The higher doses of botulinum toxin and the potentiate effect of its action after nitric oxide donors application for the treatment of chronic anal fissure

Abstract

We read with interest the article by Brisinda et al1 confirming our previous observations on good effectiveness and tolerability of higher doses of botulinum toxin type A (BTX-A). We presented our data last year at the 17th World Congress of Neurology2 and the year before at the National Congress of Polish Society of Gastroenterology.3 We concluded that higher than 20 IU doses of Botox in the treatment of benign anal disorders are safe and do not produce serious adverse events. Mild incontinence, the major adverse reaction, was noticed in only 5% of sessions,2 an incidence similar to Brisinda et al's 7%.