inmaculada; Alabajos, Ana; Guevara Salazar, Maricruz; Roda, Cristina; Sevilla, Teresa

    2016-10-01

    Spasticity can be a very disabling problem in some amyotrophic lateral sclerosis (ALS) phenotypes, such as upper motor neuron-dominant ALS (UMN-D ALS) and primary lateral sclerosis (PLS). Our aim is to describe the safety and efficacy of botulinum toxin A (BoTox-A) for improving gait in those ALS phenotypes. UMN-D ALS and PLS outpatients experiencing gait disturbances, secondary to moderate-to-severe spasticity despite optimized oral medication, were offered BoTox-A treatment. Stretching exercises were indicated to complement BoTox-A effect, and ankle-foot orthotics were prescribed when appropriate. Tolerance (muscle strength, disease progression rate) and efficacy (10-m walk test) were measured at baseline and after treatment. Eight out of 122 ALS outpatients were offered BoTox-A treatment. One declined and the other seven were administered BoTox-A in the lower limbs, every 5-8 months. All of them experienced improvement in the clinical outcome and all but one referred subjective improvement. Moreover, after a median follow-up of 16 months and three injections, BoTox-A effect was maintained with no adverse events. This study provides class IV evidence that BoTox-A is safe , and could be beneficial in the short term and long term in a subset of ALS patients with moderate-to-severe spasticity.

  7. Volume matters: the influence of different botulinum toxin-A dilutions for sialorrhea in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Anagnostou, Evangelos; Evangelos, Anagnostou; Rentzos, Michael; Michael, Rentzos; Alexakis, Theodoros; Theodoros, Alexakis; Zouvelou, Vasiliki; Vasiliki, Zouvelou; Zambelis, Thomas; Thomas, Zambelis; Evdokimidis, Ioannis; Ioannis, Evdokimidis

    2013-02-01

    We aimed to determine the effect of different botulinum toxin-A (BTX-A) dilutions on the treatment efficacy and side effects for amyotrophic lateral sclerosis (ALS) related sialorrhea. Ten patients were enrolled in the study. BTX-A dilution for Group A was 100 U in 1 ml of saline, whereas the dilution for Group B was 100 U in 2 ml of saline. Both groups received 20 U of BTX-A in each parotid gland, and assessments were made by means of the Drooling Impact Scale, items 1 and 3 of the ALS functional rating scale, and visual analog scales for drooling and swallowing function. Although both groups exhibited a similar improvement in drooling, Group B had a mild but significant deterioration in bulbar function that was not evident in Group A. These results suggest that BTX-A has a safer profile when reconstituted with 1 ml instead of 2 ml of saline. Copyright © 2012 Wiley Periodicals, Inc.

  8. Transduced PEP-1-FK506BP ameliorates corneal injury in Botulinum toxin A-induced dry eye mouse model

    Science.gov (United States)

    Kim, Dae Won; Lee, Sung Ho; Ku, Sae Kwang; Cho, Soo Hyun; Cho, Sung-Woo; Yoon, Ga Hyeon; Hwang, Hyun Sook; Park, Jinseu; Eum, Won Sik; Kwon, Oh-Shin; Choi, Soo Young

    2013-01-01

    FK506 binding protein 12 (FK506BP) belongs to a family of immunophilins, and is involved in multiple biological processes. However, the function of FK506BP in corneal disease remains unclear. In this study, we examined the protective effects on dry eye disease in a Botulinum toxin A (BTX-A) induced mouse model, using a cell-permeable PEP-1-FK506BP protein. PEP-1-FK506BP efficiently transduced into human corneal epithelial cells in a time- and dose-dependent manner, and remained stable in the cells for 48 h. In addition, we demonstrated that topical application of PEP-1-FK506BP was transduced into mouse cornea and conjunctiva by immunohistochemistry. Furthermore, topical application of PEP-1-FK506BP to BTX-A-induced mouse model markedly inhibited expression levels of pro-inflammatory cytokines such as interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and macrophage inhibitory factor (MIF) in corneal and conjunctival epithelium. These results suggest PEP-1-FK506BP as a potential therapeutic agent for dry eye diseases. [BMB Reports 2013; 46(2): 124-129] PMID:23433117

  9. Treatment outcomes and resource use of patients with neurogenic detrusor overactivity receiving botulinum toxin A (BOTOX) therapy in Germany.

    Science.gov (United States)

    Wefer, Björn; Ehlken, Birgit; Bremer, Jörn; Burgdörfer, Harald; Domurath, Burkhard; Hampel, Christian; Kutzenberger, Johannes; Seif, Christoph; Sievert, Karl D; Berger, Karin; Pannek, Jürgen

    2010-06-01

    To evaluate treatment outcomes and resource consumption of patients with neurogenic detrusor overactivity (NDO) before and after botulinum toxin A (Botox) therapy in Germany. In a multi-center, cross-sectional, retrospective cohort study, data of patients with NDO 12 months before and after the first Botox therapy were analyzed. 214 patients (mean age 38 +/- 14.8 years, 145 male, 69 female) with NDO due to spinal cord injury (81%); myelomeningocele (14%), or Multiple Sclerosis (5%) from seven hospitals were included. Mean interval between treatments was 8 months. Following treatment, mean maximum detrusor pressure, maximum cystometric capacity and detrusor compliance improved significantly. Prior to Botox therapy, 68% reported urinary tract infections (UTI), 63% had incontinence episodes, and 58% used incontinence aids. These numbers decreased significantly (p < 0.05) after treatment to 28, 33, and 28%, respectively. In patients using incontinence aids, mean costs per patient decreased from 2euro to 1euro per day, whereas the mean cost of drugs to treat UTIs per patient decreased from 163euro to 80euro per year, respectively. This is the first study demonstrating the clinical usefulness of Botox therapy in clinical practice. Successful treatment resulted in lower costs for NDO associated morbidity due to less need for incontinence aids and UTI medication.

  10. YouTube Videos on Botulinum Toxin A for Wrinkles: A Useful Resource for Patient Education.

    Science.gov (United States)

    Wong, Katharine; Doong, Judy; Trang, Trinh; Joo, Sarah; Chien, Anna L

    2017-09-01

    Patients interested in botulinum toxin type A (BTX-A) for wrinkles search for videos on YouTube, but little is known about the quality and reliability of the content. The authors examined the quality, reliability, content, and target audience of YouTube videos on BTX for wrinkles. In this cross-sectional study, the term "Botox" was searched on YouTube. Sixty relevant videos in English were independently categorized by 2 reviewers as useful informational, misleading informational, useful patient view, or misleading patient view. Disagreements were settled by a third reviewer. Videos were rated on the Global Quality Scale (GQS) (1 = poor, 5 = excellent). Sixty-three percent of the BTX YouTube videos were useful informational (GQS = 4.4 ± 0.7), 33% as useful patient view (GQS = 3.21 ± 1.2), 2% as misleading informational (GQS = 1), and 2% as misleading patient view (GQS = 2.5). The large number of useful videos, high reliability, and the wide range of content covered suggests that those who search for antiwrinkle BTX videos on YouTube are likely to view high-quality content. This suggests that YouTube may be a good source of videos to recommend for patients interested in BTX.

  11. The WE-Study: does botulinum toxin A make walking easier in children with cerebral palsy?: Study protocol for a randomized controlled trial.

    Science.gov (United States)

    Brændvik, Siri Merete; Roeleveld, Karin; Andersen, Guro Lillemoen; Raftemo, Anne Elisabeth Ross; Ramstad, Kjersti; Majkic-Tajsic, Jasmina; Lamvik, Torarin; Lund, Bendik; Follestad, Turid; Vik, Torstein

    2017-02-06

    Intramuscular injections of botulinum toxin A (BoNT-A) have been a cornerstone in the treatment of spasticity for the last 20 years. In Norway, the treatment is now offered to two out of three children with spastic cerebral palsy (CP). However, despite its common use, the evidence for its functional effects is limited and inconclusive. The objective of this study is to determine whether BoNT-A makes walking easier in children with CP. We hypothesize that injections with BoNT-A in the calf muscles will reduce energy cost during walking, improve walking capacity, increase habitual physical activity, reduce pain and improve self-perceived performance and satisfaction. This randomized, double-blinded, placebo-controlled, multicenter trial is conducted in a clinical setting involving three health regions in Norway. Ninety-six children with spastic CP, referred for single-level injections with BoNT-A in the calf muscles, will be invited to participate. Those who are enrolled will be randomized to receive either injections with BoNT-A (Botox®) or 0.9% saline in the calf muscles. Stratification according to age and study center will be made. The allocation ratio will be 1:1. Main inclusion criteria are (1) age 4 - 17.5 years, (2) Gross Motor Function Classification System levels I and II, (3) no BoNT-A injections in the lower limbs during the past 6 months and (4) no orthopedic surgery to the lower limbs during the past 2 years. The outcome measures will be made at baseline and 4, 12 (primary endpoint) and 24 weeks after injections. Primary outcome is change in energy cost during walking. Secondary outcomes are change in walking capacity, change in activity, perceived change in performance and satisfaction in mobility tasks, and pain. The primary analysis will use a linear mixed model to test for difference in change in the outcome measures between the groups. The study is approved by the Regional Ethical Committee and The Norwegian Medicines Agency. Recruitment

  12. Sensorimotor modulation by botulinum toxin A in post-stroke arm spasticity: Passive hand movement.

    Science.gov (United States)

    Veverka, Tomáš; Hluštík, Petr; Hok, Pavel; Otruba, Pavel; Zapletalová, Jana; Tüdös, Zbyněk; Krobot, Alois; Kaňovský, Petr

    2016-03-15

    In post-stroke spasticity, functional imaging may uncover modulation in the central sensorimotor networks associated with botulinum toxin type A (BoNT) therapy. Investigations were performed to localize brain activation changes in stroke patients treated with BoNT for upper limb spasticity using functional magnetic resonance imaging (fMRI). Seven ischemic stroke patients (4 females; mean age 58.86) with severe hand paralysis and notable spasticity were studied. Spasticity was scored according to the modified Ashworth scale (MAS). fMRI examination was performed 3 times: before (W0) and 4 (W4) and 11weeks (W11) after BoNT. The whole-brain fMRI data were acquired during paced repetitive passive movements of the plegic hand (flexion/extension at the wrist) alternating with rest. Voxel-by-voxel statistical analysis using the General Linear Model (GLM) implemented in FSL (v6.00)/FEAT yielded group session-wise statistical maps and paired between-session contrasts, thresholded at the corrected cluster-wise significance level of psensorimotor cortex (M1, S1, and SMA) dominated. At W4, additional clusters transiently emerged bilaterally in the cerebellum, in the contralesional sensorimotor cortex, and in the contralesional occipital cortex. Paired contrasts demonstrated significant differences W4>W0 (bilateral cerebellum and contralesional occipital cortex) and W4>W11 (ipsilesional cerebellum and SMA). The remaining paired contrast (W0>W11) showed activation decreases mainly in the ipsilesional sensorimotor cortex (M1, S1, and SMA). The present study confirms the feasibility of using passive hand movements to map the cerebral sensorimotor networks in patients with post-stroke arm spasticity and demonstrates that BoNT-induced spasticity relief is associated with changes in task-induced central sensorimotor activation, likely mediated by an altered afferent drive from the spasticity-affected muscles. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Effectiveness of resistance training in combination with botulinum toxin-A on hand and arm use in children with cerebral palsy: a pre-post intervention study

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    Elvrum Ann-Kristin G

    2012-07-01

    Full Text Available Abstract Background The aim of this pilot study was to examine the effects of additional resistance training after use of Botulinum Toxin-A (BoNT-A on the upper limbs in children with cerebral palsy (CP. Methods Ten children with CP (9–17 years with unilaterally affected upper limbs according to Manual Ability Classification System II were assigned to two intervention groups. One group received BoNT-A treatment (group B, the other BoNT-A plus eight weeks resistance training (group BT. Hand and arm use were evaluated by means of the Melbourne assessment of unilateral upper limb function (Melbourne and Assisting Hand Assessment (AHA. Measures of muscle strength, muscle tone, and active range of motion were used to assess neuromuscular body function. Measurements were performed before and two and five months after intervention start. Change scores and differences between the groups in such scores were subjected to Mann–Whitney U and Wilcoxon Signed Rank tests, respectively. Results Both groups had very small improvements in AHA and Melbourne two months after BoNT-A injections, without differences between groups. There were significant, or close to significant, short-term treatment effects in favour of group BT for muscle strength in injected muscles (elbow flexion strength, p = .08 and non-injected muscles (elbow extension and supination strength, both p = .05, without concomitant increases in muscle tone. Active supination range improved in both groups, but more so in group BT (p = .09. There were no differences between the groups five months after intervention start. Conclusions Resistance training strengthens non-injected muscles temporarily and may reduce short-term strength loss that results from BoNT-A injections without increasing muscle tone. Moreover, additional resistance training may increase active range of motion to a greater extent than BoNT-A alone. None of the improvements in neuromuscular impairments further

  14. 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.

  15. Does Adjunctive Botulinum Toxin A Reduce Pain Scores When Combined With Temporomandibular Joint Arthroscopy for the Treatment of Concomitant Temporomandibular Joint Arthralgia and Myofascial Pain?

    Science.gov (United States)

    Thomas, Nicholas J; Aronovich, Sharon

    2017-12-01

    Currently, there is no standard of care for the treatment of refractory myofascial pain and concomitant temporomandibular joint (TMJ) arthralgia. This comparative study was conducted to determine the effectiveness of botulinum toxin A (Btx), as an adjunct to TMJ arthroscopy, in this patient population. A retrospective cohort study was conducted of patients who underwent TMJ arthroscopy with (Btx group) or without (control group) intramuscular Btx for TMJ arthritis and refractory myofascial pain at the University of Michigan (Ann Arbor) from 2011 through 2014. For patients in the Btx group, intramuscular injections of Btx were administered at sites of maximal tenderness within the masseter and temporalis muscles. The primary outcome variable was pain score on the visual analog scale (VAS; 0 to 10). The secondary outcome variables included maximal interincisal opening, total score for sites of tenderness, total number of tender sites, and diet consistency tolerated. Statistical analysis included means and standard deviations, Student t test, simple regression analysis, and multiple regression analysis. The study cohort included 52 patients (30 in Btx group, 22 in control group), of which 48 (92.3%) were women. The mean follow-up was 5.56 ± 1.41 months. Patients in the Btx group had a significantly greater decrease in mean pain score (P = .04) on the VAS compared with the control group (score, 3.24 for Btx group; score, 1.13 for control group). On multivariate regression analysis, treatment with Btx trended toward significance (P = .084) and the preoperative pain score (P = .0007) was significantly correlated with the change in pain observed. The use of Btx appears to correlate with a clinically superior decrease in pain score compared with the control group. The use of Btx could be useful as an adjunctive treatment modality in the management of refractory myofascial pain. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published

  16. Randomized Controlled Trial on Effectiveness of Intermittent Serial Casting on Spastic Equinus Foot in Children with Cerebral Palsy After Botulinum Toxin-A Treatment.

    Science.gov (United States)

    Dursun, Nigar; Gokbel, Tugba; Akarsu, Melike; Dursun, Erbil

    2017-04-01

    Physical therapy (PT) and botulinum toxin-A (BTX-A) injections are widely used in the treatment of spastic equinus foot due to cerebral palsy. The aim of this study was to show effects of intermittent serial casting (SC) in addition to standard treatment on spasticity, passive range of motion (PROM), and gait. Fifty-one ambulatory patients, treated by BTX-A to plantar flexor muscles, were randomly assigned to casting or control groups in a 2:1 ratio. Both groups received PT for 3 weeks. Casting group additionally received intermittent SC during 3 consecutive weekends. Assessments included Modified Ashworth Scale (MAS), Tardieu Scale, Observational Gait Scale (OGS), and Physician Global Assessment at baseline and posttreatment weeks 4 and 12. Significant improvements in PROM, MAS, Tardieu Scale, and OGS were recorded in both groups (P casting group were significantly higher than those of the controls at week 4 (P = 0.006, P = 0.002, P casting group (P casting with an additional model of intermittent casting; and (3) describe the potential benefits of combined treatment modalities, including intermittent serial casting, for spastic equinus foot in children with cerebral palsy. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

  17. Botulinum toxin treatment of hemifacial spasm.

    OpenAIRE

    Elston, J S

    1986-01-01

    Six patients with hemifacial spasm were treated with injections of botulinum toxin A into the orbicularis oculi; the abnormal movements around the eye were relieved for an average of 15 weeks. There were no systemic or significant local side effects, and in view of the risks involved in neurosurgical treatment, a trial of botulinum toxin injections is recommended in the first instance in this condition.

  18. Botulinum toxin treatment of hemifacial spasm.

    Science.gov (United States)

    Elston, J S

    1986-01-01

    Six patients with hemifacial spasm were treated with injections of botulinum toxin A into the orbicularis oculi; the abnormal movements around the eye were relieved for an average of 15 weeks. There were no systemic or significant local side effects, and in view of the risks involved in neurosurgical treatment, a trial of botulinum toxin injections is recommended in the first instance in this condition. PMID:3746313

  19. Comparison of two different formulations of botulinum toxin A for the treatment of blepharospasm and hemifacial spasm.

    Science.gov (United States)

    Wu, Chuan-Jie; Shen, Ji-Hong; Chen, Yuan; Lian, Ya-Jun

    2011-01-01

    To confirm and compare the therapeutic efficacies and adverse effects of Chinese botulinum toxin type A (CBTX-A, Lanzhou Biological Products Institute, China) and current Botox (Allergan Inc., CA, USA) in the treatment of blepharospasm (BS) and hemifacial spasm (HFS). We performed an open, prospective, comparative trial comparing CBTX-A and Botox for the treatment of BS and HFS in 273 patients since 2006. 107 patients were treated with current Botox and 166 with CBTX-A, with the age, disease durations and severity of spasm matched. The patients enrolled were followed up for 6 months. There were no significant differences in the clinical effects of the two preparations, including the onset of response, peaked effect time and duration of effects (p > 0.05). The Cohen scores showed a significant reduction after BTX-A injections. Considerable improvement of symptoms for the BS and HFS patients was observed 7 days, 4 weeks, 12 weeks, and 24 weeks after the injection with either current Botox or CBTX-A (p 0.05). No statistical differences were noted in adverse reactions between them (p > 0.05). The two preparations were both simple and effective for the patients with blepharospasm and hemifacial spasm.

  20. Antagonism of botulinum toxin A-mediated muscle paralysis by 3, 4-diaminopyridine delivered via osmotic minipumps.

    Science.gov (United States)

    Adler, M; Capacio, B; Deshpande, S S

    2000-10-01

    The ability of 3,4-diaminopyridine (3,4-DAP) to antagonize muscle paralysis following local injection of botulinum neurotoxin A (BoNT/A) complex was evaluated in the in situ rat extensor digitorum longus (EDL) preparation. The minipumps were implanted 6 h prior to BoNT/A administration and delivered their contents over a 7-day period producing a steady plasma 3,4-DAP concentration of 27-29 microM. In the absence of 3,4-DAP, a local injection of five mouse LD(50) units of BoNT/A led to total paralysis of EDL muscles within 24 h of application. Recovery from paralysis was slow, remaining at <30% of control 14 days after toxin injection. 3,4-DAP delivery by osmotic minipumps antagonized the actions of BoNT/A on neuromuscular transmission. Seven days after the onset of 3,4-DAP infusion, indirectly elicited twitch and tetanic tensions in BoNT/A-injected EDL muscles were 72.4 and 46.9% of control, respectively. In the absence of 3,4-DAP, twitch and tetanic tensions were only 5.4 and 15. 1% of control. The benefits conferred by 3,4-DAP treatment were not maintained after minipumps were removed. Seven days after cessation of 3,4-DAP infusion, twitch and tetanic tensions were not significantly different from those observed in muscles receiving BoNT/A alone. It is concluded that 3,4-DAP may be useful for treatment of BoNT/A-induced muscle paralysis, but sustained delivery of the drug would be required for the entire period of BoNT intoxication to maintain muscle function.

  1. Botulinum toxin-a in children with congenital spastic hemiplegia does not improve upper extremity motor-related function over rehabilitation alone: a randomized controlled trial.

    NARCIS (Netherlands)

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

    2009-01-01

    BACKGROUND: Rehabilitation of the upper extremity in children with hemiplegic cerebral palsy has not been compared to the same intensity of therapy combined with injected botulinum toxin (BTX). OBJECTIVE: To measure the short-term (2 weeks) and long-term (6 and 9 months) effects of a standardized

  2. The effects of Botulinum Toxin injection in an elite sportsman with Functional Popliteal Artery Entrapment Syndrome: A case report.

    Science.gov (United States)

    Murphy, Myles; Charlesworth, Jonathon; Koh, Eamon

    2017-09-01

    Botulinum Toxin-A (BoNT-A) is an effective intervention for Functional Popliteal Artery Entrapment Syndrome (FPAES) however, concerns with this intervention include reductions in strength and performance. This case presents an elite male athlete with FPAES who underwent BoNT-A injection and the results of testing before and after injection. The athlete experienced a decrease in strength and performance at one week post-injection however, he returned to baseline levels within four weeks. When comparing sprint distance during games, before and after injection, the athlete had an increase in his sprint distance per game post-injection. Finally on ultrasound he had visible medial gastrocnemius denervation atrophy with a decrease in arterial flow velocity at four weeks post-injection. BoNT-A may be an effective minimally invasive treatment option for FPAES however, athletes may experience a transient decrease in function following BoNT-A injection and consequently caution must be taken with regard to treatment timing. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Outcomes of intra-detrusor injections of botulinum toxin in patients with spina bifida: A systematic review.

    Science.gov (United States)

    Hascoet, Juliette; Manunta, Andrea; Brochard, Charlène; Arnaud, Alexis; Damphousse, Mireille; Menard, Hélène; Kerdraon, Jacques; Journel, Hubert; Bonan, Isabelle; Odent, Sylvie; Fremond, Benjamin; Siproudhis, Laurent; Gamé, Xavier; Peyronnet, Benoit

    2017-03-01

    Bladder management in spina bifida patients relies on clean intermittent catheterization and oral antimuscarinics with a significant failure rate. The efficacy of intradetrusor injections of botulinum toxin has been confirmed in patients with spinal cord injury or multiple sclerosis but not in patients with myelomeningocele. To conduct a systematic review of current evidence regarding the efficacy of intra-detrusor injections of Botulinum Toxin A (BTX-A) in spina bifida patients with neurogenic detrusor overactivity (NDO) refractory to antimuscarinics. A research has been conducted on Medline and Embase using the keywords: ("spina bifida" OR "myelomeningocele" OR "dysraphism") AND "toxin." The search strategy and studies selection were performed using the PICOS method according to the PRISMA statement. Twelve published series were included (n = 293 patients). All patients were spina bifida but this assumption is not supported by high level of evidence studies. There is no data available in adult patients. Neurourol. Urodynam. 36:557-564, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on upper and lower limb spasticity in post-stroke patients.

    Science.gov (United States)

    Hara, Takatoshi; Abo, Masahiro; Hara, Hiroyoshi; Kobayashi, Kazushige; Shimamoto, Yusuke; Samizo, Yuta; Sasaki, Nobuyuki; Yamada, Naoki; Niimi, Masachika

    2017-06-01

    The purpose of this study was to examine the effects of combined botulinum toxin type A (BoNT-A) and inpatient multidisciplinary (MD) rehabilitation therapy on the improvement of upper and lower limb function in post-stroke patients. In this retrospective study, a 12-day inpatient treatment protocol was implemented on 51 post-stroke patients with spasticity. Assessments were performed on the day of admission, at discharge, and at 3 months following discharge. At the time of discharge, all of the evaluated items showed a statistically significant improvement. Only the Functional Reach Test (FRT) showed a statistically significant improvement at 3 months. In subgroup analyses, the slowest walking speed group showed a significantly greater change ratio of the 10 Meter Walk Test relative to the other groups, from the time of admission to discharge. This group showed a greater FRT change ratio than the other groups from the time of admission to the 3-month follow-up. Inpatient combined therapy of simultaneous injections of BoNT-A to the upper and lower limbs and MD may improve motor function.

  5. Botox facial slimming/facial sculpting: the role of botulinum toxin-A in the treatment of hypertrophic masseteric muscle and parotid enlargement to narrow the lower facial width.

    Science.gov (United States)

    Wu, Woffles T L

    2010-02-01

    Botulinum toxin A is a highly efficacious and cost-effective, nonsurgical option for reducing the width and shape of the lower face and jawline. The results can vary from the subtlest thinning of the face to an extremely thin, cachectic appearance. Many nuances can be achieved. The administration is simple, and the process takes barely 5 minutes in an office setting. Botulinum toxin A can also be effectively used to reduce the bulk of an enlarged parotid gland without affecting saliva production. Copyright 2010. Published by Elsevier Inc.

  6. Quantitative reduction of saliva production with botulinum toxin type B injection into the salivary glands.

    Science.gov (United States)

    Turk-Gonzales, Melissa; Odderson, Ib R

    2005-03-01

    Drooling is common in patients with neurological disorders. Recently, botulinum toxin type B has been shown to be effective in the treatment of drooling. The authors present a unique case of a 57-year-old man with a history of a brainstem stroke and severe drooling. The patient's parotid and submandibular glands were injected under ultra-sound guidance with botulinum toxin type B. Saliva was collected and quantified before and after the injections by 2 different collection methods: suctioning and dental rolls. Total saliva production decreased by 23.8% after injection of the parotid glands and by 85.8% after submandibular injection compared to the preinjection level. The 2 methods demonstrated similar results. In addition, the patient experienced less drooling and increased participation in therapies without any side effects. This case demonstrates that saliva secretion and drooling can effectively be treated by injections of botulinum toxin type B into the salivary glands.

  7. Botulinum toxin a does not decrease calf pain or improve ROM during limb lengthening: a randomized trial.

    Science.gov (United States)

    Lee, Dong Hoon; Ryu, Keun Jung; Shin, Dong Eun; Kim, Hyun Woo

    2014-12-01

    During lower limb lengthening, distraction-induced muscle pain and surrounding joint contractures are frustrating complications for which few effective treatments are available. We evaluated Botulinum Toxin Type A (BtX-A) injection in the calf muscles during human tibial distraction osteogenesis. We hypothesized that it may decrease calf pain and increase ROM of the surrounding joints by reducing muscle stiffness. Between April 2010 and January 2011, we evaluated 36 patients undergoing bilateral tibia lengthening who met prespecified inclusion criteria. All patients underwent stature lengthening with lengthening over a nail or lengthening and then nailing. BtX-A (200 IU) was injected at the calf muscle only in one leg for each patient and the same amount of sterile normal saline was injected into the other leg as a control. Selection of the leg receiving the toxin was randomized. Clinical evaluation included a VAS score for calf pain and measurement of ROM of the knees and ankles and calf circumference, with evaluations performed in a double-blinded manner. Side-to-side differences were analyzed until the end of consolidation phase. Minimum followup was 24 months (mean, 30 months; range, 24-39 months). The distraction rate and the final length gain were similar in the treated and control limbs. A priori power analysis suggested that 34 legs were required to achieve statistical significance of 0.05 with 80% of power to detect a 50% difference in treatment effect between treatment and control groups. There were no differences in calf pain, knee and ankle ROM, and maximal calf circumferences between the two legs at each time point. Local injection of 200 IU BtX-A at the human calf muscle does not appear to reduce calf pain or help enhance ROM of the knee and ankle during tibial lengthening. However, the small sample size provided sufficient power to detect only relatively large clinical effects; future, larger trials will be needed to determine whether smaller

  8. Keratoconus progression is not inhibited by reducing eyelid muscular force with botulinum toxin A treatment: a randomized trial

    Directory of Open Access Journals (Sweden)

    Adimara da Candelaria Renesto

    Full Text Available ABSTRACT Purpose: To evaluate whether reducing eyelid muscular force through the administration of botulinum toxin type A (BTX-A to the orbicularis oculi muscles of patients with keratoconus affected corneal parameters indicative of disease progression. Methods: In this prospective parallel randomized clinical trial, 40 eyes of 40 patients with keratoconus were randomized into equally sized control and BTX-A groups. Patients in the BTX-A group received subcutaneous BTX-A injections into the orbicularis muscle. The control group received no intervention. Palpebral fissure height, best spectacle-corrected visual acuity (BSCVA, and corneal topographic parameters were evaluated at baseline and at 3-, 6-, 12-, and 18-month follow-ups. Results: The mean ± standard deviation vertical palpebral fissure heights were 9.74 ± 1.87 mm and 9.45 ± 1.47 mm at baseline in the control and BTX-A groups, respectively, and 10.0 ± 1.49 mm and 9.62 ± 1.73 mm at 18 months, with no significant difference between the groups (p=0.337. BSCVA values were 0.63 ± 0.56 and 0.60 ± 0.27 at baseline in the control and BTX-A groups (p=0.643, and 0.52 ± 0.59 and 0.45 ± 0.26 at 18 months, again with no significant difference between the groups (p=0.452. In addition, there were no statistical differences between the groups at 18 months for the three keratometry topographic parameters: flattest (K1, steepest (K2, and mean (Km keratometry (p=0.562. Conclusion: BTX-A inhibition of eyelid force generation did not result in detectable changes in corneal parameters in keratoconic patients during 18 months of follow-up.

  9. Therapeutic effects of botulinum toxin A at different dilutions in hemifacial spasm patients: a multicenter, randomized, double-blind and self-crossover controlled trial

    Directory of Open Access Journals (Sweden)

    LI You-jia

    2013-06-01

    Full Text Available Background At present, the concentration of botulinum toxin A (BTX-A injection in the treatment of hemifacial spasm (HFS is different in various reports, and the efficacy and adverse drugreactions incidence are varied. Few randomized controlled trials are related to this subject. The aim of this study is to evaluate the efficacy and safety of two concentrations of BTX-A in the treatment for HFS. Methods Eighty patients with HFS from 4 research centers were included in this multicenter randomized double-blind self-crossover controlled trial. Patients were randomly assigned to high-density group (given injection of 50 U/ml BTX-A and low-density group (given injection of 25 U/ml BTX-A. They were Therapeutic efficacy and adverse effect were compared between two groups. Results Both high-density and low-density BTX-A were effective. Cohen spasms strength grade scores before and after the treatment in high-density group were 2.89 ± 0.53 vs 0.24 ± 0.46, while in low-density group was 2.89 ± 0.55 vs 0.24 ± 0.46 (P = 0.000, for all. The therapeutic efficacy was not different between the two groups in different concentration order (P > 0.05. But the lasting time of therapeutic efficacy was much longer in high-density group than that of low?density group (4.18 ± 0.49 months vs 3.26 ± 0.44 months, P = 0.000. Within three months, there was no significant difference between the two groups in the decrease of Cohen spasms strength grade scores (2.65 ± 0.62 vs 2.66 ± 0.66, P = 0.863. Four months after treatment, it was different between the two groups in the decrease of Cohen spasms strength grade scores (2.60 ± 0.65 vs 1.70 ± 0.72, P = 0.000. Five months after treatment, it was also different between the two groups in the decrease of Cohen spasms strength grade scores (1.56 ± 0.94 vs 0.25 ± 0.49, P = 0.000. After six months of treatment, there was no significant difference between the two groups in the decrease of Cohen spasms strength grade scores

  10. Endocardial botulinum toxin injection into ganglionated plexi in order to reduce atrial fibrillation inducibility

    Directory of Open Access Journals (Sweden)

    А. Г. Стрельников

    2016-01-01

    Full Text Available Objective. Prior animal studies suggest that botulinum toxin injection into the epicardial fat pads can suppress atrial fibrillation (AF inducibility. The purpose of the present study was to assess the efficacy and safety of endocardial botulinum toxin injection into epicardial fat pads and intramyocardial left atrial ganglionated plexi (GP for preventing AF.Methods. Twenty-four dogs were separated into 3 groups: endocardial approach for botulinum toxin (Xeomin, Germany injection into epicardial fat pads and intramyocardial GPs; endocardial approach for placebo injection (0.9% normal saline; control 1; n = 8 and epicardial approach for botulinum toxin injection (control 2; n = 8.Results. A mean of 6.9±1.7 intramyocardial injections (10 U/0.2 mL at each and 3 injections (50 U/1 mL at each were administered into each site exhibiting a positive vagal response and into each epicardial fat pad in all groups (p>0.05 between groups.The injections of botulinum toxin demonstrated dramatic prolongation of ERP in all PV-atrial junctions. This effect correlated with less pronounced ERP shortening in response to vagal nerve stimulation. Suppression of AF inducibility was observed at 7 days after endocardial botulinum toxin injections. The level of AF inducibility was: at 7 days – 57% (p<0.001 vs placebo; p<0.001 vs baseline; at 14 days – 61% (p<0.001 vs placebo; p<0.001 vs baseline; at 1 month – 38% (p<0.001 vs placebo; p<0.001 vs baseline; at 3 months – 23% (p = 0.003; p = 0.06 vs baseline. There were no differences between botulinum groups (p>0.05 for all. The effect of AF suppression disappeared at 3 months. No procedure-related complications occurred.Conclusion. Botulinum toxin injection into intramyocardial GPs and epicardial fat pads by an endocardial approach is feasible and safe. It provides complete removal of cardiac vagal responses and reliably reduces vulnerability to atrial fibrillation.

  11. Experiência com aplicação de toxina botulínica A em 115 pacientes Botulinum toxin A: experience in the treatment of 115 patients

    Directory of Open Access Journals (Sweden)

    Luiz Augusto F. Andrade

    1997-09-01

    Full Text Available A toxina botulínica A é a forma mais eficaz de tratar algumas distonias focais e o espasmo hemifacial. Devido a seu custo ainda elevado no nosso país, seu uso ainda não é disseminado. Mostramos nossa experiência com a toxina botulínica A em 115 pacientes, sendo 45 com espasmo hemifacial que apresentaram melhora acentuada ou total em 100%. Em 20 pacientes com blefaroespasmo essencial houve melhora acentuada ou total em 70% . Na síndrome de Meige, representada por 14 pacientes, a melhora acentuada ou total foi observada em 71,4%. Em 23 pacientes com distonia cervical observou-se melhora acentuada em 65,2%. Distonia da mão, com 6 pacientes, apresentou o menor índice de melhora acentuada (2 pacientes, 33,3%. As complicações de caráter transitório ocorreram, sendo as mais frequentes ptose palpebral e diminuição da força palpebral e a mais grave, pneumonia aspirativa. Acreditamos que a toxina é forma eficaz e habitualmente segura de tratamento destas condições clínicas.Botulinum toxin A is the more efficient therapy of focal dystonias and hemifacial spasm. Our experience with botulinum toxin A injections in 115 patients is reported. Marked or total improvement was achieved in all 45 patients with hemifacial spasm, in 70% of 20 patients with essential blepharospasm and in 71.4% of 14 patients with Meige's syndrome. In 65.2% of 23 patients with cervical dystonia marked but no total improvement was obtained. The worse results were seen in the 6 patients with hand dystonia (writers cramp, in whom marked improvement was obtained in just two. Mild and transient complications occurred in up to 24.4%, eyelid ptosis and eyelid weakness being the most frequent. One patient with Meige's syndrome had an aspiration pneumonia following dysphagia. Our results are in agreement with others, showing that botulinun toxin A is a useful and safe treatment for these conditions.

  12. 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 hypot...

  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

    Directory of Open Access Journals (Sweden)

    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. Safety and efficacy of intradermal injection of botulinum toxin for the treatment of oily skin.

    Science.gov (United States)

    Rose, Amy E; Goldberg, David J

    2013-03-01

    To evaluate the safety and efficacy of intradermal injection of abobotulinumtoxinA for the treatment of oily skin. Twenty-five patients with oily skin were treated in the forehead region with intradermal injections of botulinum toxin. Baseline and post-treatment sebum production was measured using a sebometer. Photographs were taken. Patients were also asked to rate their satisfaction with the treatment in terms of improvement in their oily skin. Treatment with botulinum toxin resulted in significantly lower sebum production at 1 week and 1, 2, and 3 months after injection (p oily skin. [Correction added after online publication 7-Jan-2013: the number of satisfied patients has been updated] Intradermal injection of botulinum toxin significantly reduced sebum production in the forehead region, with a high degree of patient satisfaction. Intradermal botulinum toxin may be an effective treatment to reduce sebum production in patients with oily skin. Larger, randomized, blinded, placebo-controlled studies are warranted. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

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

    DEFF Research Database (Denmark)

    Hansen, Lars Kjaersgaard; Kibæk, 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...

  16. The use of botulinum toxin-a in the treatment of severe bruxism in a patient with autism: a case report.

    Science.gov (United States)

    Monroy, Phillip G; da Fonseca, Marcio A

    2006-01-01

    This case report describes an alternative method for reducing bruxism in a special needs patient who was not a candidate for an intraoral appliance. Bruxism is often seen in patients with special needs and can result in excessive dental wear, temporo-mandibular joint pain, avulsion of teeth and other problems. Current methods of management are not typically effective in this population because most require patient compliance. An 11-year-old male diagnosed with autism and Bannayan-Zonana syndrome received bilateral injections of botulinum toxin type-A (Botox Allergan Pharmaceuticals, Irvine CA) in the masseter muscle. The patient's condition was followed up via post-operative telephone interviews with the parents for 60 days. A reduction in the frequency and severity of bruxism was reported. The only side effects noted were soreness at the injection site and mild, temporary drooling. Although further research is required to determine the optimal doses and injection frequency, botulinum toxin type-A appears to be an alternative method for controlling bruxism in the special needs population.

  17. 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......Botulinum toxin is used to diminish spasticity and reduce 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 non-injected contralateral side in all rats. Acute experiments were performed 1, 2, 4 and 8 weeks following injection. The triceps surae muscle was dissected free, the Achilles tendon was cut...

  18. Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA).

    Science.gov (United States)

    Mangera, Altaf; Andersson, Karl-Erik; Apostolidis, Apostolos; Chapple, Chris; Dasgupta, Prokar; Giannantoni, Antonella; Gravas, Stavros; Madersbacher, Stephan

    2011-10-01

    The use of botulinum toxin A (BoNTA) in the treatment of lower urinary tract dysfunction has expanded in recent years and the off-licence usage list includes neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity (IDO), painful bladder syndrome (PBS), and lower urinary tract symptoms resulting from bladder outflow obstruction (BOO) or detrusor sphincter dyssynergia (DSD). There are two commonly used preparations of BoNTA: Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA). To compare the reported outcomes of onabotulinumtoxinA and abobotulinumtoxinA in the treatment of NDO, IDO, PBS, DSD, and BOO for adults and children. We performed a systematic review of the published literature on PubMed, Scopus, and Embase in the English language reporting on outcomes of both BoNTA preparations. Review articles and series with <10 cases were excluded. The articles were graded for level of evidence and conclusions drawn separately for data with higher-level evidence. There is high-level evidence for the use of onabotulinumtoxinA and abobotulinumtoxinA in adults with NDO but only for abobotulinumtoxinA in children with NDO. Only onabotulinumtoxinA has level 1 evidence supporting its use in IDO, BOO, DSD, and PBS/interstitial cystitis. We identified good-quality studies that evaluated onabotulinumtoxinA for all the indications described above in adults; such was not the case with abobotulinumtoxinA. Although this does not imply that onabotulinumtoxinA is more effective than abobotulinumtoxinA, it should be a consideration when counselling patients on the use of botulinum toxin in urologic applications. The two preparations should not be used interchangeably, either in terms of predicting outcome or in determining doses to be used. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  19. COMPLEX RHEABILITATION INCLUDING BOTULIN TOXIN A INJECTIONS IN PATIENTS WITH INFANTILE CEREBRAL PALSY – INFLUENCE ON PHYSICAL AND MOTOR DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    E.A. Kislyakova

    2006-01-01

    Full Text Available Infantile cerebral palsy (ICP is an important medical and social problem, associated with high prevalence and disability rates. The efficacy of rehabilitation was evaluated in 38 patients with ICP. The complex rehabilitation consisted of massage, physiotherapy, therapeutic physical training, the method of dynamic proprioceptive correction using gravistat and adely therapeutic devices, traditional and laser acupuncture and botulin toxin a injections, which were used in 10 patients with symmetric neck:righting reflex. botulin toxin a was injected in m. pectoralis major. The efficacy was based on dynamic evaluation of physical and motor development regarding age, disease severity and injection route of botulin a toxin. Key words: infantile cerebral palsy, rehabilitation, botulintoxin a, physical and motor development

  20. Localized myofascial pain responds better than referring myofascial pain to botulinum toxin injections.

    Science.gov (United States)

    Abboud, W A; Hassin-Baer, S; Joachim, M; Givol, N; Yahalom, R

    2017-11-01

    Myofascial pain of the muscles of mastication is a common temporomandibular disorder. Patients unresponsive to conservative treatment modalities pose a therapeutic challenge to the treating clinician. The efficacy of intramuscular botulinum toxin injections for recalcitrant cases is still not well established due to mixed results from clinical trials. The Diagnostic Criteria of Temporomandibular Disorders (DC/TMD) classified chronic muscle pain broadly into a localized pattern (when pain is localized to the site of palpation or the muscle palpated) and a referring pattern (when the pain spreads beyond the boundary of the muscle being palpated). The medical records of 25 consecutive patients treated with botulinum were analysed retrospectively. Significant pain reduction was achieved in 69.2% of the patients with localized myofascial pain and 16.7% of the patients with referring myofascial pain (P=0.015). Seventy-seven per cent of the patients with localized myofascial pain reported using less analgesic throughout the follow-up period, whereas only 25% of the patients with referring myofascial pain (P=0.017). The effects of botulinum toxin in responsive patients subsided after a mean of 3.21 months. Patients with localized myofascial pain benefited from botulinum toxin injections, but patients with referring myofascial pain responded poorly to this treatment. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Botulinum toxin type A in chronic plantar fasciitis: clinical effects one year after injection.

    Science.gov (United States)

    Díaz-Llopis, Ismael V; Gómez-Gallego, Diego; Mondéjar-Gómez, Francisco J; López-García, Alfredo; Climent-Barberá, Jose M; Rodríguez-Ruiz, Carmen M

    2013-08-01

    To determine whether the efficacy of botulinum toxin type A in chronic plantar fasciitis was maintained for more than six months after treatment. Observational follow-up study. Twenty-four patients who received botulinum toxin type A injection in a previous randomized study of chronic plantar fasciitis (active treatment group) and who presented a benefit one month after treatment. A visual analogue scale for pain and the Foot Health Status Questionnaire were used to re-evaluate results 12 months after the botulinum toxin injection. No further injections of botulinum toxin had been administered during the follow-up period. Patients were also asked to give a subjective assessment of treatment outcome. At 12 months, compared with the six-month evaluation, there was a further improvement in foot pain measured using the visual analogue scale, though this did not reach significance (1.78 at 6 months versus 1.22 at 12 months; P = 0.142). However, there were significant improvements in two domains of Foot Health Status Questionnaire: foot pain (91.11 at 6 months versus 80.00 at 12 months; P = 0.001) and foot function (96.19 at 6 months versus 89.38 at 12 months; P = 0.047). There was a small, non-significant deterioration in the shoe and foot health domains. Satisfaction with the outcome was good or very good in the large majority of patients. In patients with chronic plantar fasciitis, the positive effect detected six months after treatment with botulinum toxin type A was maintained at 12 months and there was a further improvement in pain and foot function.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Safety and pharmacokinetics of XOMA 3AB, a novel mixture of three monoclonal antibodies against botulinum toxin A.

    Science.gov (United States)

    Nayak, S U; Griffiss, J M; McKenzie, R; Fuchs, E J; Jurao, R A; An, A T; Ahene, A; Tomic, M; Hendrix, C W; Zenilman, J M

    2014-09-01

    Botulinum neurotoxin A is a category A bioterrorism agent. Current antitoxin therapies are scarce and produce adverse reactions. XOMA 3AB consists of 3 IgG1 monoclonal antibodies (MAbs), each with a distinct human or humanized variable region, which bind to distinct epitopes on botulinum neurotoxin serotype A. This first-in-human study evaluated the safety and pharmacokinetics (PK) of escalating doses of XOMA 3AB administered intravenously (i.v.) to healthy adults. In this double-blind placebo-controlled dose escalation study, 3 cohorts of 8 healthy subjects received a single intravenous dose of XOMA 3AB or placebo at a 3:1 ratio. Follow-up examinations included physical examinations, hematology and chemistry blood tests, electrocardiograms, and pharmacokinetics. Pharmacokinetic parameters were estimated using noncompartmental methods. There were no infusion discontinuations or hypersensitivity reactions. Two or more subjects experienced headache, hyperglycemia, or anemia; none was dose related. All adverse events (AEs) were mild to moderate except for an episode of exercise-induced elevation of a subject's creatine phosphokinase (CPK) level, unrelated to XOMA 3AB. Concentration-time plots demonstrated a peak in MAb concentrations 1 to 2 h after completion of the infusion, after which the levels declined in a biexponential decay pattern for all analytes. For each MAb, the maximum concentration of drug in serum (Cmax) and the area under the concentration-time curve from 0 to infinity (AUCinf) increased as the dose increased. Clearance of the humanized mouse MAb was more rapid than that of the two fully human MAbs, particularly at the lowest dose. None of the MAbs was immunogenic. At the doses administered, XOMA 3AB was well tolerated. These safety findings support further investigation of XOMA 3AB as a potential agent for botulism treatment and postexposure prophylaxis. (This study has been registered at ClinicalTrials.gov under registration no. NCT01357213

  4. Inferior Oblique Botulinum Toxin Injection: A Postoperative Diplopia Test for Secondary Inferior Oblique Muscle Overaction.

    Science.gov (United States)

    Bansal, Shveta; Marsh, Ian B

    2016-01-01

    To evaluate the utility of botulinum toxin injection into the inferior oblique muscle for secondary inferior oblique muscle overaction. A retrospective review of 18 patients and 23 injections performed over a 9-year period. Indications and deviations in primary position and contralateral gaze before and after injection were recorded. Functional outcomes and further management (conservative vs surgical) were observed. In 14 patients, chemodenervation resulted in a temporary improvement in symptoms. Eleven of these patients went on to have inferior oblique myectomy with resolution of their diplopia. Two patients preferred to receive regular injections of botulinum toxin as a treatment. Botulinum toxin chemodenervation of the inferior oblique muscle in cases of secondary inferior oblique muscle overaction is useful where one needs to establish a risk of overcorrection following planned inferior oblique muscle weakening. This is particularly true in cases where the primary position deviation may be small but symptoms of diplopia exist on contralateral side gaze, giving rise to a narrowed field of binocular single vision. Copyright 2016, SLACK Incorporated.

  5. Physical and occupational therapy considerations in adult patients receiving botulinum toxin injections for spasticity.

    Science.gov (United States)

    Albany, K

    1997-01-01

    Physical and occupational therapists play important roles in the evaluation and management of patients receiving botulinum toxin injections for spasticity. Baseline evaluation includes areas beyond the muscles being injected, since local spasticity reduction may lead to more widespread functional changes. Because the evaluation itself influences tone, a consistent order of muscle evaluation is recommended. The range of preinjection assessments includes evaluation of tone, mobility, strength, balance, endurance, assistive devices, and others. After injection, therapeutic interventions have multiple aims, including strengthening and facilitation, increasing range of motion, retraining of ambulation and gait, improving the fit and tolerance of orthoses, and improved functioning in ADLs.

  6. Botulinum toxin A versus B in sialorrhea: a prospective, randomized, double-blind, crossover pilot study in patients with amyotrophic lateral sclerosis or Parkinson's disease.

    Science.gov (United States)

    Guidubaldi, Arianna; Fasano, Alfonso; Ialongo, Tamara; Piano, Carla; Pompili, Maurizio; Mascianà, Roberta; Siciliani, Luisa; Sabatelli, Mario; Bentivoglio, Anna Rita

    2011-02-01

    Either botulinum toxins (BoNTs) A and B have been used for improving drooling in different neurological conditions. Consecutive patients affected by Amyotrophic Lateral Sclerosis (ALS) or Parkinson's Disease (PD) accompanied by severe drooling were randomized to receive botulinum neurotoxin type A (BoNT-A) or B (BoNT-B) injections into the salivary glands. Following the first treatment, when sialorrhea returned to baseline (at least three months after the first injection), subjects were re-treated with the other serotype. Ultrasound-guided injections into parotid and submandibular glands were bilaterally performed: total doses were 250 U BoNT-A (Dysport) and 2500 U BoNT-B (Neurobloc). Objective (cotton roll weight) and subjective (ad hoc clinical scales) evaluations were performed at baseline, after 1 and 4 weeks, and every 4 weeks until drooling returned to baseline. Twenty-seven patients (15 ALS and 12 PD) were enrolled, fourteen completed the study. BoNT-A and BoNT-B treatments gave both subjective and objective improvements in all patients. The latency was significantly shorter after BoNT-B treatments (3.2 ± 3.7 days) compared to BoNT-A (6.6 ± 4.1 days; P = 0.002). The mean benefit duration was similar at 75 and 90 days for BoNT-A and BoNT-B, respectively (P = NS). The only toxin-related side effect was a change to saliva thickness. Either 250 U Dysport or 2500 U Neurobloc have similar effectiveness and safety in controlling sialorrhea. BoNT-B has a shorter latency and comparable duration. Cost analysis, considering the doses used in this study protocol favored BoNT-B treatment. Copyright © 2010 Movement Disorder Society.

  7. 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.

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

    National Research Council Canada - National Science Library

    Iannitti, Tommaso; Palmieri, Beniamino; Aspiro, Anna; Di Cerbo, Alessandro

    2014-01-01

    ...™-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...

  9. Botulinum neurotoxin type A injections for vaginismus secondary to vulvar vestibulitis syndrome.

    Science.gov (United States)

    Bertolasi, Laura; Frasson, Emma; Cappelletti, Jee Yun; Vicentini, Silvana; Bordignon, Monia; Graziottin, Alessandra

    2009-11-01

    To investigate whether botulinum neurotoxin type A improves vaginismus and study its efficacy with repeated treatments. Outpatients were referred because standard cognitive-behavioral and medical treatment for vaginismus and vulvar vestibular syndrome failed. From this group, we prospectively recruited consecutive women (n=39) whose diagnostic electromyogram (EMG) recordings from the levator ani muscle showed hyperactivity at rest and reduced inhibition during straining. These women were followed for a mean (+/-standard deviation) of 105 (+/-50) weeks. Recruited patients underwent repeated cycles of botulinum neurotoxin type A injected into the levator ani under EMG guidance and EMG monitoring thereafter. At enrollment and 4 weeks after each cycle, women were asked about sexual intercourse; underwent EMG evaluation and examinations to grade vaginal resistance according to Lamont; and completed a visual analog scale (VAS) for pain, the Female Sexual Function Index Scale, a quality-of-life questionnaire (Short-Form 12 Health Survey), and bowel and bladder symptom assessment. At 4 weeks after the first botulinum neurotoxin type A cycle, the primary outcome measures (the possibility of having sexual intercourse, and levator ani EMG hyperactivity) both improved, as did the secondary outcomes, Lamont scores, VAS, Female Sexual Function Index Scales, Short-Form 12 Health Survey, and bowel-bladder symptoms. These benefits persisted through later cycles. When follow-up ended, 63.2% of the patients completely recovered from vaginismus and vulvar vestibular syndrome, 15.4% still needed reinjections (censored), and 15.4% had dropped out. Botulinum neurotoxin type A is an effective treatment option for vaginismus secondary to vulvar vestibular syndrome refractory to standard cognitive-behavioral and medical management. After patients received botulinum neurotoxin type A, their sexual activity improved and reinjections provided sustained benefits. III.

  10. Split-screen video demonstration of sonography-guided muscle identification and injection of botulinum toxin.

    Science.gov (United States)

    Fietzek, Urban M; Schroeder, A Sebastian; Wissel, Jörg; Heinen, Florian; Berweck, Steffen

    2010-10-15

    A standardization of injection procedures for the various botulinum toxin (BoNT) indications has not been achieved to date. One established option to guide the therapist's needle is sonography guidance. It provides real-time visualization of the injection process, which is quick, allows perfect precision, and the procedure as such is painless. To demonstrate these qualities, we have recorded six split-screen video segments that show the handling of the probe and the needle during BoNT injections concurrently with the respective cross-sectional sonography recordings. The video sequences show differentiation of the pollicis longus muscle and individual finger flexor fascicles, needle tracking, and real-time sonography-guided injection of the gastrocnemius, rectus femoris, and iliopsoas muscles. We hope this short presentation will help to encourage a more widespread use of the technique as well as further research on sonography guidance for precise delivery of BoNT injections to various target muscles.

  11. A Double-Blind Randomized Controlled Trial Investigating the Most Efficacious Dose of Botulinum Toxin-A for Sialorrhea Treatment in Asian Adults with Neurological Diseases

    Directory of Open Access Journals (Sweden)

    Mazlina Mazlan

    2015-09-01

    Full Text Available This study aims to determine the most efficacious dose of Botulinum neurotoxin type A (BoNT-A in reducing sialorrhea in Asian adults with neurological diseases. A prospective, double-blind randomized controlled trial was conducted over 24 weeks. Thirty patients with significant sialorrhea were randomly assigned to receive a BoNT-A (Dysport® injection into the submandibular and the parotid glands bilaterally via an ultrasound guidance. The total dose given per patient was either BoNT-A injection of (i 50 U; (ii 100 U; or (iii 200 U. The primary outcome was the amount of saliva reduction, measured by the differential weight (wet versus dry of intraoral dental gauze at baseline and at 2, 6, 12, and 24 weeks after injection. The secondary outcome was the subjective report of drooling using the Drooling Frequency and Severity Scale (DFS. Saliva reduction was observed in response to all BoNT-A doses in 17 patients who completed the assessments. Although no statistically significant difference among the doses was found, the measured reduction was greater in groups that received higher doses (100 U and 200 U. The group receiving 200 U of Dysport® showed the greatest reduction of saliva until 24 weeks and reported the most significant improvement in the DFS score.

  12. Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap.

    Science.gov (United States)

    Ertzgaard, P; Anhammer, M; Forsmark, A

    2017-03-01

    As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap. Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke. Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%). The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Changes in masticatory function after injection of botulinum toxin type A to masticatory muscles.

    Science.gov (United States)

    Park, H U; Kim, B I; Kang, S M; Kim, S T; Choi, J H; Ahn, H J

    2013-12-01

    This study examined changes in masticatory function after botulinum toxin type A (BTX-A) injection using objective and subjective tests during 12 weeks. Also, we compared differences in masticatory function between group in which only masseter muscle (M group) was injected and group in which masseter and temporal muscle (M-T group) were injected. Forty subjects were assigned into two groups; M group (n = 20) and the M-T group (n = 20). The Meditoxin(®) was used as BTX-A injection. The mixing ability index (MAI) was used as the objective indicator, and visual analogue scale (VAS) and food intake ability (FIA) index were used as subjective indicators. Overall, the masticatory function drastically declined after 4 weeks and gradually recovered with time. Compared with the pre-injection state, the masticatory function decreased by 89·2% (MAI), 12·2% (FIA) and 32·2% (VAS) 4 weeks after the injection (P masticatory function was significantly decreased after BTX-A injection into the masticatory muscle after 4 and 8 weeks from injection. However, masticatory efficiency measured using MAI could completely recover after 12 weeks. Furthermore, after 8 weeks from the injection, the masticatory function measured after injection into only the masseter muscle was similar to that measured after injection into both masseter and temporal muscle. © 2013 John Wiley & Sons Ltd.

  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

    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.

  15. 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.

  16. Use of botulinum toxin in dentistry.

    Science.gov (United States)

    Hoque, Afreen; McAndrew, Maureen

    2009-11-01

    A growing number of dentists are providing botulinum toxin to patients. The research presented here outlines potential uses of Botox related to oral health and facial problems as compared to traditional treatment methods. The administration of Botox (historically done by dermatologists and neurologists) may fall under dentists' jurisdiction, as their training and knowledge encompasses the entire head and neck. A review is made of the literature, based on Ovid and PubMed searches, selecting articles describing the injection of botulinum toxin A in areas related to the oral cavity and the face, excluding cosmetic purposes.

  17. 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.

  18. Pseudoaneurysm of the thoracic aorta following botulinum toxin injection to the esophagus

    Directory of Open Access Journals (Sweden)

    Timothy P. Shiraev, MB, BS (Hons, BSc (Hons

    2016-09-01

    Full Text Available Aortic pseudoaneurysms are uncommon and are usually secondary to penetrating trauma. We describe the presentation and management of an elderly woman who suffered a pseudoaneurysm of the descending thoracic aorta several days after receiving botulinum toxin injection to the esophagus. Urgent thoracic endovascular aortic repair was performed, and long-term antibiotic therapy was commenced. Despite a slow initial clinical recovery, she returned to an independent lifestyle, with radiographic resolution of the pseudoaneurysm seen at follow-up. This case illustrates that endovascular aortic repair is a suitable and safe treatment option for this unusual presentation.

  19. Does giving segmental muscle vibration alter the response to botulinum toxin injections in the treatment of spasticity in people with multiple sclerosis? A single-blind randomized controlled trial.

    Science.gov (United States)

    Paoloni, Marco; Giovannelli, Morena; Mangone, Massimiliano; Leonardi, Laura; Tavernese, Emanuela; Di Pangrazio, Elisabetta; Bernetti, Andrea; Santilli, Valter; Pozzilli, Carlo

    2013-09-01

    To determine if segmental muscle vibration and botulinum toxin-A injection, either alone or in combination, reduces spasticity in a sample of patients with multiple sclerosis. Single-blind, randomized controlled trial. Physical medicine and rehabilitation outpatients service. Forty-two patients affected by the secondary progressive form of multiple sclerosis randomized to group A (30 minutes of 120 Hz segmental muscle vibration over the rectus femoris and gastrocnemius medial and lateral, three per week, over a period of four weeks), group B (botulinum toxin in the rectus femoris, gastrocnemius medial and lateral and soleus, and segmental muscle vibration) and group C (botulinum toxin). Modified Ashworth Scale at knee and ankle, and Fatigue Severity Scale. All the measurements were performed at baseline (T0), 10 weeks (T1) and 22 weeks (T2) postallocation. Modified Ashworth Scale at knee and ankle significantly decreased over time (p Fatigue Severity Scale values in groups A and C were significantly higher at T0 [A: 53.6 (2.31); C: 48.5 (2.77)] than at either T1 [A: 48.6 (2.21); p = 0.03; C: 43.5 (3.22); p = 0.03] or T2 [A: 46.7 (2.75); p = 0.02; 42.5 (2.17); p = 0.02], while no differences were detected in group B [T0: 43.4 (3.10); T1: 37.3 (3.15); T2: 39.7 (2.97)]. Segmental muscle vibration and botulinum toxin-A reduces spasticity and improves fatigue in the medium-term follow-up in patients with multiple sclerosis.

  20. Differences in Corneal Parameters Between Affected and Normal Contralateral Eyes in Patients With Hemifacial Spasm Treated With Botulinum Toxin-A: Outcomes During One Complete Treatment Cycle.

    Science.gov (United States)

    Osaki, Teissy; Osaki, Midori H; Osaki, Tammy H; Hirai, Flavio E; Campos, Mauro

    2016-02-01

    To investigate possible temporary differences in corneal topographic parameters between affected and normal eyes in patients with hemifacial spasm (HFS) treated with botulinum toxin-A (BTX-A), over the course of 1 treatment cycle. This prospective study evaluated corneal topographic differences between affected and normal contralateral eyes during a 4-month period in patients with HFS treated with BTX-A (the duration of action of BTX-A for HFS ranges from 2 to 4 months). Corneal topographic analysis was performed using a conventional topographer (Atlas; Carl Zeiss Meditec, Dublin, CA). Steep K and astigmatism measurements were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months. Twenty-four patients (16 women and 8 men) were evaluated. Steep K [46.9 ± 3.6 diopters (D)] and astigmatism values (2.6 ± 2.5 D) were significantly higher in affected eyes of HFS patients than in nonaffected eyes (45.0 ± 1.4 D and 0.9 ± 0.6 D) before treatment (P = 0.001 for steep K and P = 0.0003 for astigmatism). Astigmatism values also showed significant differences between the affected eye (1.4 ± 0.8 D) and nonaffected eye (0.9 ± 0.6 D) at 4 months (P = 0.006), whereas steep K showed significant differences between both eyes at 15 days (affected eye: 45.6 ± 1.5 D, nonaffected eye: 45.0 ± 1.4 D, P = 0.008), 3 months (affected eye: 45.6 ± 1.8 D, nonaffected eye: 45.1 ± 1.3 D, P = 0.03) and 4 months (affected eye: 45.8 ± 1.2 D, nonaffected eye: 45.1 ± 1.4 D, P = 0.003) after treatment. The differences in steep K, and especially in astigmatism values, between eyes tended to reduce during the period of action of BTX-A. At 4 months, when the BTX-A effect is considered to be over or very reduced, a significant difference between eyes for both parameters was noted again.

  1. Effects on craniofacial growth and development of unilateral botulinum neurotoxin injection into the masseter muscle.

    Science.gov (United States)

    Tsai, Chi-Yang; Chiu, Wan Chi; Liao, Yi-Hsuan; Tsai, Chih-Mong

    2009-02-01

    The effects of botulinum neurotoxin type A (BoNT/A) on masseter muscles, when injected for cosmetic purposes (volumetric reduction) or treatment of excessive muscle activity (bruxism), have been investigated. However, the full anatomic effects of treatment are not known, particularly with respect to the mandible and relevant anthropometric measurements. The intent of this study was to use unilaterial BoNT/A injections to induce localized masseter atrophy and paresis and then to measure the effects of muscle influence on craniofacial growth and development. Growing male Wistar rats, 30 days old, were studied. The experimental group consisted of 8 rats. One side of the masseter muscle was injected with BoNT/A and the other side of the masseter muscle was injected with saline. The side with BoNT/A belonged to 1 group and the side with saline was the sham group. Three rats without injections was the control. After 45 days, the masseter muscles were dissected and weighed. Dry skulls were prepared, and anthropometric measurements determined. One-way ANOVA showed that the animals maintained their weight in both groups; however, the muscles injected with BoNT/A were smaller than the sham or control muscles. Anthropometric measurements of the bony structures attached to the masseter muscle showed a significant treatment effect. After localized masseter muscle atrophy induced by BoNT/A injection, alterations of craniofacial bone growth and development were seen. The results agree with the functional matrix theory that soft tissues regulate bone growth.

  2. Virtual trainer for intra-detrusor injection of botulinum toxin to treat urinary incontinence.

    Science.gov (United States)

    Shen, Yunhe; Vasandani, Pankaj; Iyer, Jayesh; Gunasekaran, Arjune; Zhang, Yingchun; Burke, Daniel; Dykstra, Dennis; Sweet, Robert

    2012-01-01

    Here we introduce a new virtual reality (VR) based simulation system for training the urological procedure of intra-detrusor botulinum toxin (Botox®) injections into the bladder. 6 cases with different bladder anatomy and 3 subtasks are included in the curriculum; this design is guided by several expert urologists according to clinical needs and experience. These virtual bladder models can be deformed by a cystoscope model or penetrated by a needle model. Data of location and dose per injection are collected during the training. After compared among various options, magnetic motion-tracking devices are chosen and integrated onto replicas of cystoscopic instruments as the VR interface for the specific operation. A web/database based learning management platform (LMP) is developed for online data access and validation studies of the training system.

  3. No change in calf muscle passive stiffness after botulinum toxin injection in children with cerebral palsy.

    Science.gov (United States)

    Alhusaini, Adel A A; Crosbie, Jack; Shepherd, Roberta B; Dean, Catherine M; Scheinberg, Adam

    2011-06-01

    Stiffness and shortening of the calf muscle due to neural or mechanical factors can profoundly affect motor function. The aim of this study was to investigate non-neurally mediated calf-muscle tightness in children with cerebral palsy (CP) before and after botulinum toxin type A (BoNT-A) injection. Sixteen children with spastic CP (seven females, nine males; eight at Gross Motor Function Classification System level I, eight at level II; age range 4-10 y) and calf muscle spasticity were tested before and during the pharmaceutically active phase after injection of BoNT-A. Measures of passive muscle compliance and viscoelastic responses, hysteresis, and the gradient of the torque-angle curve were computed and compared before and after injection. Although there was a slight, but significant increase in ankle range of motion after BoNT-A injection and a small, significant decrease in the torque required to achieve plantigrade and 5° of dorsiflexion, no significant difference in myotendinous stiffness or hysteresis were detected after BoNT-A injection. Despite any effect on neurally mediated responses, the compliance of the calf muscle was not changed and the muscle continued to offer significant resistance to passive motion of the ankle. These findings suggest that additional treatment approaches are required to supplement the effects of BoNT-A injections when managing children with calf muscle spasticity. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.

  4. Ultrasound and Electromyography Guidance for Injection of the Longus Colli With Botulinum Toxin for the Treatment of Cervical Dystonia.

    Science.gov (United States)

    Allison, Stephen K; Odderson, Ib R

    2016-09-01

    Cervical dystonia, also called spasmodic torticollis, is a painful condition in which neck muscles contract involuntarily, and may cause abnormal head position or movements. The primary (or first line of) treatment of cervical dystonia is chemodenervation with injection of botulinum toxin into the affected muscles. We report a case of a young man with idiopathic cervical dystonia who developed anterocollis (forward flexion of the neck) not responsive to prior scalene and sternocleidomastoid muscle injections. To safely access the deeper cervical musculature, ultrasound (US) was used in conjunction with electromyography, to inject the longus colli muscles bilaterally. The patient responded well and had no complications. The longus colli has been reported to be injected using electromyography, fluoroscopy, computed tomography, and, less frequently, US. We propose that US guidance is an excellent technique for botulinum toxin injection, especially for deep cervical muscles such as the longus colli.

  5. Rapid Detection of Clostridium botulinum Toxins A, B, E, and F in Clinical Samples, Selected Food Matrices, and Buffer Using Paramagnetic Bead-Based Electrochemiluminescence Detection

    National Research Council Canada - National Science Library

    Rivera, Victor R; Gamez, Frank J; Keener, William K; White, Jill A; Poli, Mark A

    2006-01-01

    Sensitive and specific electrochemiluminescence (ECL) assays were used to detect Clostridium botulinum neurotoxins serotypes A, B, E, and F in undiluted human serum, undiluted human urine, assay buffer, and selected food matrices...

  6. Botulinum toxin injections for the treatment of hemifacial spasm over 16 years.

    Science.gov (United States)

    Sorgun, Mine Hayriye; Yilmaz, Rezzak; Akin, Yusuf Alper; Mercan, Fatma Nazli; Akbostanci, Muhittin Cenk

    2015-08-01

    The aim of this study was to investigate the efficacy and side effects of botulinum toxin (BTX) in the treatment of hemifacial spasm (HFS). We also focused on the divergence between different injection techniques and commercial forms. We retrospectively evaluated 470 sessions of BTX injections administered to 68 patients with HFS. The initial time of improvement, duration and degree of improvement, and frequency and duration of adverse effects were analysed. Pretarsal and preseptal injections and Botox (Allergan, Irvine, CA, USA) and Dysport (Ipsen Biopharmaceuticals, Paris, France) brands were compared in terms of efficacy and side effects, accompanied by a review of papers which reported BTX treatment of HFS. An average of 34.5 units was used per patient. The first improvement was felt after 8 days and lasted for 14.8 weeks. Patients experienced a 73.7% improvement. In 79.7% of injections, no adverse effect was reported, in 4.9% erythema, ecchymosis, and swelling in the injection area, in 3.6% facial asymmetry, in 3.4% ptosis, in 3.2% diplopia, and in 2.3% difficulty of eye closure was detected. Patients reported 75% improvement on average after 314 sessions of pretarsal injections and 72.7% improvement after 156 sessions of preseptal injections (p=0.001). The efficacy and side effects of Botox and Dysport were similar. BTX is an effective and safe treatment option for HFS. No difference was determined between Botox and Dysport, and pretarsal injection is better than preseptal injection regarding the reported degree of improvement. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2014-02-06

    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. 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 with symptomatic ankle OA (Kellgren-Lawrence grade 2) were randomized to receive either a single 100-unit BoNT-A injection into the target ankle (n = 38) or a single hyaluronate injection plus 12 sessions of rehabilitation exercise (30 minutes/day, 3 times/week for 4 weeks) (n = 37). The primary outcome measure was the Ankle Osteoarthritis Scale (AOS). Secondary outcome measures included American Orthopedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score, visual analog scale (VAS) for ankle pain, single leg stance test (SLS), Timed "Up-and-Go" test (TUG), consumption of rescue analgesics and global patient satisfaction. There were no significant between-group differences in total AOS scores, pain subscale and disability subscale scores (adjusted mean difference AMD = -0.2, 95% CI = (-0.5, 0.2), p = 0.39; AMD = -0.1, 95% CI = (-0.5, 0.3), p = 0.57; AMD = -0.2, 95% CI = (-0.6, 0.2), p = 0.36). The 2 groups showed no significant differences in AOFAS, VAS, SLS, TUG scores and consumption of rescue analgesics at each follow-up visit, except that the hyaluronate group improved more in SLS than the BoNT-A group at 1-month follow-up. Patients' satisfaction rate was high, with no serious adverse events. There was no difference in adverse events between the two groups (p = 1.00). Treatment with intraarticular BoNT-A or hyaluronate injection plus rehabilitation exercise was associated with improvements in pain, physical function and balance in patients

  8. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome.

    Science.gov (United States)

    Kamanli, A; Kaya, A; Ardicoglu, O; Ozgocmen, S; Zengin, F Ozkurt; Bayik, Y

    2005-10-01

    Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. Several methods have been recommended for the inactivation of trigger points (TrP). This prospective, single-blind study was proposed to compare TrP injection with botulinum toxin type A (BTX-A) to dry needling and lidocaine injection in MPS. Eighty-seven trigger points (cervical and/or periscapular regions) in 23 female and six male patients with MPS were treated and randomly assigned to three groups: lidocaine injection (n=10, 32 TrP), dry needling (n=10, 33 TrP), and BTX-A injection (n=9, 22 TrP). Clinical assessment including cervical range of motion, TrP pain pressure threshold (PPT), pain scores (PS), and visual analog scales for pain, fatigue, and work disability were evaluated at entry and the end of the 4th week. Additionally, depression and anxiety were evaluated with the Hamilton depression and anxiety rating scales, and quality of life was assessed using the Nottingham health profile (NHP). The subjects were also asked to describe side effects. INJECTION PROCEDURE: One milliliter of 0.5% lidocaine was administered to each TrP in the lidocaine injection group, 10-20 IU of BTX-A to each TrP in the BTX-A group, and dry needling to each TrP in the last group, followed by stretching of the muscle groups involved. The patients were instructed to continue their home exercise programs. Pain pressure thresholds and PS significantly improved in all three groups. In the lidocaine group, PPT values were significantly higher than in the dry needle group, and PS were significantly lower than in both the BTX-A and dry needle groups. In all, visual analog scores significantly decreased in the lidocaine injection and BTX-A groups and did not significantly change in the dry needle group. Disturbance during the injection procedure was lowest in the lidocaine injection group. Quality of life scores assessed by NHP significantly improved in the lidocaine and BTX-A groups but not

  9. 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,…

  10. Botulinum Toxin Injection for Treatment of Chronic Anal Fissure: Is There Any Dose-Dependent Efficiency? A Meta-Analysis.

    Science.gov (United States)

    Bobkiewicz, Adam; Francuzik, Wojciech; Krokowicz, Lukasz; Studniarek, Adam; Ledwosiński, Witold; Paszkowski, Jacek; Drews, Michal; Banasiewicz, Tomasz

    2016-12-01

    Chronic anal fissure (CAF) is a linear split of the anoderm. The minimally invasive management of CAF such as botulinum toxin (BT) injection is recommended. However, the exact efficient dose of BT, number of injections per session and the injection sites are still debatable. The aim of this analysis was to assess the dose-dependent efficiency of botulinum toxin injection for CAF. PubMed and Web of Science databases were searched for terms: "anal fissure" AND "botulinum toxin." Studies published between October 1993 and May 2015 were included and had to meet the following criteria: (1) chronic anal fissure, (2) prospective character of the study, (3) used simple BT injection without any other interventions and (4) no previous treatment with BT. A total of 1577 patients from 34 prospective studies used either Botox or Dysport formulations were qualified for this meta-analysis. A total number of BT units per session ranged from 5 to 150 IU, whereas the efficiency across analyzed studies ranged from 33 to 96 %. Surprisingly, we did not observe a dose-dependent efficiency (Spearman's rank correlation coefficient, ρ = 0.060; p = 0.0708). Moreover, there were no BT dose-dependent postoperative complications or fecal incontinence and significant difference in healing rates compared BT injection into the anal sphincter muscles. BT injection has been an accepted method for the management of CAF. Surprisingly, there is no dose-dependent efficiency, and the postoperative incontinence rate is not related to the BT dosage regardless the type of formulation of botulinum neurotoxin used. Moreover, no difference in healing rate has been observed in regard to the site and number of injections per session.

  11. Botulinum toxin.

    Science.gov (United States)

    The National Institutes of Health Consensus Development Conference on Clinical Use of Botulinum Toxin brought together neurologists, ophthalmologists, otolaryngologists, speech pathologists, and other health care professionals as well as the public to address: the mechanisms of action of botulinum toxin, the indications and contraindications for botulinum toxin treatment, the general principles of technique of injection and handling for its safe and effective use, and the short-term and long-term side effects and complications of therapy. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel recommended that (1) botulinum toxin therapy is safe and effective for treating strabismus, blepharospasm, hemifacial spasm, adductor spasmodic dysphonia, jaw-closing oromandibular dystonia, and cervical dystonia; (2) botulinum toxin is not curative in chronic neurological disorders; (3) the safety of botulinum toxin therapy during pregnancy, breast feeding, and chronic use during childhood is unknown; (4) the long-term effects of chronic treatment with botulinum toxin remain unknown; and (5) botulinum toxin should be administered by committed interdisciplinary teams of physicians and related health care professionals with appropriate instrumentation. The full text of the consensus panel's statement follows.

  12. A new mouse model for renal lesions produced by intravenous injection of diphtheria toxin A-chain expression plasmid

    Directory of Open Access Journals (Sweden)

    Nakamura Shingo

    2004-04-01

    Full Text Available Abstract Background Various animal models of renal failure have been produced and used to investigate mechanisms underlying renal disease and develop therapeutic drugs. Most methods available to produce such models appear to involve subtotal nephrectomy or intravenous administration of antibodies raised against basement membrane of glomeruli. In this study, we developed a novel method to produce mouse models of renal failure by intravenous injection of a plasmid carrying a toxic gene such as diphtheria toxin A-chain (DT-A gene. DT-A is known to kill cells by inhibiting protein synthesis. Methods An expression plasmid carrying the cytomegalovirus enhancer/chicken β-actin promoter linked to a DT-A gene was mixed with lipid (FuGENE™6 and the resulting complexes were intravenously injected into adult male B6C3F1 mice every day for up to 6 days. After final injection, the kidneys of these mice were sampled on day 4 and weeks 3 and 5. Results H-E staining of the kidney specimens sampled on day 4 revealed remarkable alterations in glomerular compartments, as exemplified by mesangial cell proliferation and formation of extensive deposits in glomerular basement membrane. At weeks 3 and 5, gradual recovery of these tissues was observed. These mice exhibited proteinuria and disease resembling sub-acute glomerulonephritis. Conclusions Repeated intravenous injections of DT-A expression plasmid DNA/lipid complex caused temporary abnormalities mainly in glomeruli of mouse kidney. The disease in these mice resembles sub-acute glomerulonephritis. These DT-A gene-incorporated mice will be useful as animal models in the fields of nephrology and regenerative medicine.

  13. Systematic review of adjunct therapies to improve outcomes following botulinum toxin injection for treatment of limb spasticity.

    Science.gov (United States)

    Mills, Patricia Branco; Finlayson, Heather; Sudol, Malgorzata; O'Connor, Russell

    2016-06-01

    To determine the quality of evidence from randomized controlled trials on the efficacy of adjunct therapies following botulinum toxin injections for limb spasticity. MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials electronic databases were searched for English language human studies from 1980 to 21 May 2015. Randomized controlled trials assessing adjunct therapies postbotulinum toxin injection for treatment of spasticity were included. Of the 268 studies screened, 17 met selection criteria. Two reviewers independently assessed risk of bias using the Physiotherapy Evidence Database (PEDro) scale and graded according to Sackett's levels of evidence. Ten adjunct therapies were identified. Evidence suggests that adjunct use of electrical stimulation, modified constraint-induced movement therapy, physiotherapy (all Level 1), casting and dynamic splinting (both Level 2) result in improved Modified Ashworth Scale scores by at least 1 grade. There is Level 1 and 2 evidence that adjunct taping, segmental muscle vibration, cyclic functional electrical stimulation, and motorized arm ergometer may not improve outcomes compared with botulinum toxin injections alone. There is Level 1 evidence that casting is better than taping, taping is better than electrical stimulation and stretching, and extracorporeal shock wave therapy is better than electrical stimulation for outcomes including the Modified Ashworth Scale, range of motion and gait. All results are based on single studies. There is high level evidence to suggest that adjunct therapies may improve outcomes following botulinum toxin injection. No results have been confirmed by independent replication. All interventions would benefit from further study. © The Author(s) 2015.

  14. Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series.

    Science.gov (United States)

    Charrow, Alexandra; DiFazio, Marc; Foster, Leslie; Pasquina, Paul F; Tsao, Jack W

    2008-07-01

    To study the effectiveness of botulinum toxin type A (BTX-A) therapy for residual limb hyperhidrosis, prosthesis fit and function, and residual and phantom limb pain in patients with limb amputation. Consecutive case series. Outpatient physical medicine and rehabilitation clinic. Walter Reed Army Medical Center patients (N=8) with unilateral traumatic upper- or lower-limb amputation. BTX-A was injected transdermally in a circumferential pattern around the residual limb by using a 1-cm matrix grid. A 10-cm continuous Likert visual analog scale was used to assess residual limb sweating and pain and prosthesis fit and function before and 3 weeks after BTX-A injections. Patients reported a significant reduction in sweating and improvement in prosthesis fit and function after treatment. However, residual limb and phantom pain were unaffected by treatment. BTX-A may be an effective treatment for residual limb hyperhidrosis, resulting in subjective improvement in prosthesis fit and functioning. BTX-A should be considered as a method to manage excessive sweating in the residual limb of traumatic amputees.

  15. Case Report: Impact of Botulinum Toxin Injection on Function of Affected Upper Extremity in A Patient, 16 Years after Stroke

    Directory of Open Access Journals (Sweden)

    Malek Amini

    2012-10-01

    Full Text Available Objective: Case report Impact of Botulinum Toxin injection on function of affected upper extremity in a patient after 16 years since stroke (CVA. Botulinum toxin injection is one the treatments in spasticity reduction and consequently in recovery of upper limb function in stroke patients. The purpose of this case study is to report the effect of Botulinum toxin injection on upper extremity function after 16 years of stroke. Materials & Methods: The patient was a 63-year-old man who has had a cerebrovascular accident that happened in the left hemisphere about 16 years ago, and as a result, a paresis in dominant hand and arm. Although the patient was able to perform simple movements but he was complaining about the slowness and stiffness in the movements. To treat spasticity the Botulinum toxin type A was used. Injection into selected muscles of hemiparetic upper limb was done by a specialist physician and was between 50-150IU based on specific volume of each muscle. After injection, the patient was monitored for 3 months and at the end of each month, the assessments were reevaluated. During this period, although research team suggested the patient to continue the rehabilitation but for personal reasons he didn’t participate in any treatment and didn`t receive any other antispasmodic medications. Results: An increase in range of motion was seen in all joints but this improvement was not significant. The greatest improvement in passive and active range of motion was seen in Metacarpophalengeal joints. At the end of each month, compared to the first month the recovery of function in upper extremity was significant. Maximum recovery of upper extremity function was related to the hand section of fugl-meyer assessment. At the end of the first month, spasticity significantly decreased so that the patient was able to extend all his joints more easily than before injection. Although spasticity never reached zero. Conclusion: Botulinum toxin injection

  16. 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.

  17. Office-based Electromyography-guided Botulinum Toxin Injection to the Cricopharyngeus Muscle: Optimal Patient Selection and Technique.

    Science.gov (United States)

    Kim, Min-Su; Kim, Go-Woon; Rho, Young-Soo; Kwon, Kee-Hwan; Chung, Eun-Jae

    2017-05-01

    This retrospective study was carried out to investigate the effectiveness and safety of office-based electromyography-guided injection of botulinum toxin in the cricopharyngeus muscle of patients who did not show upper esophageal sphincter passage in a swallowing study in spite of maximal swallowing rehabilitation. Thirty-six patients who showed no or limited ability to oral feed after maximum swallowing rehabilitation were enrolled. Video fluoroscopic swallowing study, flexible endoscopic evaluation of swallowing, disability rating scale, penetration aspiration score, and National Institutes of Health swallowing safety scale were used in the evaluation of dysphagia. Success was defined as nondependence on gastrostomy for patients who previously were dependent on gastrostomy and improvement in disability rating scale score after botulinum toxin injections. The total success rate was 63.9%. The complication rate was very low, with only 1 patient showing temporary unilateral vocal fold paralysis. Botulinum toxin injection was more effective in patients with cranial nerve IX or X palsy than in those without it ( P = .006). This procedure can be a simple, safe, and effective tool in patients with cricopharyngeal dysfunction after swallowing rehabilitation, especially for cranial nerve IX or X palsy.

  18. Predicting Improvement in Writer's Cramp Symptoms following Botulinum Neurotoxin Injection Therapy

    Directory of Open Access Journals (Sweden)

    Mallory Jackman

    2016-09-01

    Full Text Available Introduction: Writer's cramp is a specific focal hand dystonia causing abnormal posturing and tremor in the upper limb. The most popular medical intervention, botulinum neurotoxin type A (BoNT-A therapy, is variably effective for 50–70% of patients. BoNT-A non-responders undergo ineffective treatment and may experience significant side effects. Various assessments have been used to determine response prediction to BoNT-A, but not in the same population of patients. Methods: A comprehensive assessment was employed to measure various symptom aspects. Clinical scales, full upper-limb kinematic measures, self-report, and task performance measures were assessed for nine writer's cramp patients at baseline. Patients received two BoNT-A injections then were classified as responders or non-responders based on a quantified self-report measure. Baseline scores were compared between groups, across all measures, to determine which scores predicted a positive BoNT-A response. Results: Five of nine patients were responders. No kinematic measures were predictably different between groups. Analyses revealed three features that predicted a favorable response and separated the two groups: higher than average cramp severity and cramp frequency, and below average cramp latency. Discussion: Non-kinematic measures appear to be superior in making such predictions. Specifically, measures of cramp severity, frequency, and latency during performance of a specific set of writing and drawing tasks were predictive factors. Since kinematic was not used to determine the injection pattern and the injections were visually guided, it may still be possible to use individual patient kinematics for better outcomes. 

  19. Assay of diffusion of different botulinum neurotoxin type a formulations injected in the mouse leg.

    Science.gov (United States)

    Carli, Luca; Montecucco, Cesare; Rossetto, Ornella

    2009-09-01

    Botulinum neurotoxin type-A (BoNT/A) is very effective in the therapy of a wide range of human syndromes characterized by hyperactivity of peripheral cholinergic nerve terminals. Little diffusion of this toxin from the site of injection is commonly observed, but even minor changes in this property would greatly affect the validity of the treatment. Different pharmacological formulations of BoNT/A are available, and they may have different diffusion characteristics due to protein complex size, product format, and pharmacological properties. Here we assessed the extent of diffusion of three commercial preparations of BoNT/A: Botox (Allergan), Dysport (Ipsen), and Xeomin (Merz Pharmaceuticals) using a novel and highly sensitive test based on neural cell adhesion molecule (N-CAM) expression in muscle. N-CAM is a membrane glycoprotein that accumulates on muscle fibers after denervation and is not expressed in untreated adult muscle. This allows fine monitoring of the functional diffusion of this toxin, and the sensitivity of this assay is emphasized by the use of the mouse model because of the small muscle dimensions. The results presented here indicate that there is no significant difference between Botox, Dysport, and Xeomin with respect to diffusion into adjacent muscles in the mouse leg.

  20. Botulinum Neurotoxin A injections influence stretching of the gastrocnemius muscle-tendon unit in an animal model.

    Science.gov (United States)

    Haubruck, Patrick; Mannava, Sandeep; Plate, Johannes F; Callahan, Michael F; Wiggins, Walter F; Schmidmaier, Gerhard; Tuohy, Christopher J; Saul, Katherine R; Smith, Thomas L

    2012-08-01

    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. Mousegastrocnemius 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 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.

  1. 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. © The Author(s) 2013.

  2. Botulinum toxin injection into the forearm muscles for wrist and fingers spastic overactivity in adults with chronic stroke: a randomized controlled trial comparing three injection techniques.

    Science.gov (United States)

    Picelli, Alessandro; Lobba, Davide; Midiri, Alessandro; Prandi, Paolo; Melotti, Camilla; Baldessarelli, Silvia; Smania, Nicola

    2014-03-01

    To compare the outcome of manual needle placement, electrical stimulation and ultrasonography-guided techniques for botulinum toxin injection into the forearm muscles of adults with arm spasticity. Randomized controlled trial. University hospital. Sixty chronic stroke patients with wrist and fingers spasticity. After randomization into three groups, each patient received botulinum toxin type A in at least two of these muscles: flexor carpi radialis and ulnaris, flexor digitorum superficialis and profundus (no fascicles selection). The manual needle placement group underwent injections using palpation; the electrical stimulation group received injections with electrical stimulation guidance; the ultrasonography group was injected under sonographic guidance. A sole injector was used. All patients were evaluated at baseline and four weeks after injection. Modified Ashworth Scale; Tardieu Scale; wrist and fingers passive range of motion. One month after injection, Modified Ashworth Scale scores improved more in the electrical stimulation group than the manual needle placement group (wrist: P = 0.014; fingers: P = 0.011), as well as the Tardieu angle (wrist: P = 0.008; fingers: P = 0.015) and passive range of motion (wrist: P = 0.004). Furthermore, Modified Ashworth Scale scores improved more in the ultrasonography group than in the manual needle placement group (wrist: P = 0.001; fingers: P = 0.003), as well as the Tardieu angle (wrist: P = 0.010; fingers: P = 0.001) and passive range of motion (wrist: P muscles of stroke patients.

  3. Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics.

    Science.gov (United States)

    Samotus, Olivia; Kumar, Niraj; Rizek, Philippe; Jog, Mandar

    2018-01-01

    There is a significant need for a targeted therapy for essential tremor (ET), as medications have not been developed specifically for ET, and the ones prescribed are often not well-tolerated, so that many patients remain untreated. Recent work has shown that, unlike previous experience, kinematically guided individualized botulinum toxin type A (BoNT-A) injections provide benefit along with minimal weakness. Ours is the first long-term (96-week) safety and efficacy study of BoNT-A as monotherapy for ET using kinematically driven injection parameters. Ten ET patients were administered six serial BoNT-A treatments every 16 weeks and were assessed at 6 weeks following treatment. During each study visit, the Fahn-Tolosa-Marin (FTM) scale, the Unified Parkinson's Disease Rating Scale, and the Quality of Life for Essential Tremor Questionnaire (QUEST) were administered along with kinematic assessment of the treated limb. Participants performed scripted tasks with motion sensors placed over each arm joint. Dosing patterns were determined using the movement disorder neurologist's interpretation of muscles contributing to the kinematically analyzed upper limb tremor biomechanics. There was a 33.8% (pfunctional improvement (FTM part C) and a 39.8% (ptremor score was reduced by 62.9% (p=0.001) in the treated and by 44.4% (p=0.03) in the untreated arm at week 96 compared to week 48. Individualized BoNT-A dosing patterns to each individual's tremor biomechanics provided an effective monotherapy for ET as function improved without functionally limiting muscle weakness.

  4. Utility of ultrasound-guided injection of botulinum toxin type A for muscle imbalance in children with obstetric brachial plexus palsy: Description of the procedure and action protocol.

    Science.gov (United States)

    García Ron, A; Gallardo, R; Huete Hernani, B

    2017-03-24

    Obstetric brachial plexus palsy (OBPP) usually has a favourable prognosis. However, nearly one third of all severe cases have permanent sequelae causing a high level of disability. In this study, we explore the effectiveness of ultrasound-guided injection of botulinum toxin A (BoNT-A) and describe the procedure. We designed a prospective, descriptive study including patients with moderate to severe OBPP who were treated between January 2010 and December 2014. We gathered demographic data, type of OBPP, and progression. Treatment effectiveness was assessed with the Active Movement Scale (AMS), the Mallet classification, and video recordings. We gathered a total of 14 133 newborns, 15 of whom had OBPP (1.6 per 1000 live births). Forty percent of the cases had severe OBPP (0.4/1000), a dystocic delivery, and APGAR scores treatment onset was 11.5 months. The muscles most frequently receiving BoNT-A injections were the pronator teres, subscapularis, teres major, latissimus dorsi, and pectoralis major. All the patients who completed the follow-up period (83%) experienced progressive improvements: up to 3 points on the AMS and a mean score of 19.5 points out of 25 on the Mallet classification at 2 years. Treatment improved muscle function and abnormal posture in all cases. Surgery was avoided in 3 patients and delayed in one. Adverse events were mild and self-limited. Due to its safety and effectiveness, BoNT-A may be used off-label as an adjuvant to physical therapy and/or surgery in moderate to severe OBPP. Ultrasound may increase effectiveness and reduce adverse effects. Copyright © 2017 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Taping versus electrical stimulation after botulinum toxin type A injection for wrist and finger spasticity. A case-control study.

    Science.gov (United States)

    Carda, Stefano; Molteni, Franco

    2005-09-01

    To compare results from two approaches used in conjunction with botulinum toxin type A administration in rehabilitation: the application of a taping system and the electrical stimulation of the injected muscles and splinting. Case-control study. Two tertiary care rehabilitation hospitals in Italy. Sixty-five adult subjects affected by spasticity of the wrist and finger flexors. After injection with botulinum toxin type A, the group at hospital A (n=33) was treated with adhesive taping for six days and those at hospital B (n=32) with electrical stimulation and splinting for six days. Spastic hypertonia at the injected muscles was assessed before treatment, one week and one month post injection. Modified Ashworth Scale. In group A, the mean Modified Ashworth Scale reduction was 2.76 +/- 0.94 for wrist flexors and 2.45 +/- 0.92 for finger flexors; in group B the mean Modified Ashworth Scale reduction was 2.18 +/- 1.11 for wrist flexors and 2.1 +/- 0.98 for finger flexors. The observed difference between the two groups was statistically relevant (p spastic hypertonia as measured with Modified Ashworth Scale, with less time dedicated for the treatment.

  6. A prospective crossover trial of botulinum toxin chemodenervation versus injection augmentation for essential voice tremor.

    Science.gov (United States)

    Estes, Christine; Sadoughi, Babak; Coleman, Rachel; Sarva, Harini; Mauer, Elizabeth; Sulica, Lucian

    2018-02-01

    Botulinum toxin chemodenervation (BTX) is used to treat essential voice tremor (EVT), but results are not uniformly satisfactory. This study sought to assess the comparative utility of injection augmentation (IA) for EVT. Prospective crossover treatment study. Patients with EVT underwent BTX. After washout patients underwent IA. Multidimensional assessment carried out prior to and 30 days after each treatment included 1) videostroboscopy graded by the Vocal Tremor Scoring System (VTSS), 2) acoustic and aerodynamic assessment (cepstral peak prominence, cepstral spectral index of dysphonia, cepstral peak prominence fundamental frequency, airflow, peak air pressure and intensity, maximum phonation time, and amplitude/frequency of tremor), 3) audio-perceptual assessment via Consensus Audio-Perceptual Evaluation of Voice (CAPE-V), and 4) patient self-assessment via Voice Handicap Index-10 (VHI-10) and Percent of Normal Function (PNF) scale. Findings were analyzed via paired t tests and Wilcoxon rank sum tests. Seven patients (five female and two male; mean age 67 years old; range, 46-82 years old) participated. VTSS grading showed divergent outcomes for certain individual sites of tremor, but without significant differences. Airflow increased following BTX and decreased following IA, and VHI-10 scores indicated slight improvement post-BTX (26.29-23.57), and decline post-IA (25.86-29.86), although differences were not significant. Only changes in audio-perceptual ratings of loudness achieved significance, which decreased with BTX and increased with IA. Five patients chose to resume BTX; two elected long-term IA. No findings supported patient preferences. IA demonstrated no advantage over BTX in the treatment of EVT. 2b. Laryngoscope, 128:437-446, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Early physiotherapy after injection of botulinum toxin increases the beneficial effects on spasticity in patients with multiple sclerosis.

    Science.gov (United States)

    Giovannelli, M; Borriello, G; Castri, P; Prosperini, L; Pozzilli, C

    2007-04-01

    To determine whether additional physiotherapy increases botulinum toxin type A effects in reducing spasticity in patients with multiple sclerosis. A single-blind, randomized, controlled pilot trial with a 12-week study period. Thirty-eight patients with progressive multiple sclerosis affected by focal spasticity and who were observed at the Multiple Sclerosis Centre operating in the S. Andrea Hospital in Rome. For intervention all patients received botulinum toxin type A; the treatment group also received additional physiotherapy to optimize management through passive or active exercise and stretching regimens. To measure objective and subjective level of spasticity, patients were assessed at baseline, 2, 4 and 12 weeks post treatment by Modified Ashworth Scale and visual analogue scale. When compared with the control group, we found a significant decrease of spasticity by Modified Ashworth Scale (P < 0.01 by t-test) in the treatment group at week 2 (2.73 versus 3.22), week 4 (2.64 versus 3.33) and week 12 (2.68 versus 3.33). The mean (%) difference in Modified Ashworth Scale score between baseline and the end of follow-up was -0.95 (26.1) in the treatment group and -0.28 (7.7) in the control group (P < 0.01). The combined treatment proved also to be more effective by visual analogue scale (P < 0.01) at week 4 (6.95 versus 5.50) and at week 12 (7.86 versus 6.56) but not at week 2 (5.18 versus 5.50; P = 0.41). Our data suggest that physiotherapy in combination with botulinum toxin type A injection can improve overall response to botulinum toxin.

  8. 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

  9. NO DECREASE IN MUSCLE STRENGTH AFTER BOTULINUM NEUROTOXIN-A INJECTION IN CHILDREN WITH CEREBRAL PALSY

    Directory of Open Access Journals (Sweden)

    Meta Nyström Eek

    2016-10-01

    Full Text Available 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 cerebral palsy. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion.Twenty children with spastic cerebral palsy were included in the study, eight 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 six weeks after at the peak effect of BoNT-A, and at six 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

  10. The effect and complication of botulinum toxin type a injection with serial casting for the treatment of spastic equinus foot.

    Science.gov (United States)

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

    2011-06-01

    To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot. 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 weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modified Tardieu scale (MTS). Gait pattern was measured using the physician's rating scale (PRS). The degree of ankle dorsiflexion and the MAS improved significantly until 12 weeks following the BTX-A injection in the serial casting group (pcasting. Our study demonstrated that the effect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.

  11. Quantitative evaluation for spasticity of calf muscle after botulinum toxin injection in patients with cerebral palsy: a pilot study.

    Science.gov (United States)

    Lin, Yu-Ching; Lin, I-Ling; Chou, Te-Feng Arthur; Lee, Hsin-Min

    2016-03-12

    Cerebral palsy (CP) is the most common pediatric disease to cause motor disability. Two common symptoms in CP are spasticity and contracture. If this occurred in the ankle plantar flexors of children with CP, it will impair their gait and active daily living profoundly. Most children with CP receive botulinum toxin type A (BoNT-A) injection to reduce muscle tone, but a knowledge gap exists in the understanding of changes of neural and non-neural components of spasticity after injection. The purpose of this study was to determine if our device for quantitative modified Tardieu approach (QMTA) is a valid method to assess spasticity of calf muscles after botulinum toxin injection. In this study, we intended to develop a device for quantitative measurement of spasticity in calf muscles based on the modified Tardieu scale (MTS) and techniques of biomedical engineering. Our QMTA measures the angular displacement and resistance of stretched joint with a device that is light, portable and can be operated similar to conventional approaches for MTS. The static (R2), dynamic (R1) and R2-R1 angles derived from the reactive signals collected by the miniature sensors are used to represent the non-neural and neural components of stretched spastic muscles. Four children with CP were recruited to assess the change in spasticity in their gastrocnemius muscles before and 4 weeks after BoNT-A injection. A simulated ankle model validated the performance of our device in measuring joint displacement and estimating the angle of catch. Data from our participants with CP showed that R2 and R2-R1 improved significantly after BoNT-A administration. It indicates both neural and non-neural components of the spastic gastrocnemius muscles improved at four weeks after BoNT-A injection in children with CP. Our device for QMTA can objectively measure the changes in spasticity of the gastrocnemius muscle in children with cerebral palsy after BoNT-A injection.

  12. SiMa Cells for a Serotype Specific and Sensitive Cell-Based Neutralization Test for Botulinum Toxin A and E

    Directory of Open Access Journals (Sweden)

    Nicola Bak

    2017-07-01

    Full Text Available Botulinum toxins (BoNTs, of which there are seven serotypes, are among the most potent neurotoxins, with serotypes A, B and E causing human botulism. Antitoxins form the first line of treatment for botulism, and functional, highly sensitive in vitro methods for toxin neutralization are needed to replace the current in vivo methods used for determination of antitoxin potency. In this preliminary proof of concept study, we report the development of a neutralization test using the neuroblastoma SiMa cell line. The assay is serotype specific for either BoNT/A or BoNT/E, which both cleave unique sequences on SNAP-25 within SiMa cells. The end point is simple immunodetection of cleaved SNAP-25 from cell lysates with antibodies detecting only the newly exposed sequence on SNAP-25. Neutralizing antibodies prevent the toxin-induced cleavage of SNAP-25. The toxin neutralization assay, with an EC50 of ~2 mIU/mL determined with a standardized reference antiserum, is more sensitive than the mouse bioassays. Relevance was demonstrated with commercial and experimental antitoxins targeting different functional domains, and of known in vivo neutralizing activities. This is the first report describing a simple, specific, in vitro cell-based assay for the detection of neutralizing antibodies against BoNT/A and BoNT/E with a sensitivity exceeding that of the mouse bioassay.

  13. Patient Perceived Benefit in Facial Aesthetic Procedures: FACE-Q as a Tool to Study Botulinum Toxin Injection Outcomes.

    Science.gov (United States)

    Chang, Brian L; Wilson, Anthony J; Taglienti, Anthony J; Chang, Catherine S; Folsom, Nancy; Percec, Ivona

    2016-07-01

    There are numerous methods of assessing patient satisfaction with botulinum toxin type A neuromodulation of the glabellar rhytids. As the use of aesthetic neuromodulation increases both in breadth and number of procedures, there is a need for more comprehensive tools to evaluate patient-reported outcomes. The FACE-Q is a recently validated patient-reported outcome instrument that can be used to measure patient perceptions of botulinum toxin type A neuromodulation. This study used the FACE-Q to assess patient satisfaction following botulinum toxin type A neuromodulation of the glabellar rhytids. 57 female patients completed the FACE-Q, a survey that evaluates patients' satisfaction with their facial appearance. After this baseline survey, the patients received injections of one of onabotulinumtoxinA (Botox, Allergan, Dublin, Ireland), abobotulinumtoxinA (Dysport, Galderma, Lausanne, Switzerland), or incobotulinumtoxinA (Xeomin, Merz Pharmaceuticals, Frankfurt am Main, Germany) in the glabella. Two weeks post-injection, the patients completed the FACE-Q again. The percentage changes in patient responses were tabulated to determine how neuromodulation affects patient satisfaction with their facial appearance. The percentage changes for each of the neurotoxin groups were compared to determine if patient satisfaction with neuromodulation varies with the type of neurotoxin. Patient satisfaction with their overall facial appearance increased by 28% following neuromodulation. Patients stated that they believe they look an average of 5.6 years younger post-neuromodulation. There were no significant differences among the treatment groups. The FACE-Q demonstrates that patients are more satisfied by their overall facial appearance and age appearance following neuromodulation of their glabellar rhytids. Patients are equally satisfied with the improvement of their facial appearance regardless of which neurotoxin they received. LEVEL OF EVIDENCE 2: Therapeutic. © 2016 The

  14. 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.

  15. Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes.

    Science.gov (United States)

    Cillino, S; Raimondi, G; Guépratte, N; Damiani, S; Cillino, M; Di Pace, F; Casuccio, A

    2010-04-01

    To investigate the long-term effectiveness and safety of botulinum neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation index percentage' (BEI-%), in the dose-escalation evaluation. All patients in this multicentre study were followed for at least 10 years and main outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and frequency of adverse events. BEB, HFS, and EN patients received a mean BoNT-A dose with a significant inter-group difference (P<0.0005, respectively). The mean (+/-SD) effect duration was statistically different (P=0.009) among three patient groups. Regarding the BoNT-A escalation indexes, the mean (+/-SD) values of BEI-U and BEI-% were statistically different (P=0.035 and 0.047, respectively) among the three groups. In BEB patients, the BEI-% was significantly increased in younger compared with older patients (P=0.008). The most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and localized bruising. This long-term multicentre study supports a high efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB patients compared with HFS or EN patients and a significantly greater BEI-% in younger vsolder BEB patients. These results confirm a greater efficacy in the elderly and provide a framework for long-term studies with a more flexible and reliable evaluation of drug-dose escalation.

  16. What Clinical Strategies Are Applied for Botulinum Toxin Injection in the Oromandibular Region?

    DEFF Research Database (Denmark)

    Bakke, Merete; Dalager, Torben; Møller, Eigild

    2016-01-01

    Botulinum neurotoxin (BoNT) inhibits the release of acetylcholine from cholinergic nerve terminals in muscles or salivary glands. With reduced activation, the muscle activity or secretion decreases. Indications for medical, non‐cosmetic use of BoNT in the orofacial area include among others oroma...

  17. Treatment of superior limbic keratoconjunctivitis with a large-diameter contact lens and Botulium Toxin A.

    Science.gov (United States)

    Chun, Yeoun Sook; Kim, Jae Chan

    2009-08-01

    To evaluate the effect of a large-diameter (16-20 mm) hydrogel contact lens (CL) or an injection of Botulinum Toxin A to Riolan muscle for the treatment of superior limbic keratoconjunctivitis (SLK). Eight eyes from 8 patients were fitted with large-diameter CL for 7 days. The clinical improvement and changes of fluorescein and rose bengal staining were examined on the day of diagnosis and 3, 7, 14, and 30 days after the CL was fitted. Three eyes showing symptoms of recurrence of SLK within 1 month after removal of the CL and 2 eyes with complications related to CL were treated with an injection of Botulinum Toxin A to pretarsal orbicularis muscle, Riolan. The changes of symptoms and vital stains were also evaluated on day 7 and 1, 2, 3, and 6 months after the injection. The mean age was 48 +/- 13.5 years, and the group consisted of 6 females and 2 males. Dry eye syndrome and horizontal conjunctival corrugation were found in all 8 patients, superior conjunctivochalasis in 5 patients, and floppy eyelid syndrome in 2 patients. Complete resolution after more than 1 month with CL only was seen in 3 eyes (37.5%). Clinical symptoms improved in 4.62 days and vital staining in 10.75 days after fitting of the CL. Superficial punctuate keratopathy related to CL occurred in 3 eyes (37.5%). Five eyes (62.5%) that were treated with botulinum showed distinct improvement within 7 days after the injection, and the effect was maintained for 2-7 months. The fitting of large-diameter CL can be considered for the treatment of acute severe symptoms of SLK for a short time. An injection of Botulinum toxin to the Riolan muscle can effectively and rapidly resolve the symptoms associated with SLK, and its effect of maintenance was a mean of 4 months.

  18. An MRI evaluation of changes in piriformis muscle morphology induced by botulinum toxin injections in the treatment of piriformis syndrome.

    Science.gov (United States)

    Al-Al-Shaikh, M; Michel, F; Parratte, B; Kastler, B; Vidal, C; Aubry, S

    2015-01-01

    Botulinum toxin (BT) injection is a new treatment for piriformis syndrome (PS). The main purpose of our study was to use MRI to evaluate changes in piriformis muscle morphology after treatment with BT injections. Twenty patients presenting with PS who had undergone an MRI were included retrospectively: 12 patients treated with BT injections and eight untreated patients. The following parameters were assessed and compared to a normal contralateral muscle: maximum thickness, volume, and Goutallier's classification grade of fatty infiltration of the piriformis and internal obturator muscles. Pain was assessed through a visual analogue scale (VAS). The untreated patients had no significant difference in the volume (P=1.0) or thickness of the piriformis muscle (P=0.61). The treated patients showed a significant reduction in the thickness (-4.2mm; P<0.001) and volume (-74.4mm(3); P<0.001) and an increase in the fatty infiltration (P<0.001) of the piriformis muscle treated by BT injection. Muscular atrophy was correlated with the number of BT injections and with the time until an MRI was performed. There was also significant pain relief after BT treatment. BT leads to atrophy and fatty degeneration of the piriformis muscle that can be quantified by MRI and these factors explain why BT injections are effective in the treatment of PS. Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  19. A comparative crossover study on the treatment of hemifacial spasm and blepharospasm: preseptal and pretarsal botulinum toxin injection techniques.

    Science.gov (United States)

    Lolekha, Praween; Choolam, Arthita; Kulkantrakorn, Kongkiat

    2017-11-01

    Hemifacial spasm (HFS) and benign essential blepharospasm (BEB) are chronic and disabling abnormal craniofacial movements that produce involuntary eyelid twitching and closure. The efficacy and safety of botulinum toxin type A (BoNT-A) injections have been accepted and widely used for the treatment of HFS and BEB. However, different injection sites may influence the effectiveness, doses, and side effects. The aim of this study is to compare the efficacy, patient satisfaction, and complications of low-dose BoNT-A injections between injection at the preseptal (PS) and the pretarsal (PT) portion of the orbicularis oculi muscle. A total of 40 patients, 31 patients with HFS and 9 patients with BEB, participated in this study. Each patient received both PS and PT BoNT-A injections in a crossover design study. Latency to response, duration of improvement, the Jankovic Rating Scale (JRS), self-response scale, patient satisfaction scale, and complications were compared. Low-dose injections of BoNT-A at the PT portion produced a significantly higher response rate in terms of latency to response, duration of improvement, JRS, self-response scale, and patient satisfaction scale than the PS injections. Major side effects including ptosis and droopy eyelid were observed only after the PS injections. These findings confirmed that low-dose injections of BoNT-A at the PT portion provide more efficacy, patient satisfaction, and fewer complications than the PS injections for the treatment of involuntary eyelid twitching and closure in patients with HFS and BEB.

  20. A survey of the current practice of intramuscular Botulinum toxin injections for hemiplegic shoulder pain in the UK.

    Science.gov (United States)

    Holmes, Richard J; Connell, Louise A

    2017-11-10

    To describe the current UK practice for the use of intramuscular Botulinum Toxin type A injections to treat hemiplegic shoulder pain. A UK-based cross-sectional study using an online survey. Participants (n = 68) were medical and non-medical practitioners recruited via the membership of the British Society for Rehabilitation Medicine and the British Neurotoxin Network. Data was analysed using descriptive statistics and content analysis. The majority of respondents would consider Botulinum Toxin type A for hemiplegic shoulder pain (86.8%), though most of these respondents inject for this goal infrequently (83.1%). Pectoralis major was most commonly selected to achieve this goal. Barriers to this intervention included difficulties determining the cause of pain (29.4%), difficulty isolating muscles (27.9%), and a lack of evidence (25%). The doses reported regularly deviated from guidelines and a substantial range in the volumes suggested was observed. Clinicians were mostly reliant on unstandardised measures to assess outcomes. Current UK practice of Botulinum Toxin type A injections for hemiplegic shoulder pain associated with spasticity is highly variable. There are large gaps between current practice and available evidence with regards to muscle selection and doses used. A number of areas for further investigation have been identified to progress current understanding of this intervention. Implications for rehabilitation There are wide variations in practice for this complex intervention and clinicians should consider that their individual decision-making could be based on their own beliefs rather than available evidence. Pectoralis major is most commonly injected to treat hemiplegic shoulder pain, but further evaluation is required to address whether it is the most effective. Clinicians most often use a limitation of shoulder abduction and external rotation, flexor patterning of the upper limb, and pain on passive movement to identify when hemiplegic shoulder

  1. Comparison of clinical marking and ultrasound-guided injection of Botulinum type A toxin into the masseter muscles for treating bruxism and its cosmetic effects.

    Science.gov (United States)

    Quezada-Gaon, Natacha; Wortsman, Ximena; Peñaloza, Osvaldo; Carrasco, Juan Eduardo

    2016-09-01

    Botulinum toxin type A has been used for treating the hypertrophy of the masseter muscles and its cosmetic effects. Ultrasound is increasingly used in dermatology, along with the guidance of mini-invasive procedures. To evaluate the role of ultrasound for guiding the application of Botulinum A toxin in patients with cosmetic alterations due to bruxism, correlate the clinical landmarks with the ultrasound findings, and study the effect on the symptoms, cosmetics, and quality of life. Twenty individuals with bruxism and cosmetic alterations underwent an ultrasound-guided injection of Botulinum toxin type A in each masseter muscle. Clinical and ultrasound marking of the procedure was compared. Clinical and sonographic evaluation was performed at the time of injection and 3 months later. Ten normal individuals underwent ultrasound of the masseter muscles as a control group. Up to 65% of individuals showed anatomical variants of the salivary glands. The method for clinically marking the skin showed a frequently erroneous location of the anterior point (up to 40% of cases) that was proven by ultrasound to be out of the muscle. In 20% of cases, ultrasound showed that the needle should be longer to enter the muscle. After injection, most of the patients demonstrated a decrease of the symptoms and cosmetic and quality of life improvements. Ultrasound can be a potent tool for guiding the injection of Botulinum toxin into the masseter muscles. It may contribute to a more personalized procedure, better cosmetic results, and help to avoid potential complications. © 2016 Wiley Periodicals, Inc.

  2. Negative effects of submandibular botulinum neurotoxin A injections on oral motor function in children with drooling due to central nervous system disorders

    NARCIS (Netherlands)

    Hulst, K. van; Kouwenberg, C.V.; Jongerius, P.H.; Feuth, T.; Hoogen, F.J.A. van den; Geurts, A.C.H.; Erasmus, C.E.

    2017-01-01

    AIM: The aims of this study were: (1) to determine the incidence and nature of adverse effects on oral motor function after first injections of botulinum neurotoxin A (BoNT-A) in submandibular glands for excessive drooling in children with central nervous system disorders; and (2) to identify

  3. Accuracy of botulinum toxin type A injection into the forearm muscles of chronic stroke patients with spastic flexed wrist and clenched fist: manual needle placement evaluated using ultrasonography.

    Science.gov (United States)

    Picelli, Alessandro; Roncari, Laura; Baldessarelli, Silvia; Berto, Giulia; Lobba, Davide; Santamato, Andrea; Fiore, Pietro; Smania, Nicola

    2014-11-01

    To investigate the accuracy of manual needle placement for injection of botulinum toxin type A into the forearm muscles of adults with spastic flexed wrist and clenched fist as a consequence of stroke. Prospective clinical study. A total of 41 adults with chronic stroke who were scheduled to receive botulinum toxin type A injection into the following forearm muscles: flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis and flexor digitorum profundus. According to Huber & Heck's atlas suggestions on treatment of spasticity with botulinum toxin, surface identification of muscles to inject was performed by means of palpation and anatomical landmarks. Accuracy of needle placement and muscle thickness at the site of needle insertion were assessed using ultrasonography. Overall accuracy of manual needle placement evaluated using ultrasonography was 51.2%. Accuracy was significantly higher for the finger flexors than for the wrist flexors (63.4% vs 39.0%). The finger flexors were significantly thicker than the wrist flexors (mean 1.58 vs 0.49 cm). Instrumental guidance should be used in order to achieve an acceptable accuracy of needle placement when performing botulinum toxin type A injections into the forearm muscles of chronic stroke patients with spastic flexed wrist and clenched fist.

  4. Side effects and potential risk factors of botulinum toxin type A intramuscular injections in knee flexion contractures of hemophiliacs.

    Science.gov (United States)

    Rodriguez-Merchan, E Carlos; De la Corte-Rodriguez, Hortensia

    2017-07-01

    Knee flexion contracture (KFC) is a common complication of recurrent hemarthrosis in children and young adults with hemophilia. If the KFC is not prevented (by means of primary prophylaxis) and treated properly and early (be means of physical medicine and rehabilitation), it will become fixed. Areas covered: The aim of this article is to review the potential role of botulinum toxin type A (BTX-A) intramuscular injections for the treatment of KFC in people with hemophilia (PWH). Expert commentary: Although two recent reports have mentioned the benefits of intramuscular injections of BTX-A in PWH with KFC, the data are still scant and too preliminary. The use of intramuscular injections of BTX-A in PWH today should not be recommended until more case studies/small series (ideally well-designed clinical trials) fully demonstrate that this is safe and effective. The risks of intramuscular injections to a hemophilia patient cannot be underestimated (iatrogenic muscle hematomas and pseudotumors). This paper calls the attention of hemophilia treaters on the potential risks of this apparently interesting technique. The current use of BTX-A intramuscular injections in KFC of PWH could make no sense. Raising false expectations in these patients should be avoided.

  5. Botulinum neurotoxin type A injections reduce spasticity in mild to moderate hereditary spastic paraplegia--report of 19 cases.

    Science.gov (United States)

    Hecht, Martin J; Stolze, Henning; Auf dem Brinke, Matthias; Giess, Ralf; Treig, Thoams; Winterholler, Martin; Wissel, Jörg

    2008-01-30

    Hereditary spastic paraplegia (HSP) is characterized by lower extremity spasticity. Symptomatic therapy generally includes physical therapy and oral antispastic agents, in selected cases intrathecal baclofen. Because of the positive results in other treatments of spasticity, the use of botulinum neurotoxin type A (BoNT-A) might also be considered for patients with HSP. We report the effect of BoNT-A injections in 19 unselected patients with HSP treated by the members of the German Spasticity Education Group. In 17 patients, the modified Ashworth scale had improved by one point. In one patient, it improved by three points. Most of the patients reported reduction of spasticity. BoNT-A injections were continued in 11 of 19 patients (57.9%). All of the patients with continued injections had a good or very good global subjective improvement. Patients with less pronounced spasticity and patients with accompanying physical therapy tended to exhibit a better effect. Only four patients reported adverse effects which were increased weakness in three patients and pain in one patient. BoNT-A injections appear to reduce spasticity effectively and safely, especially in patients with mild to moderate spasticity. The preliminary results of our case series should encourage larger studies of BoNT-A injections in HSP. 2007 Movement Disorder Society

  6. Physical Therapy for an Adult with Chronic Stroke after Botulinum Toxin Injection for Spasticity: A Case Report

    Science.gov (United States)

    Phadke, Chetan P.; Ismail, Farooq; Boulias, Chris

    2015-01-01

    ABSTRACT Purpose: In this case report, we describe the type and duration of a physical therapy and botulinum toxin type A (BoNTA) intervention directed at lower limb spasticity and the gait and balance improvement in a patient post-stroke. Treatment of focal spasticity with BoNTA intramuscular injections combined with physical therapy is recommended by rehabilitation experts. However, the optimal type and duration of physical therapy intervention to optimize any functional gains that follow chemodenervation induced by BoNTA has not been established. Method: One individual with chronic stroke who received BoNTA injections for upper and lower extremity spasticity was included. Physical therapy intervention consisted of 45- to 60-min sessions twice weekly for 12 weeks, based on the Bobath–neurodevelopmental therapy approach, and an activity-based home program. Results: After BoNTA injections and physical therapy, the patient made clinically significant improvements in balance and gait speed and became more independent with his ambulation. Conclusions: This case report demonstrates that physical therapy after BoNTA injections can result in significant functional improvements for individuals with spasticity after chronic stroke that may not be possible with BoNTA injections alone. PMID:25931655

  7. Physical therapy for an adult with chronic stroke after botulinum toxin injection for spasticity: a case report.

    Science.gov (United States)

    Gallagher, Shannon; Phadke, Chetan P; Ismail, Farooq; Boulias, Chris

    2015-01-01

    In this case report, we describe the type and duration of a physical therapy and botulinum toxin type A (BoNTA) intervention directed at lower limb spasticity and the gait and balance improvement in a patient post-stroke. Treatment of focal spasticity with BoNTA intramuscular injections combined with physical therapy is recommended by rehabilitation experts. However, the optimal type and duration of physical therapy intervention to optimize any functional gains that follow chemodenervation induced by BoNTA has not been established. One individual with chronic stroke who received BoNTA injections for upper and lower extremity spasticity was included. Physical therapy intervention consisted of 45- to 60-min sessions twice weekly for 12 weeks, based on the Bobath-neurodevelopmental therapy approach, and an activity-based home program. After BoNTA injections and physical therapy, the patient made clinically significant improvements in balance and gait speed and became more independent with his ambulation. This case report demonstrates that physical therapy after BoNTA injections can result in significant functional improvements for individuals with spasticity after chronic stroke that may not be possible with BoNTA injections alone.

  8. Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke

    OpenAIRE

    Aryan Shamili; Bijan Forogh; Marzieh Pashmdarfard

    2017-01-01

    Background and objective: Spasticity is one of the problems following stroke. Due to this increase in muscle tone, patients are confronted to problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of Simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period. Methods: The design ...

  9. Can botulinum toxin type A injection technique influence the clinical outcome of patients with post-stroke upper limb spasticity? A randomized controlled trial comparing manual needle placement and ultrasound-guided injection techniques.

    Science.gov (United States)

    Santamato, Andrea; Micello, Maria Francesca; Panza, Francesco; Fortunato, Francesca; Baricich, Alessio; Cisari, Carlo; Pilotto, Alberto; Logroscino, Giancarlo; Fiore, Pietro; Ranieri, Maurizio

    2014-12-15

    Botulinum toxin type A is a first-line treatment for post-stroke focal spasticity, and the accuracy in delivering the toxin to the target muscles may influence the treatment outcome. Our aim was to compare the reduction of spasticity and the related finger position at rest improvement in post-stroke patients treated with botulinum toxin type A in upper limb muscles using ultrasound guidance and manual needle placement. In a randomized clinical trial, two groups of 15 stroke patients were treated with botulinum toxin type A injections in the wrist and finger flexor muscles of the affected upper limb using ultrasound guidance or manual needle placement. The Modified Ashworth Scale and the finger position at rest were measured at baseline and one month after toxin injections. After one month of follow-up from toxin injections, the Modified Ashworth Scale and finger position at rest significantly improved in both treatment groups, although these clinical outcomes were significantly better in patients treated under ultrasound guidance than in patients injected using manual needle placement. Ultrasound guidance for botulinum toxin type A injections could improve clinical outcome measures better than manual needle placement in post-stroke patients with spasticity. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. [Development of motor functions and manual abilities in pediatric patients with spastic cerebral palsy after botulinum toxin treatment and complex rehabilitation].

    Science.gov (United States)

    Klochkova, O A; Kurenkov, A L; Namazova-Baranova, L S; Mamed'iarov, A M; Zherdev, K V

    2013-01-01

    To investigate the dynamic of general motor function and manual abilities in children with spastic forms of cerebral palsy (CP) after complex rehabilitation combined with single and repeated injections of botulinum toxin A (BTA). The article presents 18 month followup of 52 patients with mono- and bilateral spastic forms of CP after single and multiple injections of botulinum toxin A and complex rehabilitation/ Patients received totally 74 injection sessions: 17 (32.7%) children--twice, 5 (9.6%) children--three times. Motor development assessment was done according to the GMFCS and GMFMS-88 scales and centile curves of normal motor development connected with these scales, hand function was classified according to the MACS scale. For the first time results of botulinum toxin therapy and rehabilitation were compared with the natural motor development of patients with different levels of motor disturbances according to centile tables. Patients with bilateral cerebral palsy improved slowly than hemiparetic and changes lasted for longer period. Level according to the MACS scale didn't depend on the gestational age of the patients, was higher in children with hemiparesis and changed for 1 level in 4 (7.7%) patients after the first botulinum toxin A injections.

  11. The effects of intradermal botulinum toxin type a injections on pain symptoms of patients with diabetic neuropathy

    Directory of Open Access Journals (Sweden)

    Majid Ghasemi

    2014-01-01

    Full Text Available Background: Considering the dramatic increasing rate of diabetes and consequently its related complications, most importantly diabetic peripheral neuropathy (DPN, challenges regarding proper treatment of DPN and its effect on the quality-of-life and care of diabetic patients, the aim of this current study is to evaluate the effect of intradermal botulinum toxin type A (BTX-A injections on pain symptoms of patients with diabetic neuropathic pain. Materials and Methods: In this randomized double-blind placebo-controlled clinical trial study, diabetic patients aged <70 years with neuropathic pain in both feet were enrolled. Diabetic neuropathy (DN in selected patients was diagnosed using DN4 questionnaire and nerve conduction velocity examinations. They randomized in two intervention (BTX-A injection/100 unit, N = 20 and placebo groups (normal saline injection, N = 20. The outcome of injection on diabetic neuropathic pain was assessed using neuropathy pain scale (NPS and visual analog scale (VAS score and compared in two studied groups. Results: There was no significant difference in DN4, NPS and VAS scales of studied population after intervention in the placebo group. Intradermal injection of BTX-A reduced NPS scores for all items except cold sensation (P = 0.05. It reduced DN4 scores for electric shocks, burning, pins and needles and brushing (P < 0.05. According to VAS scale 30% and 0% of patients in intervention and placebo groups have no pain after intervention (P = 0.01. Conclusion: Intradermal injection of BTX-A is a well-tolerated agent that has a significant effect on DPN pain.

  12. Isokinetic assessment of the effects of botulinum toxin injection on spasticity and voluntary strength in patients with spastic hemiparesis.

    Science.gov (United States)

    Hameau, S; Bensmail, D; Robertson, J; Boudarham, J; Roche, N; Zory, R

    2014-10-01

    Peak knee flexion during swing phase is frequently reduced following stroke. The main treatment is botulinum toxin injection (BoNT-A) of the Rectus Femoris (RF) muscle. BoNT-A injections have been shown to decrease spasticity (assessed using the modified Ashworth scale) and to improve peak knee flexion during swing phase. Although the effect of BoNT-A has been clearly demonstrated on kinematic parameters during gait, the direct effects on spasticity and strength have been little studied using objective and sensitive outcome measures. The aim of this study was to use an isokinetic dynamometer to assess the effects of BoNT-A injection in the RF on stretch reflex-related torque at the knee joint and peak voluntary knee flexor and extensor torque and to evaluate the effect on functional capacity. Before-after trial: Assessments were carried out pre and post (four weeks) RF BoNT-A injection. Clinical and isokinetic evaluations were carried out. Ambulatory care in a hospital setting. Participants. Population-based sample of fourteen chronic spastic hemiparetic patients with stiff knee gait. Primary outcome measurements were stretch reflex-related torque at the knee joint and peak voluntary knee flexor and extensor torque. Secondary outcomes were knee angle at peak torque, the slope of the torque velocity curve, stiffness and functional outcomes. Peak knee extensor torque was significantly decreased and peak knee flexor torque was significantly increased during maximal voluntary concentric and isometric contractions following BoNT-A injection of the RF. Stretch reflex-related torque evaluated during passive stretching movements was reduced and the angle of occurrence of the peak was greater. Functional outcomes did not change. CONCLUSIONS AND CLINICAL REHABILITATION IMPACT: The results of this study indicate that BoNT-A injection reduced RF spasticity but also reduced quadriceps strength. In contrast, knee flexor strength increased. These changes did not, however, lead to

  13. Evidence to Use Botulinum Toxin Injections in Tension-Type Headache Management: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Mieszko Wieckiewicz

    2017-11-01

    Full Text Available Tension-type headache (TTH is the most common type of chronic recurring head pain. It can occur twice as often in women as in men. It is the most common type of headache. Its lifetime prevalence is 30% to 78% in the general population. TTH treatment should be multilevel. It often consists of taking pain medication, muscle relaxants, antidepressants, using biofeedback therapy, acupuncture, and attending behavioral therapy. Several clinical trials also suggest that botulinum toxin (BTX may be an effective treatment option for such patients. The aim of this study was to evaluate if BTX can be used as a treatment method in TTH in the light of current medical literature. The authors searched the PubMed, EBSCOhost, OVID, Web of Knowledge, Cochrane Library and CINAHL databases to identify relevant publications. The authors finally included 11 papers—prospective and retrospective cohort studies. Among most of the selected studies, there was a significant correlation between using BTX and reduction of TTH pain intensity and severity. By analyzing qualified studies, it can be concluded that botulinum toxin seems to be effective in TTH management.

  14. Evidence to Use Botulinum Toxin Injections in Tension-Type Headache Management: A Systematic Review.

    Science.gov (United States)

    Wieckiewicz, Mieszko; Grychowska, Natalia; Zietek, Marek; Wieckiewicz, Gniewko; Smardz, Joanna

    2017-11-15

    Tension-type headache (TTH) is the most common type of chronic recurring head pain. It can occur twice as often in women as in men. It is the most common type of headache. Its lifetime prevalence is 30% to 78% in the general population. TTH treatment should be multilevel. It often consists of taking pain medication, muscle relaxants, antidepressants, using biofeedback therapy, acupuncture, and attending behavioral therapy. Several clinical trials also suggest that botulinum toxin (BTX) may be an effective treatment option for such patients. The aim of this study was to evaluate if BTX can be used as a treatment method in TTH in the light of current medical literature. The authors searched the PubMed, EBSCOhost, OVID, Web of Knowledge, Cochrane Library and CINAHL databases to identify relevant publications. The authors finally included 11 papers-prospective and retrospective cohort studies. Among most of the selected studies, there was a significant correlation between using BTX and reduction of TTH pain intensity and severity. By analyzing qualified studies, it can be concluded that botulinum toxin seems to be effective in TTH management.

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

    Science.gov (United States)

    Evans, Susan Florence; Porter, Justin Matthew

    2015-12-01

    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. © 2015 The Authors Australian and New Zealand Journal of Obstetrics and Gynaecology published by Wiley Publishing Asia Pty Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  16. Localization of the motor endplate zone in human skeletal muscles of the lower limb: anatomical guidelines for injection with botulinum toxin.

    Science.gov (United States)

    Van Campenhout, Anja; Molenaers, Guy

    2011-02-01

    Botulinum toxin gives a local tone reduction by blocking neurotransmission at the motor endplate (MEP). The importance of using MEP-targeted injections is demonstrated in animal models and in a clinical human study. The goal of this review is to present the available data on the localization of the MEP zone of frequently injected muscles of the lower limb and to compare this with current practice. Current knowledge on the localization of the MEP zone is based on some older histological studies, and for some of the more frequently injected muscles also on more recent anatomical dissection. We find that for some muscles the MEP zone can be more precisely demarcated, and for many other muscles that its location is somewhat different than the currently injected areas in clinical practice. Optimal injection sites are presented for gastrocnemius, soleus, tibialis posterior, semitendinosus, semimembranosus, gracilis, biceps femoris, rectus femoris, adductor longus, brevis and magnus, and psoas muscles. We propose optimal injection sites in relation to external anatomical landmarks for the frequently injected muscles of the human lower limb to facilitate the efficiency of botulinum toxin injections. © The Authors. Journal compilation © Mac Keith Press 2010.

  17. Botulinum toxin type a injections for cervical and shoulder girdle myofascial pain using an enriched protocol design.

    Science.gov (United States)

    Nicol, Andrea L; Wu, Irene I; Ferrante, F Michael

    2014-06-01

    Myofascial pain syndrome is a regional condition of muscle pain and stiffness and is classically characterized by the presence of trigger points in affected musculature. Botulinum toxin type A (BoNT-A) has been shown to have antinociceptive properties and elicit sustained muscle relaxation, thereby possibly affording even greater relief than traditional strategies. Our goal was to determine whether direct injection of BoNT-A into painful muscle groups is effective for cervical and shoulder girdle myofascial pain. An enriched protocol design was used, wherein 114 patients with cervical and shoulder girdle myofascial pain underwent injection of BoNT-A to determine their response to the drug. Fifty-four responders were then enrolled in a 12-week, randomized, double-blind, placebo-controlled trial. Pain scales and quality of life measures were assessed at baseline and at routine follow-up visits until completion of the study after 26 weeks. Injection of BoNT-A into painful muscle groups improved average visual numerical pain scores in subjects who received a second dose of BoNT-A compared to placebo (P = 0.019 [0.26, 2.78]). Subjects who received a second dose of BoNT-A had a reduced number of headaches per week (P = 0.04 [0.07, 4.55]). Brief Pain Inventory interference scores for general activity and sleep were improved (P = 0.046 [0.038, 3.700] and 0.02 [0.37, 4.33], respectively) in those who received a second dose of BoNT-A. BoNT-A injected directly into painful muscle groups improves average pain scores and certain aspects of quality of life in patients experiencing severe cervical and shoulder girdle myofascial pain.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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.; 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. PMID:23533477

  1. Botulinum type A toxin complex for the relief of upper back myofascial pain syndrome: how do fixed-location injections compare with trigger point-focused injections?

    Science.gov (United States)

    Benecke, Reiner; Heinze, Axel; Reichel, Gerhard; Hefter, Harald; Göbel, Hartmut

    2011-11-01

    This was a prospective, randomized, double-blind, placebo-controlled, 12-week, multicenter study to evaluate the efficacy and tolerability of fixed location injections of botulinum type A toxin (BoNT-A, Dysport) in predetermined injection sites in patients with myofascial pain syndrome of the upper back. Patients with moderate-to-severe myofascial pain syndrome affecting cervical and/or shoulder muscles (10 trigger points, disease duration 6-24 months) and moderate-to-severe pain intensity were randomized to BoNT-A (N = 81) or saline (N = 72). Patients received treatment into 10 predetermined fixed injection sites in the head, neck, and shoulder (40 units of BoNT-A per site or saline, a total of 400 units of BoNT-A). The primary efficacy outcome was the proportion of patients with mild or no pain at week 5 (responders). Secondary outcomes included changes in pain intensity and the number of pain-free days per week. At week 5, 49% (37/76) of BoNT-A patients and 38% (27/72) of placebo patients had responded to treatment (P = 0.1873). Duration of daily pain was reduced in the BoNT-A group compared with the placebo group from week 5, with statistically significant differences at weeks 9 and 10 (P = 0.04 for both). Treatment was well tolerated. Fixed-location treatment with BoNT-A of patients with upper back myofascial pain syndrome did not lead to a significant improvement of the main target parameter in week 5 after treatment. Only in week 8 were significant differences found. Several secondary parameters, such as physicians' global assessment and patients' global assessment, significantly favored BoNT-A over placebo at weeks 8 and 12. Wiley Periodicals, Inc.

  2. Ultrasonographic Evaluation of Botulinum Toxin Injection Site for the Medial Approach to Tibialis Posterior Muscle in Chronic Stroke Patients with Spastic Equinovarus Foot: An Observational Study

    Directory of Open Access Journals (Sweden)

    Alessandro Picelli

    2017-11-01

    Full Text Available The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: tibialis posterior muscle depth, thickness, and echo intensity. As to the spastic tibialis posterior, we found a mean muscle depth of 26.5 mm and a mean muscle thickness of 10.1 mm. Furthermore we observed a median tibialis posterior muscle echo intensity of 3.00 on the Heckmatt scale. The tibialis posterior muscle thickness was found to be inversely associated with its depth (p < 0.001 and echo intensity (p = 0.006. Furthermore, tibialis posterior muscle depth was found to be directly associated with its echo intensity (p = 0.004. Our findings may usefully inform manual needle placement into the tibialis posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.

  3. Long-term tremor therapy for Parkinson and essential tremor with sensor-guided botulinum toxin type A injections.

    Science.gov (United States)

    Samotus, Olivia; Lee, Jack; Jog, Mandar

    2017-01-01

    Current pharmacological agents used to treat Parkinson disease (PD) tremor and essential tremor (ET) provide suboptimal benefit and are commonly associated with significant adverse effects. Botulinum toxin type A (BoNT-A) has been shown to be effective for wrist tremor though functionally bothersome muscle weakness frequently occurs. This is the longest study to date demonstrating that BoNT-A therapy coupled with kinematic guidance can provide efficacious outcomes for upper limb tremor with minimized unwanted weakness. A total of 28 PD and 24 ET participants with bothersome, disabling tremor, received six serial BoNT-A treatments every 16 weeks starting at week 0 with a follow-up visit 6 weeks following a treatment, totaling 96 weeks. Clinical scales, including Fahn-Tolosa-Marin tremor rating scale (FTM), and sensor-based tremor assessments were conducted at each visit. Kinematics was utilized to identify which arm muscles contributed to the tremulous movements and the experienced injector used clinical expertise in determining BoNT-A dosages. Following BoNT-A treatment, clinical ratings of tremor severity and functional ability (FTM) showed significant improvements following the first treatment which was maintained up to week 96 in PD and ET. Kinematics detected a significant reduction in PD and ET tremor amplitudes by 70% and 76% over the treatment course, respectively. By objectively distinguishing tremulous muscles and tremor severity, adverse effects were limited to mild perceived weakness by participants in injected muscles during follow-ups. Following the fourth treatment, BoNT-A dosages in flexor and extensor wrist muscles and biceps were reduced for those experiencing residual weakness which ultimately did not interfere with tremor relief or arm function. Kinematics is an objective method that can aid clinicians in assessing and determining optimal BoNT-A parameters to alleviate both PD and ET tremor. BoNT-A injections are tolerable and effective when

  4. Safety and efficacy of multiuse botulinum toxin vials for intralaryngeal injection.

    Science.gov (United States)

    Barrow, Emily M; Rosen, Clark A; Hapner, Edie R; Smith, Sarah; Hatcher, Jeanne L; Simpson, Blake; Johns, Michael M

    2015-05-01

    Centers for Disease Control and Prevention guidelines maintain that single-use vials cannot be used for multiple patients. Botox product labeling states that the reconstituted toxin should be used within 4 hours on a single patient based on concerns of reduced potency, contamination, and consequent infections. The purpose of this study was to determine the safety and efficacy of using single-use vials in a multidose fashion. Prospective study and cohort chart review. A multi-institutional three-part study was performed between May 2013 and October 2013: 1) a summation of subjects' recall of their past experiences (symptoms/response) with previous multidose Botox injections, 2) a prospective study of intralaryngeal injections, and 3) a chart review of injection responses in a subset of the cohort. Seven hundred forty-three subjects receiving 6,216 injections demonstrated zero infection-related complications on retrospective chart review. One hundred seventy-nine subjects recalled 24.0% overall adverse events, 10.6% redness, 7.3% pain and swelling at the injection site, and 0% fever. One hundred seventy-four subjects prospectively reported 12.6% overall adverse events. The self-reported efficacy rate of Botox injection was 96.6%. The low rates of adverse events following the use of Botox in a multipatient fashion are consistent with other percutaneous injections. No evidence of infection was found with multidose Botox use. Given the low incidence of side effects and high success rate, Botox can be used both safely and effectively in a multipatient fashion. 4 © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Blefarospasmo essencial e espasmo hemifacial: características dos pacientes, tratamento com toxina botulínica A e revisão da literatura Essential blepharospasm and hemifacial spasm: characteristic of the patient, botulinum toxin A treatment and literature review

    Directory of Open Access Journals (Sweden)

    Silvana Artioli Schellini

    2006-02-01

    Full Text Available OBJETIVO: Conhecer as características dos portadores de blefarospasmo essencial e espasmo hemifacial, assim como a resposta ao tratamento utilizando toxina botulínica A. MÉTODOS: Trinta e quatro portadores de blefarospasmo essencial ou espasmo hemifacial foram avaliados quanto a idade, sexo, queixas oculares, tempo de existência da doença, tipo de comprometimento, complicações e resultado do tratamento com toxina botulínica A. RESULTADOS: A mediana da idade dos pacientes foi de 63 anos e a média, de 61 anos, sem diferença quanto ao sexo; 66,66% possuíam espasmo hemifacial e 33,33%, blefarospasmo essencial. Vários pacientes apresentavam também olho seco. A melhora com a utilização da toxina botulínica A ocorreu em 91,30% dos pacientes tratados. As complicações com o tratamento foram ptose palpebral (8,33% e desvio da rima bucal (8,33%. CONCLUSÃO: O blefarospasmo essencial e o espasmo hemifacial geralmente acometem idosos, de ambos os sexos. O tratamento com a toxina botulínica A é eficiente, com índice muito baixo de complicações.PURPOSE: To evaluate the characteristics of the essential blepharospasm and hemifacial spasm patients and the feasible treatment with botulinum toxin A. METHODS: Thirty-four essential blepharospasm or hemifacial spasm patients were evaluated according to gender, ocular complaint, time of disease, treatment outcome and complications. RESULTS: Age median was 63 years and the mean was 61 years, with no difference regarding sex; 66.66% of the patients had hemifacial spasm and 33.33%, essential blepharospasm. Many patients complained of dry eye associated with involuntary spasm. Botulinum toxin A showed a positive outcome in 91.30% of the treated patients and complications observed after treatment were eyelid ptosis (8.33% and buccal angle deviation (8.33%. CONCLUSION: Essential blepharospasm and hemifacial spasm occurred in the elderly, of both sexes. Treatment with botulinum toxin A was useful, with

  6. Injection of botulinum toxin type a to reduce saliva in patients with neurological diseases

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    Dayse Manrique

    2005-09-01

    Full Text Available Objective: To demonstrate the effect of local injection of Botox® inpatients with neurological diseases, following our protocol for thetreatment of sialorrhea. Study design: clinical prospective study.Methods: Twenty-one patients with neurological diseases seen atthe Otorhinolaryngology of the Associação de Assistência à CriançaDeficiente. They were all submitted to local injection of Botox® insalivary glands and followed up for one year. The protocol consistsof a clinical questionnaire about inability to swallow saliva and itsrepercussions in general health and quality of life. Patients must nothave periodontal disease or intolerance to adverse effects ofanticholinergic agents and must not have used Botox® at least inthe last six months. The injection was ultrasonographically guidedand the dose was 30 U in one site of the submandibular glands, and20 U in two sites in each parotid gland. Results: Twenty-one patientswith sialorrhea resulting from several neurological diseases (chronicencephalopathy, Parkinson’s disease, amyotrophic lateral sclerosis,neuromuscular diseases, cerebral tumor, trauma, aged 2 to 66 yearsold, were submitted to Botox® injection in their salivary glands. Weobserved a markedly improvement of sialorrhea in all but one patient.Seventeen patients had no complaints of sialorrhea or salivaaspiration for approximately four months with good repercussion intheir quality of life. No patient presented local or systemic effectswith local injection of Botox®. Conclusion: the injection of Botox® asindicated in the present study was able to reduce sialorrhea resultingfrom several neurological conditions.

  7. 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

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

    Science.gov (United States)

    Hassel, Bjørnar

    2013-01-01

    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. PMID:23299659

  9. 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.

  10. Functional impact of different muscle localization techniques for Botulinum neurotoxin A injections in clinical routine management of post-stroke spasticity.

    Science.gov (United States)

    Zeuner, Kirsten E; Knutzen, Arne; Kühl, Carina; Möller, Bettina; Hellriegel, Helge; Margraf, Nils G; Deuschl, Günther; Stolze, Henning

    2017-01-01

    Treatment options for spasticity include intramuscular botulinum neurotoxin A (BoNT-A) injections. Both ultrasound (US) or electromyographic (EMG) guided BoNT-A injections are employed to isolate muscles. To date, most studies have included patients naïve to BoNT-A or following a prolonged wash out phase. To determine the impact of US/EMG guided BoNT-A injections on function in outpatients with spasticity receiving an established re-injection regime. Thirty patients post-stroke were investigated in a single-blinded, randomized controlled trial using a cross-over design for the EMG and US and a parallel design for the control group. The Modified Ashworth (MAS), Disability Assessment (DAS), Quality of Life (EQ-5D), self-rating scale and Barthel Index were assessed pre- and post-BoNT-A injections of upper limb muscles by a to the injection technique blinded person. MAS improved in arm, finger and upper limb 4 weeks after BoNT-A treatment. The improvement showed no significant differences between the three injection techniques. Barthel Index, DAS and EQ-5D remained unchanged in all groups. This pilot study questions the impact of the instrumental guided injection techniques on everyday functionality in a routine clinical setting with established re-injection intervals. Larger trials are warranted with patients who are under long-term treatment on a regular basis.

  11. Long-term tremor therapy for Parkinson and essential tremor with sensor-guided botulinum toxin type A injections

    Science.gov (United States)

    Samotus, Olivia; Lee, Jack; Jog, Mandar

    2017-01-01

    Objective Current pharmacological agents used to treat Parkinson disease (PD) tremor and essential tremor (ET) provide suboptimal benefit and are commonly associated with significant adverse effects. Botulinum toxin type A (BoNT-A) has been shown to be effective for wrist tremor though functionally bothersome muscle weakness frequently occurs. This is the longest study to date demonstrating that BoNT-A therapy coupled with kinematic guidance can provide efficacious outcomes for upper limb tremor with minimized unwanted weakness. Methods A total of 28 PD and 24 ET participants with bothersome, disabling tremor, received six serial BoNT-A treatments every 16 weeks starting at week 0 with a follow-up visit 6 weeks following a treatment, totaling 96 weeks. Clinical scales, including Fahn-Tolosa-Marin tremor rating scale (FTM), and sensor-based tremor assessments were conducted at each visit. Kinematics was utilized to identify which arm muscles contributed to the tremulous movements and the experienced injector used clinical expertise in determining BoNT-A dosages. Results Following BoNT-A treatment, clinical ratings of tremor severity and functional ability (FTM) showed significant improvements following the first treatment which was maintained up to week 96 in PD and ET. Kinematics detected a significant reduction in PD and ET tremor amplitudes by 70% and 76% over the treatment course, respectively. By objectively distinguishing tremulous muscles and tremor severity, adverse effects were limited to mild perceived weakness by participants in injected muscles during follow-ups. Following the fourth treatment, BoNT-A dosages in flexor and extensor wrist muscles and biceps were reduced for those experiencing residual weakness which ultimately did not interfere with tremor relief or arm function. Conclusions Kinematics is an objective method that can aid clinicians in assessing and determining optimal BoNT-A parameters to alleviate both PD and ET tremor. BoNT-A injections

  12. The Anatomical Basis of Paradoxical Masseteric Bulging after Botulinum Neurotoxin Type A Injection

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    Hyung-Jin Lee

    2016-12-01

    Full Text Available The aim of this study was to determine the detailed anatomical structures of the superficial part of the masseter and to elucidate the boundaries and locations of the deep tendon structure within the superficial part of the masseter. Forty-four hemifaces from Korean and Thai embalmed cadavers were used in this study. The deep tendon structure was located deep in the lower third of the superficial part of the masseter. It was observed in all specimens and was designated as a deep inferior tendon (DIT. The relationship between the masseter and DIT could be classified into three types according to the coverage pattern: Type A, in which areas IV and V were covered by the DIT (27%, 12/44; Type B, in which areas V and VI were covered by the DIT (23%, 10/44; and Type C, in which areas IV, V, and VI were covered by the DIT (50%, 22/44. The superficial part of the masseter consists of not only the muscle belly but also the deep tendon structure. Based on the results obtained in this morphological study, we recommend performing layer-by-layer retrograde injections into the superficial and deep muscle bellies of the masseter.

  13. [Input from a specialized nurse consultation in the management of detrusor overactivity treated with intradetrusor injections of botulinum toxin in urology department. Pilot study].

    Science.gov (United States)

    Le Gal, S; Safsaf, A; Galliot, I; Catovic, B; Grise, P

    2010-09-01

    To adapt in daily practice, in a urology department, recommendations for good clinical practice for follow-up of neurological patients with neurogenic detrusor overactivity treated with injections of botulinum toxin type A by involving a referent nurse in neuro-urology. A nurse consultation in neuro-urology has been created in June 2007 to intervene at each follow-up consultation at D0, D8, D45, then by phone until reappearance of functional signs to organize a new injection of botulinum toxin. This pilot study evaluated the faisability, the input on clinical workload, and the benefit on relationship between the patient and the caregiver. An improvement of the quality of care has been given to the patient since first contact to follow-up. The number of neurological patient transfers and waiting time between the recurrence of functional signs and new therapeutic care were reduced. The number of medical consultations has been reduced saving time to redistribute on other activities. Knowledge improvement and privileged relationship with the patient and the doctor were reported by the referent nurse. The participation of a referent nurse in neuro-urology has improved the quality of care of these patients from first contact to follow-up and has allowed adaptation of the recommendations in the practice of caring of an urology department. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  14. 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.

  15. Beyond Beauty : Botulinum Toxin Use in Anal Fissure

    National Research Council Canada - National Science Library

    Mehrotra, S

    2009-01-01

    .... In this scenario chemical sphincterotomy using Botulinum toxin offers an alternative modality. A total of 30 patients of chronic fissure in ano were treated with Botulinum toxin injection in the internal sphincter...

  16. Intradetrusor injections of onabotulinum toxin A (Botox®) 300 U or 200 U versus abobotulinum toxin A (Dysport®) 750 U in the management of neurogenic detrusor overactivity: A case control study.

    Science.gov (United States)

    Peyronnet, Benoit; Castel-Lacanal, Evelyne; Roumiguie, Mathieu; Even, Lucie; Marque, Philippe; Soulié, Michel; Rischmann, Pascal; Game, Xavier

    2017-03-01

    To compare the outcomes of the first intradetrusor injections of abobotulinum toxin 750 U and onabotulinum toxin 200 and 300 U in patients with neurogenic detrusor overactivity (NDO). A retrospective case-control study was conducted including 211 NDO patients treated in three consecutives eras with onabotulinum toxin 300 U (2004-2006; 80 patients), abobotulinum toxin 750 U (2007-2011; 78 patients) or onabotulinum toxin 200 U (2011-2014; 53 patients). Urodynamic and clinical parameters were compared between groups. The primary endpoint was the rates of success defined as the combination of urgency, urinary incontinence, and detrusor overactivity resolution. When comparing abobotulinum toxin to onabotulinum toxin any doses (200 or 300 U; n = 133), success rates were similar (65.4% vs. 55.6%; P = 0.16). Patients treated with abobotulinum toxin 750 U had higher success rate (65.4% vs. 41.5%; P = 0.007) compared to those who received onabotulinum toxin 200 U. In contrast, there were similar success rates in abobotulinum toxin 750 U and onabotulinum toxin 300 U groups (65.4% vs. 65%; P = 0.91) but with a trend towards longer interval between the first and the second injection in the onabotulinum toxin 300 U group (12.4 vs. 9.3 months; P = 0.09). Intradetrusor injections of abobotulinum toxin 750 U for NDO provided better outcomes than injections of onabotulinum toxin 200 U. Success rates of abobotulinum toxin 750 U and onabotulinum toxin 300 U were similar but interval between injections tended to be longer with onabotulinum toxin 300 U. Neurourol. Urodynam. 36:734-739, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. The Evaluation of the Clinical Effects of Botulinum Toxin on Nocturnal Bruxism

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    Fatih Asutay

    2017-01-01

    Full Text Available Objectives. Nocturnal bruxism can be managed by botulinum toxin (Botox® in patients who have not responded to conservative treatment. The aim of this study was to evaluate the efficacy of botulinum toxin A (BTXA in the treatment of nocturnal bruxism. Material and Methods. The retrospective study comprised 25 female patients, aged 23–55 years (mean 35.84±8.41 years. All patients received a single injection of BTXA in the right and left masseters. Evaluation was made by Visual Analogue Scale (VAS values, complaint duration, onset of effect, and duration of effectiveness. Results. BTXA produced significant improvements in pain scores. Only 2 adverse events (8% were recorded. Conclusion. BTX-A is effective in the treatment of nocturnal bruxism.

  18. 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.

  19. 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.

  20. A Prospective Randomized Double-blinded Pilot Study to Examine the Effect of Botulinum Toxin Type A Injection Versus Lidocaine/Depomedrol Injection on Residual and Phantom Limb Pain

    Science.gov (United States)

    Wu, Hong; Sultana, Rizwana; Taylor, Kerrey Barton; Szabo, Aniko

    2013-01-01

    Objective Botulinum toxin type A (Botox) injection has been used to manage pain. However, it remains to be proved whether Botox injection is effective to relieve residual limb pain (RLP) and phantom limb pain (PLP). Design Randomized, double-blinded pilot study. Setting Medical College and an outpatient clinic in Department of Physical Medicine and Rehabilitation. Participants Amputees (n=14) with intractable RLP and/or PLP who failed in the conventional treatments. Interventions Study amputees were randomized to receive 1 Botox injection versus the combination of Lidocaine and Depomedrol injection. Each patient was evaluated at baseline and every month after the injection for 6 months. Main Outcome Measure The changes of RLP and PLP as recorded by VAS, and the changes of the pressure pain tolerance as determined by a pressure algometer. Results All patients completed the protocol treatment without acute side effects, and monthly assessments of RLP, PLP, and pain tolerance after the treatment. The time trend in the outcomes was modeled as an immediate change owing to the treatment followed by a linear tread afterward. Repeated measures were incorporated using mixed effects modeling. We found that both Botox and Lidocaine/Depomedrol injections resulted in immediate improvements of RLP (Botox: P=0.002; Lidocaine/Depomedrol: P=0.06) and pain tolerance (Botox: P=0.01; Lidocaine/Depomedrol: P=0.07). The treatment effect lasted for 6 months in both groups. The patients who received Botox injection had higher starting pain than those who received Lidocaine/Depomedrol injection (P=0.07). However, there were no statistical differences in RLP and pain tolerance between these 2 groups. In addition, no improvement of PLP was observed after Botox or Lidocaine/Depomedrol injection. Conclusions Both Botox and Lidocaine/Depomedrol injections resulted in immediate improvement of RLP (not PLP) and pain tolerance, which lasted for 6 months in amputees who failed in conventional

  1. 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

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    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.

  2. 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.

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

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    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

  4. Adhesive taping vs. daily manual muscle stretching and splinting after botulinum toxin type A injection for wrist and fingers spastic overactivity in stroke patients: a randomized controlled trial.

    Science.gov (United States)

    Santamato, Andrea; Micello, Maria Francesca; Panza, Francesco; Fortunato, Francesca; Picelli, Alessandro; Smania, Nicola; Logroscino, Giancarlo; Fiore, Pietro; Ranieri, Maurizio

    2015-01-01

    To compare the effectiveness of two procedures increasing the botulinum toxin type A effect for wrist and finger flexor spasticity after stroke. A single-blind randomized trial. Seventy patients with upper limb post-stroke spasticity. Adults with wrist and finger flexor muscles spasticity after stroke were submitted to botulinum toxin type A therapy. After the treatment, the subjects injected were randomly divided into two groups and submitted to adhesive taping (Group A) or daily muscle manual stretching, passive articular mobilization of wrist and fingers, and palmar splint (Group B) for 10 days. We measured spasticity with Modified Ashworth Scale, related disability with Disability Assessment Scale, and fingers position at rest. The measurements were done at baseline, after two weeks, and after one month from the treatment session. After two weeks, subjects in Group A reported a significantly greater decrease in spasticity scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.3±0.6 vs. 2.1±0.6; Modified Ashworth Scale wrist: 1.7 ±0.6 vs. 2.3 ±0.8), and after one month in spasticity and disability scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.9 ±0.7 vs. 2.5 ±0.6; Modified Ashworth Scale wrist: 2.0 ±0.7 vs. 2.6 ±0.6; Disability Assessment Scale: 1.6 ±0.7 vs. 2.1 ±0.7) compared with Group B subjects. Subjects in Group A reported also a significantly improved fingers position at rest compared with Group B subjects after two weeks (2.8 ±0.9 vs. 2.1 ±0.7) and one month (2.3 ±0.7 vs. 1.5 ±0.6). Adhesive taping of wrist and finger flexor muscles appeared to enhance the effect of botulinum toxin type A therapy more than daily manual muscle stretching combined with passive articular mobilization and palmar splint. © The Author(s) 2014.

  5. Botulinum Neurotoxin A Injected Ipsilaterally or Contralaterally into the Striatum in the Rat 6-OHDA Model of Unilateral Parkinson’s Disease Differently Affects Behavior

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    Veronica A. Antipova

    2017-06-01

    Full Text Available Parkinson’s disease (PD is one of the most frequent neurodegenerative disorders. The loss of dopaminergic neurons in the substantia nigra leads to a disinhibition of cholinergic interneurons in the striatum. Pharmacotherapeutical strategies of PD-related hypercholinism have numerous adverse side effects. We previously showed that ipsilateral intrastriatal injections of 1 ng in unilaterally 6-hydroxydopamine (6-OHDA-lesioned rats inhibit apomorphine-induced rotation behavior significantly up to 6 months. In this study, we extended the behavioral testing of ipsilateral botulinum neurotoxin A (BoNT-A-injection and additionally investigated the impact of intrastriatal BoNT-A-injections contralateral to the 6-OHDA-lesioned hemisphere on the basal ganglia circuity and motor functions. We hypothesized that the interhemispheric differences of acetylcholine (ACh concentration seen in unilateral hemi-PD should be differentially and temporally influenced by the ipsilateral or contralateral injection of BoNT-A. Hemi-PD rats were injected with 1 ng BoNT-A or vehicle substance into either the ipsilateral or contralateral striatum 6 weeks after 6-OHDA-lesion and various behaviors were tested. In hemi-PD rats intrastriatal ipsilateral BoNT-A-injections significantly reduced apomorphine-induced rotations and increased amphetamine-induced rotations, but showed no significant improvement of forelimb usage and akinesia, lateralized sensorimotor integration and also no effect on spontaneous locomotor activity. However, intrastriatal BoNT-A-injections contralateral to the lesion led to a significant increase of the apomorphine-induced turning rate only 2 weeks after the treatment. The apomorphine-induced rotation rate decreases thereafter to a value below the initial rotation rate. Amphetamine-induced rotations were not significantly changed after BoNT-A-application in comparison to sham-treated animals. Forelimb usage was temporally improved by contralateral BoNT-A-injection

  6. Combined effect of botulinum toxin and splinting on motor components and function of people suffering a stroke

    OpenAIRE

    Amini, Malek; Shamili, Aryan; Frough, Bijan; Pashmdarfard, Marzieh; Fallahzadeh Abarghouei, AbolGhasem

    2016-01-01

    Background: Spasticity is one of the problems after a stroke. Due to this increase in muscle tone, patients are confronted with problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of the simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period. Methods: In this study a compariso...

  7. Botulinum Toxin to Improve Results in Cleft Lip Repair: A Double-Blinded, Randomized, Vehicle-Controlled Clinical Trial

    Science.gov (United States)

    Chang, Chun-Shin; Wallace, Christopher Glenn; Hsiao, Yen-Chang; Chang, Chee-Jen; Chen, Philip Kuo-Ting

    2014-01-01

    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 PMID:25541942

  8. 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 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.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.58 patients completed the trial. All scar assessment modalities revealed statistically significantly better scars in the experimental than the vehicle-control group.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.ClinicalTrials.gov NCT01429402.

  9. 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.

  10. Efficacy and Safety of Single Botulinum Toxin Type A (Botox®) Injection for Relief of Upper Trapezius Myofascial Trigger Point: A Randomized, Double-Blind, Placebo-Controlled Study.

    Science.gov (United States)

    Kwanchuay, Photsawee; Petchnumsin, Thavatchai; Yiemsiri, Pichet; Pasuk, Nakkamol; Srikanok, Wannarat; Hathaiareerug, Chanasak

    2015-12-01

    Botulinum toxin injection has been applied for pain relief in various chronic pain syndromes. Recently, systematic review studies reported inconclusive effects of Botulinum toxin in myofascial pain management. The present study aimed to demonstrate the efficacy and safety of Botulinum toxin type A (BTxA) (Botox®) injection for pain reduction in myofascial trigger point (MTrP) of the upper trapezius muscle. Thirty-three patients with 48 MTrP on the upper trapezius muscles over three months with moderate to severe pain intensity diagnosed at physical medicine and rehabilitation outpatient department were recruited between December 2011 and March 2012. Eligible patients were blinded and randomly injected with single 0.2 ml (20 IU) of BTxA for 24 MTrP and 0.2 ml of 0.9% NaCl solution for 24 MTrP at the most tender trigger point on the upper trapezius muscle. All patients were advised for stretching exercise and ergonomic adaptation throughout the study. At 3- and 6-week after injections, visual analogue scale (VAS), the pressure pain threshold (PPT), and reported adverse effects were measured. Both BTxA and control groups demonstrated statistically significant differences in VAS reduction and increased PPT after 3 weeks and 6 weeks compared with before treatment. There were no statistically significant differences in VAS reduction from baseline between the two groups at 3- and 6-week after treatment. A statistically significant difference in improvement of PPT from baseline and 6-week after BTxA injection compared with 0.9% NaCl group was shown (1.0 ± 0.9 and 0.5 ± 0.7, p = 0.036). There was mild degree side-effects that spontaneous resolved within one week in both groups without significant difference in percentage. No severe adverse effects were reported during the study. The efficacy in VAS reduction of a single 20 IU of Botulinum toxin type A (Botox®) injection was not different from 0.9% NaCl for myofascial trigger point at the upper trapezius muscle. However

  11. Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke

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    Aryan Shamili

    2017-02-01

    Full Text Available Background and objective: Spasticity is one of the problems following stroke. Due to this increase in muscle tone, patients are confronted to problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of Simultaneous use of both splint and botulinum toxin-A (BTX-A injection on spasticity, range of motion and upper extremity function in a 3-month period. Methods: The design of this study was a comparison between 3 groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about 3 months and the evaluations were done monthly. Goniometry was the method to measure range of motion, and Modified Ashworth scale was used to examine the spasticity and the upper extremity function was scored based on Fugl-Meyer assessment.   Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times.  Significance was set at 0.05. Results: All outcome measures improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month (p> 0 / 05. The results also showed that the changes in elbow`s spasticity {p= 0.05} and wrist`s spasticity {p= 0.007} and upper extremity function { p = 0.04} were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin and splint was more than other groups. Conclusion: In this

  12. Isolation of a nanomolar scFv inhibiting the endopeptidase activity of botulinum toxin A, by single-round panning of an immune phage-displayed library of macaque origin

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    Chahboun Siham

    2011-11-01

    Full Text Available Abstract Background Botulinum neurotoxin A (BoNT/A, mainly represented by subtype A1, is the most toxic substance known. It causes naturally-occurring food poisoning, and is among the biological agents at the highest risk of being weaponized. Several antibodies neutralizing BoNT/A by targeting its heavy chain (BoNT/A-H have been isolated in the past. For the first time however, an IgG (4LCA recently isolated by hybridoma technology and targeting the BoNT/A light chain (BoNT/A-L, was shown to inhibit BoNT/A endopeptidase activity and protect in vivo against BoNT/A. In the present study, a phage-displayed library was constructed from a macaque (Macaca fascicularis hyper-immunized with BoNTA/L in order to isolate scFvs inhibiting BoNT/A endopeptidase activity for clinical use. Results Diversity of the scFvs constituting the library was limited due to the frequent presence, within the genes intended to be part of the library, of restriction sites utilized for its construction. After screening with several rounds of increasing stringency, as is usual with phage technology, the library got overwhelmed by phagemids encoding incomplete scFvs. The screening was successfully re-performed with a single round of high stringency. In particular, one of the isolated scFvs, 2H8, bound BoNT/A1 with a 3.3 nM affinity and effectively inhibited BoNT/A1 endopeptidase activity. The sequence encoding 2H8 was 88% identical to human germline genes and its average G-score was -0.72, quantifying the high human-like quality of 2H8. Conclusions The presence of restrictions sites within many of the sequences that were to be part of the library did not prevent the isolation of an scFv, 2H8, by an adapted panning strategy. ScFv 2H8 inhibited toxin endopeptidase activity in vitro and possessed human-like quality required for clinical development. More generally, the construction and screening of phage-displayed libraries built from hyper-immunized non-human primates is an

  13. 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…

  14. Muscle disuse caused by botulinum toxin injection leads to increased central gain of the stretch reflex in the rat

    DEFF Research Database (Denmark)

    Pingel, Jessica; Hultborn, Hans; Naslund-Koch, Lui

    2017-01-01

    . However, significant changes were also observed in post-activation depression of the MSR suggesting that plastic changes in transmission from Ia afferent to the motor neurons may also be involved. The data demonstrate that muscle paralysis induced by Btx injection is accompanied by plastic adaptations...... in the triceps surae muscle in rats. Experiments were performed in 21 rats. 8 rats were in a control group and 13 rats were injected with 6 IU of Btx in the left triceps surae muscle. Two weeks after Btx injection larger monosynaptic reflexes (MSR) were recorded from the left (injected) than the right (non...

  15. Treatment of ovarian cancer ascites by intra-peritoneal injection of diphtheria toxin A chain-H19 vector: a case report

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    Abu-lail Rasha

    2010-07-01

    Full Text Available Abstract Introduction Ovarian cancer ascitic fluid, which contains malignant cells, is usually present in women with an advanced stage disease. There are currently no effective therapies for the treatment of ovarian cancer ascitic fluid. We developed a new therapeutic strategy to target expression of the diphtheria toxin fragment A gene in ovarian tumor cells under the control of H19 regulatory sequences. Case presentation A 64-year-old Caucasian woman was diagnosed with a stage IIIc epithelial ovarian cancer. She suffered from progressive disease, accumulation of malignant ascites that needed to be drained weekly, abdominal pain, vomiting, anorexia and severe weakness. Infusion of the diphtheria toxin A chain-H19 plasmid into the peritoneum of our patient resulted in complete resolution of the ascites with minimum adverse events. Conclusion On the basis of this preliminary experience, we are currently conducting an extensive Phase I study on a larger number of patients in order to assess the safety and preliminary efficacy of this novel patient-oriented treatment approach.

  16. 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.

  17. An objective assessment of botulinum toxin type A injection in the treatment of post-facial palsy synkinesis and hyperkinesis using the synkinesis assessment questionnaire.

    Science.gov (United States)

    Neville, Catriona; Venables, Vanessa; Aslet, Margaret; Nduka, Charles; Kannan, Ruben

    2017-11-01

    This study aimed to provide reliable and valid evidence that botulinum toxin type A (BTX-A) is a successful treatment for facial synkinesis in facial palsy by using the synkinesis assessment questionnaire (SAQ) tool. Fifty-one patients completed questionnaires pre- and post-BTX-A treatment over 103 cycles of treatment. Each patient was individually assessed and then treated according to their presenting symptoms with a dosage in each injection site of between 0.5 and 5 U of BTX-A. A two-tailed paired samples t-test was used to compare the scores for each question before and after treatment. A significant difference was found between all scores before and after treatment at the level of p < 0.05. There was not only an improvement in the mean score in the post-treatment group but also a smaller spread of scores in the post-treatment group than in the pre-treatment group. The study showed that SAQ scores decreased significantly for every question on the SAQ after treatment. This indicates that BTX-A is an effective treatment for synkinesis, adding further weight to current evidence. The study also indicated that BTX-A continues to be effective even after three rounds of treatment, with a significant decrease in overall scores after each treatment cycle. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  18. Objective assessment of cortical activity changes in stroke patients before and after hand rehabilitation with and without botulinum toxin injection

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    Omnia A Abu-Bakr

    2017-01-01

    Conclusion BTX injection in spastic muscles of the wrist and hand, followed by a rehabilitation program led to greater clinical and functional improvement compared with implementing the rehabilitation program alone.

  19. Long-term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction.

    Science.gov (United States)

    Pannek, Jürgen; Göcking, Konrad; Bersch, Ulf

    2009-11-01

    To evaluate the influence of repeated botulinum neurotoxin A (BoNT-A) treatments on detrusor function in patients with neurogenic detrusor overactivity (DOA) due to spinal cord lesions. In a retrospective study, urodynamic evaluations of 27 consecutive patients with neurogenic DOA due to spinal cord lesions who received at least five BoNT-A treatments were analysed. After the first BoNT-A treatment, bladder capacity, reflex volume, continence status and detrusor compliance were significantly improved and maximum detrusor pressure (P(detmax)) was significantly reduced. The mean number of BoNT-A treatments was 7.1. Compared with the results of the first treatment, the incontinence rate (seven patients) and the number of patients with an elevated P(detmax) (five patients) were slightly increased after the final BoNT-A treatment. The long-term success rate was 74%. Every fourth patient needed a major surgical intervention. There was a significant decrease in P(detmax) before BoNT-A treatments, indicating that detrusor contraction strength did not completely recover after treatment. Our study confirmed the long-term efficacy of repeated BoNT-A treatments in patients with neurogenic DOA. However, in long-term follow-up, every fourth patient required surgical interventions. Moreover, our data give the first hint that BoNT-A may lead to impaired detrusor contraction strength, which could influence future treatment options. Prospective studies are necessary to elucidate the impact of repeated BoNT-A treatments on detrusor function and the interactions with future treatment options.

  20. The role of kinesiotaping combined with botulinum toxin to reduce plantar flexors spasticity after stroke.

    Science.gov (United States)

    Karadag-Saygi, Evrim; Cubukcu-Aydoseli, Koza; Kablan, Nilufer; Ofluoglu, Demet

    2010-01-01

    To evaluate the effect of kinesiotaping as an adjuvant therapy to botulinum toxin A (BTX-A) injection in lower extremity spasticity. This is a single-center, randomized, and double-blind study. Twenty hemiplegic patients with spastic equinus foot were enrolled into the study and randomized into 2 groups. The first group (n=10) received BTX-A injection and kinesiotaping, and the second group (n=10) received BTX-A injection and sham-taping. Clinical assessment was done before injection and at 2 weeks and 1, 3, and 6 months. Outcome measures were modified Ashworth scale (MAS), passive ankle dorsiflexion, gait velocity, and step length. Improvement was recorded in both kinesiotaping and sham groups for all outcome variables. No significant difference was found between groups other than passive range of motion (ROM), which was found to have increased more in the kinesiotaping group at 2 weeks. There is no clear benefit in adjuvant kinesiotaping application with botulinum toxin for correction of spastic equinus in stroke.

  1. Impact of Injection-Guiding Techniques on the Effectiveness of Botulinum Toxin for the Treatment of Focal Spasticity and Dystonia: A Systematic Review.

    Science.gov (United States)

    Grigoriu, Anca-Irina; Dinomais, Mickael; Rémy-Néris, Olivier; Brochard, Sylvain

    2015-11-01

    To conduct a systematic review of the impact of different injection-guiding techniques on the effectiveness of botulinum toxin type A (BoNT-A) for the treatment of focal spasticity and dystonia. MEDLINE via PubMed, Academic Search Premier, PASCAL, The Cochrane Library, Scopus, SpringerLink, Web of Science, EM Premium, and PsycINFO. Two reviewers independently selected studies based on predetermined inclusion criteria. Data relating to the aim were extracted. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale. Ten studies were included. Seven were randomized. There was strong evidence (level 1) that instrumented guiding (ultrasonography [US], electrical stimulation [ES], electromyogram [EMG]) was more effective than manual needle placement for the treatment of spasmodic torticollis, upper limb spasticity, and spastic equinus in patients with stroke, and spastic equinus in children with cerebral palsy. Three studies provided strong evidence (level 1) of similar effectiveness of US and ES for upper and lower limb spasticity in patients with stroke, and spastic equinus in children with cerebral palsy, but there was poor evidence or no available evidence for EMG or other instrumented techniques. These results strongly recommend instrumented guidance of BoNT-A injection for the treatment of spasticity in adults and children (ES or US), and of focal dystonia such as spasmodic torticollis (EMG). No specific recommendations can be made regarding the choice of instrumented guiding technique, except that US appears to be more effective than ES for spastic equinus in adults with stroke. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  2. Adverse Events of Intravesical Onabotulinum Toxin A Injection between Patients with Overactive Bladder and Interstitial Cystitis—Different Mechanisms of Action of Botox on Bladder Dysfunction?

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    Yuh-Chen Kuo

    2016-03-01

    Full Text Available Intravesical onabotulinumtoxinA (BoNT-A injections have been proposed to treat both overactive bladder (OAB and interstitial cystitis/bladder pain syndrome (IC/BPS in patients with refractory conditions. We compared adverse events (AEs after BoNT-A treatment between IC/BPS and OAB in women. IC/BPS patients who failed conventional treatments were enrolled to receive suburothelial injections of BoNT-A (100 U followed by hydrodistention. Age matched OAB female patients refractory to antimuscarinic agents underwent BoNT-A (100 U injections. The bladder capacity, maximum flow rate (Qmax, post-void residual (PVR, and voiding efficiency (VE at baseline, 3 and 6 months, and the post-treatment AEs were analyzed between groups. Finally, 89 IC/BPS and 72 OAB women were included. In the OAB group, the bladder capacity and PVR increased, and VE decreased significantly at three and six months after BoNT-A treatment. In the IC/BPS group, the Qmax increased significantly at six months. There were significant differences in changes of capacity, Qmax, PVR and VE between the two groups. Moreover, OAB patients suffered more frequently from events of hematuria, UTI, and large PVR (>200 mL, but less frequently from events of straining to void. In conclusion, OAB women had higher PVR volume and lower VE than those in IC/BPS after BoNT-A injections. These results imply that the bladder contractility of OAB patients are more susceptible to BoNT-A, which might reflect the different mechanisms of action of Botox on bladder dysfunction. Further investigations to confirm this hypothesis are warranted.

  3. Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone

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    Anido J

    2017-10-01

    Full Text Available Javier Anido,1 Daniel Arenas,2 Cristina Arruabarrena,3 Alfonso Domínguez-Gil,4 Carlos Fajardo,5 Mar Mira,6 Javier Murillo,7 Natalia Ribé,8 Helga Rivera,9 Sofia Ruiz del Cueto,6 Helder Silvestre,10 Marisa Tirado11 1A-Clinic, Madrid, 2Hospital Cruz Roja, Madrid, 3Clinic Cristina Arruabarrena, San Sebastiá, 4Salamanca University, Salamanca, 5Clinic Fajardo, Malaga, 6Clinic Mira+Cueto, Madrid, 7Clinic CIR, Seville, 8Institute Natalia Ribé, Barcelona, 9Clinic Helga Rivera, Vigo, Spain; 10Clinic Europa, Lisbon, Portugal; 11Clinic Derma Alemar, Castellón, Spain Background: Facial lines and wrinkles are strongly influenced by individual differences in anatomy and muscle activity and no single injection protocol will suit all patients. However, there is only limited information in the published literature on how to develop a tailored approach to botulinum toxin treatment.Methods: An expert panel of physicians was convened to establish a consensus on developing an individualized approach to treatment of the forehead with incobotulinumtoxinA. Separate treatment protocols were developed for men and women and subdivided by background level of muscle activity: kinetic, hyperkinetic, and hypertonic. Each muscle tone category was then further subdivided to take account of individual characteristics that can influence treatment.Results: Consensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is described for men and women with a wide range of forehead presentations. For each presentation, units of toxin as well as the precise location of injection points were defined by creating a 12-zone map of the forehead.Conclusion: These recommendations depart from traditional consensus documents by providing detailed incobotulinumtoxinA injection protocols for the forehead based on the major parameters that differ between patients, including muscular anatomy, size, and

  4. Botulinum toxin: treatment of self-mutilation in patients with Lesch-Nyhan syndrome.

    Science.gov (United States)

    Gutierrez, Cristiam; Pellene, Alejandro; Micheli, Federico

    2008-01-01

    Lesch-Nyhan syndrome (LNS) is a rare X-linked recessive disorder involving purine metabolism caused by the congenital absence of hypoxanthine guanine phosphoribosyl transferase. A characteristic feature of LNS is the appearance of intractable self-injurious behavior, usually in the form of severe lip and finger biting. The mechanism behind this severe self-mutilating behavior is unknown, and is one of the main challenges in the management of this condition. We here report the case of a 30-year-old man with a confirmed diagnosis of LNS who was successfully treated for self-mutilation of his lips with repeated botulinum toxin A (BTX-A) injections in the facial perioral muscles. Our findings suggest that treatment with BTX-A helped reduce self-abusive behavior in this patient. Our case illustrates that BTX-A injections can be a useful therapeutic approach in patients with self-abusive behavior.

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

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    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.

  6. Combined effect of botulinum toxin and splinting on motor components and function of people suffering a stroke.

    Science.gov (United States)

    Amini, Malek; Shamili, Aryan; Frough, Bijan; Pashmdarfard, Marzieh; Fallahzadeh Abarghouei, AbolGhasem

    2016-01-01

    Spasticity is one of the problems after a stroke. Due to this increase in muscle tone, patients are confronted with problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of the simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period. In this study a comparison was done between three groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about three months and the evaluations were done monthly. Goniometry was the method to measure the range of motion, and Modified Ashworth Scale was used to examine the spasticity and the upper extremity function was scored based on Fugl- Meyer Assessment. Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times. Significance was set at 0.05. All outcome measures were improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during the 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month) (p>0.05). The results also showed that the changes in elbow`s spasticity (p=0.05) and wrist`s spasticity (p=0.007) and upper extremity function (p=0.04) were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin, and the splint was more than other groups. In this study, the effects of botulinum toxin injection and Volar

  7. Comparative assessment of therapeutic response to physiotherapy with or without botulinum toxin injection using diffusion tensor tractography and clinical scores in term diplegic cerebral palsy children.

    Science.gov (United States)

    Chaturvedi, Saurabh K; Rai, Yogita; Chourasia, Ankita; Goel, Puneet; Paliwal, Vimal K; Garg, Ravindra K; Rathore, Ram Kishore S; Pandey, Chandra M; Gupta, Rakesh K

    2013-08-01

    The present study was to compare the effects of combined therapy [botulinum (BTX) plus physiotherapy] with physiotherapy alone using diffusion tensor imaging (DTI) derived fractional anisotropy (FA) values of motor and sensory fiber bundles and clinical grade of the disability to see the value of BTX in term children with spastic diplegic cerebral palsy (CP). Clinically diagnosed 36 children participated in the study. All these children were born at term, and had no history of seizures. The study was randomly categorized into two groups: group I (n=18) - physiotherapy alone and group II (n=18) - physiotherapy plus BTX injection. Quantitative diffusion tensor tractography on all these children was performed on motor and sensory fiber bundles on baseline as well as after 6months of therapy. Motor function and clinical grades were also measured by gross motor function measures (GMFM) scale on both occasions. We observed significant change in FA value in motor and sensory fiber bundle as well as in GMFM scores at 6months compared to baseline study in both the groups. However, delta change and relative delta change in FA values of sensory and motor fiber bundle as well as GMFM score between group I and group II was statistically insignificant. We conclude that addition of BTX to physiotherapy regimen does not influence the outcome at 6months with similar insult in children with term diplegic spastic CP. This information may influence management of diplegic CP especially in developing countries, where BTX is beyond the reach of these children. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  8. Pelvic-Spinal Analysis and the Impact of Onabotulinum toxin A Injections on Spinal Balance in one Child With Cerebral Palsy.

    Science.gov (United States)

    Chaléat-Valayer, Emmanuelle; Bernard, Jean-Claude; Deceuninck, Julie; Roussouly, Pierre

    2016-01-01

    In children with cerebral palsy, primary (eg, abnormal muscle tone and weakness) and secondary impairments (eg, contractures) can modify pelvic-spinal alignment. The main aim of this article was to establish a new approach to pelvic-spinal analysis in children with cerebral palsy, taking into account the whole pelvis-spine complex, illustrated by a case study. This is a case study of an ambulatory child with cerebral palsy (spastic diplegia) who underwent analysis of the pelvic-spine complex from X-ray images taken in standing position from C2 to the proximal femur. Pelvic shape was characterized by the pelvic incidence angle, which is the sum of sacral slope and pelvic tilt, before and after the treatment by regular onabotulinumtoxinA injections into the hip flexors, and the use of soft lumbar brace over 5 years. The sagittal balance of the spine was improved following the treatment, with a reduction in lumbar lordosis and sacral slope. The reduction in lumbar hyperextension likely reduced the risk of spondylolysis, low back pain, and degenerative spondylolisthesis in adulthood. A biomechanical approach to the evaluation of the pelvic-spinal complex offers new perspectives to increase the understanding of spinal balance in children with cerebral palsy, providing more options for treatment, such as onabotulinumtoxinA.

  9. Pelvic-Spinal Analysis and the Impact of Onabotulinum toxin A Injections on Spinal Balance in one Child With Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Emmanuelle Chaléat-Valayer MD

    2016-11-01

    Full Text Available Background: In children with cerebral palsy, primary (eg, abnormal muscle tone and weakness and secondary impairments (eg, contractures can modify pelvic-spinal alignment. The main aim of this article was to establish a new approach to pelvic-spinal analysis in children with cerebral palsy, taking into account the whole pelvis-spine complex, illustrated by a case study. Methods: This is a case study of an ambulatory child with cerebral palsy (spastic diplegia who underwent analysis of the pelvic-spine complex from X-ray images taken in standing position from C2 to the proximal femur. Pelvic shape was characterized by the pelvic incidence angle, which is the sum of sacral slope and pelvic tilt, before and after the treatment by regular onabotulinumtoxinA injections into the hip flexors, and the use of soft lumbar brace over 5 years. Results: The sagittal balance of the spine was improved following the treatment, with a reduction in lumbar lordosis and sacral slope. The reduction in lumbar hyperextension likely reduced the risk of spondylolysis, low back pain, and degenerative spondylolisthesis in adulthood. Conclusion: A biomechanical approach to the evaluation of the pelvic-spinal complex offers new perspectives to increase the understanding of spinal balance in children with cerebral palsy, providing more options for treatment, such as onabotulinumtoxinA.

  10. Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study

    Directory of Open Access Journals (Sweden)

    Fabienne Schasfoort

    2017-09-01

    Full Text Available Objective: Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. Design: A pragmatically designed, multi-centre trial, comparing the effectiveness of botulinum toxin + intensive physiotherapy with intensive physiotherapy alone, including economic evaluation. Subjects/patients: Children with spastic cerebral palsy, age range 4–12 years, cerebral palsy-severity Gross Motor Function Classification System levels I–III, received either botulinum toxin type A + intensive physiotherapy or intensive physiotherapy alone and, if necessary, ankle-foot orthoses and/or casting. Methods: Primary outcomes were gross motor func-tion, physical activity levels, and health-related quality-of-life, assessed at baseline, 12 (primary end-point and 24 weeks (follow-up. Economic outcomes included healthcare and patient costs. Intention-to-treat analyses were performed with linear mixed models. Results: There were 65 participants (37 males, with a mean age of 7.3 years (standard deviation 2.3 years, equally distributed across Gross Motor Function Classification System levels. Forty-one children received botulinum toxin type A plus intensive physio-therapy and 24 received intensive physiotherapy treatment only. At primary end-point, one statistically significant difference was found in favour of intensive physiotherapy alone: objectively measured percentage of sedentary behaviour (–3.42, 95% confidence interval 0.20–6.64, p=0.038. Treatment costs were significantly higher for botulinum toxin type A plus intensive physiotherapy (8,963 vs 6,182 euro, p=0.001. No statistically significant differences were found between groups at follow-up. Conclusion: The addition of botulinum toxin type A to intensive physiotherapy did not improve the effectiveness of rehabilitation for ambulatory children with spastic cerebral palsy and was also

  11. The use of botulinum toxin in the treatment of the consequences of bruxism on cervical spine musculature.

    Science.gov (United States)

    Finiels, P J; Batifol, D

    2014-03-01

    Hypertonia and hyperactivity of masticatory muscles are involved in pain and contractions of the cervical spine musculature, but their pathophysiology remains nonetheless unknown and its treatment far to be codified. In this study, 8 patients, showing disabling posterior neck muscle contractures linked with bruxism were prospectively treated and followed for an average 15 months period, after having received Injections of botulinum toxin A essentially in masticatory muscles. Injections were made every 3 months, varying from 10 to 100 U Botox* by muscles, without administrating more than 300 U Botox* in the same patient. The angle of cervical lordosis were calculated on lateral sitting radiographs in neutral position, good results being considered to be achieved in the case of a 2 point diminution of VAS score as well as at least a 5° positive gain in the curve. 7 patients out of 8 showed a real improvement in their symptoms after an average of 3 injections, showing a decrease of 4.5 points on the VAS score and an average increment of 15° in cervical lordosis. Although the follow-up period of patients was relatively short and the sample quite small, the general impression, confirmed by the patients' experience, seems to suggest a potential place for the use of botulinum toxin amongst the array of treatments which can be offered in certain selected cases which associate bruxism and posterior cervical contractions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. A double-blind, randomized, placebo-controlled health-outcomes survey of the effect of botulinum toxin type a injections on quality of life and self-esteem.

    Science.gov (United States)

    Dayan, Steven H; Arkins, John P; Patel, Amit B; Gal, Thomas J

    2010-12-01

    Although studies show that botulinum toxin type A (BoNTA) can positively influence one's first impression, little research has been conducted to measure the effect that BoNTA has on mental well-being. To determine the effects that BoNTA injections for the treatment of facial wrinkles had on quality of life (QOL) and self-esteem. One hundred participants received treatment with BoNTA or placebo saline in this double-blind randomized placebo-controlled survey. All participants completed a health outcomes survey consisting of Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form and Heatherton and Polivy State Self-Esteem measurements before injection and 2 weeks and 3 months after injection. Statistically significant improvements (pself-consciousness, intellect, self-worth, appearance, comprehension, weight satisfaction, attractiveness, and sense of well-being. Increases in overall self-esteem and appearance-, social-, and performance-related self-esteem were observed in participants treated with BoNTA. Our findings showed that BoNTA injections result in improvements in QOL and self-esteem. In addition, BoNTA-naïve participants demonstrate greater improvements in QOL and self-esteem than participants previously exposed to BoNTA. Moreover, BoNTA-familiar participants demonstrated sustained improvement in QOL and self-esteem relative to BoNTA-naïve participants, even when injected with placebo. © 2010 by the American Society for Dermatologic Surgery, Inc.

  13. Botulinum Toxin Therapy

    Science.gov (United States)

    ... AADA Health System Reform Principles Drug pricing and availability CVS dermatologic formulary restrictions Access to compounded medications ... Botulinum toxin therapy: Overview Also called botulinum rejuvenation Brand names: Botox® Cosmetic, Dysport®, MYOBLOC®, and XEOMIN® When ...

  14. Botulinum toxin in the treatment of vocal fold nodules.

    Science.gov (United States)

    Allen, Jacqui E; Belafsky, Peter C

    2009-12-01

    Promising new techniques in the management of vocal fold nodules have been developed in the past 2 years. Simultaneously, the therapeutic use of botulinum toxin has rapidly expanded. This review explores the use of botulinum toxin in treatment of vocal nodules and summarizes current therapeutic concepts. New microsurgical instruments and techniques, refinements in laser technology, radiosurgical excision and steroid intralesional injections are all promising new techniques in the management of vocal nodules. Botulinum toxin-induced 'voice rest' is a new technique we have employed in patients with recalcitrant nodules. Successful resolution of nodules is possible with this technique, without the risk of vocal fold scarring inherent in dissection/excision techniques. Botulinum toxin usage is exponentially increasing, and large-scale, long-term studies demonstrate its safety profile. Targeted vocal fold temporary paralysis induced by botulinum toxin injection is a new, well tolerated and efficacious treatment in patients with persistent vocal fold nodules.

  15. Pretarsal application of botulinum toxin for treatment of blepharospasm

    NARCIS (Netherlands)

    Aramideh, M.; Ongerboer de Visser, B. W.; Brans, J. W.; Koelman, J. H.; Speelman, J. D.

    1995-01-01

    The response to botulinum toxin type A was compared after two injection techniques in 45 patients with blepharospasm. Initially, patients were treated according to a triple injection technique; two injections into the upper eyelid and one injection into the lower eyelid. Subsequently, without

  16. 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.

  17. Botulinum toxin is efficient to treat obstructive symptoms in children with Hirschsprung disease.

    Science.gov (United States)

    Wester, Tomas; Granström, Anna Löf

    2015-03-01

    Obstructive symptoms are common after pull-through for Hirschsprung disease. Botulinum toxin injection treatment may improve the bowel function if internal sphincter achalasia is the cause of obstructive symptoms. The aim of this study was to review the outcome in patients treated with intrasphincteric botulinum toxin injections after pull-through for Hirschsprung disease. The operative records were used to identify children with Hirschsprung disease who were treated with botulinum toxin injections at Karolinska University Hospital, Stockholm, Sweden, from September 2007 to November 2014. Data on age, sex, associated syndromes, length of aganglionic segment, age at pull-through, type of pull-through, age at first botulinum toxin injection, indication for botulinum toxin injection, and effect of first botulinum toxin injection were retrieved from the case records. Bowel function at last follow-up visit or telephone contact was recorded. Nineteen patients were identified. All had biopsy-verified Hirschsprung disease. Eighteen (15 males and 3 females) children had undergone intrasphincteric botulinum toxin injection treatment for obstructive symptoms after pull-through, which was done at 127 (18-538) days of age. Four children had total colonic aganglionosis. The first botulinum toxin injection was given at 2.4 (0.53-6.9) years of age. Thirteen children (72 %) had a good response to the first injection treatment. The children underwent 3 (1-13) injection treatments. At follow-up four patients had improved and did not need treatment for obstruction, four were scheduled for further botulinum toxin injections, eight had persistent obstructive symptoms treated with laxatives or enemas, and two children had an ileostomy. Botulinum toxin injection treatment improves the obstructive symptoms in children after pull-through for Hirschsprung disease. The effect is reversible and a majority of patients need repeat injections. When injection treatment is not repeated, a large

  18. Botulinum toxin for the treatment of bruxism.

    Science.gov (United States)

    Tinastepe, Neslihan; Küçük, Burcu Bal; Oral, Koray

    2015-10-01

    Botulinum toxin, the most potent biological toxin, has been shown to be effective for a variety of disorders in several medical conditions, when used both therapeutically and cosmetically. In recent years, there has been a rising trend in the use of this pharmacological agent to control bruxing activity, despite its reported adverse effects. The aim of this review was to provide a brief overview to clarify the underlying essential ideas for the use of botulinum toxin in bruxism based on available scientific papers. An electronic literature search was performed to identify publications related to botulinum toxin and its use for bruxism in PubMed. Hand searching of relevant articles was also made to identify additional studies. Of the eleven identified studies, only two were randomized controlled trials, compared with the effectiveness of botulinum toxins on the reduction in the frequency of bruxism events and myofascial pain after injection. The authors of these studies concluded that botulinum toxin could be used as an effective treatment for reducing nocturnal bruxism and myofascial pain in patients with bruxism. Evidence-based research was limited on this topic. More randomized controlled studies are needed to confirm that botulinum toxin is safe and reliable for routine clinical use in bruxism.

  19. Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial.

    Science.gov (United States)

    Thomas, Rachel E; Johnston, Leanne M; Sakzewski, Leanne; Kentish, Megan J; Boyd, Roslyn N

    2016-01-01

    This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4-3.1; pphysiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. 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

    INTRODUCTION: Vestibulodynia is an increasingly recognized problem among women and is often difficult to treat. AIM: This randomized, double blinded, placebo-controlled study aimed to evaluate the efficacy of Botox in the treatment of vestibulodynia. METHODS: Sixty-four women were randomized...... 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...... using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale at baseline and at 3 and 6 months follow up. Quality of life was measured using the 36-item short-form (SF-36). RESULTS: Sixty women (94%) completed the 6 months follow up. Both Botox and placebo produced significantly...

  1. 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

  2. Cosmetic use of botulinum toxin type A in the elderly

    Directory of Open Access Journals (Sweden)

    Christine M Cheng

    2007-04-01

    Full Text Available Christine M ChengDepartment of Clinical Pharmacy, University of California, San Francisco, CA, USAAbstract: Botulinum toxin type A injections are one of the most popular cosmetic procedures for diminishing the appearance of facial lines caused by habitual facial muscle contractions. Although the manufacturer’s labeling recommends botulinum toxin only for the treatment of glabellar lines among adults younger than 65 years of age, there is widespread use of the toxin for other cosmetic purposes and for patients who may be older than 65. Evidence-based safety and efficacy data on botulinum toxin use in elderly patients is limited. However, given the age-related skin changes and multifactorial causes of wrinkles in the elderly, as well as the higher risk for potential side effects due to concomitant diseases and medications, a careful risk-benefit assessment should precede the decision to use botulinum toxin in the elderly patient.Keywords: Botox Cosmetic, botulinum toxin, facial wrinkles, aging

  3. Alkalinized lidocaine versus lidocaine gel as local anesthesia prior to intra-vesical botulinum toxin (BoNTA) injections: A prospective, single center, randomized, double-blind, parallel group trial of efficacy and morbidity.

    Science.gov (United States)

    Nambiar, Arjun K; Younis, Ayman; Khan, Zainab A; Hildrup, Iona; Emery, Simon J; Lucas, Malcolm G

    2016-04-01

    To assess the efficacy and morbidity of alkalinized lidocaine solution compared to lidocaine gel for intra-vesical anesthesia during botulinum toxin (BoNTA) injections in a statistically powered, prospective, parallel group, double-blind randomized controlled trial. Fifty-four patients of either sex were randomized to receive either alkalinized lidocaine (AL) solution (10 ml 8.4% sodium bicarbonate + 20 ml 2% lidocaine solution + 22 ml sterile Aquagel®) or lidocaine gel (LG) (22 ml standard 2% lidocaine gel Instillagel® + 30 ml 0.9% normal saline solution). Primary outcome was average pain (assessed by 100 mm visual analog score) felt during intra-vesical BoNTA injections performed at least 20 min after instillation. Secondary outcome was the rate of adverse events. Of 60 randomized patients 54 received the allocated intervention and were analyzed. Mean pain score in the AL group was 17.11 mm (95%CI 8.65-25.57 mm) and in the LG group was 19.53 mm (95%CI 13.03-26.03mm) with no significant difference between the groups. Cost of interventional medication in the AL group was almost double that of the LG group. No adverse events were attributable to local anesthetic instillation in either group. Alkalinized lidocaine solution is not superior to lidocaine gel for anesthesia during intra-vesical BoNTA injections, and the higher cost precludes its use over lidocaine gel at our centre. We have used the results of this study to adapt our local protocol for BoNTA injections and continue to use lidocaine gel as the local anesthetic of choice. Neurourol. Urodynam. 35:522-527, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

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

    OpenAIRE

    Lakshmana B Rao; Rajashekar Sangur; S Pradeep

    2011-01-01

    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 neurotra...

  5. Botulinum Toxin (Botox) for Facial Wrinkles

    Science.gov (United States)

    ... Eye Health / Eye Health A-Z Botulinum Toxin (Botox) for Facial Wrinkles Sections Botulinum Toxin (Botox) for ... How Does Botulinum Toxin (Botox) Work? Botulinum Toxin (Botox) for Facial Wrinkles Leer en Español: La toxina ...

  6. 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.

  7. Long-Term Effect of Botulinum Toxin in the Treatment of Benign Essential Blepharospasm and Hemifacial Spasm

    Directory of Open Access Journals (Sweden)

    Mehmet Orçun

    2015-01-01

    Full Text Available Objectives: In this study, we evaluated the long-term effects of botulinum toxin A (BTA in patients diagnosed with benign essential blepharospasm (BEB and hemifacial spasm (HFS comparing the drug dose in early and late periods and mean duration of relief. Materials and Methods: The records of patients who were treated with BTA for BEB and HFS were analyzed retrospectively. The patients who had <10 injections and did not attend the follow-up examinations were excluded from the study. The first and last 5 injection doses and the mean duration of relief in 12 patients were compared between the groups. Results: Of the 12 patients, 6 (4 females, 2 males had treatment for BEB and 6 (5 females, 1 male for HFS. The mean follow-up was 66.17 months for all patients, 51.83 months in the BEB group and 90.33 months in the HFS group. Average treatment dose was 40.79 U for BEB group and 29.07 U for HFS group. Mean duration of relief time was 16.1 weeks after the first 5 injections and 18.9 weeks after the last 5 injections (p=0.172. In HFS group, mean duration of relief time was 23.6 weeks after the first 5 injections and 23.0 weeks after the last 5 injections (p=0.463. In BEB group, mean duration of relief after the last 5 injections was increased by 2.7 weeks compared with the first 5 injections. Conclusion: BTA injection is a safe and effective method in the treatment of BEB and HFS. With similar injection doses in long-term, the mean duration of relief time after treatment was unchanged in the HFS group and was increased in the BEB group, although the difference was not statistically significant. (Turk J Ophthalmol 2015; 45: 9-13

  8. 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

  9. Botulinum toxin type A for the management of glabellar rhytids

    Directory of Open Access Journals (Sweden)

    Anne Marie Tremaine

    2010-04-01

    Full Text Available Anne Marie Tremaine, Jerry L McCulloughDepartment of Dermatology, University of California, Irvine, CA, USAAbstract: There is an increasing demand for minimally-invasive cosmetic procedures to arrest the aging process. Botulinum toxin type A injections are the most commonly used nonsurgical cosmetic procedures in the United States. There has been research spanning over two decades dedicated to safety, efficacy, dosing, and complications of botulinum toxin type A. There are now two Food and Drug Administration (FDA approved botulinum toxin type A options in the United States: Botox® and Dysport™, with new advances being made in the field.Keywords: botulinum toxin type A, glabella, Botox, Dysport, complications, dosing

  10. 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

  11. Botulinum Toxin in Parkinson Disease Tremor: A Randomized, Double-Blind, Placebo-Controlled Study With a Customized Injection Approach.

    Science.gov (United States)

    Mittal, Shivam Om; Machado, Duarte; Richardson, Diana; Dubey, Divyanshu; Jabbari, Bahman

    2017-09-01

    In essential tremor and Parkinson disease (PD) tremor, administration of onabotulinumtoxinA via a fixed injection approach improves the tremor, but many patients (30%-70%) develop moderate to severe hand weakness, limiting the use of onabotulinumtoxinA in clinical practice. To evaluate the safety and efficacy of incobotulinumtoxinA (IncoA) injection for the treatment of tremor in PD. In this double-blind, placebo-controlled, crossover trial, 30 patients each received 7 to 12 (mean, 9) IncoA injections into hand and forearm muscles using a customized approach. The study was performed from June 1, 2012, through June 30, 2015, and participants were followed for 24 weeks. Treatment efficacy was evaluated by the tremor subsets of the Unified Parkinson's Disease Rating Scale and the Patient Global Impression of Change 4 and 8 weeks after each of the 2 sets of treatments. Hand strength was assessed using an ergometer. There was a statistically significant improvement in clinical rating scores of rest tremor and tremor severity 4 and 8 weeks after the IncoA injection and of action/postural tremor at 8 weeks. There was a significant improvement in patient perception of improvement at 4 and 8 weeks in the IncoA group. There was no statistically significant difference in grip strength at 4 weeks between the 2 groups. Injection of IncoA via a customized approach improved PD tremor on a clinical scale and patient perception, with a low occurrence of significant hand weakness. clinicaltrials.gov Identifier: NCT02419313. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  12. Botulinum a toxin treatment of hemifacial spasm and blepharospasm.

    OpenAIRE

    Park, Y. C.; Lim, J. K.; Lee, D. K.; Yi, S. D.

    1993-01-01

    We studied the effects of botulinum A toxin in 101 patients with hemifacial spasm and 11 patients with blepharospasm in an open trial and double blind manner. All patients in the open trial and 6 patients in the double blind trial improved after the first injection of botulinum toxin. There was no improvement with placebo. The peak effect ranged from one to 6 days after injection and mean peak effect was 3.6 days in blepharospasm, and 4 days in hemifacial spasm. Of 144 treatments, 98.6% had e...

  13. 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.

  14. Botulinum toxin in poststroke spasticity.

    Science.gov (United States)

    Ozcakir, Suheda; Sivrioglu, Koncuy

    2007-06-01

    Poststroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Although most hemiparetic patients are able to reach different ambulatory levels with rehabilitation efforts, upper and lower limb spasticity can impede activities of daily living, personal hygiene, ambulation and, in some cases, functional improvement. The goals of spasticity management include increasing mobility and range of motion, attaining better hygiene, improving splint wear and other functional activities. Conservative measures, such as positioning, stretching and exercise are essential in spasticity management, but alone often are inadequate to effectively control it. Oral antispastic medications often provide limited effects with short duration and frequent unwanted systemic side effects, such as weakness, sedation and dry mouth. Therefore, neuromuscular blockade by local injections have become the first choice for the treatment of focal spasticity, particularly in stroke patients. Botulinum toxin (BTX), being one of the most potent biological toxins, acts by blocking neuromuscular transmission via inhibiting acetylcholine release. Currently, focal spasticity is being treated successfully with BTX via injecting in the spastic muscles. Two antigenically distinct serotypes of BTX are available on the market as type A and B. Clinical studies of BTX used for spastic hemiplegic patients are reviewed in this article in two major categories, upper and lower limb applications. This review addresses efficacy in terms of outcome measures, such as muscle tone reduction and functional outcome, as well as safety issues. Application modifications of dose, dilutions, site of injections and combination therapies with BTX injections are also discussed.

  15. 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.

  16. Application of Botulinum toxin type A: an arsenal in dentistry.

    Science.gov (United States)

    Rao, Lakshmana B; Sangur, Rajashekar; Pradeep, S

    2011-01-01

    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.

  17. Antispastic therapy with botulinum toxin type A in patients with traumatic spinal cord lesion

    OpenAIRE

    Spiegl, Ulrich J.; Maier, Doris; Gonschorek, Oliver; Heyde, Christoph-Eckhard; Bühren, Volker

    2014-01-01

    Objectives: The purpose of this study was to determine the effect of botulinum toxin injections for the treatment of spasticity after traumatic spinal cord injury. Methods: 9 patients were included in this prospective designed study, with a follow-up of at least 2 years. All patients suffered from a massive spasticity after traumatic spinal cord lesion. Conservative treatment options did not show satisfying results. All patients were injected a maximal dose of 2,000 units of botulinum tox...

  18. Botulinum toxin in children with cerebral palsy.

    Science.gov (United States)

    Singhi, Pratibha; Ray, Munni

    2004-12-01

    Botulinum toxin is a neurotoxin that blocks the synaptic release of acetylcholine from cholinergic nerve terminals mainly at the neuromuscular junction, resulting in irreversible loss of motor end plates. It is being widely tried as a targeted antispasticity treatment in children with cerebral palsy. A number of studies have shown that it reduces spasticity and increases the range of motion and is particularly useful in cases with dynamic contractures. However improvement in function has not been convincingly demonstrated. It is an expensive mode of therapy and the injections need to be repeated after 3-6 months. Whereas Botulinum toxin can be a valuable adjunct in select cases, it should not be projected as a panacea for children with spastic cerebral palsy.

  19. Botulinum toxin in cervical dystonia: low dosage with electromyographic guidance

    NARCIS (Netherlands)

    Brans, J. W.; de Boer, I. P.; Aramideh, M.; Ongerboer de Visser, B. W.; Speelman, J. D.

    1995-01-01

    Sixty patients with idiopathic cervical dystonia were treated a total of 240 times with botulinum toxin type A (BTA). Selected muscles were injected with BTA under electromyographic (EMG) guidance. The clinical effect was measured on the Tsui scale and a 10-point anchored visual analogue scale. A

  20. Computer-Assisted Communication Device for Botulinum-Intoxicated Patients

    Science.gov (United States)

    2008-01-01

    Souayah, N., Karim, H., Kamin, S.S., McArdle, J. and Marcus, S. (2006) ‘Severe botulism after focal injection of botulinum toxin’, Neurology , Vol...67, pp.1855–1856. Tacket, C.O., Shandera, W.X., Mann, J.M., Hargrett, N.T. and Blake, P.A. (1984) ‘ Equine antitoxin use and other factors that

  1. The use of Botulinum Toxin in Cosmetic Dermatology: Implications ...

    African Journals Online (AJOL)

    Botulinum toxin (BoNT) though a potentially lethal substance responsible for botulinism, it has however over the years found a place in cosmetic derrmatological procedures for the reduction of the tell tale signs of ageing. Locally injected BoNT has the capacity to spread to adjacent and distant tissues as well as systemic ...

  2. Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures.

    Science.gov (United States)

    Alter, Katharine E; Karp, Barbara I

    2017-12-28

    Injections of botulinum neurotoxins (BoNTs) are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US) based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

  3. Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures

    Directory of Open Access Journals (Sweden)

    Katharine E. Alter

    2017-12-01

    Full Text Available Injections of botulinum neurotoxins (BoNTs are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

  4. Botulinum neurotoxin serotype D is poorly effective in humans: an in vivo electrophysiological study.

    Science.gov (United States)

    Eleopra, Roberto; Montecucco, Cesare; Devigili, Grazia; Lettieri, Christian; Rinaldo, Sara; Verriello, Lorenzo; Pirazzini, Marco; Caccin, Paola; Rossetto, Ornella

    2013-05-01

    Botulinum neurotoxins act on nerve endings and block neurotransmitter release. Their potency is due to their enzymatic activity and high affinity binding to neurons. Botulinum toxin type A is used in the treatment of human diseases characterized by hyperactivity of peripheral cholinergic nerve terminals, but some patients are or become resistant to it. This can be overcome by using other botulinum toxins, and studies have been performed with different toxin serotypes. Botulinum neurotoxin type D has never been tested in humans in vivo, and, therefore, we investigated the action of this toxin in mouse and human muscles. Botulinum toxin type D potency was determined on mouse hemidiaphragm and on rat neuronal cultures. From these experiments, doses to be injected in human volunteers were decided. The compound muscle action potential of toxin-injected Extensor Digitorum Brevis muscle was measured at different times points after injection in human volunteers. Botulinum toxin type D is poorly effective in inducing human skeletal muscle paralysis. Botulinum toxin type D is very potent in mice and almost ineffective in humans in vivo. The results shed new light on the mechanism of toxin type D binding to the neuronal surface receptors. Copyright © 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Botulinum Toxin in Management of Limb Tremor

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    Elina Zakin

    2017-11-01

    Full Text Available Essential tremor is characterized by persistent, usually bilateral and symmetric, postural or kinetic activation of agonist and antagonist muscles involving either the distal or proximal upper extremity. Quality of life is often affected and one’s ability to perform daily tasks becomes impaired. Oral therapies, including propranolol and primidone, can be effective in the management of essential tremor, although adverse effects can limit their use and about 50% of individuals lack response to oral pharmacotherapy. Locally administered botulinum toxin injection has become increasingly useful in the management of essential tremor. Targeting of select muscles with botulinum toxin is an area of active research, and muscle selection has important implications for toxin dosing and functional outcomes. The use of anatomical landmarks with palpation, EMG guidance, electrical stimulation, and ultrasound has been studied as a technique for muscle localization in toxin injection. Earlier studies implemented a standard protocol for the injection of (predominantly wrist flexors and extensors using palpation and EMG guidance. Targeting of muscles by selection of specific activators of tremor (tailored to each patient using kinematic analysis might allow for improvement in efficacy, including functional outcomes. It is this individualized muscle selection and toxin dosing (requiring injection within various sites of a single muscle that has allowed for success in the management of tremors.

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

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    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.

  7. Botulinum toxin therapy of hemifacial spasm: comparing different therapeutic preparations.

    Science.gov (United States)

    Frei, K; Truong, D D; Dressler, D

    2006-02-01

    Hemifacial spasm (HFS) is characterized by involuntary irregular clonic or tonic movements of the muscles innervated by cranial nerve VII on one side of the face, and is most often a result of vascular compression of the facial nerve at the root exit zone (Muscle and Nerve 1998;21:1740). Disability associated with this disorder ranges from social embarrassment to interference with vision resulting from involuntary eye closure. Treatment of HFS most often involves botulinum toxin injections, but may also include medications and surgery. We describe treatment with the three types of botulinum toxin currently commercially available--Botox, Dysport and Myobloc/NeuroBloc.

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

    Science.gov (United States)

    Jhang, Jia-Fong; Kuo, Hann-Chorng

    2015-01-01

    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. PMID:26094697

  9. Serial Casting as an Adjunct to Botulinum Toxin Type A Treatment in Children With Cerebral Palsy and Spastic Paraparesis With Scissoring of the Lower Extremities.

    Science.gov (United States)

    Dai, Alper I; Demiryürek, Abdullah T

    2017-06-01

    The purpose of this study was to examine whether combination therapy of serial casting and botulinum toxin type A injection can further enhance the effects of botulinum toxin type A in children with cerebral palsy with scissoring of both legs. This study was a prospective and randomized trial. The children were divided into 2 groups, one of which received serial casting after botulinum toxin type A (n = 40), and the other which only received botulinum toxin type A (n = 40). Serial casting started 3 weeks after the botulinum toxin type A. Both groups received physiotherapy. Groups were assessed at baseline then compared at 6 and 12 weeks following the intervention. Significant improvements in Gross Motor Function Measure-66 and Caregiver Health Questionnaire were recorded in both groups ( P casting group ( P casting after botulinum toxin type A can enhance the benefits of botulinum toxin type A in children with cerebral palsy.

  10. 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

  11. Beyond Beauty : Botulinum Toxin Use in Anal Fissure.

    Science.gov (United States)

    Mehrotra, S

    2009-07-01

    Chronic fissure in ano is a common distressing problem with high recurrence rates. Any treatment modality should be simple, effective and reversible with no permanent sequelae. Long term medical management with poor compliance or surgical therapy with risk of incontinence are both less than ideal. In this scenario chemical sphincterotomy using Botulinum toxin offers an alternative modality. A total of 30 patients of chronic fissure in ano were treated with Botulinum toxin injection in the internal sphincter. All patients had significant symptomatic relief with high rates of fissure healing. The simplicity of administration, lack of complications and cost effectiveness make it a useful alternative to the currently practiced approaches. Botulinum toxin offers a simple outpatient treatment of chronic fissure in ano, which is safe, cost effective and reversible without significant complication. It has the potential of being used as a first line treatment in chronic fissure in ano.

  12. Efficacy of botulinum toxin in the treatment of intermittent exotropia.

    Science.gov (United States)

    Etezad Razavi, Mohammad; Sharifi, Mohammad; Armanfar, Fateme

    2014-12-01

    Multiple surgical interventions are burden to patients with intermittent exotropia (IXT) due to a high recurrence rate. This study was designed to evaluate the efficacy of botulinum toxin injection in the treatment of intermittent exotropia (IXT). A total of 21 patients with IXT, who had a far deviation of less than 40 prism diopters (PD), were enrolled. All cases were followed for at least 6 months with non-surgical management and had decremented fusional control (increasing 3 or more scores in Newcastle Control Score [NCS]). Botulinum toxin was injected (10 units Dysport) to both lateral rectus muscles. Fusional control, sensory and motor status were evaluated at 1 day, 1 week, and 1, 3, and 6 months after injection to compare with the pre-injection values. Fusional control (based on NCS) showed a significant improvement during 6-month follow-up. Mean NCS was 4.4±0.8 SD before botulinum toxin injection and 1.4±0.4 SD after 6 months (psensorial status with Worth Four Dot Test (WFDT) also demonstrated an improvement of fusion (the percentage of patients demonstrating fusion on WFDT were 10.5% before injection and 61.5% after 6 months). The mean far and near deviations decreased during 6 months of follow-up examination. Satisfactory outcome (stable binocular alignment of the eyes to an orthophoria+/-10 PD in primary position) for far distance was achieved in 38.1% at 6 months. The percentage of satisfactory outcome at near was 86% at 6 months follow-up examination. Botulinum toxin injection to lateral rectus muscles seems to be a promising procedure in the management of fusional control, far and near deviations in patients with intermittent exotropia in short time.

  13. Botulinum toxin for treatment of blepharospasm and hemifacial spasm

    Directory of Open Access Journals (Sweden)

    Soltanzadeh A

    1997-04-01

    Full Text Available Botulinum toxin produced by Clostridium butolinum in one of the most fatal toxins known. Botulism is the name given to condition produced by this toxin. In recent years the diluted form of this toxin has been produced in injection form and used for treatment of hemifacial spasm and blepharospasm. This toxin blocks neuromuscular junction and inhibits acetylcholine release. In this article we reported 36 patients suffering from hemifacial & blepharospasm treated by injections of botulinum A toxin. 85 to 90 percent of patients responded well. The common complications of this drug were ptosis, hemifacial paresis, burning of the mouth and discoloration of the injection site. Generally speaking the patients preferred this toxin to taking oral medications which were less effective.

  14. Botulinum toxin in the treatment of refractory vaginismus.

    Science.gov (United States)

    Ghazizadeh, Shirin; Nikzad, Masoomeh

    2004-11-01

    To investigate the efficacy of botulinum toxin injection to treat women with moderate and severe vaginismus. Twenty-four women referred to our clinic from February 2002 to February 2004 (mean age 25 years; range 19-34 years) with third- to fourth-degree vaginismus were recruited for this study. These women had previous unsuccessful treatments. Botulinum toxin (150-400 mIU) was injected into the puborectalis muscles in 3 sites on each side of the vagina. Twenty-three patients (95.8%) had vaginal examinations 1 week postoperatively that showed little or no vaginismus, 18 (75%) achieved satisfactory intercourse after the first injection, 4 (16.7%) had mild pain, 1 was cured after a second injection, 1 patient refused vaginal examination and did not attempt to have coitus, and another had no coitus as a result of her husband's secondary impotence. The women were followed up for a mean of 12.3 months (range 2-24 months), and there were no cases of recurrence. In refractory cases of vaginismus when conventional therapies have failed, local injection of botulinum toxin can be considered. III.

  15. Intraluminal Administration of Resiniferatoxin Protects against Clostridium difficile Toxin A-Induced Colitis

    Directory of Open Access Journals (Sweden)

    Steven R. Vigna

    2017-01-01

    Full Text Available Clostridium difficile toxin A is a colonic inflammatory agent that acts partially by activation of TRPV1 (transient receptor potential vanilloid type 1. Resiniferatoxin (RTX is an excitotoxin that activates TRPV1 at low concentrations and defunctionalizes TRPV1 at high concentrations. RTX at various doses was injected intraluminally into isolated ileal segments in anesthetized rats. After 3 hours, the treated segments were removed and inflammation was assessed. This acute treatment with RTX resulted in biphasic responses: (1 an increase in inflammation similar to that caused by toxin A and capsaicin at low doses of up to 100 ng RTX and (2 no inflammatory effect of RTX at higher doses (1–100 μg, consistent with a defunctionalizing or neurotoxic effect of RTX at high doses. Separately, anesthetized rats were treated with RTX enemas and one or four weeks later were challenged with toxin A. Toxin A-induced colitis was significantly inhibited one week after an RTX enema, and this effect was RTX dose dependent. When tested four weeks after administration of the RTX enema, protection against toxin A colitis was lost. In conclusion, an RTX enema protects against toxin A-induced colitis in rats for at least one week but less than four weeks.

  16. Botulinum toxin in the management of lower urinary tract dysfunction: contemporary update.

    Science.gov (United States)

    Cruz, Francisco; Silva, Carlos

    2004-11-01

    To review the most recent experience concerning the application of botulinum toxin in the human lower urinary tract. Botulinum toxin was initially applied in the bladder of patients with spinal neurogenic detrusor overactivity and urinary incontinence, or in the urethra in cases of detrusor external sphincter dyssynergia. A large multicentric European study fully confirmed the initial expectancy in the former condition. In addition, the application of botulinum toxin was extended to the treatment of other urological disorders including non-neurogenic detrusor overactivity, non-relaxing urethral sphincter and detrusor underactivity. Interesting reports on the injection of botulinum toxin into the prostate of patients with benign prostatic hyperplasia are also reviewed. Bladder injection of botulinum toxin is not yet an approved treatment for lower urinary tract dysfunction. Nevertheless, available data suggest that in the near future the toxin will become a standard therapeutic option in incontinent patients with neurogenic and non-neurogenic forms of overactive bladder, who do not respond to or do not tolerate anticholinergic medication. In addition, it might be expected that urethral botulinum toxin injections improve bladder emptying in patients with dysfunctional voiding problems besides detrusor external sphincter dyssynergia.

  17. [Safety and efficacy of botulinum toxin in hemifacial spasm].

    Science.gov (United States)

    Mazlout, H; Kamoun Gargouri, H; Triki, W; Kéfi, S; Brour, J; El Afrit, M A; Chéour, M; Kraiem, A

    2013-03-01

    Given the failure of pharmacologic and surgical treatment in the management of hemifacial spasm, the use of botulinum toxin as first line therapy is interesting. To evaluate the safety and efficacy of type A botulinum toxin in the treatment of hemifacial spasm. We conducted a retrospective, descriptive and comparative study of 25 patients with hemifacial spasm followed in the ophthalmology department of Habib Thameur hospital in Tunis over the period from June 2003 to June 2009. All patients received injections of botulinum toxin type A (Botox). We carried out 168 Botulinum A toxin injections (Botox) with an average of 6.85 ± 4.32 injections per patient. Doses varied between 12.5 U and 28 U Botox. A good response to treatment was observed in 92% of patients with a satisfactory return to daily activities and work. Based on a subjective scale from 1 to 3, the average total functional benefit was 2.55 ± 0.56. Average total duration of therapeutic response was 9.35 ± 3.64 weeks. Local side effects observed were comparable to those described in the literature: ptosis (32.4%), diplopia (8.2%), drooping of the labial commissure (11.2%), lagophthalmos (21.3%), tearing (7%), dry eye (4%). No systemic complication was noted. Botulinum toxin type A provides effective short-term and medium-term results in the treatment of hemifacial spasm. It is well tolerated locally and systemically. This safety and efficacy make it a valuable therapeutic alternative in the management of hemifacial spasm. Copyright © 2012. Published by Elsevier Masson SAS.

  18. Successful use of botulinum toxin type a in the treatment of refractory postoperative dyspareunia.

    Science.gov (United States)

    Park, Amy J; Paraiso, Marie Fidela R

    2009-08-01

    Refractory dyspareunia presents a challenging therapeutic dilemma. A woman with defecatory dysfunction and dyspareunia presented with stage 2 prolapse. She underwent laparoscopic and vaginal pelvic floor reconstruction with excision of endometriosis. The patient experienced increased dyspareunia and de novo vaginismus postoperatively that were refractory to trigger point injections, physical therapy, and medical and surgical management. She underwent botulinum toxin type A injections into her levator ani muscles, which allowed her to have sexual intercourse again after 2 years of apareunia with no recurrence of pain for 12 months. Injecting botulinum toxin into the levator ani muscles shows promise for postoperative patients who develop vaginismus and do not respond to conservative therapy.

  19. 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.

  20. 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

  1. 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.

  2. Treatment diary for botulinum toxin spasticity treatment

    DEFF Research Database (Denmark)

    Biering-Sørensen, Bo; Iversen, Helle K; Frederiksen, Inge M S

    2017-01-01

    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...

  3. Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON§ Project

    Science.gov (United States)

    Peloso, Paul M; Khan, Mahweesh; Gross, Anita R; Carlesso, Lisa; Santaguida, Lina; Lowcock, Janet; MacDermid, Joy C; Walton, Dave; Goldsmith, Charlie H; Langevin, Pierre; Shi, Qiyun

    2013-01-01

    Objectives: To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain. Search Strategy: Computerized databases and grey literature were searched from 2006 to 2012. Selection Criteria: Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review. Main Results: We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of: a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; andno long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability; Reviewers' Conclusions: While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain. PMID:24155805

  4. Botulinum toxin treatment of lower extremity spasticity

    Directory of Open Access Journals (Sweden)

    S. E. Khat’kova

    2017-01-01

    Full Text Available The article reviews the current concept of lower extremity spasticity, which is a frequent disabling consequence of stroke. Gait biomechanics, step cycle and main pathologic patterns of lower extremity are described (hip adduction, knee flexion, knee extension, foot plantar flexion, equinovarus foot position, toes flexion, hallux extension, including muscles involved in the pathological process. Additionally the article contains detailed information on pathologic principles of lower extremity spasticity development. Special focus is given to sarcomeregenesis as an essential element of the development of potential conditions for muscle tissue adaptation to a new state and restoration of muscle length and strength. At present Botulinum toxin A (BTA is used in a complex spasticity management programs. The results of clinical studies performed in the last decade supporting the efficacy of Botox® (Onabotulinumtoxin A in the treatment of spasticity are reviewed. Effective BTA doses are proposed. Authors came to the conclusion that BTA as a part of complex rehabilitation in patients with poststroke spasticity of lower extremity promotes treatment efficacy due to a decrease of muscle tone and increase of range of movements in the joints. BTA should be regarded as an essential part of standard rehabilitation programs. Further studies to define optimal muscles for intervention, BTA doses and rehabilitation schemes are still needed. 

  5. Childhood-onset hemifacial spasm: successful treatment with botulinum toxin.

    Science.gov (United States)

    Singer, Carlos; Papapetropoulos, Spiridon; Farronay, Oscar

    2005-09-01

    Hemifacial spasm is a disorder characterized by involuntary contractions of muscles innervated by the ipsilateral facial nerve. The majority of cases are of adult-onset. However, a few cases have been described in children. Detectable causes of pediatric hemifacial spasm include facial nerve compression by vasculature and brainstem masses. In the treatment of hemifacial spasm, surgical decompression of the facial nerve has been used with good results in both adults and children. However, surgical procedures have serious risks and should be used only in selected cases. Although injections of botulinum toxin type A have been successfully used in adult hemifacial spasm patients, to our knowledge there is no report of use of this indication in children. This report presents the first case of a pediatric patient with childhood-onset hemifacial spasm successfully treated with periorbital botulinum toxin injections. The literature on the subject is also reviewed.

  6. 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.

  7. Efficacy of botulinum toxins on bruxism: an evidence-based review.

    Science.gov (United States)

    Long, Hu; Liao, Zhengyu; Wang, Yan; Liao, Lina; Lai, Wenli

    2012-02-01

    The objective of this study was to assess the efficacy of botulinum toxins on bruxism. Electronic databases (PubMed, Embase and Science Citation Index), websites (Cochrane Central Register of Controlled Trials and ClinicalTrials.gov) and the literature database of SIGLE (System for Information on Grey Literature in Europe) were searched from January 1990 to April 2011 for randomised controlled trials or nonrandomised studies assessing the efficacy of botulinum toxins on bruxism. There was no language restriction. Through a predefined search strategy, we retrieved 28 studies from PubMed, 94 from Embase, 60 from the Science Citation Index, two ongoing clinical trials and two from the Cochrane Central Register of Controlled Trials. Of these, only four studies met our inclusion criteria and were finally included. Of the four included studies, two were randomised controlled trials and two were controlled before-and-after studies. These studies showed that botulinum toxin injections can reduce the frequency of bruxism events, decrease bruxism-induced pain levels and satisfy patients' self-assessment with regard to the effectiveness of botulinum toxins on bruxism. In comparison with oral splint, botulinum toxins are equally effective on bruxism. Furthermore, botulinum toxin injections at a dosage of bruxism and are safe to use. Therefore, they can be used clinically for otherwise healthy patients with bruxism. © 2012 FDI World Dental Federation.

  8. Botulinum neurotoxin C mutants reveal different effects of syntaxin or SNAP-25 proteolysis on neuromuscular transmission.

    Science.gov (United States)

    Zanetti, Giulia; Sikorra, Stefan; Rummel, Andreas; Krez, Nadja; Duregotti, Elisa; Negro, Samuele; Henke, Tina; Rossetto, Ornella; Binz, Thomas; Pirazzini, Marco

    2017-08-01

    Botulinum neurotoxin serotype C (BoNT/C) is a neuroparalytic toxin associated with outbreaks of animal botulism, particularly in birds, and is the only BoNT known to cleave two different SNARE proteins, SNAP-25 and syntaxin. BoNT/C was shown to be a good substitute for BoNT/A1 in human dystonia therapy because of its long lasting effects and absence of neuromuscular damage. Two triple mutants of BoNT/C, namely BoNT/C S51T/R52N/N53P (BoNT/C α-51) and BoNT/C L200W/M221W/I226W (BoNT/C α-3W), were recently reported to selectively cleave syntaxin and have been used here to evaluate the individual contribution of SNAP-25 and syntaxin cleavage to the effect of BoNT/C in vivo. Although BoNT/C α-51 and BoNT/C α-3W toxins cleave syntaxin with similar efficiency, we unexpectedly found also cleavage of SNAP-25, although to a lesser extent than wild type BoNT/C. Interestingly, the BoNT/C mutants exhibit reduced lethality compared to wild type toxin, a result that correlated with their residual activity against SNAP-25. In spite of this, a local injection of BoNT/C α-51 persistently impairs neuromuscular junction activity. This is due to an initial phase in which SNAP-25 cleavage causes a complete blockade of neurotransmission, and to a second phase of incomplete impairment ascribable to syntaxin cleavage. Together, these results indicate that neuroparalysis of BoNT/C at the neuromuscular junction is due to SNAP-25 cleavage, while the proteolysis of syntaxin provides a substantial, but incomplete, neuromuscular impairment. In light of this evidence, we discuss a possible clinical use of BoNT/C α-51 as a botulinum neurotoxin endowed with a wide safety margin and a long lasting effect.

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

    Science.gov (United States)

    Meijer, Jan-Willem G; van Kuijk, Annet A; Geurts, Alexander C H; Schelhaas, H Jurgen; Zwarts, Machiel J

    2008-04-01

    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 literature. A 64-yr-old woman with bulbar ALS for 6 mos was treated for disabling sialorrhoea. She had moderate dysphagia, but she was able to swallow. The submandibular and parotid glands were injected transcutaneously, under ultrasound guidance, with botulinum toxin (Dysport), 80 U on each side. Four days later, her bulbar function rapidly deteriorated, resulting in complete aphagia and anarthria on the fifth day. A PEG catheter was placed. Although according to the literature this treatment can be made safer by cautiously increasing the dosage and injecting the parotid glands first, BTX should not be the first-line treatment of sialorrhoea in ALS; comparative studies of BTX, amitryptiline, scopolamine, and radiation should be performed first.

  10. Phospholipase A2(PLA2) Regulates Neuroexocytosis to Counteract Botulinum Toxin A (BONT/A) Poisoning

    National Research Council Canada - National Science Library

    Zhang, Xieping; Ishida, Hiroshi; Ray, Prabhati

    2003-01-01

    ...) release is associated with acetylcholine (ACh) release and BoNT/A inhibits both. We report the effect of PLA2 over expression on inhibition of ACh exocytosis due to BoNT/A light chain (LC) in PC12 cells...

  11. Successful treatment of a postpolio tinnitus with type a botulinum toxin.

    Science.gov (United States)

    Scolozzi, Paolo; Carrera, Emmanuel; Jaques, Bertrand; Kuntzer, Thierry

    2005-07-01

    Objective tinnitus is a symptom often observed in patients with chronic hyperactivity of masticatory muscles. We report here the unusual case of a 63-year-old woman who developed a distressing tinnitus related to contractions of reinnervated masticatory muscles. This reinnervation process was caused by a postpolio syndrome that gave rise to an acoustic resonance phenomenon transmitted to the middle ear as an audible sound. The tinnitus was successfully treated with electromyography-guided intramuscular injections of type A botulinum toxin. The intramuscular injection of botulinum toxin was found to be effective in relieving severe and disabling postpolio tinnitus.

  12. Abobotulinum Toxin A in the Treatment of Chronic Low Back Pain.

    Science.gov (United States)

    Machado, Duarte; Kumar, Aditya; Jabbari, Bahman

    2016-12-15

    Chronic low back pain is a debilitating condition with a complex and multifactorial pathophysiology. Botulinum neurotoxins (BoNTs) have strong analgesic effects, as shown in both animal models of pain and in human beings. A randomized, double-blind, placebo-controlled, parallel format study to investigate the efficacy of abobotulinum toxin A (aboA) in chronic low back pain was conducted. The study cohort consisted of 18 patients who received 100 units of aboA into each of the five lumbar extensor spinae muscles unilaterally or bilaterally (total dose 500 to 1000 units), and 19 who received normal saline of the same volume. The level of pain and quality of life were assessed using the visual analogue scale (VAS) and three questionnaires including the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ). Patients' perception of improvement was recorded via patient global impression of change (PGIC). The primary outcome measure, the proportion of responders with VAS of low back pain as "much improved" in the abobotulinum toxin A group (0.0293).

  13. Botulinum neurotoxin type A in the treatment of classical Trigeminal Neuralgia (BoTN): study protocol for a randomized controlled trial

    National Research Council Canada - National Science Library

    Burmeister, Jan; Holle, Dagny; Bock, Eva; Ose, Claudia; Diener, Hans-Christoph; Obermann, Mark

    2015-01-01

    .... This is the study protocol of a prospective, placebo-controlled, double blind clinical trial investigating the add-on therapy of subcutaneous administration of botulinum toxin type A injections...

  14. 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.

  15. [Therapy of Hemifacial Spasm with Botulinum Toxin].

    Science.gov (United States)

    Jost, Wolfgang H; Laskawi, Rainer; Palmowski-Wolfe, Anja; Urban, Peter P

    2017-04-01

    Hemifacial spasm (HFS) is a frequent disorder characterized by involuntary contractions of those muscles innervated by the facialis nerve on one side of the face. The symptoms can appear as tonic or clonic, intermittent or permanent. Diagnosis is based purely on clinical observation. Differential diagnosis should rely on cranial MRI, which can demonstrate a pathological contact between the nerves and vessels and exclude alternative causation. Often, the symptoms are not marked so that therapy may not be necessary. The therapy of choice is an injection of botulinum toxin to reduce the underlying pathological activity. As an alternative, decompression operation according to Jannetta can be considered, although it is frequently rejected by patients. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Botulinum a toxin treatment of hemifacial spasm and blepharospasm.

    Science.gov (United States)

    Park, Y. C.; Lim, J. K.; Lee, D. K.; Yi, S. D.

    1993-01-01

    We studied the effects of botulinum A toxin in 101 patients with hemifacial spasm and 11 patients with blepharospasm in an open trial and double blind manner. All patients in the open trial and 6 patients in the double blind trial improved after the first injection of botulinum toxin. There was no improvement with placebo. The peak effect ranged from one to 6 days after injection and mean peak effect was 3.6 days in blepharospasm, and 4 days in hemifacial spasm. Of 144 treatments, 98.6% had excellent results, (below grade I). The duration of beneficial effect ranged 11 to 40 weeks (mean 16.5 weeks) in hemifacial spasm and 9 to 30 weeks (mean 14.2 weeks) in blepharospasm. Complications were encountered in 63.4% in hemifacial spasm and 72.7% in blepharospasm. The common side effects were dry eyes, mouth droop, ptosis and lid edema in order of frequency. These side effects were mild and resolved spontaneously in 1 to 3 weeks. Botulinum A toxin therapy is effective and convenient, and the treatment of choice for patients with hemifacial spasm and blepharospasm. PMID:8305141

  17. Botulinum toxin type A as treatment of partially accommodative esotropia.

    Science.gov (United States)

    Flores-Reyes, E M; Castillo-López, M G; Toledo-Silva, R; Vargas-Ortega, J; Murillo-Correa, C E; Aguilar-Ruiz, A

    2016-03-01

    To determine the effectiveness of a botulinum toxin type A injection in both medial rectus muscles in patients with partially accommodative esotropia. Residual deviation and stability of strabismus were evaluated at 18 months follow up. A prospective, analytical, quasi-experimental study was conducted on a cohort of 21 patients who underwent total cycloplegic refraction and with a residual deviation of at least 14 DP. A botulinum toxin type A dose of 5 IU was injected into each medial rectus muscle for a residual deviation greater than 18 DP, with a dose of 2.5 IU being used for a deviation between 14 and 18 DP. Multivariate logistic regression analyses were performed to relate residual deviation to variables recorded as potential predictors. A total of 21 patients were included, 33.3% (n=7) males and 66.6% (n=14) females. Mean visual acuity was -.28±.25 logMAR for right eye (range 0 to -1) and -.42±.31 logMAR for left eye (range 0 to -1.3). Mean angle of residual deviation before application of botulinum toxin was 40.95±8.6DP without spectacles correction, and 22.3±7.99 DP with full cycloplegic refraction. Adverse effects were ptosis in 14.2% (n=3), diplopia 23.8% (n=5), and vertical deviation in 33% (n=7). One patient had a poor outcome, therefore required surgical treatment. At one year follow up, 85.71% of patients showed good results with esotropia of 12 DP or less, dropping to 71.43% at 18 months of follow up. Botulinum toxin type A is an effective long-term treatment with a good response in 71.43% of patients. No predictors of good response were demonstrated. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Botulinum toxin for myofascial pain syndromes in adults.

    Science.gov (United States)

    Soares, Adriana; Andriolo, Régis B; Atallah, Alvaro N; da Silva, Edina M K

    2014-07-25

    This is an updated version of the original Cochrane review published in Issue 4, 2012. Myofascial pain syndrome (MPS) is a regional muscular pain syndrome characterised by the presence of trigger points, which are painful points in one or more muscles. The pain can be felt at the site where the trigger point is located or it can be felt away from that place when the muscle is pressed (referred pain). Botulinum toxin is a protein produced by the bacterium Clostridium botulinum and is a potent neurotoxin that eventually inhibits muscle contractions. It is capable of selectively weakening painful muscles and interrupting the pain cycle. To assess the effectiveness and safety of botulinum toxin A (BTXA) in the treatment of myofascial pain syndrome (MPS), excluding MPS in neck and head muscles. This is an updated version of the original Cochrane review published in Issue 4, 2012. The search strategy for the update was the same as in the original review and we searched CENTRAL in The Cochrane Library (2013, Issue 11 of 12), MEDLINE (Ovid) (2012 to 29 November 2013) and EMBASE (Ovid) (2012 to 27 November 2013). The search strategy was composed of terms for myofascial pain and botulinum toxin. For the original review, we also searched the Cochrane Pain, Palliative and Supportive Care (PaPaS) Review Group Specialised Register until December 2011, PubMed (from 1966 to 2011) and LILACS (from 1982 to 2011). There was no language restriction. We included randomised controlled trials (RCTs) involving botulinum toxin for treating participants with MPS. We excluded studies with MPS of the neck and head from this review as they have already been assessed in existing systematic reviews. We considered a diagnosis of MPS to be based on the identification of trigger points in the taut band through palpation of sensitive nodules, local twitch response and specific patterns of referred pain associated with each trigger point. Two review authors independently screened identified studies

  19. Treatment of Plantar Fasciitis With Botulinum Toxin.

    Science.gov (United States)

    Ahmad, Jamal; Ahmad, Stacy H; Jones, Kennis

    2017-01-01

    This study examined the effect of botulinum toxin upon plantar fasciitis through a randomized, controlled, and blinded trial. Between 2012 and 2015, 50 patients presented with plantar fasciitis. Twenty-five patients each randomly received an IncobotulinumtoxinA (IBTA) or saline injection of their affected foot. Pre- and postinjection function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. All 50 study patients who randomly received either placebo or IBTA presented at 6 and 12 months after injection. At 6 months, the mean FAAM increased from 35.9 to 40.9 of 100, and the mean pain score decreased from 8.4 to 7.9 of 10 within the placebo group. At 6 months, the mean FAAM increased from 36.3 to 73.8 of 100, and mean pain score decreased from 7.2 to 3.6 of 10 within the IBTA group. These postinjection scores were significantly better than the placebo group ( P = .01). At 12 months after injection, the IBTA group maintained significantly better function and pain than the placebo group ( P plantar fasciitis ( P plantar fasciitis resulted in significantly better improvement in foot function and pain. IBTA also lessened the need for operative treatment of plantar fasciitis. I, Randomized, double-blinded, placebo-controlled study.

  20. The innovative therapeutic application of botulinum toxin type A in urology patients

    Directory of Open Access Journals (Sweden)

    Chrysoula Belai

    2016-06-01

    Full Text Available In the history of medical science the use of botulinum toxin was impressive. In the early 18th century it was defined as the neurotoxin implicated in the deadly disease botulism. Today, despite the toxic action finds application in the treatment of various diseases in a wide range of Medicine. Its use in urology was revolutionary in the treatment of neurogenic bladder, refractory idiopathic detrusor overactivity and other painful syndromes. The purpose of this review was to describe the treatment option of intravesical injection of botulinum toxin, in diseases of the urinary tract. The review showed that after many test applications under the experimental studies, the botulinum toxin type A has already established itself as the new treatment of choice after failure of conservative drug dealing in patients with neuro-urological symptoms of lower urinary tract. Cases of application of botulinum toxin in Urology are related to overactive bladder, neurogenic or idiopathic etiology, as bladder pain syndrome and chronic pelvic pain syndrome. According to the guidelines of the European Union directives Urology, the intravesical botulinum toxin injections are the most effective, minimally invasive treatment which results in reducing neurogenic hyperactivity of detrusor. In conclusion, this is a safe, easy and effective method that can be applied by health professionals, helping improve patients’ quality of life with neuro-urological diseases.

  1. A pilot study to evaluate effectiveness of botulinum toxin in treatment of androgenetic alopecia in males

    Directory of Open Access Journals (Sweden)

    Sehdev Singh

    2017-01-01

    Full Text Available Introduction: Androgenetic alopecia is a common form of alopecia with multifactorial etiology. Finasteride and minoxidil are approved by the FDA for the treatment of androgenetic alopecia. Balding scalp is believed to have relative microvascular insufficiency. Blood vessels in the scalp travel through the intramuscular plane. Intramuscular injection of botulinum toxin relaxes muscles and thereby increases blood flow in balding scalp. We conducted a pilot study to evaluate the efficacy of botulinum toxin in androgenetic alopecia management. Material and Methods: The study was conducted in a tertiary care center. A total of 10 male patients with androgenetic alopecia meeting inclusion criteria of the study were included. In the scalp, 30 sites were injected with 5 U of botulinum toxin in each site. Preprocedure photograph taken and evaluation was done, which was repeated after 24 weeks. Efficacy was assessed by photography and self-assessment scoring was done by patients. Results: Of 10 patients, 8 had good to excellent response on photographic assessment. At the end of 24 weeks, 1 patient showed poor and 1 showed fair response to treatment. As per self-assessment, 7of 10 patients showed good to excellent response. Two patients had fair response and 1 patient showed poor response to treatment. Conclusion: Botulinum toxin was found to be safe and effective therapy for the management of androgenetic alopecia in this pilot study. Studies with larger sample size and randomized controlled trials are required to establish the role of botulinum toxin in the management of androgenetic alopecia.

  2. Validation of a new photogrammetric technique to monitor the treatment effect of Botulinum toxin in synkinesis.

    Science.gov (United States)

    Mabvuure, N T; Hallam, M-J; Venables, V; Nduka, C

    2013-07-01

    To validate a new photogrammetric technique for quantifying eye surface area and using this to quantify the degree of improvement in symmetry in patients with oral-ocular synkinesis following Botulinum toxin injection. Feasibility study and retrospective outcomes analysis Ten patients' photographs were chosen from a photographic database. Their eye surface areas were measured independently by two raters using a graphics tablet. One rater repeated the procedure after 15 days. Bland-Altman plots were computed, ascertaining inter-rater and intra-rater variability. The eye surface areas of 19 patients were then derived from photographs taken before and after Botulinum toxin injections. Paired t-tests were used to analyse the significance of the difference in pre- and post-treatment symmetry. Ninety per cent of eye surface areas derived from the two raters were within a coefficient of variation of 0.1 (95% CI: 0.05-0.15). Similarly, 90% of eye surface areas derived from one rater had a coefficient of variation of 0.08 (95% CI: 0.04-0.12). Botulinum toxin significantly reduced synkinesis resulting from lip puckering, Mona Lisa smiling and Hollywood smiling (P<0.05). We have proposed a clinically valid tool for quantifying the effects of Botulinum toxin treatment for oral-ocular synkinesis. We recommend this method be used to monitor the response of such patients when receiving Botulinum toxin treatment.

  3. [Treatment of blepharospasm, hemifacial spasm and facial synkinesis with botulinum toxin].

    Science.gov (United States)

    Winterhoff, J; Laskawi, R

    2012-06-01

    Involuntary facial movements are caused by various diseases. This article describes three of these diseases: blepharospasm, hemifacial spasm and facial synkinesis following facial nerve paralysis. The different etiologies, clinical symptoms and diagnosis are discussed. A common therapeutic approach for these three diseases is presented. Involuntary facial movements can be reduced or even completely suppressed by local injections of botulinum toxin.

  4. 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.

  5. 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

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

    NARCIS (Netherlands)

    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

  7. Botulinum toxin for vaginismus treatment.

    Science.gov (United States)

    Ferreira, Juliana Rocha; Souza, Renan Pedra

    2012-01-01

    Vaginismus is characterized by recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when penile, finger, tampon, or speculum penetration is attempted. Recent results have suggested the use of botulinum toxin for the treatment of vaginismus. Here, we assessed previously published data to evaluate the therapeutic effectiveness of botulinum toxin for vaginismus. We have carried out a systematic review followed by a meta-analysis. Our results indicate that botulinum toxin is an effective therapeutic option for patients with vaginismus (pooled odds ratio of 8.723 with 95% confidence interval limits of 1.942 and 39.162, p = 0.005). This may hold particularly true in treatment-refractory patients because most of the studies included in this meta-analysis have enrolled these subjects in their primary analysis. Botulinum toxin appears to bea reasonable intervention for vaginismus. However, this conclusion should be read carefully because of the deficiency of placebo-controlled randomized clinical trials and the quality issues presented in the existing ones.

  8. Hemicrania continua responsive to botulinum toxin type a: a case report.

    Science.gov (United States)

    Khalil, Modar; Ahmed, Fayyaz

    2013-05-01

    Hemicrania continua (HC) is a primary headache disorder with full response to indomethacin as one of its diagnostic criteria; however, indomethacin's side effects could limit its use in HC. We report a 33-year-old lady whose headache fulfilled the criteria for HC, but the patient developed gastric side effect to indomethacin and did not respond to other pharmacological treatments; however, injecting botulinum toxin type A has led to complete resolution of all of her symptoms. We hypothesize the mechanism by which botulinum toxin type A has led to our results through reviewing recent functional neuroimaging findings used to understand the pathophysiology of different primary headache disorders. © 2013 American Headache Society.

  9. 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.

  10. Pain in Parkinson's Disease

    Science.gov (United States)

    ... it is working well. Botulinum injections ( Botox The brand name for botulinum toxin A, a neurotoxin that ... help - more than ever - in helping us raise awareness to beat Parkinson's disease and ensuring a better ...

  11. 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.

  12. Prospective, randomized, double-blind study, comparing botulinum toxins type a botox and prosigne for blepharospasm and hemifacial spasm treatment.

    Science.gov (United States)

    Quagliato, Elizabeth Maria Aparecida Barasnevicius; Carelli, Edmur Franco; Viana, Maura Aparecida

    2010-01-01

    Botulinum toxin A (BTA) is considered an effective treatment of blepharospasm and hemifacial spasm, but there are few studies to permit a comparison of its different formulations. This prospective, randomized, double-blind study compared Prosigne, a BTA of Chinese origin, with Botox to establish safety, efficacy, and equivalence of doses between those 2 formulations in blepharospasm and hemifacial spasm treatment. Fifty-seven patients participated in this study: 21 blepharospasm (from whom 11 were treated with Botox; and 10, with Prosigne) and 36 hemifacial spasm patients (17 were treated with Botox; and 19, with Prosigne). All patients were similar in age, disease time span, number of previous shots, and time elapsed since the last BTA application. Pain and burning during the injection and the result of the treatment were similar in both groups. There were no systemic adverse events, and the local ones were observed with similar intensity and frequency for both groups. The mean effect time length was similar for both blepharospasm (11.3 weeks for both toxins) and hemifacial spasm patients (12.8 weeks for Botox and 12.9 weeks for Prosigne). In both blepharospasm groups, only the 36-Item Short-Form Health Survey emotional aspects domain showed improvement from baseline after 16 weeks. There were no differences between the 36-Item Short-Form Health Survey scores before and after the treatment of all hemifacial spasm patients. Therefore, it has been concluded that Botox and Prosigne have similar efficacy, safety, and tolerability profiles, so that a dose equivalence of 1:1 may be considered for blepharospasm and hemifacial spasm treatments.

  13. Comparative effectiveness of propranolol and botulinum for the treatment of essential voice tremor.

    Science.gov (United States)

    Justicz, Natalie; Hapner, Edie R; Josephs, Joshua S; Boone, Benjamin C; Jinnah, Hyder A; Johns, Michael M

    2016-01-01

    To assess the comparative effectiveness of botulinum toxin and propranolol in patients with essential vocal tremor (EVT). Individual prospective cohort study. Study patients were recruited at the Emory Voice Center from patients seeking treatment for EVT. Exclusion criteria included current β-blocker treatment, spasmodic dysphonia, or other disease that prevented the use of propranolol therapy. A 10-week washout period from prior botulinum toxin treatment occurred before enrollment. Patients were assessed via the Voice-Related Quality-Of-Life (VRQOL) questionnaire, Quality of life in Essential Tremor questionnaire, and blinded perceptual voice assessment. These assessments were made at baseline voice 2 weeks after propranolol therapy and 4 weeks after botulinum toxin injection. Eighteen patients were enrolled. After 2 to 4 weeks of propranolol therapy (with a maximum dosage of 60 mg to 90 mg per day), patients report an average ΔVRQOL of 9.31. Six patients report significant VRQOL improvement >10, with the rest reporting changes between -7.5 and 7.5. Fifteen patients were followed for at least 4 weeks after botulinum toxin injection, reporting an average improvement in scaled VRQOL of 22.00. Blinded perceptual voice assessment demonstrates an improvement in overall severity of tremor with botulinum toxin. In some patients with EVT, propranolol led to significant vocal improvement with no major side effects. Although botulinum toxin remains the gold-standard therapy for patients with EVT, propranolol represents a possible alternative or adjuvant therapy for certain patients. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Efficacy of botulinum toxin therapy in treatment of myofascial pain.

    Science.gov (United States)

    Chaurand, Jorge; Pacheco-Ruíz, Laura; Orozco-Saldívar, Hector; López-Valdés, Julio

    2017-01-01

    The present study aimed to assess the efficacy of using botulinum toxin (BTX) in temporomandibular joint disorders, particularly pertaining to myofascial pain from masseter and temporal muscles. The study included 11 patients who were diagnosed with masseter and temporalis myofascial pain. Visual analog scale for pain and pressure algometry were conducted initially, after 1 month of conservative therapy (control group), and after 1 month of BTX type A injections (study group). Data were statistically analyzed (analysis of variance and Wilcoxon's test) to determine intergroup differences. Both conservative therapy and BTX injections showed reduction in pain scores and increase in pain threshold compared with baseline, and statistically significant differences were noted between both groups. Thus, BTX injections appear to be effective in management of chronic myofascial pain targeting masseter and temporalis muscles.

  15. Botulinum toxin: mechanisms of action

    OpenAIRE

    Dirk Dressler; Fereshte Adib Saberi; Egberto Reis Barbosa

    2005-01-01

    This review describes therapeutically relevant mechanisms of action of botulinum toxin (BT). BT's molecular mode of action includes extracellular binding to glycoproteine structures on cholinergic nerve terminals and intracellular blockade of the acetylcholine secretion. BT affects the spinal stretch reflex by blockade of intrafusal muscle fibres with consecutive reduction of Ia/II afferent signals and muscle tone without affecting muscle strength (reflex inhibition). This mechanism allows fo...

  16. 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.

  17. 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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. 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.

  19. Botulinum toxin — therapeutic effect in cosmetology

    OpenAIRE

    Morrison A.V.; Bocharova Y.M.; Morrison V.V.

    2016-01-01

    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.

  20. Botulinum Toxin Treatment on Upper Limb Function in School Age Children With Bilateral Spastic Cerebral Palsy: One Year Follow-up

    OpenAIRE

    Lee, Jee Sun; Lee, Kyu Bum; Lee, Yu Ryun; Choi, You Nam; Park, Chul Woo; Park, Sang Duck; Jung, Dong Hwa; Lee, Chul Sang

    2013-01-01

    Objective To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities. Methods Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evalu...

  1. Intravitreal injection

    Science.gov (United States)

    Antibiotic - intravitreal injection; Triamcinolone - intravitreal injection; Dexamethasone - intravitreal injection; Lucentis - intravitreal injection; Avastin - intravitreal injection; Bevacizumab - intravitreal injection; Ranibizumab - intravitreal injection; ...

  2. 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.

  3. Use of botulinum toxin in the treatment of chronic myofascial pain.

    Science.gov (United States)

    De Andrés, J; Cerda-Olmedo, G; Valía, J C; Monsalve, V; Lopez-Alarcón; Minguez, A

    2003-01-01

    Myofascial pain syndrome (MPS) is defined as acute or chronic pain with sensory or motor autonomic symptoms, referred from active myofascial triggering points with associated dysfunction. Previous studies have suggested the usefulness of botulinum toxin A (BTX-A) in the treatment of MPS since it is capable of controlling muscular spasms, as well as other alternative mechanisms of action. To analyze the efficacy of BTX-A treatment and its effect on daily life activities assessing pain reduction using a visual analogue scale (VAS); degree of improvement in physical impairment and disability scoring in the Oswestry low back pain questionnaire; and psychologic status using the Hospital Anxiety and Depression Scale (HAD), in patients suffering from MPS. An open-label interventional prospective trial was conducted in 77 patients diagnosed of refractory MPS (defined as the presence of muscle spasm with pain on mobilization or stretching, plus the existence of trigger points with associated referred pain), resistant to both conservative management and to physical therapy. The BTX-A dosages for the different muscles were chosen according to a standardized protocol. Electromyographic guidance was used to localize the motor end plate prior to injection in superficial muscles; while fluoroscopic guidance was employed to evidence intramyofascial spread of the contrast solution within deep muscles. The assessment of treatment efficacy was based on a pain VAS applied before enrollment, at 15, 30, and 90 days and upon completion of the study; the Lattinen test to establish a relationship between pain intensity and its corresponding impact on daily living; and the HAD scale to assess psychologic stress, performed both before treatment and at the end of the study; and the Oswestry Questionnaire was used to evaluate patients' ability to carry out daily life activities according to their degree of physical impairment and disability scores. The global analysis revealed a positive

  4. The Concept of «Key Muscles» and the Early Onset of Botulinum Therapy in Spastic Forms of Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Olga A. Klochkova

    2017-01-01

    Full Text Available The botulinum therapy remains the most effective and safe method for reducing local spasticity in patients with cerebral palsy (CP. However, the list of indications for injections of botulinum toxin type A (BTA in cerebral palsy is limited both in terms of target muscles and the treatment initiation age. In this regard, doctors are guided by the data of clinical studies, reviews and consensuses of experts, which are advisory in nature. One of the most urgent issues in the modern CP botulinum therapy is the evaluation of risks andbenefits of initiating injections at an early age (up to 2 years in order to prevent orthopedic complications and stimulate the optimal motor development of a child. The review analyzes the history of the development of modern approaches to the use of botulinum therapy in cerebral palsy and the tactics of selecting target muscles and doses for multilevel injections. The authors focus on the latest international data on the feasibility and safety of reducing the admissible initiation age for botulinum therapy in cerebral palsy. The results from the studies of the effect of the early initiation of BTA injections on motor development, formation of secondary orthopedic complications in children under 2 years of age, and morphological changes in the neuromotor apparatus in animal experiments are presented. The concept of «key muscles» is considered in detail as one of the possible reference points in the planning of safe andeffective early injections.

  5. A pilot study to investigate the combined use of Botulinum toxin type-a and ankle foot orthosis for the treatment of spastic foot in chronic hemiplegic patients.

    Science.gov (United States)

    Pradon, Didier; Hutin, Emilie; Khadir, Simon; Taiar, Redha; Genet, François; Roche, Nicolas

    2011-10-01

    Botulinum toxin is commonly used to treat spastic equinus foot. This treatment seems to improve gait in hemiplegic patients when used alone or combined with an ankle-foot orthosis. However, the nature and effects of this improvement have until now rarely been studied. The aim of this study was to quantify the impact of a Botulinum toxin injection in the triceps surae of hemiplegic patients with equinus foot, used either alone or in combination with an ankle-foot orthosis, on the kinematics and dynamics of the paretic lower limb, and to determine the advantage of combining an ankle-foot orthosis with this pharmacological treatment. Patients were assessed using gait analysis to measure spatio-temporal, kinematic and dynamic parameters of the gait cycle before Botulinum toxin injection and then 3 and 6weeks after injection. Eight chronic hemiplegics following central nervous system lesion were included. Botulinum toxin injection led to an increase in velocity, peak ankle dorsiflexion during stance phase, and peak knee flexion during swing phase. It also resulted in an increased peak plantarflexion moment. Use of ankle-foot orthosis led to a specific increase in peak ankle dorsiflexion during swing phase and also increased peak plantarflexion moment. The results indicate that combined Botulinum toxin injection of the triceps surae and wearing an ankle-foot orthosis is more effective than the use of Botulinum toxin only. Use of an ankle-foot orthosis increases ankle dorsiflexion during the swing phase and does not reduce the benefits gained by the use of Botulinum toxin in stance phase. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Botulinum toxin vs. topical glyceryl trinitrate ointment for pain control in patients undergoing hemorrhoidectomy: a randomized trial.

    Science.gov (United States)

    Patti, Rosalia; Almasio, Piero Luigi; Luigi, Almasio Piero; Arcara, Matteo; Matteo, Arcara; Sammartano, Sergio; Sergio, Sammartano; Romano, Pietro; Pietro, Romano; Fede, Calogero; Calogero, Fede; Di Vita, Gaetano; Gaetano, Di Vita

    2006-11-01

    The maximum resting pressure in the anal canal is greatly raised after hemorrhoidectomy. This increase is likely to be the cause of postoperative pain, which is still the most troublesome early problem after hemorrhoidectomy. This study was designed to compare, after hemorrhoidectomy, the effects of intrasphincter injection of botulinum toxin vs. application of glyceryl trinitrate ointment in improving wound healing and reducing postoperative pain at rest or during defecation. Thirty patients with hemorrhoids of third and fourth degree were included in the study and randomized in two groups. Anorectal manometry was performed preoperatively and 5 and 40 days after hemorrhoidectomy. One group received one injection containing 20 IU of botulinum toxin, whereas the other an application of 300 mg of 0.2 percent glyceryl trinitrate ointment three times daily for 30 days. Five days after hemorrhoidectomy, maximum resting pressure was significantly reduced compared with baseline values in both groups (85 +/- 15 vs. 68 +/- 11 mmHg for the group treated with botulinum toxin, 87 +/- 11 vs. 78 +/- 11 mmHg for the group treated with glyceryl trinitrate ointment). Overall analysis of postoperative pain at rest showed a significant reduction in the botulinum toxin group vs. glyceryl trinitrate group, whereas pain during defecation and time of healing were similar. Adverse effects, such as headaches, were observed only in the glyceryl trinitrate group. Forty days after hemorrhoidectomy in the glyceryl trinitrate group, maximum resting pressure values were similar to preoperative ones, whereas the values were still reduced in the botulinum toxin group. A single intrasphincter injection of botulinum toxin was more effective and safer than repeated applications of glyceryl trinitrate in reducing early postoperative pain at rest but not during defecation.

  7. Acoustic variations in reading produced by speakers with spasmodic dysphonia pre-botox injection and within early stages of post-botox injection.

    Science.gov (United States)

    Sapienza, Christine M; Cannito, Michael P; Murry, Thomas; Branski, Ryan; Woodson, Gayle

    2002-10-01

    Acoustic analysis of a reading passage was used to identify the abnormal phonatory events associated with adductor spasmodic dysphonia (ADSD) pre- and postinjection of Botulinum Toxin A (Botox). Thirty-one patients (age 22 to 74 years) diagnosed with ADSD were included for study. All patients were new recipients of Botox, and the examination of their voice occurred before and after their initial injection of Botox. Acoustic events were identified from reading samples of the Rainbow Passage produced by each of the patients. These events were examined from sentences containing primarily voiced sound segments. Dependent variables included the number of phonatory breaks, frequency shifts, and aperiodic segments--all variables previously defined by the investigators. Additionally, calculated variables were made of the percentage of time these events occurred relative to the duration of the cumulative voiced segments. A sex- and age-matched control group (+/-2 years) was included for statistical comparison. Results indicated that those with ADSD produced more aberrant acoustic events than the controls. Aperiodicity was the predominant acoustic event produced during the reading, followed by frequency shifts and phonatory breaks. Within the ADSD group, the number of atypical acoustic events decreased following Botox injection. It is important that the occurrence of specific abnormal acoustic events was sufficient to differentiate the disordered speakers from the controls following as well as preceding initial Botox injection, as indicated by discriminant function analysis. This paper complements our previous work using this acoustic analysis method for defining the abnormal events present in the voice of those with ADSD and further suggests that these measures can be used in conjunction with perceptual impressions to differentiate speakers on the basis of initial severity.

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

    Science.gov (United States)

    2010-01-01

    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 Standards for Reporting

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

    Directory of Open Access Journals (Sweden)

    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

  10. Botulinum A toxin utilizations in obstetric palsy

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    Atakan Aydin

    2012-12-01

    Conclusion: We conclude that with the help of botulinum A toxin and physyotherapy, obstetrical palsy patient with cocontractions can significantly improve movements and may have less surgery. [Hand Microsurg 2012; 1(3.000: 89-94

  11. Reducing severe spasticity in cerebral palsy following meningoencephalitis by botulinum toxin

    Directory of Open Access Journals (Sweden)

    Prastiya I. Gunawan

    2017-05-01

    Full Text Available A 3-year-old boy diagnosed with diplegic cerebral palsy had received Botulinum toxin injection to reduce severe spasticity. There was an improvement of muscles tone and motor function including better ability of limb flexion of the knees and hip, adduction of the hip, flexion of the toes, and plantar flexion of the foot. No side effect was observed after the procedure.

  12. Effect of botulinum toxin type-A in patients with focal spasticity

    OpenAIRE

    Selimoglu, Esra; Turgut, Selin Turan; Akpinar, Pinar; Yumusakhuylu, Yasemin; Haliloglu, Sema; Baklacioglu, Hatice Sule; Icagasioglu, Afitap

    2015-01-01

    OBJECTIVE: To investigate the effect of botulinum toxin type-A (BTX-A) on spasticity and function in patients with focal spasticity. METHODS: Patients attended to the outpatient clinic of physical medicine and rehabilitation department with a diagnosis of focal spasticity and had BTX-A injections because of spasticty were evaluated for the study. Demographic data, exercise status, orthoses, drugs used for spasticity, functional status, stages of spasticity of muscles before and after 1st and ...

  13. Medical Countermeasure Models. Volume 8. Botulinum Neurotoxin

    Science.gov (United States)

    2013-04-12

    of Internal Medicine . 129(221-228). 1998. Medical Countermeasure Models Volume 8: Botulinum Neurotoxin Gryphon Scientific, LLC 6 Figure...Sauteed Onions . Clinical and Epidemiological Observations.” Journal of the American Medical Association. 253(9). 1985. 23 Arnon SS et al. “Botulinum...Factors that Predict Outcome in Type A Foodborne Botulism.” The American Journal of Medicine . 76. 1984. 25 CDC. “Notice of CDC’s Discontinuation of

  14. Protein Receptor(s) of Botulinum Neurotoxin

    Science.gov (United States)

    2005-01-01

    affinity gel and CelLytic B II Bacterial Cell Lysis extraction Reagent were obtained from Sigma (St. Louis, MO). Anti-His antibody was from Amersham...Pharmacia Bioth (Piscataway, NJ). Culture and chromosomal DNA isolation of Clostridium botulinum type B cells (strain Okra ) Clostridium botulinum type...B cells (strain Okra ) in a 1.5 ml microcentrifuge tube kept in -80’C was added to a 10 ml cooked meat medium (Difco Laboratories, Becton Dickinson, MD

  15. Injectables in the prostate.

    Science.gov (United States)

    Saemi, Arash M; Plante, Mark K

    2008-01-01

    Benign prostatic hyperplasia with associated symptoms and morbidity is increasingly common among aging men. Medical treatment of lower urinary tract symptoms is the mainstay of therapy with progressive disease requiring more invasive intervention. Transurethral resection of the prostate remains a widely applied gold standard therapy. Numerous minimally invasive surgical therapy options have arisen and subsequently faded over recent years. Those remaining in use are largely positioned between pharmacological treatment and transurethral resection of the prostate. Intraprostatic injection therapy, the oldest minimally invasive surgical therapy, has been investigated for over 100 years with renewed interest recently. This review will provide some history of intraprostatic injection for benign prostatic hyperplasia including the most recent reports using transperineal, transrectal and transurethral routes with different injectables. For benign prostatic hyperplasia, transperineal and transurethral injection routes have received the most systematic evaluation. Intraprostatic injection of botulinum toxin type A has received much recent attention with regards to mechanism of action and efficacy. Anhydrous ethanol remains the most extensively studied injectable to date. Injection therapy remains a very promising minimally invasive surgical therapy for benign prostatic hyperplasia with increased attention from the urologic community in recent years. Further experience both with systematic laboratory and clinical trials investigation will be necessary before widespread clinical adoption.

  16. Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm.

    Science.gov (United States)

    Wang, Xuhui; Thirumala, Parthasarathy D; Shah, Aalap; Gardner, Paul; Habeych, Miguel; Crammond, Donald J; Balzer, Jeffrey; Horowitz, Michael

    2013-03-01

    The objective of this study was to investigate the clinical characteristics, intraoperative findings, complications, and outcomes after the first microvascular decompression (MVD) in patients with and without previous botulinum neurotoxin treatment for hemifacial spasm (HFS). The authors analyzed 246 MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000, and December 31, 2007. One hundred and seventy-six patients with HFS underwent botulinum neurotoxin injection treatment prior to first MVD (Group I), and 70 patients underwent their first MVD without previous botulinum neurotoxin treatment (Group II). Clinical outcome data were obtained immediately after the operation, at discharge, and at follow-up. Follow-up data were collected from 177 patients with a minimum follow-up period of 9 months (mean 54.48 ± 27.84 months). In 246 patients, 89.4% experienced immediate postoperative relief of spasm, 91.1% experienced relief at discharge, and 92.7% experienced relief at follow-up. There was no significant difference in outcomes and complications between Group I and Group II (p > 0.05). Preoperatively, patients in Group I had higher rates of facial weakness, tinnitus, tonus, and platysmal involvement as compared with Group II (p 0.05). No significant differences in complications were noted between the 2 groups. Microvascular decompression is an effective and safe procedure for patients with HFS previously treated using botulinum neurotoxin. Intraoperative monitoring with LSR is an effective tool for evaluating adequate decompression.

  17. Botulinum toxin for the treatment of strabismus.

    Science.gov (United States)

    Rowe, Fiona J; Noonan, Carmel P

    2017-03-02

    The use of botulinum toxin as an investigative and treatment modality for strabismus is well reported in the medical literature. However, it is unclear how effective it is in comparison to other treatment options for strabismus. The primary objective was to examine the efficacy of botulinum toxin therapy in the treatment of strabismus compared with alternative conservative or surgical treatment options. This review sought to ascertain those types of strabismus that particularly benefit from the use of botulinum toxin as a treatment option (such as small angle strabismus or strabismus with binocular potential, i.e. the potential to use both eyes together as a pair). The secondary objectives were to investigate the dose effect and complication rates associated with botulinum toxin. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2016), Embase (January 1980 to July 2016), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to July 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 July 2016. We handsearched the British and Irish Orthoptic Journal, Australian Orthoptic Journal, proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and International Orthoptic Association (IOA) (www.liv.ac.uk/orthoptics/research/search.htm) and American Academy of Paediatric Ophthalmology and Strabismus meetings (AAPOS). We contacted researchers who are active in this field for information about further

  18. The Role of Botulinum Toxin Type A in the Clinical Management of Refractory Anterior Knee Pain.

    Science.gov (United States)

    Singer, Barbara J; Silbert, Benjamin I; Silbert, Peter L; Singer, Kevin P

    2015-08-25

    Anterior knee pain is a highly prevalent condition affecting largely young to middle aged adults. Symptoms can recur in more than two thirds of cases, often resulting in activity limitation and reduced participation in employment and recreational pursuits. Persistent anterior knee pain is difficult to treat and many individuals eventually consider a surgical intervention. Evidence for long term benefit of most conservative treatments or surgical approaches is currently lacking. Injection of Botulinum toxin type A to the distal region of vastus lateralis muscle causes a short term functional "denervation" which moderates the influence of vastus lateralis muscle on the knee extensor mechanism and increases the relative contribution of the vastus medialis muscle. Initial data suggest that, compared with other interventions for anterior knee pain, Botulinum toxin type A injection, in combination with an active exercise programme, can lead to sustained relief of symptoms, reduced health care utilisation and increased activity participation. The procedure is less invasive than surgical intervention, relatively easy to perform, and is time- and cost-effective. Further studies, including larger randomized placebo-controlled trials, are required to confirm the effectiveness of Botulinum toxin type A injection for anterior knee pain and to elaborate the possible mechanisms underpinning pain and symptom relief.

  19. Rate of epithelialisation and re-operations in corneal ulcers treated with amniotic membrane transplantation combined with botulinum toxin-induced ptosis.

    Science.gov (United States)

    Fuchsluger, Thomas; Tuerkeli, Emre; Westekemper, Henrike; Esser, Joachim; Steuhl, Klaus-Peter; Meller, Daniel

    2007-07-01

    To examine the efficacy of amniotic membrane transplantation (AMT) and/or botulinum toxin type A-induced ptosis (Dysport) in the treatment of corneal ulcerations of different entities. Retrospective evaluation of 137 cases of corneal ulcers which have been treated with AMT, botulinum toxin type A and perforating keratoplasty (pKP). Regarding corneal ulcerations the patients were divided into three groups: group A, patients initially having received an AMT (92 eyes eventually followed by AMT or pKP as a second intervention); group B, patients initially having received an AMT (32 eyes followed by botulinum toxin type A injection in the upper lid as a second intervention); group C, patients initially treated only by botulinum toxin type A injection (13 eyes followed occasionally by AMT or pKP or additional botulinum toxin type A injection). Additionally, we analysed the complete epithelialisation rate of the ocular surface in respect to different ocular and systemic diseases and compared the frequency of re-operations in each group. The overall follow-up was 14.2 (+/-14.7 months; range from 1 to 60 months). The total frequency of re-operations was 45.3% (overall time until complete epithelialisation 12.7 (+/-6.1) days). If the patient was initially treated with an AMT (group A), the re-operation rate was 44.6%. Treating affected eyes in this group with a subsequent amniotic membrane resulted in a reduction of re-operation rate to 30.4%. In cases with induced ptosis by injecting botulinum toxin type A in the M. levator palpebrae (group B), the re-operation frequency could be reduced to 34.4% with similar times of epithelialisation [group A: 12.0 (+/-6.5) days and group B: 11.7 (+/-5.5) days]. In group C, with botulinum toxin type A alone initially, the re-operation rate of 69.2% was the highest one compared with groups A and B; this rate could be drastically reduced by a following AMT to 23.1%. Surprisingly, in the few successful cases with botulinum toxin type A alone

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

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

    Science.gov (United States)

    Degelaen, Marc; de Borre, Ludo; Kerckhofs, Eric; de Meirleir, Linda; Buyl, Ronald; Cheron, Guy; Dan, Bernard

    2013-01-01

    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. PMID:23344454

  3. [Effects of botulinum toxin guided by electric stimulation on spasticity in ankle plantar flexor of children with cerebral palsy: a randomized trial].

    Science.gov (United States)

    Xu, Kai-shou; Yan, Tie-bin; Mai, Jian-ning

    2006-12-01

    To compare the effects of botulinum toxin A (BTX-A) injection guided by electric stimulation combined with physiotherapy, with physiotherapy only on the spasticity of the ankle plantar flexor in children with cerebral palsy (CP). After signing the informed consent, 43 children with CP, aged 52.4 +/- 13.2 months (35 to 82 months), were randomly assigned into 2 groups, (1) BTX-A group (n = 23) treated with BTX-A injection guided by electric stimulation and (2) physiotherapy alone group (n = 20). Children in BTX-A group received injection of HengLi BTX-A in the ankle plantar flexors. A maximum dose of 12 units of BTX-A per kilogram body weight and maximumly 10 units of BTX-A per site were administered. Localization technique was the use of electrical stimulation guidance. Physiotherapy and ankle-foot orthosis were applied to children at 72 hours after injection in BTX-A group and at the time of being recruited into physiotherapy group. Ten days after entering into the study, the program was applied by the parents. Demographic data, including age, gender, number of the spastic lower limbs, affected side (left or right) were recorded. Clinical assessments included the range of passive movement (PROM) measured by goniometer while children maintained the knee extended, modified Ashworth scale (MAS), composite spasticity scale (CSS), D and E dimensions of the Gross Motor Function Measure (GMFM), and walking velocity (WV) was determined before treatment and at 2 weeks, 1, 2, and 3 months after treatment. No statistically significant differences were found in age, gender, number of the spastic lower limbs, affected side, as well as clinical assessments (PROM, MAS, CSS, GMFM and WV) before treatment between the 2 groups (P > 0.05). All the children showed a reduction of spasticity (PROM, MAS and CSS) after 2 weeks, 1, 2, and 3 months of treatment (P spasticity and improving functional performance in standing, walking, walking pattern and velocity on spasticity in ankle

  4. 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

  5. Systematic review of the effectiveness of botulinum toxin or radiotherapy for sialorrhea in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Stone, Carol A; O'Leary, Norma

    2009-02-01

    Fifty percent of patients with amyotrophic lateral sclerosis (ALS) experience problems handling serous saliva and 20% fail to achieve adequate control of sialorrhea with anticholinergic medications, or experience intolerable adverse effects from these drugs. Both botulinum and radiotherapy have been suggested in the literature as treatments for intractable sialorrhea. In this review, we assess the evidence for the effectiveness and toxicity of botulinum toxin and radiotherapy for sialorrhea in patients with ALS. Relevant studies were retrieved from Medline, Embase and Cochrane Databases. Handsearching of Neurology, Journal of Pain and Symptom Management, and Palliative Medicine and of reference lists, was carried out. Five studies (28 patients) were included in the analysis of botulinum. Of the four studies using an intraglandular method of injection, no adverse effects occurred. Two of these had positive findings of the effect of botulinum in salivary secretion rate and quality of life. In contrast, significant adverse effects were experienced by two patients in a study of retrograde injections into the salivary ducts. Two studies were included in the analysis of radiotherapy (27 patients). Both demonstrated a positive effect of radiotherapy on salivary secretion rate. Some patients experienced mild acute side effects. Because of the small numbers of studies, small sample sizes, and poor quality of reporting, it is not possible to draw firm conclusions. There is some evidence indicating that both botulinum and radiotherapy are well tolerated, effective treatments for persistent sialorrhea in patients with ALS and that the duration of action is up to three months with botulinum and six months with radiotherapy.

  6. Use of botulinum toxin in individuals with neurogenic detrusor overactivity: State of the art review

    Science.gov (United States)

    Linsenmeyer, Todd A.

    2013-01-01

    Background Botulinum neurotoxin (BoNT) injection into the bladder wall has been shown to be an effective alternative to anticholinergic (antimuscarinic) medications and more invasive surgery in those with multiple sclerosis and spinal cord injury with neurogenic detrusor overactivity (NDO) and urinary incontinence who are not tolerating anticholinergic medications. In August 2011, Botox® (onabotulinumtoxinA) received Food and Drug Administration (FDA) approval for this use. Clinically, intradetrusor injection of BoNT has been found to decrease urinary incontinence and improve quality of life. Its impact on urodynamic parameters is an increase in the maximum cystometric (bladder) capacity and decrease in the maximum detrusor pressures. The most common side effects are urinary tract infections and urinary retention. There have been rare reports and a black box warning of distant spread of BoNT. BoNT has gained popularity because of its effectiveness and long duration of action, relative ease of administration, easy learning curve, reproducibility of results on repeated administration, and low incidence of complications. Objective To discuss the structure and function, mechanisms of action, clinical and urodynamic studies, injection technique, potential beneficial and adverse effects, and potential areas of research of BoNT. Methods Literature search focused on botulinum toxin in MEDLINE/PubMed. Search terms included botulinum toxin, neurogenic bladder, NDO, botox bladder, botox spinal cord injury, botox, FDA, botox side effects. All papers identified were English language, full-text papers. In addition, English abstracts of non-English papers were noted. The reference list of identified articles was also searched for further papers. Conclusion Botulinum toxin is an alternative treatment for individuals with NDO who fail to tolerate anticholinergic medications. Its popularity has increased because of the literature, which has supported its effectiveness, safety, easy

  7. Clostridium difficile toxins A and B: Receptors, pores, and translocation into cells.

    Science.gov (United States)

    Orrell, Kathleen E; Zhang, Zhifen; Sugiman-Marangos, Seiji N; Melnyk, Roman A

    2017-08-01

    The most potent toxins secreted by pathogenic bacteria contain enzymatic moieties that must reach the cytosol of target cells to exert their full toxicity. Toxins such as anthrax, diphtheria, and botulinum toxin all use three well-defined functional domains to intoxicate cells: a receptor-binding moiety that triggers endocytosis into acidified vesicles by binding to a specific host-cell receptor, a translocation domain that forms pores across the endosomal membrane in response to acidic pH, and an enzyme that translocates through these pores to catalytically inactivate an essential host cytosolic substrate. The homologous toxins A (TcdA) and Toxin B (TcdB) secreted by Clostridium difficile are large enzyme-containing toxins that for many years have eluded characterization. The cell-surface receptors for these toxins, the non-classical nature of the pores that they form in membranes, and mechanism of translocation have remained undefined, exacerbated, in part, by the lack of any structural information for the central ∼1000 amino acid translocation domain. Recent advances in the identification of receptors for TcdB, high-resolution structural information for the translocation domain, and a model for the pore have begun to shed light on the mode-of-action of these toxins. Here, we will review TcdA/TcdB uptake and entry into mammalian cells, with focus on receptor binding, endocytosis, pore formation, and translocation. We will highlight how these toxins diverge from classical models of translocating toxins, and offer our perspective on key unanswered questions for TcdA/TcdB binding and entry into mammalian cells.

  8. Writer′s Cramp - Treatment With Botulinum Toxin

    Directory of Open Access Journals (Sweden)

    Borgohain R

    1998-01-01

    Full Text Available Writer′s cramp is undoubtedly the most frustrating and difficult focal dystonia to treat. We treated 33 patients (32 males and 1 female with writer′s cramp with EMG-guided injection botulinum toxin (BTX. Muscle selection for injection was done clinically. Their mean age at presentation was 39.48+9.38 years (range 18-57 years and mean duration of symptoms was 3.84+4.15 years (range 0.3-20 years. A detailed clinical assessment and video-taping while writing was done. Fourteen (42.4% of the 33 patients received injections in forearm extensors, 10 (30.3% in flexors and 9 (27.3% in both extensors and the flexors. Mean dosage of BTX used for initial injections was 127.7+28.4 units of Dysport and 22.9+3.1 units of Botox for twenty-tow and eleven patients respectively. Functional improvement was seen in 30(93.75% and was marked to striking in 15(46.9% of 32 patients who reported for follow-up. More patients with extensor (44.4% patients with both flexor and extensor involvement had similar response. While BTX therapy is currently the most effective therapy for Writer′s cramp, it is also the most challenging indication for BTX. This is a technically demanding procedure requiring meticulous documentation.

  9. 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…

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

    Directory of Open Access Journals (Sweden)

    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

  11. Bioimaging of botulinum toxin and hyaluronate hydrogels using zwitterionic near-infrared fluorophores.

    Science.gov (United States)

    Kim, Ki Su; Kim, Yun Seop; Bao, Kai; Wada, Hideyuki; Choi, Hak Soo; Hahn, Sei Kwang

    2017-01-01

    The injection of botulinum toxin (BTX) to reduce facial wrinkles is one of the most frequently performed plastic surgery procedures. The biocompatible hydrogels are injected with BTX for effective tissue augmentation. However, it is difficult to determine the interval of injection for effective tissue augmentation. BTX and hyaluronate (HA) hydrogels were labeled with zwitterionic (ZW) near-infrared (NIR) fluorophores and visualized for 3 weeks after injection to BALB/c nude mice. BTX-ZW conjugates and diaminohexane (DAH)-HA-ZW hydrogels were successfully prepared by the conventional EDC/NHS chemistry. Using the NIR fluorescence imaging, we confirmed that approximately 10% of BTX-ZW conjugates and 50% of DAH-HA-ZW hydrogels remained 3 weeks post-injection. This bioimaging technique using invisible NIR fluorescence light can be exploited for various biomedical applications.

  12. [Botulinum toxin for the treatment of major depressive disorder].

    Science.gov (United States)

    Hawlik, A E; Freudenmann, R W; Pinkhardt, E H; Schönfeldt-Lecuona, C J; Gahr, M

    2014-02-01

    Botulinum toxin (BTX) plays an important role in the treatment and prophylaxis of migraine and is also used for the treatment of focal dystonia, spasm, hypersalivation, and hyperhydrosis. Recent clinical trials suggest that BTX treatment of muscles involved in the development of negative emotions may also have an antidepressant effect. This article gives a systematic review of the literature regarding BTX in the treatment of major depression. We screened the databases of Medline and Scopus using the search terms [("botulinum toxin" OR "botox") AND ("antidepressant" OR "depression" OR "depressed")]. The website www.clinicaltrials.gov was screened with the same search terms in order to detect current studies. As of April 2013, we identified 3 studies that evaluated the antidepressant effects of BTX in the treatment of major depression. An improvement in mood after treatment with BTX was seen in a case series of 10 depressed patients. In a randomised, placebo-controlled study of thirty patients assigned to a verum (BTX, n = 15) or placebo (saline, n = 15) group, treatment with BTX has also shown a positive effect on mood. Another prospective, open-label study evaluated the antidepressive effect of BTX in 25 subjects with major depression. On www.clinicaltrials.gov we identified 2 ongoing studies, which are currently investigating the antidepressant effect of BTX. Recently published studies have shown a reduction of depressive symptoms after treatment of the glabellar frown lines with BTX injections. Further clinical studies in larger patient samples are necessary to prove the efficacy and safety of BTX injections used for the treatment of depressive disorders. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Impact of Clostridium botulinum genomic diversity on food safety.

    Science.gov (United States)

    Peck, Michael W; van Vliet, Arnoud Hm

    2016-08-01

    The deadly botulinum neurotoxin formed by Clostridium botulinum is the causative agent of foodborne botulism. The increasing availability of C. botulinum genome sequences is starting to allow the genomic diversity of C. botulinum Groups I and II and their neurotoxins to be characterised. This information will impact on microbiological food safety through improved surveillance and tracing/tracking during outbreaks, and a better characterisation of C. botulinum Groups I and II, including the risk presented, and new insights into their biology, food chain transmission, and evolution.

  14. Treatment of chronic anal fissure: Botulinum toxin (Dysport versus lateral internal anal sphincterotomy

    Directory of Open Access Journals (Sweden)

    Asgari M

    2010-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Botulinum toxin (Dysport is a powerful semi-biological toxin. It has proved to be a remarkable therapeutic agent for treatment of benign anal disorders. Different results have been achieved from injection of botulinum toxin in order to treatment of anal fissure since 1993. The aim of this study was to evaluate the efficacy of botulinum toxin injection in the treatment of chronic anal fissure Comparing with lateral internal anal sphincterotomy (LIS."n"nMethods: 36 patients entered into two groups, Dysport injection and Lateral Internal Sphincterotomy, randomly. Dysport group were treated by injection of 50 units of botulinum toxin, 25 units of drugs in each side, and LIS was done in surgery group by open method in left side. Pain, recovery and incontinency were compared between two groups during six months of follow up."n"nResults: Based on this study, treatment of anal fissure does not affected by age and gender. Regarding to location of fissure, there was no difference between two different genders. Mean of age and ratio of gender were similar in both groups. The severity of pain in surgery group was lower than Dysport group six months after treatment (0.4±0.7 and 3.2±2.6 respectively, p<0.001. Recovery

  15. Detection of Clostridium botulinum in natural sweetening.

    Science.gov (United States)

    Nakano, H; Yoshikuni, Y; Hashimoto, H; Sakaguchi, G

    1992-06-01

    Various sugar products were examined for contamination with C. botulinum spores. Type A, B and C spores were detected in three of 56 samples of sugar for apiculture, which may attest the significance of bee-feed as a source of contamination of honey. The heavy contamination of honey with C. botulinum spores sometimes encountered, however, can not be explained unless some other factors, e.g., that allowing germination and multiplication of the spores somewhere during honey production, are found. Type A spores were detected in some samples of raw sugar and molasses and also in two of 41 samples of brown sugar lump, but not in refined sugar or other various samples taken at a sugar factory or in sugar cane left on the field in Okinawa. The fact that some natural sweetenings are contaminated with C. botulinum spores, even in low concentrations, may be food-hygienically important.

  16. Botulinum toxin paralysis of the orbicularis oculi muscle. Types and time course of alterations in muscle structure, physiology and lid kinematics.

    Science.gov (United States)

    Horn, A K; Porter, J D; Evinger, C

    1993-01-01

    In chronically prepared guinea pigs, we investigated the time course of botulinum toxin A's (Bot A) effect on the blink reflex by monitoring lid movements and EMG activity prior to and after Bot A injection into the orbicularis oculi muscle (OOemg), or after nerve crush of the zygomatic nerve. We correlated these alterations with the morphological changes of the orbicularis oculi (lid-closing) muscles of the same animals. After Bot A treatment there was a profound reduction of OOemg activity and blink amplitudes as well as a slowing of maximum blink down-phase velocity. Blink up-phases, however, remained unchanged. Gradual recovery of OOemg magnitude and blink amplitude started around day 6; a functioning blink reflex appeared on day 21, and full recovery of blink amplitude occurred by day 42. Crushing the zygomatic branch of the facial nerve produced similar changes in blink parameters, but recovery was much more rapid (15 days) than for Bot A-treated guinea pigs. The morphological analysis demonstrated that Bot A produced a denervation-like atrophy in the orbicularis oculi. No fiber type-specific alterations were noted, and all muscle fiber types ultimately recovered, with no longstanding consequences of the transient denervation. Our findings support the notion that functional recovery was the result of preterminal and terminal axonal sprouting that subsequently re-established functional innervation. Moreover, differences between the present findings and those seen after injection of Bot A into the extraocular muscles strongly support the hypothesis that the composition in terms of muscle fiber type and the properties of the motor control system of a given muscle greatly influence both how the particular muscle responds to toxin injection, and how effective the toxin is in resolution of neuromuscular disorders that affect a particular muscle. The present findings were consistent with clinical observations that Bot A produces only temporary relief in patients

  17. Zebrafish Sensitivity to Botulinum Neurotoxins

    Science.gov (United States)

    Chatla, Kamalakar; Gaunt, Patricia S.; Petrie-Hanson, Lora; Ford, Lorelei; Hanson, Larry A.

    2016-01-01

    Botulinum neurotoxins (BoNT) are the most potent known toxins. The mouse LD50 assay is the gold standard for testing BoNT potency, but is not sensitive enough to detect the extremely low levels of neurotoxin that may be present in the serum of sensitive animal species that are showing the effects of BoNT toxicity, such as channel catfish affected by visceral toxicosis of catfish. Since zebrafish are an important animal model for diverse biomedical and basic research, they are readily available and have defined genetic lines that facilitate reproducibility. This makes them attractive for use as an alternative bioassay organism. The utility of zebrafish as a bioassay model organism for BoNT was investigated. The 96 h median immobilizing doses of BoNT/A, BoNT/C, BoNT/E, and BoNT/F for adult male Tübingen strain zebrafish (0.32 g mean weight) at 25 °C were 16.31, 124.6, 4.7, and 0.61 picograms (pg)/fish, respectively. These findings support the use of the zebrafish-based bioassays for evaluating the presence of BoNT/A, BoNT/E, and BoNT/F. Evaluating the basis of the relatively high resistance of zebrafish to BoNT/C and the extreme sensitivity to BoNT/F may reveal unique functional patterns to the action of these neurotoxins. PMID:27153088

  18. Zebrafish Sensitivity to Botulinum Neurotoxins

    Directory of Open Access Journals (Sweden)

    Kamalakar Chatla

    2016-05-01

    Full Text Available Botulinum neurotoxins (BoNT are the most potent known toxins. The mouse LD50 assay is the gold standard for testing BoNT potency, but is not sensitive enough to detect the extremely low levels of neurotoxin that may be present in the serum of sensitive animal species that are showing the effects of BoNT toxicity, such as channel catfish affected by visceral toxicosis of catfish. Since zebrafish are an important animal model for diverse biomedical and basic research, they are readily available and have defined genetic lines that facilitate reproducibility. This makes them attractive for use as an alternative bioassay organism. The utility of zebrafish as a bioassay model organism for BoNT was investigated. The 96 h median immobilizing doses of BoNT/A, BoNT/C, BoNT/E, and BoNT/F for adult male Tübingen strain zebrafish (0.32 g mean weight at 25 °C were 16.31, 124.6, 4.7, and 0.61 picograms (pg/fish, respectively. These findings support the use of the zebrafish-based bioassays for evaluating the presence of BoNT/A, BoNT/E, and BoNT/F. Evaluating the basis of the relatively high resistance of zebrafish to BoNT/C and the extreme sensitivity to BoNT/F may reveal unique functional patterns to the action of these neurotoxins.

  19. [Botulinum toxin therapy for spasticity].

    Science.gov (United States)

    Masakado, Yoshihisa

    2014-09-01

    Botulinum toxin (BTX) administered as an adjunct to other interventions for spasticity can act as a useful and effective therapeutic tool for treating patients disabled by spasticity. Presence of other non-reflex motor disorders (muscle stiffness, shortness, and contracture) can complicate the clinical course and disturb rehabilitative process of patients with spasticity. Treatment of spasticity using BTX can improve paralysis by correcting muscular imbalance that follows these diseases. In patients with chronic severe spasticity, we also have to address unique and difficult-to-treat clinical conditions such as abnormal posture and movement disorders. The effectiveness of BTX in treating some of these conditions is discussed. Because patients with neurological disabilities can show complex dysfunctions, specific functional limitations, goals, and expected outcomes of treatment should be evaluated and discussed with the patient, family members, and caregivers, prior to initiating BTX therapy. BTX therapy might improve not only care, passive function, but also motor functions in these patients by supplementing intensive rehabilitation with repetitive transcranial magnetic stimulation, transcranial direct-current stimulation, peripheral electrical stimulation, muscle stretching, and other rehabilitation strategies.

  20. Neurologic uses of botulinum neurotoxin type A

    Directory of Open Access Journals (Sweden)

    John P Ney

    2007-01-01

    Full Text Available John P Ney, Kevin R JosephMadigan Army Medical Center, Neurology Service, Tacoma, WA, USAAbstract: This article reviews the current and most neurologic uses of botulinum neurotoxin type A (BoNT-A, beginning with relevant historical data, neurochemical mechanism at the neuromuscular junction. Current commercial preparations of BoNT-A are reviewed, as are immunologic issues relating to secondary failure of BoNT-A therapy. Clinical uses are summarized with an emphasis on controlled clinical trials (as appropriate, including facial movement disorders, focal neck and limb dystonias, spasticity, hypersecretory syndromes, and pain.Keywords: botulinum neurotoxins, BOTOX®, Dysport®, chemodenervation

  1. Ablative Fractional CO2 Laser may be a Novel Treatment for Tattoo Allergic Reaction

    National Research Council Canada - National Science Library

    Behrooz Barikbin; Zahra Akbari; Somayeh Hejazi

    2012-01-01

      A 47 year-old woman presented with eight-month history of tattoo allergic reaction of eyebrows after botulinum toxin A injection that was resistant to oral, topical and intralesional injection of corticosteroids...

  2. Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystonias and hemifacial spasm.

    Science.gov (United States)

    Jankovic, J; Schwartz, K; Donovan, D T

    1990-01-01

    In the past five years, 477 patients with various focal dystonias and hemifacial spasm received 3,806 injections of botulinum A toxin for relief of involuntary spasms. A definite improvement with a global rating greater than or equal to 2 on a 0-4 scale, was obtained in all 13 patients with spasmodic dysphonia, 94% of 70 patients with blepharospasm, 92% of 13 patients with hemifacial spasm, 90% of 195 patients with cervical dystonia, 77% of 22 patients with hand dystonia, 73% of 45 patients with oromandibular dystonia, and in 90% of 21 patients with other focal dystonia who had adequate follow up. While the average duration of maximum improvement lasted about 11 weeks after an injection (range seven weeks in patients with hand dystonia to 15 weeks in patients with hemifacial spasm), some patients benefited for over a year. Only 16% of the 941 treatment visits with follow up were not successful. Except for transient focal weakness, there were very few complications or systemic effects attributed to the injections. This study supports the conclusion that botulinum toxin injections are a safe and effective therapy for patients with focal dystonia and hemifacial spasm. Images PMID:2213039

  3. [Botulinum toxin treatment of hip adductor spasticity in multiple sclerosis].

    Science.gov (United States)

    Wissel, J; Entner, T

    2001-01-01

    Spasticity results in a resistance to passive movement and decrease of passive mobility of the involved joints and is defined as a state of hypertonicity with exaggeration of tendon reflexes mediated by a loss of inhibitory control of upper motor neurons. In patients with severe stages of multiple sclerosis (MS) spasticity of the lower limbs often leeds to a spastic pattern with hip adduction resulting in decreased range-of-motion (ROM), increased pain, spasms, and functional disability (disturbed gait and sitting position) as well as difficulties with perineal hygiene. Local botulinum toxin type A (Btx-A) injections in spastic muscles offer a new treatment approach for managing spasticity and associated problems. Up to now Btx-A is approved for the treatment of blepharospasm and cervical dystonia and the treatment of equinous gait in children with cerebral palsy in Austria and Germany. Up to now only in Switzerland Botox is licensed for the treatment of focal spasticity. Btx-A is a neurotoxin derived from Clostridium botulinum. In most european countries Btx-A is available as Dysport (vial = 500 units) and Botox (vial = 100 units). In prospective studies a ratio of 1 unit Botox to 3-4 units Dysport was found. Following intramuscular injection Btx-A blocks the release of acetylcholine at the neuromuscular junctions, thereby inhibiting muscle contraction, and decreases spastic muscle tone and muscle spindles afferent information to the spinal cord. The spectrum of side effects includes local weakening of the injected and adjacent muscles as well as pain and haematoma at the injection site. At therapeutic doses side effects are local and transient. According to a double blind, placebo controlled, dose ranging study published by Hyman et al. (2000, Dysport in a dose of 500, 1000 and 1500 units reduced the degree of hip adductor spasticity associated with MS, and this benefit was evident despite concomitant use of oral antispasticity medication. According to the

  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.

  5. Dynamic splinting after treatment with botulinum toxin type-A: a randomized controlled pilot study.

    Science.gov (United States)

    Lai, Jenny M; Francisco, Gerard E; Willis, F Buck

    2009-02-01

    Over 1.5 million Americans are diagnosed with a stroke each year, and excessive flexion or extension (hypertonia) of upper extremity joints are common secondary conditions. The purpose of this study was to compare the efficacy of botulinum toxin type-A and manual therapy, with the adjunct treatment of dynamic splinting on range of motion, spasticity, and elbow flexor hypertonia, in a randomized trial. Thirty-six subjects were recruited for this pilot study and all exhibited hypertonia in elbow flexion. Six patients were excluded due to noncompliance. Testing was done with pre/post active range of motion in elbow extension, and the Modified Ashworth Scale (extension) for spasticity. All patients received the current standard of care: botulinum toxin type-A injections and manual therapy. Experimental patients were randomly assigned adjunct treatment with Elbow Extension Dynasplint. Thirty patients completed the study (mean age [SD] 52+/-17 years). The percentage of change in active range of motion in elbow extension was greater for the experimental than for control subjects (33.5% vs. 18.7%). The Modified Ashworth Scale (extension) scores showed comparable changes of a mean 9.3% improvement for experimental versus 8.6% for the control subjects. This study confirmed the efficacy of botulinum toxin type-A in tone management and occupational therapy in contracture reduction. It also showed the value of dynamic splinting in maintaining gains in range of motion.

  6. Botulinum toxin type A therapy for hemifacial spasm.

    Science.gov (United States)

    Costa, J; Espírito-Santo, C; Borges, A; Ferreira, J J; Coelho, M; Moore, P; Sampaio, C

    2005-01-25

    Hemifacial spasm is characterised by unilateral involuntary contractions of muscles innervated by the facial nerve. The usual cause is a vessel touching the facial nerve near its origin from the brain stem. Although it is a benign condition it can cause significant cosmetic and functional disability. It is a chronic disease and spontaneous recovery is very rare. The two treatments routinely available are microvascular decompression and Botulinum Toxin type A (BtA) muscular injections. To determine whether botulinum toxin (BtA) is an effective and safe treatment for hemifacial spasm. We searched the Cochrane Movement Disorders Group trials register, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1977 to December 2003), EMBASE (1977 to December 2003), and reference lists of articles. We also contacted drug manufacturers and researchers in the field. Randomised studies comparing BtA with placebo in people with hemifacial spasm. Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. We found only one small randomised, placebo-controlled trial involving 11 people. It was a crossover trial during which patients underwent four sets of injections, comparing placebo with three different doses of BtA - formulation Botox(r) (low dose: one-half of the intermediate dose; intermediate dose; and high dose: twice the intermediate dose), and one of placebo. In this trial BtA was superior to placebo. The findings of this single eligible trial support the results of large, open, case-control studies showing a benefit rate between 76 and 100%. This effect size probably makes it very difficult to perform new large placebo controlled trials for hemifacial spasm. Despite the paucity of good quality controlled data, all the studies available suggest that BtA is effective and safe for treating hemifacial spasm

  7. Functional end-plate recovery in long-term botulinum toxin therapy of hemifacial spasm: a nerve conduction study.

    Science.gov (United States)

    Butera, C; Guerriero, R; Amadio, S; Ungaro, D; Tesfaghebriel, H; Bianchi, F; Comi, G; Del Carro, U

    2013-02-01

    Botulinum toxin type-A is currently thought to be effective and safe for hemifacial spasm (HFS). The pre-synaptic block of acetylcholine release at the neuromuscular junction induces depression of orbicularis oculi muscle compound motor action potential (CMAP). The aim of our study was to evaluate at what extent end-plate functional recovery is possible even in botulinum toxin treatments lasting up to 15 years. We examined 81 outpatients with primary HFS (mean treatment duration = 7.2 ± 4.2 years) who underwent neurophysiologic study, once clinical effect of the previous treatment had vanished. The mean CMAP amplitude, mean rectified amplitude of response 1 (R1) of the blink reflex and area of response 2 (R2) of treated orbicularis oculi muscle were measured in comparison to the controlateral side. Mean amplitude of the above mentioned parameters was slightly lower (about 20%; p botulinum toxin affects compound motor action potential and blink-reflex responses for at least 4-5 months in HFS patients. The residual block is slight and does not increase with repeated injections after several years of treatment. Our study, beside confirming the long-term efficacy of botulinum toxin treatment for HFS, provides neurophysiologic evidence that therapeutic effect may be obtained without hindering the regenerative potential of the nerve-muscle complex.

  8. [Advantages of combined therapies in cosmetic medicine for the treatment of face aging: botulinum toxin, fillers and mesotherapy].

    Science.gov (United States)

    Braccini, F; Dohan Ehrenfest, D M

    2010-01-01

    Non surgical cosmetic medicine procedures for the face are developing considerably, as they deliver good results using simple, non invasive, atraumatic and reproducible techniques. Aesthetic mesotherapy, also known as anti-aging mesotherapy, uses intra-dermal injections of a nutritive and moisturizing solution to improve brightness, skin hydration and tonus, and also smooth out superficial wrinkles. Subcutaneous filler injections enable to fill wrinkles and folds; by using high density products it is also able to provide genuine facial volumetric reconstruction. Finally, botulinum toxin acts by reducing certain muscle contractions to smooth out expression lines and folds induced by facial dynamics. In this article, we explore the concept of combined therapy and describe our experience associating anti-aging mesotherapy (NCTF-135HA, Filorga, Paris, France), hyaluronic acid based fillers (X-HA3 and X-HA-Volume, Filorga, Paris, France) and botulinum toxin (Vistabel, Allergan, Irvine CA, USA). A therapy combining anti-aging mesotherapy, botulinum toxin and filler injections, offers full treatment of the 3 biological levels of the covering tissues. This non-invasive therapeutic strategy brings patient satisfaction through a global approach to facial aging.

  9. Medroxyprogesterone Injection

    Science.gov (United States)

    Medroxyprogesterone intramuscular (into a muscle) injection and medroxyprogesterone subcutaneous (under the skin) injection are used to prevent pregnancy. Medroxyprogesterone subcutaneous injection is also used to treat endometriosis ( ...

  10. Tyrosine Phosphorylation of Botulinum Neurotoxin Protease Domains

    OpenAIRE

    Stephen eToth; Ernst E Brueggemann; Oyler, George A.; Smith, Leonard A.; Hines, Harry B.; S. Ashraf eAhmed

    2012-01-01

    Botulinum neurotoxins are most potent of all toxins. Their N-terminal light chain domain (Lc) translocates into peripheral cholinergic neurons to exert its endoproteolytic action leading to muscle paralysis. Therapeutic development against these toxins is a major challenge due to their in vitro and in vivo structural differences. Although three-dimensional structures and reaction mechanisms are very similar, the seven serotypes designated A through G vastly vary in their intracellular catalyt...

  11. Characterization of Hemagglutinin Negative Botulinum Progenitor Toxins

    Directory of Open Access Journals (Sweden)

    Suzanne R. Kalb

    2017-06-01

    Full Text Available Botulism is a disease involving intoxication with botulinum neurotoxins (BoNTs, toxic proteins produced by Clostridium botulinum and other clostridia. The 150 kDa neurotoxin is produced in conjunction with other proteins to form the botulinum progenitor toxin complex (PTC, alternating in size from 300 kDa to 500 kDa. These progenitor complexes can be classified into hemagglutinin positive or hemagglutinin negative, depending on the ability of some of the neurotoxin-associated proteins (NAPs to cause hemagglutination. The hemagglutinin positive progenitor toxin complex consists of BoNT, nontoxic non-hemagglutinin (NTNH, and three hemagglutinin proteins; HA-70, HA-33, and HA-17. Hemagglutinin negative progenitor toxin complexes contain BoNT and NTNH as the minimally functional PTC (M-PTC, but not the three hemagglutinin proteins. Interestingly, the genome of hemagglutinin negative progenitor toxin complexes comprises open reading frames (orfs which encode for three proteins, but the existence of these proteins has not yet been extensively demonstrated. In this work, we demonstrate that these three proteins exist and form part of the PTC for hemagglutinin negative complexes. Several hemagglutinin negative strains producing BoNT/A, /E, and /F were found to contain the three open reading frame proteins. Additionally, several BoNT/A-containing bivalent strains were examined, and NAPs from both genes, including the open reading frame proteins, were associated with BoNT/A. The open reading frame encoded proteins are more easily removed from the botulinum complex than the hemagglutinin proteins, but are present in several BoNT/A and /F toxin preparations. These are not easily removed from the BoNT/E complex, however, and are present even in commercially-available purified BoNT/E complex.

  12. [Comparative analysis of occupational therapy benefits in spastic patients with hands involvement before and after botulinum toxin infiltration].

    Science.gov (United States)

    Rampazo, F M; Bianchin, M A; Oliveira, F N; Lucato, R V

    Spasticity is the most difficult motor disorder to be treated after an encephalic vascular accident or stroke, which interferes in the patient's selective motor functioning. To compare the involvement type of the extrinsic muscles, the functionality degree of the hand and functional independence of patients with spastic hemiplegia due to stroke after botulinum toxin A (BTA) infiltration. They were divided into a group receiving occupational therapy treatment (group I), and other who has not received it (group II). Longitudinal study with 20 spastic hemiplegic outpatients due to stroke, both sexes, with average age of 53.1 +/- 15.3 years-old who have been attending in the botulinum toxin service. They have received BTA infiltration in the muscles responsible for the hand functional movements, and they were evaluated before and after 3-months infiltration. To collect data, these instruments were used: anamnesis questionnaire of occupational therapy, the Classification of involvement types of extrinsic muscle, according to adapted Zancolli, the adapted Hausen's Functional Classification, the Functional Independence Measure Scale, the Rivermead's Scale of Activity of Daily Life and the Barthel Index. In the classification, according to adapted Zancolli, group I presented higher improvement of involvement than group II. Statistical significance (p occupational therapy were observed in the rehabilitation of patients with spastic hemiplegia due to stroke after infiltration of BTA providing them greater abilities and functional independence in their daily life activities.

  13. Therapeutic applications of botulinum neurotoxins in head and neck disorders

    Directory of Open Access Journals (Sweden)

    Ahmad Alshadwi

    2015-01-01

    Conclusion: Botulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.

  14. 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.

  15. Sumatriptan Injection

    Science.gov (United States)

    Alsuma® Injection ... Imitrex® Injection ... Sumavel® Injection ... Sumatriptan injection is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by ...

  16. The binding of botulinum neurotoxins to different peripheral neurons.

    Science.gov (United States)

    Rossetto, O

    2017-10-16

    Botulinum neurotoxins are the most potent toxins known. The double receptor binding modality represents one of the most significant properties of botulinum neurotoxins and largely accounts for their incredible potency and lethality. Despite the high affinity and the very specific binding, botulinum neurotoxins are versatile and multi-tasking toxins. Indeed they are able to act both at the somatic and at the autonomic nervous system. In spite of the preference for cholinergic nerve terminals botulinum neurotoxins have been shown to inhibit to some extent also the noradrenergic postganglionic sympathetic nerve terminals and the afferent nerve terminals of the sensory neurons inhibiting the release of neuropeptides and glutamate, which are responsible of nociception. Therefore, there is increasing evidence that the therapeutic effect in both motor and autonomic disorders is based on a complex mode of botulinum neurotoxin action modulating the activity of efferent as well as afferent nerve fibres. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Modification of Chin Projection and Aesthetics With OnabotulinumtoxinA Injection.

    Science.gov (United States)

    Hsu, Amy K; Frankel, Andrew S

    2017-12-01

    Because of the soft-tissue envelope and the dimensional complexity of the muscular contraction of the mentalis muscle, the projection and shape of the chin is not determined by only the bony projection. In a subset of patients with a seemingly underprojected chin, a hyperactive, high-riding mentalis muscle contributes to a blunted chin contour. To evaluate the use of onabotulinumtoxinA (botulinum toxin A) for improving chin aesthetics in patients with an underprojected bony chin and a high-riding hyperactive mentalis muscle. This case series and photographic analysis included 11 patients presenting with an underprojected bony chin and a high-riding hyperactive mentalis muscle at a private facial plastic surgery practice from August 25, 2006, to November 10, 2012. Data were analyzed from November 13, 2012, to April 9, 2013. Injection with 12 to 15 U of onabotulinumtoxinA into the mentalis muscle. Photographic analysis of the vertical and horizontal positions of the pogonion relative to fixed facial points before and after injection. A patient satisfaction scale was also used to assess improvement in overall chin aesthetic. Eleven patients (3 men and 8 women; mean [SD] age, 46.3 [16.4] years) participated in the study, including 2 who had undergone prior chin implantation. The vertical position of the pogonion was more inferior after injection in 10 of 11 patients (mean [SD] vertical position, 1.36 [0.18] preinjection and 1.44 [0.18] postinjection; P = .005). Although the horizontal position of the pogonion changed in all patients, this change was not statistically significant (mean [SD] horizontal position, 0.11 [0.13] preinjection and 0.14 [0.13] postinjection; P = .32). All patients experienced improvement in their overall chin aesthetic and a subjective decrease in chin tension. Chin contour was improved, with soft-tissue volume overall displaced more inferiorly with a rounded rather than blunted appearance. No adverse effects were reported after

  18. Phosphatidylcholine/deoxycholate lipolysis and hyaluronic acid augmentation to enhance nonsurgical lower facial contouring using botulinum toxin type A.

    Science.gov (United States)

    Wong, Garsing Roger; Chen, Wen-Pei

    2011-06-01

    Botulinum toxin type A can produce dramatic improvements in patients with benign masseteric hypertrophy but this method alone is not as effective for patients with a rounded lower face. The paper describes the effective use of selective lower jowl phosphatidylcholine/deoxycholate lipolysis and chin, cheek, and nose augmentation with hyaluronic acid to refine cosmetic lower facial contouring using botulinum toxin type A in a young Asian woman. A series of treatments was administered over 26 months. The patient's lower cheeks were slimmed and jowl definition was improved producing the patient's desired sculptured, heart-shaped face. The injection-based procedures provided much preferable alternative to surgery from the perspective of both the patient and her family. The authors believe that this is the first case report in the published literature reporting these three methods used in conjunction. © 2011 Wiley Periodicals, Inc.

  19. Botulinum toxin type A in the treatment of lower-limb spasticity in children with cerebral palsy Toxina botulínica tipo A como tratamento para espasticidade de membros inferiores em crianças com paralisia cerebral

    Directory of Open Access Journals (Sweden)

    Carlos Henrique F. Camargo

    2009-03-01

    Full Text Available We evaluated the safety and effectiveness of botulinum toxin A (BoNT/A in the treatment of spasticity in 20 children with spastic diplegic cerebral palsy (CP. All the patients received injections in the gastrocnemius and soleus, and 15 received injections in the adductors. The total dose varied from 70 to 140 U (99.75±16.26 U, or 7.45±2.06 U/kg per patient. The treatment improved the patients' walking and gait pattern significantly. There was also a significant alteration in the heel-ground distance and increased motion of the ankle joint. These structural changes in the feet were sustained until the end of the follow-up, although the same was not observed for the functional parameters. Three patients complained of weakness in the lower limbs. In conclusion, BoNT/A is safe and effective when used in a single session of injections and produces a sustained structural modification of the lower limbs. However, functional changes are temporary and are only observed during the peak effect of the drug.Para avaliação da segurança e eficácia do tratamento com toxina botulínica A (TB-A na espasticidade na paralisia cerebral (PC, foram selecionadas 20 crianças com a forma diplegia espástica. Todos os pacientes receberam injeções nos gastrocnêmios e sóleos, 15 receberam doses nos adutores da coxa. A dose total variou de 70 a 140 Us (99,75±16,26 U, 7,45±2,06 U/Kg por paciente. O tratamento com a TB-A melhorou significativamente a deambulação e o padrão de marcha. Houve também significativa alteração da distância tornozelo-solo e aumento da amplitude de movimento da articulação do tornozelo. Essas mudanças estruturais dos pés se mantiveram até o final do acompanhamento. O mesmo não foi observado com parâmetros funcionais. Três pacientes apresentaram fraqueza em membros inferiores. Conclui-se que a TB-A, em uma única aplicação, é segura e eficaz. Há modificação sustentada da estrutura motora dos membros inferiores, por

  20. Botulinum toxin in the management of facial paralysis.

    Science.gov (United States)

    Cabin, Jonathan A; Massry, Guy G; Azizzadeh, Babak

    2015-08-01

    Complete flaccid facial paralysis, as well as the synkinetic and hyperkinetic sequelae of partial recovery, has significant impact on quality of life. Patients suffer from functional deficiencies, cosmetic deformity, discomfort and social consequences leading to emotional distress. Despite an extensive and sophisticated array of available interventions for facial reanimation, most patients have persistent issues that require consistent follow-up. In long-term management, botulinum toxin (BT) injection remains a critical tool in the treatment of the facial paralysis patient, particularly in the case of synkinesis, hyperkinesis and imbalance. We review the recent scientific literature and highlight key principles and developments in the use of BT in the management of facial paralysis, including less common applications for acute facial paralysis, hyperlacrimation and pseudoptosis. We reviewed the literature for the latest advances in the use of BT in facial paralysis, including applications and technique, as well as measurement tools and adjunct exercises. We also share our experience in treating our own patient population. BT continues to be a well tolerated and effective tool in the long-term management of facial paralysis, specifically in treating synkinesis, imbalance and hyperkinesis, as well as hyperlacrimation and pseudoptosis. Consistent measurement tools and adjunct neuromuscular retraining are crucial in the successful deployment of BT. Controversy exists as to whether BT should be used to manage facial paralysis during the acute phase, and whether BT application to the nonparalyzed face can improve long-term recovery in the paralyzed side.

  1. 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

  2. The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache.

    Science.gov (United States)

    Pihut, Malgorzata; Ferendiuk, Ewa; Szewczyk, Michal; Kasprzyk, Katarzyna; Wieckiewicz, Mieszko

    2016-01-01

    Temporomandibular joint dysfunction are often accompanied by symptoms of headache such as tension-type headache which is the most frequent spontaneous primary headache. Masseter muscle pain is commonly reported in this group. The purpose of the study was to assess the efficiency of intramuscular botulinum toxin type A injections for treating masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. This prospective outcome study consisted of 42 subjects of both genders aged 19-48 years diagnosed with masseter muscle pain related to temporomandibular joint dysfunction and tension-type headache. The subjects were treated by the intramuscular injection of 21 U (mice units) of botulinum toxin type A (Botox, Allergan) in the area of the greatest cross-section surface of both masseter bellies. Pain intensity was evaluated using visual analogue scale (VAS) and verbal numerical rating scale (VNRS) 1 week before the treatment and 24 weeks after the treatment. The obtained data were analyzed using the Wilcoxon matched pairs test (p ≤ 0,005). The results of this study showed a decrease in the number of referred pain episodes including a decrease in pain in the temporal region bilaterally, a reduction of analgesic drugs intake as well as a decrease in reported values of VAS and VNRS after injections (p = 0,000). The intramuscular botulinum toxin type A injections have been an efficient method of treatment for masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache.

  3. Botulinum toxin type A in the treatment of hemifacial spasm: an 11-year experience.

    Science.gov (United States)

    Barbosa, Egberto Reis; Takada, Leonel Tadao; Gonçalves, Lilian Regina; Costa, Rose Mary Paulo do Nascimento; Silveira-Moriyama, Laura; Chien, Hsin Fen

    2010-08-01

    In order to evaluate the long-term effect of botulinum toxin type A (BTX) in the treatment of hemifacial spasm (HFS), a retrospective analysis of patients treated at the Movement Disorders Unit of the Division of Neurology, Clinical Hospital, University of São Paulo, School of Medicine from 1993 to 2004 was made. A total of 808 injections with BTX were administered to 54 patients with HFS. The mean duration of improvement per application was 3.46 months and the mean rate of improvement using subjective judgement by the patient was of 83%. Adverse effects, mostly minor, were observed in 64.8% of patients at least once along the period of follow-up and the most frequent of them was orbicularis oris paralysis (38.8%). There was no decrement in response when compared the first and the last injection recorded.

  4. Physical Characterization of Clostridium Botulinum Neurotoxin Genes

    Science.gov (United States)

    1993-10-01

    modern food -preserving processes in Western countries has made 1 outbreaks of botulism extremely rare. The frequent use of C.botulinum as a test...organism in the food industry, and the growing use of the toxin by neurobiochemists, has, however, led to the development of human vaccines. The...390v 400v DOTE [• - F -TK--VQ -- 0Q ---YI G Q KM YLFKL NS N - S - N I G NF N K 383 DOTFIFT ED L AINIK FIKIV C RINIT YIF I K MCF LVPIN L L D DDIDII YIT

  5. Botulinum neurotoxins: genetic, structural and mechanistic insights.

    Science.gov (United States)

    Rossetto, Ornella; Pirazzini, Marco; Montecucco, Cesare

    2014-08-01

    Botulinum neurotoxins (BoNTs) are produced by anaerobic bacteria of the genus Clostridium and cause a persistent paralysis of peripheral nerve terminals, which is known as botulism. Neurotoxigenic clostridia belong to six phylogenetically distinct groups and produce more than 40 different BoNT types, which inactivate neurotransmitter release owing to their metalloprotease activity. In this Review, we discuss recent studies that have improved our understanding of the genetics and structure of BoNT complexes. We also describe recent insights into the mechanisms of BoNT entry into the general circulation, neuronal binding, membrane translocation and neuroparalysis.

  6. 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.

  7. Botulinum and tetanus neurotoxins: structure, function and therapeutic utility.

    Science.gov (United States)

    Turton, Kathryn; Chaddock, John A; Acharya, K Ravi

    2002-11-01

    The toxic products of the anaerobic bacteria Clostridium botulinum, Clostridium butyricum, Clostridium barati and Clostridium tetani are the causative agents of botulism and tetanus. The ability of botulinum neurotoxins to disrupt neurotransmission, often for prolonged periods, has been exploited for use in several medical applications and the toxins, as licensed pharmaceutical products, now represent the therapeutics of choice for the treatment for several neuromuscular conditions. Research into the structures and activities of botulinum and tetanus toxins has revealed features of these proteins that might be useful in the design of improved vaccines, effective inhibitors and novel biopharmaceuticals. Here, we discuss the relationships between structure, mechanism of action and therapeutic use.

  8. 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.

  9. Adalimumab Injection

    Science.gov (United States)

    Humira® Injection ... Adalimumab injection is used alone or with other medications to relieve the symptoms of certain autoimmune disorders (conditions in ... some areas of the body) in adults. Adalimumab injection is in a class of medications called tumor ...

  10. Oxacillin Injection

    Science.gov (United States)

    Oxacillin injection is used to treat infections caused by certain bacteria. Oxacillin injection is in a class of medications called penicillins. ... works by killing bacteria.Antibiotics such as oxacillin injection will not work for colds, flu, or other ...

  11. Rituximab Injection

    Science.gov (United States)

    Rituximab injection (Rituxan) and rituximab and hyaluronidase human injection (Rituxin Hycela) are used alone or with other medications to ... that begins in the white blood cells). Rituximab injection is also used with another medication to treat ...

  12. Fluorouracil Injection

    Science.gov (United States)

    Adrucil® Injection ... Fluorouracil injection comes as a solution (liquid) to be given intravenously (into a vein) by a doctor or nurse ... you are feeling during your treatment with fluorouracil injection.

  13. Ondansetron Injection

    Science.gov (United States)

    Zofran® Injection ... Ondansetron injection is used to prevent nausea and vomiting caused by cancer chemotherapy and surgery. Ondansetron is in a ... medications: or any of the ingredients in ondansetron injection. Ask your pharmacist for a list of the ...

  14. Romiplostim Injection

    Science.gov (United States)

    ... or may tell you to stop taking these medications if romiplostim injection works well for you.Romiplostim injection does not ... will give you the manufacturer's patient information sheet (Medication ... romiplostim injection. Read the information carefully and ask your doctor ...

  15. Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins

    Directory of Open Access Journals (Sweden)

    Bahman Jabbari

    2013-05-01

    Full Text Available Sialorrhea or excessive drooling is a major issue in children with cerebral palsy and adults with neurodegenerative disorders. In this review, we describe the clinical features, anatomy and physiology of sialorrhea, as well as a review of the world literature on medical treatment using Yale University’s search engine; including but not limited to Medline and Erasmus. Level of drug efficacy is defined according to the guidelines of American Academy of Neurology. Current medical management is unsatisfactory. Topical agents (scopolamine and tropicamide and oral agents (glyccopyrolate combined render a level B evidence (probably effective; however, this treatment is associated with troublesome side effects. Double-blind and placebo-controlled studies of botulinum toxin (BoNT provide a level A evidence for type B (two class I studies; effective and established and both overall and individual B level of evidence for OnabotulinumtoxinA (A/Ona and AbobotulinumtoxinA (A/Abo; these are probably effective. For IncobotulinumtoxinA (A/Inco, the level of evidence is U (insufficient due to lack of blinded studies. Side effects are uncommon; transient and comparable between the two types of toxin. A clinical note at the end of this review comments on fine clinical points. Administration of BoNTs into salivary glands is currently the most effective way of treating sialorrhea.

  16. Clostridium botulinum in cattle and dairy products.

    Science.gov (United States)

    Lindström, Miia; Myllykoski, Jan; Sivelä, Seppo; Korkeala, Hannu

    2010-04-01

    The use of plastic-wrapped and nonacidified silage as cattle feed has led to an increasing number of botulism outbreaks due to Clostridium botulinum Groups I-III in dairy cattle. The involvement of Groups I and II organisms in cattle botulism has raised concern of human botulism risk associated with the consumption of dairy products. Multiplication of C. botulinum in silage and in the gastrointestinal tract of cattle with botulism has been reported, thus contamination of the farm environment and raw milk, and further transmission through the dairy chain, are possible. The standard milk pasteurization treatment does not eliminate spores, and the intrinsic factors of many dairy products allow botulinal growth and toxin production. Although rare, several large botulism outbreaks due to both commercial and home-prepared dairy products have been reported. Factors explaining these outbreaks include most importantly temperature abuse, but also unsafe formulation, inadequate fermentation, insufficient thermal processing, post-process contamination, and lack of adequate quality control for adjunct ingredients were involved. The small number of outbreaks is probably explained by a low incidence of spores in milk, the presence of competitive bacteria in pasteurized milk and other dairy products, and growth-inhibitory combinations of intrinsic and extrinsic factors in cultured and processed dairy products.

  17. Agitation predicts response of depression to botulinum toxin treatment in a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Marc Axel Wollmer

    2014-03-01

    Full Text Available In a randomized, controlled trial (n=30 we showed that botulinum toxin injection to the glabellar region produces a marked improvement in the symptoms of major depression. We hypothesized that the mood-lifting effect was mediated by facial feedback mechanisms. Here we assessed if agitation, which may be associated with increased dynamic psychomotor activity of the facial musculature, can predict response to the treatment. To test this hypothesis we re-analyzed the data of the scales from our previous study on a single item basis and compared the baseline scores in the agitation item (item 9 of the Hamilton Depression Rating Scale (HAM-D between responders (n=9 and participants who did not attain response (n=6 among the recipients of onabotulinumtoxinA (n=15. Results: Responders had significantly higher item 9 scores at baseline (1.56+0.88 vs. 0.33+0.52, t(13=3.04, d=1.7, p=0.01, while no other single item of the HAM-D or the Beck Depression Inventory was associated with treatment response. The agitation score had an overall precision of 78% in predicting response in a receiver operating characteristic (ROC analysis (area under the curve, AUC=0.87. These data provide a link between response to botulinum toxin treatment with a psychomotor manifestation of depression and thereby indirect support of the proposed facial feedback mechanism of action. Moreover, it suggests that patients with agitated depression may particularly benefit from botulinum toxin treatment.

  18. [Food poisoning caused by Clostridium botulinum type E].

    Science.gov (United States)

    Aureli, P; Fenicia, L; Ferrini, A M

    1984-01-01

    The results of a microbiological investigation carried out into a home-canned tuna fish are reported in relation to a suspected botulism case. Toxin of Cl. botulinum type E was detected by mouse toxicity and neutralization tests. The food specimen were also cultured for Cl. botulinum. The isolates was identified as Cl. botulinum type E by biochemical, gas chromatographic and immunological tests. The outbreak in which for the first time in Italy, the Cl. botulinum type E is involved, concerns one person who showed typical signs and symptoms consistent with botulism (abdominal cramps, dilatated pupils, diplopia, dysphagia, paralysis of lower upper limbs). The laboratory results are discussed with relation to environmental characteristics of the micro-organism and their resistance to same chemical and physical factors with are involved in the canning practice.

  19. The botulinum neurotoxin LD50 test - problems and solutions

    National Research Council Canada - National Science Library

    Bitz, Silke

    2010-01-01

    ... on cosmetic testing in animals in the case of Botulinum Neurotoxin (BoNT) testing. The European Pharmacopoeia monograph allows for the use of three alternative methods provided they are validated...

  20. Women's perspective of botulinum toxin treatment for overactive bladder symptoms.

    Science.gov (United States)

    Digesu, G Alessandro; Panayi, Demetri; Hendricken, Caroline; Camarata, Michelle; Fernando, Ruwan; Khullar, Vikram

    2011-04-01

    This study aimed to evaluate the women's' views and expectations about outcomes and complications of botulinum toxin treatment for overactive bladder (OAB) symptoms. Consecutive women with OAB symptoms and detrusor overactivity were requested to fill out a multiple choice questionnaire to assess whether they would consider botulinum and what outcomes as well as complications they would find acceptable to undergo this treatment. Two hundred sixty-one women, mean age of 58 (range, 38-78) years, were studied. Two hundred twenty-four were treatment-naive women (group A), while 37 were no responders to anticholinergics (group B). Only 49.6% of women in group A and 54% in group B would accept botulinum toxin. No significant differences were found between treatment-naive women and non-responders to anticholinergics (p > 0.05). Acceptance of botulinum toxin treatment involves a complex interaction of efficacy and possible complications. The balance of these factors changes the acceptability of the treatment.

  1. Hemifacial Spasm due to Compression of the Posterior Inferior Cerebellar Artery Aneurysm Treated with Botulinum Toxin Type-A: A Case Report

    OpenAIRE

    Azize Esra Gürsoy; Gülsen Babacan Yildiz; Adam Mehmet Gülhan; Mehmet Kolukisa

    2012-01-01

    A 79-year-old female presented with five months history of progressive involuntary twitching movement on left face. Brain MR imaging revealed a heterogeneous T2 hyperintense lesion at left cerebellopontine angle. CT angiography showed a partially thrombosed saccular aneurysm of left PICA (posterior inferior cerebellar artery). The patient was treated with Botulinum toxin type A and almost total relief of symptoms was noticed during one month followup. Botulinium toxin injection is an effectiv...

  2. Cellular and Matrix Response of the Mandibular Condylar Cartilage to Botulinum Toxin.

    Directory of Open Access Journals (Sweden)

    Eliane H Dutra

    Full Text Available To evaluate the cellular and matrix effects of botulinum toxin type A (Botox on mandibular condylar cartilage (MCC and subchondral bone.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.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.Injection of Botox in masseter muscle leads to decreased mineralization and matrix deposition, reduced chondrocyte proliferation and differentiation and increased cell apoptosis in the MCC and subchondral bone.

  3. Mechanisms of Toxin Production of Food Bacteria (Clostridium botulinum)

    Science.gov (United States)

    1983-12-01

    found, such as in wounds or infant intestinal tracts. Another exanple may be the production of bacteriocins . Nonproteolytic B strain 17844 carries...l~ V- 9;-iC -’.1,- r, 4. •, . . . . . MECHANISMS OF TOXIN PRODUCTION OF FOOD BACTERIA (CLOSTRIDIUM BOTULINUM) FINAL REPORT DR. H. U. EKLUND F. T...Mechanisms of Toxin Production of Food Bacteria Clostridium botulinum Final Y,’v/ ’ "D30 • ’q• 6, PERFORM G ORG. REPORT NUMBER 7. AUTHOR(.) S

  4. 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.

  5. Ibandronate Injection

    Science.gov (United States)

    Boniva® Injection ... Ibandronate injection is used to treat osteoporosis (a condition in which the bones become thin and weak and break ... Ibandronate injection comes as a solution (liquid) to be injected into a vein by a doctor or nurse in ...

  6. Tocilizumab Injection

    Science.gov (United States)

    ... or the syringe and do not inject the medication.You may inject tocilizumab injection on the front of the thighs or anywhere ... your doctor about the risks of receiving this medication.Tocilizumab injection may cause other side effects. Call your doctor ...

  7. Certolizumab Injection

    Science.gov (United States)

    ... package or the syringe. Do not inject the medication.You may inject certolizumab injection anywhere on your stomach or thighs except your ... your doctor about the risks of receiving this medication.Certolizumab injection may cause other side effects. Call your doctor ...

  8. Sarilumab Injection

    Science.gov (United States)

    ... for RA or who could not take these medications. Sarilumab injection is in a class of medications called interleukin- ... are any problems and do not inject the medication.You may inject sarilumab injection on the front of the thighs or anywhere ...

  9. 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.

  10. Functional effects of botulinum toxin type-A treatment and subsequent stretching of spastic calf muscles: a study in patients with hereditary spastic paraplegia.

    Science.gov (United States)

    de Niet, Mark; de Bot, Susanne T; van de Warrenburg, Bart P C; Weerdesteyn, Vivian; Geurts, Alexander C

    2015-02-01

    Although calf muscle spasticity is often treated with botulinum toxin type-A, the effects on balance and gait are ambiguous. Hereditary spastic paraplegia is characterized by progressive spasticity and relatively mild muscle weakness of the lower limbs. It is therefore a good model to evaluate the functional effects of botulinum toxin type-A. Explorative pre-post intervention study. Fifteen subjects with pure hereditary spastic paraplegia. Patients with symptomatic calf muscle spasticity and preserved calf muscle strength received botulinum toxin type-A injections in each triceps surae (Dysport®, 500-750 MU) followed by daily stretching exercises (18 weeks). Before intervention (T0), and 4 (T1) and 18 (T2) weeks thereafter, gait, balance, motor selectivity, calf muscle tone and strength were tested. Mean comfortable gait velocity increased from T0 (0.90 m/s (standard deviation (SD) 0.18)) to T1 (0.98 m/s (SD 0.20)), which effect persisted at T2, whereas balance and other functional measures remained unchanged. Calf muscle tone declined from T0 (median 2; range 1-2) to T1 (median 0; range 0-1), which effect partially persisted at T2 (median 1; range 0-2). Calf muscle strength did not change. Botulinum toxin type-A treatment and subsequent muscle stretching of the calves improved comfortable gait velocity and reduced muscle tone in patients with hereditary spastic paraplegia, while preserving muscle strength. Balance remained unaffected.

  11. Investigation of Clostridium botulinum group III's mobilome content.

    Science.gov (United States)

    Woudstra, Cédric; Le Maréchal, Caroline; Souillard, Rozenn; Anniballi, Fabrizio; Auricchio, Bruna; Bano, Luca; Bayon-Auboyer, Marie-Hélène; Koene, Miriam; Mermoud, Isabelle; Brito, Roseane B; Lobato, Francisco C F; Silva, Rodrigo O S; Dorner, Martin B; Fach, Patrick

    2017-12-26

    Clostridium botulinum group III is mainly responsible for botulism in animals. It could lead to high animal mortality rates and, therefore, represents a major environmental and economic concern. Strains of this group harbor the botulinum toxin locus on an unstable bacteriophage. Since the release of the first complete C. botulinum group III genome sequence (strain BKT015925), strains have been found to contain others mobile elements encoding for toxin components. In this study, seven assays targeting toxin genes present on the genetic mobile elements of C. botulinum group III were developed with the objective to better characterize C. botulinum group III strains. The investigation of 110 C. botulinum group III strains and 519 naturally contaminated samples collected during botulism outbreaks in Europe showed alpha-toxin and C2-I/C2-II markers to be systematically associated with type C/D bont-positive samples, which may indicate an important role of these elements in the pathogenicity mechanisms. On the contrary, bont type D/C strains and the related positive samples appeared to contain almost none of the markers tested. Interestingly, 31 bont-negative samples collected on farms after a botulism outbreak revealed to be positive for some of the genetic mobile elements tested. This suggests loss of the bont phage, either in farm environment after the outbreak or during laboratory handling. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Epidemiologic Overview of Synkinesis in 353 Patients with Longstanding Facial Paralysis under Treatment with Botulinum Toxin for 11 Years.

    Science.gov (United States)

    Salles, Alessandra Grassi; da Costa, Eduardo Fernandes; Ferreira, Marcus Castro; Remigio, Adelina Fatima do Nascimento; Moraes, Luciana Borsoi; Gemperli, Rolf

    2015-12-01

    Patients with longstanding facial paralysis often exhibit synkinesis. Few reports describe the prevalence and factors related to the development of synkinesis after facial paralysis. Botulinum toxin type A injection is an important adjunct treatment for facial paralysis-induced asymmetry and synkinesis. The authors assessed the clinical and epidemiologic characteristics of patients with sequelae of facial paralysis treated with botulinum toxin type A injections to evaluate the prevalence of synkinesis and related factors. A total of 353 patients (age, 4 to 84 years; 245 female patients) with longstanding facial paralysis underwent 2312 botulinum toxin type A injections during an 11-year follow-up. Doses used over the years, previous treatments (electrical stimulation, operations), and how they correlated to postparalysis and postreanimation synkinesis were analyzed. There was a significant association between cause and surgery. Most patients with facial paralysis caused by a congenital defect, trauma, or a tumor underwent reanimation. There were no sex- or synkinesis-related differences in the doses used, but the doses were higher in the reanimation group than in the no-surgery group. Synkinesis was found in 196 patients; 148 (41.9 percent) presented with postparalysis synkinesis (oro-ocular, oculo-oral) and 58 (16.4 percent) presented with postreanimation synkinesis. Ten patients pres