Abstract
Background: The number of botulinum toxin applications is expanding, as evidenced by the studies that demonstrate its new therapeutic indications. Botulinum toxin type A (BoNT-A) alone or adjunct to other agents has emerged as a new important therapeutic strategy for clinicians treating a wide range of neurological and not-neurological disturbances, and it may result useful for particular clinical pictures. Case description: A 73 year-old male subject had a severe sub-arachnoid hemorrhage following the rupture of a giant aneurism of the middle left cerebral artery. Its clinical features showed quadriplegia, vegetative state and oro-mandibular dyskinesia. The dyskinetic repetitive disorder produced a chronic ulcer on the lower lip. The ulcer had slightly irregular borders and resulted stage II–III according to the European Pressure Ulcer Advisory Panel wound classification system. Because of dyskinetic movement disorder, all efforts to heal the ulcer by topical medication were vanished. The upper and lower orbicularis oris and masseter muscles with a total of 320 units per single session botulinum toxin type A (BoNT-A) (Dysport® Ipsen) were injected. The treatment reduced the sucking and forced jawing and promoted the care of ulcer, which after 3 months from the initial infiltration healed completely. Outcome and discussion: The vegetative state can represent a dramatic neurological sequel of extensive brain tissue damage. The rehabilitation process of these patients involves all clinicians, nurses and caregivers in several complex and challenging tasks. BoNT-A infiltration reduced oro-mandibular dyskynesia and weakened orbicularis oris muscle and repetitive sucking hallowing topical medication and the ulcer healing. It has been suggested that the use of BoNT-A as adjunct to other interventions may represent an important therapeutic aid for the clinicians treating rare pathological conditions that otherwise result untreatable.
Published Version
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