Application Of Botulinum Toxin Research Articles

Botulinum toxin in wound treatment – literature review

Introduction and purpose Botulinum toxin has been used in medicine since the 1970s, although many years earlier it was known only as a biological weapon. Originally, it was used in medicine to treat strabismus in children. Over time, it has been used in the treatment of neurological disorders, excessive sweating of the armpits, wrinkles, and bladder disorders. In recent years, botulinum toxin has also begun to be used in wound healing. The paralyzing effect of botulinum toxin on the muscles within the wound eliminates micro-injuries caused by tension in these muscles. The aim of the article is to summarize information on the effects of botulinum toxin on the wound, its impact on inflammation, and the type of scar formation. Materials and methods The literature included in the PubMed databases is searched through the words such as botulinum toxin, wounds, and scars. Description of the state of knowledge: The literature review shows the breadth of the issue. Scientific studies showing the effect of using botulinum toxin on wounds emphasize its beneficial effects. However, it should be remembered that wound healing has a complex, dynamic course supported by numerous cellular processes that must be closely coordinated to effectively repair damaged tissues. Determinants influencing the course of wound healing include both local and systemic factors. Important factors influencing the process of proper wound healing are specialized wound preparation, pharmacotherapy, and other aspects of therapeutic intervention. Conclusions The range of applications of botulinum toxin is constantly expanding. In addition to reducing muscle tension within the wound, it also inhibits the production of inflammatory transmitters, limiting its development, and also reduces the development of microcirculation by preventing the development of vessels in hypertrophic scars.

Clinical Application of Botulinum Toxin A on Nasal Reconstruction with Expanded Forehead Flap for Asian Patients.

Because of its unique advantages, frontal expansion has become a common tool for Asian nasal reconstruction, but it has the limitations of prolonging the duration and pain in the expansion area. Based on the fact that the denervation effect of botulinum toxin type A (BTX-A) has been widely used in the reconstruction of superficial organs, we hypothesized that BTX-A would shorten the length of nasal reconstruction sequence and alleviate the discomfort of patients. A comparative retrospective study was conducted of consecutive patients underwent sequential treatment of nasal reconstruction between June 2010 and July 2012. Data on demographics, BTX-A injection plan and expansion duration were collected and analyzed. Phased pain intensity outcomes were evaluated by visual analogue scale (VAS). Photographs were collected during the follow-up period. Thirty patients were enrolled in the study; 15 (50%) with and 15 (50%) without BTX-A pre-injection. Demographic data were homogeneous. The duration of the observation group (BTX-A pretreated) (133.87 ± 13.64 days) was significantly shortened versus the control group (164.27 ± 14.08 days, P<0.001). At the initial stage, no significant difference was found in the VAS scores (P=0.64). At the medium stage, the VAS score of the observation group (2.07 ± 0.80) was significantly lower than the control group (3.00 ± 0.53, P<0.01). At the terminal stage, the VAS score of the observation group (1.93 ± 0.59) was significantly lower than the control group (2.73 ± 0.70) but with a narrower disparity. Pre-injection of BTX-A is effective in shortening the duration of the expansion phase, as well as relieving the pain associated with expansion. The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

Reshaping Smiles: A Successful Clinical Case with Botulinum Toxin for Gummy Smile Reduction

The use of botulinum toxin (BTX) represents an effective and safe approach in treating the gummy smile, reducing excessive gum exposure during smiling. This minimally invasive procedure can yield remarkable aesthetic results and contribute to an increase in the patient's self-confidence. The aim of this study is to report a clinical case of a female patient undergoing treatment to correct a gummy smile. The case study involves a 21-year-old patient with excessive gum exposure (5 mm when smiling) who sought dental treatment. The origin of her gummy smile was mixed, and the treatment involved the application of 6 units of BTX type A at three specific points on the face. No complications were observed during the three-month follow-up period. Based on the case report, it can be concluded that BTX application for gummy smile treatment proved to be effective, safe, and comfortable in terms of recovery. The BTX approach to correcting a gummy smile is considered safe and entails straightforward recovery, producing satisfactory results that contribute to the improvement of aesthetics and the patient's well-being.

Objective demonstration of eyelid spasm relief with smartphone and custom software in hemifacial spasm patients.

To objectively demonstrate eyelid spasms relief in hemifacial spasm (HFS) patients using a smartphone and a custom-made software. Nineteen patients with HFS had standardized videos recorded with a smartphone (iPhone 6S, Apple) camera before and 15days after receiving onabotulinumtoxinA injections. Nineteen age-matched control subjects were also assessed. The Eye Aspect Ratio (EAR) is an algorithm previously described to determine whether the eye is opened or closed. When the eye is closed, EAR tends to be closer to zero. Analogously, if the eye is wide open, values are greater. A custom-made software using the EAR concept was developed and pre- and post-treatment EARs were analyzed to assess HFS patients. Botulinum toxin (BoNT) injections led to a significant increase inthe average EAR of the affected side: + 10.4% (p = 0.0175) of HFS patients, compared to baseline. MeanEAR before BoNT applications were significantly lower (16.2%) on the affected side (0.25 ± 0.05) of HFS patients when compared to controls (0.30 ± 0.05, p = 0.004). After BoNT injections, no statistically significant difference was observed forthe average EAR between the affected side of HFS patients (0.27 ± 0.04) and controls (p = 0.20). Use of a smartphone and custom-made software objectively demonstrated eyelid spasm relief in patients with HFS. Additional refinement of this system could permit more accurate assessments of treatment response rates for each patient, making it possible to be used in clinical practice.

In-vivo assessment of application of folinic acid and botulinum toxin A in cleft lip surgical defects.

Folinic acid and botulinum toxin A have shown promising results in wound healing in different studies. This study aimed to compare the effects of these approaches on wound healing after simulating cleft lip surgery in rats. In this experimental animal study, after creating lip defects, 30 rats were randomly divided into three groups and received normal saline (CTL), botulinum toxin A (BOT), and folinic acid (FOL). Biopsy from the skin wounds was performed after 14- and 28-days. These samples were stained with haematoxylin and eosin and Masson trichrome staining. Finally, each pathological parameter of wound healing was rated in this study. While the inflammatory response was not different among the study groups, fibroblast proliferation and collagen deposition were significantly higher in FOL group compared to BOT group. Moreover, both BOT and FOL facilitated epithelial healing and 14-day angiogenesis as compared with normal saline. Improved wound healing was observed using both botulinum toxin A and folinic acid in rat animal models. However, the application of botulinum toxin A caused less fibroblast proliferation and collagen deposition which can potentially lead to less scar formation, which can be particularly important in the aesthetic zone.

Subjective Discomfort during Botulinumtoxin Injections Dependent on Injection Site and Needle Size: A Comparison Between 30G, 33G and 34G Needles.

Botulinumtoxin application in the face is amongst the most common aesthetic procedures in the head and neck region. It also has numerous medical uses. One of the main reasons for patients to refrain from it is the subjective discomfort that is experienced during injections. The study at hand aimed to determine whether needles with 33G and 34G offer an advantage in terms of individual pain perception during botulinumtoxin injections. We conducted a prospective study where patients were asked to grade subjective discomfort on a visual analogue scale for each region (forehead, glabella, temple) that was treated directly after treatment and 15 minutes after. Patients were treated with 30G, 33G or 34G needles, respectively. Ninety-nine patients that underwent treatment of 189 regions were included in the study. Patients were evenly distributed amongst the different needle sizes and regions. Subjective discomfort was greatest in all regions for 30G needles (3.9 ± 1.6 forehead, 4.3 ± 1.7 glabella and 4.0 ± 1.6 temple) followed by 33G (2.7 ± 1.5 forehead, 2.7 ± 1.9 glabella and 2.2 ± 1.2 temple) and 34G (1.7 ± 1.2 forehead, 1.6 ± 1.4 glabella and 1.6 ± 1.4 temple). All differences between needle size were statistically significant (p < 0.05) CONCLUSION: 33G and 34G needles seem to offer smaller discomfort during BTX treatments of the head and neck, with 34G being superior to 33G. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Effectiveness of Botulinum Toxin for Oncologic Pain

Introduction: The use of botulinum toxin for medical purposes has expanded nowadays through the extensive study of its complex structure and mechanism of action, highlighting its ability to inhibit the release of acetylcholine, and its impact on the chemical signaling cascade involved in different models of pain.&#x0D; Objective: To evaluate the association of the use of botulinum toxin A with the reduction of pain in oncologic patients at Instituto Nacional de Cancerología, México.&#x0D; Methodology: A retrospective, observational, descriptive, and cross-sectional study was performed. Data were obtained from patients attended during the period from January 1, 2022 to September 30, 2023 in whom botulinum toxin was applied as an adjuvant for pain management.&#x0D; Results: Thirty-two patients who met the inclusion criteria were included. After the application of botulinum toxin there was a statistically significant reduction in pain, as measured by the Numeric Pain Rating Scale and Verbal Rating Scale. The degree of satisfaction after the application of botulinum toxin was measured by a Likert-type scale, and 68% satisfaction was found in the patients who underwent the onotoxin treatment.&#x0D; Conclusions: The use of botulinum toxin proved to be an effective and safe therapy, complementary to the multimodal approach for the treatment of different pain patterns in oncologic patients. It can be considered as a pharmacological option for use in this group of patients.&#x0D; Keywords: Oncologic pain, Pain management, Botulinum toxin

Five decades of the use of botulinum toxin in ophthalmology.

Botulinum toxin (BoNT) has been known for over 50 years. It has conquered many areas of medicine and has become indispensable in contemporary medicine. Now, BoNT is used to treat at least 26 conditions in six medical specialties. Although the use of BoNT began in strabology, it became the gold standard for many ophthalmologic pathologies. The present review of the literature focuses on the use of BoNT in ophthalmology and treatment of the following conditions: blepharospasm, facial hemispasm, facial palsy, spastic entropion, strabismus, endocrine orbitopathy, convergence spasm, and facial trauma. We conclude that nearly half a century of experience in utilizing BoNT in ophthalmology ensured a satisfactory level of effectiveness and safety for patients with many pathologies. Areas of future research include the application of BoNT in new selected indications, the development of the route of application without injections, and the development of long-acting BoNT forms for patients who require repeated long-term treatment.

Botulinum Toxin to Improve the Prognosis of Skin Transplantation: A Short Narrative Review.

Skin transplantation is a traditional and well-established method of repairing skin loss, especially deep second-degree postburn wounds. Complications often happen amid the healing process, including necrosis and skin contracture, which has raised widespread concern from patients and doctors. Since the first recorded medical application of botulinum toxin for strabismus, accumulating evidence has enclosed all-round potential of botulinum toxin, more than aesthetic management. In recent decades, botulinum toxin also has been revealed to improve the prognosis of skin grafts. This literature review aims to briefly summarize the history and latest advances of its use for skin transplantation.

Manejo de rítides supralabiales con complejos híbridos de ácido hialurónico

Introduction. Facial rejuvenation is currently a trend in aesthetic medicine and dermatology. The supralabial region is an area with significant aging changes, and there are only a few options for aesthetic treatments to improve the appearance of the skin. Some of them are the application of botulinum toxin, cross - linked and non - cross - linked hyaluronic acid, and apparatus. Thus, it is recommended to use a combined approach when treating this area. A new procedure is presented using hybrid hyaluronic acid complexes for the bioremodeling of supralabial skin. Objective. This prospective, non - comparative, uncontrolled study brings together a series of Mexican patients who were administered intradermal stabilized hyaluronic acid hybrid complexes in the supralabial region to investigate the effectiveness and safety of their use in this area in a protocolized manner. Material and Methods. Three visits were made, and digital photographs were taken in each one. The doctor evaluated the degree of fine supralabial wrinkles. The patient assessed the degree of pain during the procedure, and the patient and the doctor evaluated the degree of satisfaction after the procedure. Likewise, an independent specialist, not involved in treating the patients, carried out an evaluation. Adverse events that occurred during the study were documented. Results. The supralabial rhytides scale score improved from 5.5 at the initial visit to 3.3 at the end of treatment. The patient's GAIS (global aesthetic improvement scale assessment) rating with the treatment outcome at the final visit was 1.4, indicating very good satisfaction. Likewise, the GAIS classification of the treating physician at the end of treatment was very satisfactory, with 1.6. Discussion. According to the ratings obtained from the treating physician (GAIS and Likert), the patient himself (GAIS), and the independent researcher (Likert), this study demonstrated aesthetic improvement in the supralabial rhytides. No adverse events were reported with the treatment. Conclusions. The supralabial rhytides scale can be treated with hybrid hyaluronic acid complexes because they remodel the extracellular matrix and stimulate the cells of the three layers of skin.

Evaluation of Botulinum Toxin Applications in a Tertiary Cosmetic Department

Aim: Botulinum toxin type A (BTX-A) treatment for facial rejuvenation has&#x0D; been started to used widely and become the most common aesthetic procedure. The aim in&#x0D; this study to evaluate the patients features and outcomes who had Onabotulinumtoxin A.&#x0D; Material and Method: The data of the BTX-A patient’s gender, age, occupation, history of cosmetic&#x0D; procedures, history of disease, doses of the first and control injections, complications and&#x0D; expectations from the therapy collected from the medical records. The patients were divided&#x0D; into two groups as under the age of 45 and age of 45 and older. These groups were compared&#x0D; with each other in terms of mentioned variables.&#x0D; Results: A total of 200 patients included in this study. The mean botulinum toxin dose was&#x0D; 33.7 units and the mean control dose was 4.5 units. Three (1.5%) of the patients developed a&#x0D; complication, all of them were eyelid ptosis. Most common expectation from the toxin&#x0D; injection was to look more young (69%) and vigorous (75.5%). There were no significant&#x0D; difference between the under the age of 45 and 45 and older group in terms of total BTX-A&#x0D; dose and control dose and complication rate (p=0.8, p=0.5, p=0.6). Expectation of looking&#x0D; less angry and less saggy were significantly higher in the 45 year and older group (p=0.02,&#x0D; p=0.02).&#x0D; Conclusion: It is important to evaluate the patient’s gender, age and expectations from the&#x0D; botulinum toxin injection to get the highest efficiency from BTX-A injection.

Facial phantom model: a low-cost and safe tool for teaching botulinum toxin application in neurology residencies.

The application of botulinum toxin (BoNT) in the treatment of blepharospasm and hemifacial spasm (HS) is a well-established practice. However, neurology residency programs often rely on real patients for training, which has limitations in terms of patient availability and skill acquisition. Assess the efficacy of a new facial phantom model for acquiring motor skills in BoNT application. An anthropomorphic facial phantom model was developed in collaboration with a medical training simulator start-up. A group of seven neurologists and one ophthalmologist with expertise in BoNT application evaluated the model using an adapted learning object review instrument (LORI). The instrument assessed aspects such as: content quality, alignment of learning objectives, feedback and adaptation, motivation, presentation design, and accessibility. The facial phantom model received high scores in the LORI evaluation, with the highest ratings given to alignment with learning objectives and motivation. The model also scored well in terms of accessibility, content quality, and presentation design. However, feedback and adaptation received a lower score due to the static nature of the model. The facial phantom model shows promise as a valuable tool for teaching and developing competence in BoNT application for HS and blepharospasm. The model reduces the reliance on real patients for training, providing a broader and safer learning experience for neurology residents. It also provides a realistic learning experience and offers portability, cost-effectiveness, and ease of manufacturing for use in various medical training scenarios. It is an effective and accessible tool for teaching BoNT application.

Optimizing Facial Aesthetics: Sequential Application of Botulinum Toxin A and Dermal Fillers for Enhanced Results.

Optimizing Facial Aesthetics: Sequential Application of Botulinum Toxin A and Dermal Fillers for Enhanced Results.

Characterization of environmental factors in children and adolescents with cerebral palsy in Minas Gerais: Participa Minas.

To characterize the environmental factors of children and adolescents with Cerebral Palsy (CP) in the state of Minas Gerais (MG), Brazil. This is a cross-sectional study involving 164 caregivers of children/adolescents with CP, aged 1-14 years. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were used to classify the participants' functioning, and environmental factors were evaluated by an on-line questionnaire that examined products and technologies, physical environment, services, and systems. A descriptive analysis was performed using percentage and frequency. Most participants had bilateral CP (66.9%) and 45% of them were spastic. Levels II and V of the GMFCS and MACS were the most frequent. About half (49.4%) used anticonvulsants, 27.4% underwent botulinum toxin application, and 29% went through orthopedic surgery in the lower limbs. Among the participants, 71.3% used orthoses in the lower limbs, and 51.8% used the public health care system. Most had access to physiotherapy (91.5%), but found difficulties to access interventions with other professionals, such as psychologists (28%) and nutritionists (37.8%). The school was the most frequently adapted environment (78%), and had the highest level of structural adaptation (42.7%). The results of this study suggest that the barriers to access health services and barriers to the physical environment may impact participation and social inclusion.

Effective Management of Giant Ventral Hernias: A Comprehensive Approach Combining Preoperative Botulinum Toxin Application, Modified Ramírez's Component Separation, and Rives-Stoppa Hernioplasty.

Introduction Giant ventral hernias are a surgical challenge due to their size and the need for a specialized approach during repair. Over the decades, abdominal wall surgery has evolved into a sophisticated field with a wide range of techniques aimed at improving patient outcomes. However, there is no universally accepted method suitable for repairing all giant ventral hernias. Surgeons must rely on a combination of techniques, choosing the approach that best matches their expertise, available resources, and the individual patient's specific needs. This article explores the effective use of a combination of techniques, including preoperative botulinum toxin application, modified Ramírez's component separation, and Rives-Stoppa hernioplasty, yielding excellent results and minimizing recurrences. Objective This study aims to provide a comprehensive literature review of giant ventral hernias. Additionally, we aim to share our experience in managing and repairing giant ventral hernias using a multi-modal approach, combining various surgical techniques with a focus on patient safety, reduced recurrence rates, and improved quality of life. Methods Between October 1, 2019, and October 1, 2021, six patients with giant ventral hernias were enrolled at our department of surgery. They received preoperative botulinum toxin A (BT) application, underwent corrective surgery involving modified component separation following the Ramírez method, and received Rives-Stoppa hernioplasty. Follow-up was conducted for at least six months. Results Six patients were included in the study: three women and three men. They had an average age of 53.6 years and an average body mass index of 31.8 kg/m2. The most common location of the hernia defect was supra and infraumbilical, among 66% of cases. The primary adverse effect associated with BT application was abdominal distension, reported in 33% of patients. No postoperative complications, such as abscesses or seromas, were observed. After the surgical procedure, the average hospital stay was 2.6 days, and no recurrences were noted within six months post-surgery. Conclusion The proposed method, which involves a combination of techniques, has demonstrated promising results based on our experience. However, to solidify these findings and better understand the full scope of this approach, further comprehensive statistical studies involving larger populations are essential. These studies will not only validate our results but also provide valuable insights for optimizing the management of giant ventral hernias.

Use of botulinum toxin in the management of radiotherapy side effects.

Many experimental and clinical studies are conducted to investigate the effects of various applications of botulinum toxin (BTx) in the treatment of radiation related side effects. There are no studies that show clear results about the positive and negative effects of its active clinical use in the long run, and discussions are ongoing. In addition, there is a need for various researches about how BTx can be used and how long it can be used, and the side effects it may cause. BTx-A, which is one of the options in the treatment of side effects that will occur due to radiotherapy, is an effective and safe option. Applying BTx injection to the right place with specific injection methods increases the effectiveness and safety of the treatment. It has been investigated whether BTx will be a potential tool to perfect the esthetic and functional results in reducing the chronic side effects associated with radiotherapy.

Ultrasound Guidance Superiority in Pediatric Sialorrhea Treatment With Intraglandular Botulinum Toxin Application: A Four-Year Retrospective Study.

Introduction The management ofsialorrheain children with multiple disabilities isextremely importantnot only for aesthetic/psychosocial reasons but also for functional and clinical ones. There are several recommended management methods with strong evidence of the effectiveness of intraglandular application of botulinum toxin A. Materials and methods In this four-year retrospective report, we compare two populations who received intraglandular type A botulinum toxin injections in the pediatric unit of the Physical Medicine and Rehabilitation (PM&R) Department at a central hospital. The injections were administered using either ultrasound guidance (US) or anatomical landmarks. Results Out of a total of 29 patients with neurological conditions, 16 met the eligibility criteria for this study. The study group comprised seven females (44%) and nine males (56%), with a median age of 9 years. The average pre-procedure sialorrhea staging was four. A total of 23 procedures were performed, with 16 conducted under ultrasound guidance (US) and seven via anatomical landmarks (non-US). In the US group, a statistically significant difference in sialorrhea staging was observed at one and three months post-procedure (p<0.05), but not at six months post-procedure. Conversely, no statistically significant difference in sialorrhea staging was found at any time point in the non-US group. The comparison between the two groups supports the use of ultrasound guidance, showing superior outcomes at one and three months post-procedure (p<0.05). Conclusion The results of this study align with global trends seen in medical publications and guidelines advocating for the use of ultrasound in this procedure. Future prospective and larger-scale studies are essential to validate these findings.

An Assessment of the Quality and Reliability of Gastric Botox Information Videos on YouTube.

Background and objective Intragastric botulinum toxin (Botox) applications have emerged as a novel endoscopic intervention method to treat obesity. YouTube stands out as one of the primary online platforms frequently utilized for accessing health-related information. In light of this, this study aimed to evaluate the accuracy and reliability of informational videos about gastric Botoxon YouTube. Materials and methods In July 2023, a comprehensive evaluation of gastric Botox information videos on YouTube was conducted by querying "Gastric Botox" on YouTube. A total of 70 videos were initially reviewed and 48 videos were meticulously analyzed by a general surgeon. Videos were categorized based on their sourcesand attributes and evaluated using standard scales like the Journal of the American Medical Association (JAMA) score, modified DISCERN, and the Global Quality Scale (GQS). Results A total of 48 videos were assessed. Of these, 2.1% originated from academic institutions, 20.8% from private hospitals/organizations, and 52.1% from physicians. Videos by other healthcare professionals accounted for 2.1%, health information websites 12.5%, and independent users 10.4%. Video durations varied significantly across sources (p<0.001). Independent user videos had the highest likes/views. JAMA scores (p=0.009) and DISCERN scores (p=0.045) showed significant differences among sources. Academic institution videos had a median JAMA score of 4; independent users scored 1. As for DISCERN, academic videos scored the highest at 5, while independent users scored the lowest at 1.8. Conclusions YouTube is filled with healthcare information videos today. Although the quality and reliability scores based on conventional assessment methods might be moderate, we advise utilizing videos from academic institutions and reputable health information websites as primary sources to educate patients about gastric Botox.

Wide range applications of botulinum toxin in medicine - literature review

Introduction and purpose : Botulinum toxin is one of the most dangerous natural toxins. Botulinum toxin poisoning causes botulism. Botulism is a set of systemic symptoms resulting from flaccid muscle paralysis. The first symptomatology of toxin poisoning was described at the beginning of the 19th century. After more than 200 years, botulinum toxin is associated primarily with aesthetic medicine treatments, where it is used to temporarily improve the appearance, mainly by reducing mimic wrinkles. Aim of the study: The aim of the study is to collect information available in PubMed, Google Scholar, academic textbooks and characteristics of botulinum toxin medicinal products, especially regarding its wide use, mechanism of action, adverse events and contraindications. As a result, the presentation of the versatile use of botulinum toxin as a medicinal product in many fields of medicine. Brief description of the state of knowledge: Botulinum toxin is produced by the anaerobic bacteria Clostridium botulinum. Its mechanism of action consists in flaccid muscle paralysis. Most preparations with botulinum toxin are only registered for strictly defined aesthetic medicine treatments. Other registered indications for the use of medicinal products with botulinum toxin include overactive bladder, various types of spasticity and prevention of headaches. In addition, in medicine, botulinum toxin is commonly used off-label. Summary: Botulinum toxin is widely used not only in aesthetic medicine. Intramuscular injections of botulinum toxin are successfully used in various fields of medicine, such as: urology, neurology, ophthalmology, gastroenterology, dermatology, gynecology, otolaryngology, dentistry and even psychiatry.

Clinical Application of Botulinum Toxin for Hemifacial Spasm.

Hemifacial spasm is typically caused by contact between the facial nerve and blood vessels. Microvascular decompression, a treatment that directly addresses this pathogenesis, is often considered the most effective treatment method. However, surgery is not immediately performed for patients at risk from the surgical treatment, or for those with an unclear diagnosis. In these instances, Botulinum toxin injection can help manage the patient's symptoms. Numerous studies corroborate the effectiveness and safety of Botulinum toxin treatment, with large-scale studies indicating symptom control lasts, on average, around 15 weeks.