Botulinum Toxin Research Articles

The Initial Exploration of Polidocanol Sclerotherapy for the Treatment of Axillary Osmidrosis: A Retrospective Study

BACKGROUND Axillary osmidrosis (AO) is a strong, unpleasant odor that originates from the apocrine axillary glands. Treatments of AO include surgical treatment and nonsurgical treatment. The surgical procedure yields effective results with a low recurrence rate but requires a longer recovery time and has more postoperative complications. Nonsurgical treatments are minimally invasive and safe, but short-term recurrence may occur in some cases. OBJECTIVE Polidocanol sclerotherapy was first described for management of AO. This retrospective study explored the clinical efficacy in relieving symptom of AO assessed by AO severity using the axillary osmidrosis grading system and safety of polidocanol sclerotherapy in treating AO. PATIENTS AND METHODS This retrospective study included 25 patients with AO single-site study, with 12 patients receiving polidocanol (1%) sclerotherapy (the polidocanol group) and 13 receiving botulinum toxin A (BTX-A) injection (the BTX-A group). The short-term efficacy (7 days after injection), the long-term efficacy (6 months after injection), the recurrence rate, and complications were compared between the 2 groups. A p-value of <0.05 was considered statistically significant. RESULTS The short-term efficacies of polidocanol sclerotherapy and BTX-A injection were 100% and 69.2%, which was not clinically significant (p > .05), whereas their long-term efficacies were 100% and 46.2%, respectively (p < .05). The recurrence rates in the polidocanol and BTX-A groups were 25.0% and 84.6%, respectively (p < .05). The complications did not differ significantly between the 2 groups (p > .05). Although the short-term efficacy and complications were comparable between the 2 groups, the long-term efficacy of polidocanol sclerotherapy was superior to BTX-A injection. The polidocanol group has a lower recurrence rate than the BTX-A group. CONCLUSION Polidocanol sclerotherapy may provide an effective and safe treatment with longer efficacy compared to toxin, which is an effective and safe option for AO treatment.

Correlation between blepharospasm and psychological diseases: the anxiety, depression and sleep disorder study

AIM: To investigate the relationship between benign essential blepharospasm (BEB) symptoms and depression/anxiety/sleep disorder in a prospective manner and to determine whether treatment the BEB with botulinum toxin type A (BoNT/A) can impact psychological symptoms. METHODS: This prospective interventional case series recruited 61 adults with evidence of BEB. Patients were administered the Jankovic Rating Scale (JRS), the Blepharospasm Disability Index (BSDI), Personal Health Questionnaire Depression Scale (PHQ-8), Generalized Anxiety Disorder 7-item scale (GAD-7) and the Athens insomnia scale (AIS) to evaluate the severity of BEB symptoms, depression, anxiety and sleep disorder before and 1wk, 1, 3mo after the BoNTA treatment. Statistical analysis was performed to assess the relationships between changes in the survey scores. RESULTS: The mean score for JRS, BSDI, PHQ-8, and GAD-7 improved significantly (P<0.0001), respectively, compared to the initial visit at follow-up. At baseline, worse BSDI scores were correlated with worse GAD-7 and PHQ-8, but not with worse AIS. At 1mo follow-up visit, there was no correlation between change in BSDI and PHQ-8/AIS, the change in GAD-7 showed a mild association with change in BSDI. The change in BSDI was correlated with the change in both PHQ-8 and GAD-7 in the subgroup of patients without a prior diagnosis of depression or anxiety. Patient satisfaction with BoNT/A treatment reached the highest at 1mo of follow-up (83.6%, 51/61). CONCLUSION: BEB may lead to psychological diseases. BoNT/A can significantly improve motor and non-motor symptoms of BEB, which emphasize the effectiveness of BoNT/A and therefore pave the way for its use in the field of psychiatry. However, further research is needed to confirm these findings and understand the underlying mechanisms.

Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Infants With Unilateral Cerebral Palsy

ImportanceEarlier detection of cerebral palsy (CP) and the high neuroplastic potential during the first years of life have motivated a search for early interventions to improve children’s long-term motor abilities.ObjectiveTo determine the effectiveness of baby Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) to improve motor function in infants with unilateral CP (UCP).Design, Setting, and ParticipantsThis parallel group, 1:1, randomized clinical trial was conducted between December 1, 2020, and September 9, 2022, in infants recruited through centers specializing in CP treatment and parents’ spontaneous applications. Therapy took place in Brussels, Belgium, from March 8, 2021, through June 17, 2022. Infants were matched in pairs by age and lesion type and randomized to either the treatment or control group. Infants were assessed at baseline (T0) and 1 (T1) and 3 months (T2) follow-up. Inclusion criteria were aged 6 to 18 months at T0 (corrected age if preterm birth), a diagnosis or being at risk of UCP, and the ability to comply with the testing and training procedures. Exclusion criteria were uncontrolled seizures, botulinum toxin injections, orthopedic surgery, or specific intensive therapy within 6 months before and until the end of the study.InterventionInfants in the treatment group received 50 hours of baby HABIT-ILE over 2 weeks, while those in the control group continued their usual motor activities.Main Outcomes and MeasuresThe primary outcome was use of the more affected hand as measured using the Mini-Assisting Hand Assessment (Mini-AHA). Secondary outcomes included Canadian Occupational Performance Measure (COPM) performance and satisfaction scores, Gross Motor Function Measure-66 (GMFM-66) scores, and other motor and functional outcomes. Between-group comparisons were calculated using repeated-measures analysis of variance (2 groups × 3 assessment times). Effect sizes were reported as partial η squared (ηp2) (small, 0.01; medium, 0.06; large, 0.14).ResultsOf the 48 infants entering the study, 46 (mean [SD] age, 13.3 [4.1] months; 27 boys [58%]) were included in the final analyses, with 24 in the treatment group and 22 in the control group. Group × assessment time interactions showed significant improvements that favored the treatment group for the Mini-AHA (mean [SE] difference from T0 to T2, 7.4 [1.4] Mini-AHA units in the treatment group vs 1.9 [1.5] Mini-AHA units in the control group; P = .008; ƞp2 = 0.11) and for both parts of the COPM (mean [SE] difference from T0 to T2, 5.0 [0.4] in the treatment group vs 2.9 [0.4] in the control group; P < .001; ƞp2 = 0.35 for the performance score and 4.4 [0.4] in the treatment group vs 2.1 [0.4] in the control group; P < .001; ƞp2 = 0.33 for the satisfaction score). Although both groups improved in the GMFM-66 (mean [SE] difference from T0 to T2, 6.6% [0.7%] logits in the treatment group vs 5.5% [0.7%] logits in the control group; P < .001; ηp2 = 0.68), there was no significant interaction (P = .43; ηp2 = 0.02).Conclusions and RelevanceThis randomized clinical trial demonstrates the feasibility of delivering 50 hours of HABIT-ILE over a 2-week period in infants with UCP. These findings show that the intervention is effective in improving motor abilities, as revealed by an increase in the use of the more affected hand in bimanual tasks and in enhanced reported functional goal outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT04698395

TOXINA BOTULÍNICA ASSOCIADA À FISIOTERAPIA NEUROFUNCIONAL EM PACIENTES PEDIÁTRICOS ESPÁSTICOS: UMA REVISÃO INTEGRATIVA DA LITERATURA

Introduction: Cerebral palsy (CP) is the leading cause of motor disability in children, affecting movement and posture due to non-progressive brain injuries during development. Globally, the prevalence of CP is 2 to 3 cases per 1,000 live births, with prematurity being a significant risk factor. Methodology: This study conducted an Integrative Literature Review to evaluate physical therapy approaches in children with spastic CP following the use of botulinum toxin (BTX). Descriptors such as Cerebral Palsy, Physiotherapy, Botulinum Toxin, and Spasticity were used, with searches performed in databases like PubMed and Cochrane. From an initial 153 articles, after exclusion of duplicates and screening, seven studies were selected for analysis. Results and Discussion: The results indicate that the combination of BTX with physical therapy improves functionality and quality of life in children with CP. BTX reduces muscle spasticity, allowing physical therapy interventions such as stretching and strengthening to be more effective, potentially delaying surgical interventions. Studies have shown that this integrated strategy promotes motor rehabilitation and contributes to increased patient independence. Conclusion: The combination of BTX and physical therapy is a promising approach in managing spasticity in CP, standing out as an effective treatment for improving motor functionality and quality of life in these patients, as well as providing a foundation for future research.

Is Vibration Anesthesia Effective and Safe for Pain Reduction in Botulinum Toxin Injection? A Randomized Split-Face Controlled Trial and Cadaver Experiment.

Pain is an important issue in botulinum toxin injection. Vibration anesthesia is a noninvasive way for pain alleviation, but few study reported its use during botulinum toxin injection. To investigate whether vibration anesthesia is effective and safe for pain reduction during botulinum toxin injection for masseter reduction. A randomized split-face controlled trial was performed in patients who required masseter reduction. Vibration anesthesia was randomly administered on either side. Study outcomes were pain scores on a visual analog scale, duration of effect, satisfaction, and complications. Intergroup comparison and linear regression analyses were performed. In a total of 216 patients, the pain score on the vibration side (2.97 ± 1.44) was significantly lower than that on the non-vibration side (4.72 ± 2.13) (p < 0.0001), with a higher proportion of mild pain. Linear regression showed that history of injection, more injection points and doses increased the pain, while 2 ml syringe reduced the pain compared to 1ml syringe. Side effects were found in 19 patients and 21 sides (7%), but were not associated with vibration. High satisfactions were reported. Cadaver experiment confirmed that vibration did not alter the diffusion radius and depth of injection. Vibration anesthesia could significantly relieve the pain during botulinum toxin injection for masseter reduction, while did not affect adverse effect and effect duration. Therefore, we recommended the use of vibration anesthesia, larger syringe size, and less injection points to improve patient experience and satisfaction.

Patient Safety: Acknowledging Acute Angioedema Following Cosmetic Injections

To report a case of acute angioedema following hyaluronic acid filler and onabotulinumtoxinA injection in an individual with allergies, recent viral vaccination, and polymyalgia rheumatica. This is a retrospective case report. A 63-year-old female with a history of allergies, asthma, and polymyalgia rheumatica on lisinopril presented with angioedema 4 hours following facial filler injection and botulinum toxin injection. The patient was successfully treated with epinephrine, diphenhydramine, and methylprednisolone. Although cosmetic injections are commonly performed, clinicians must be vigilant about rare, yet serious side-effects such as angioedema. This case underscores the importance of thoroughly evaluating medical histories before cosmetic injections and addressing patient concerns after the procedure.

Effect of zinc or copper supplementation on the efficacy and sustainability of botulinum toxin A "Botox" injection in masseter muscle of albino rats.

This study aimed to evaluate whether oral zinc or copper supplementation affected the efficacy and sustainability of botulinum toxin-A (BTX-A) injection in masseter muscle of albino rats. 32 adult male albino rats were allocated equally into four groups: group I (control), group II received 10U BTX-A injection, group III received 10U BTX-A injection + zinc (1 mg, 4 days pre-injection), and group IV received 10U BTX-A injection + copper (0.04 mg, 7 days post-injection). Rats were euthanized at 2 and 12 weeks (4 rats per subgroup) after injection. The masseter muscle was examined via histological, histochemical, histomorphometrical and real-time polymerase chain reaction (qRT-PCR) analyses. The histopathological results of the BTX-A group showed atrophied muscle fibers with increased atrophy with time compared to the control group. The BTX-A + zinc group displayed more atrophy compared to BTX-A group. Conversely, the BTX-A + copper group demonstrated improved histology of muscle fibers compared to BTX-A and BTX-A + zinc groups. Histomorphometric analysis of Masson trichrome staining at 2 and 12 weeks revealed that collagen area percentage was the highest in the BTX-A + copper and control groups, followed by BTX-A and BTX-A + zinc groups. At 12 weeks, the nuclear factor kappa beta (NF-κB) mRNA expression was significantly higher in BTX-A + zinc and BTX-A groups compared to BTX-A + copper group and relative to the control group. Zinc supplementation significantly improved the effectiveness and durability of BTX-A, whereas copper supplementation reduced its efficacy.

Vertical inhibition of p110α/AKT and N-cadherin enhances treatment efficacy in PIK3CA-aberrated ovarian cancer cells.

Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha [PIK3CA, encoding PI3Kalpha (also known as p110α)] is one of the most commonly aberrated genes in human cancers. In serous ovarian cancer, PIK3CA amplification is highly frequent but PIK3CA point mutation is rare. However, whether PIK3CA amplification and PIK3CA driver mutations have the same functional impact in the disease is unclear. Here, we report that both PIK3CA amplification and E545K mutation are tumorigenic. While the protein kinase B (AKT) signaling axis was activated in both E545K knock-in cells and PIK3CA-overexpressing cells, the mitogen-activated protein kinase 3/1 (ERK1/2) pathway was induced selectively by E545K mutation but not PIK3CA amplification. Intriguingly, AKT signaling in these PIK3CA-aberrated cells increased transcriptional coactivator YAP1 (YAP) Ser127 phosphorylation and thereby cytoplasmic YAP levels, which in turn increased cell migration through Ras-related C3 botulinum toxin substrate 1 (RAC1) activation. In addition to the altered YAP signaling, AKT upregulated N-cadherin expression, which also contributed to cell migration. Pharmacological inhibition of N-cadherin reduced cell migratory potential. Importantly, co-targeting N-cadherin and p110α/AKT caused additive reduction in cell migration in vitro and metastases formation in vivo. Together, this study reveals the molecular pathways driven by the PIK3CA aberrations and the exploitable vulnerabilities in PIK3CA-aberrated serous ovarian cancer cells.

Ultrasound assessment of muscle and fascia properties and the effects of spasticity and botulinum toxin injections on spastic muscles in chronic stroke survivors

Abstract Objective To objectively quantify changes in muscle properties in chronic stroke survivors and the effects of spasticity and botulinum toxin injections (BoNTi) on muscle properties using ultrasonography. Design In this cross-sectional observational study, 24 stroke subjects with history of BoNTi to biceps brachii muscles (BB) but without BoNTi to the triceps (TRI) were included. Results 12 subjects had spastic TRI, the other half did not. 20 subjects had spasticity in wrist flexors, and 11 subjects received BoNTi to the flexor carpii ulnaris (FCU). On average, a significant decrease in muscle thickness (16.5% loss in TRI), a thicker fascia with higher echo intensity were noted on muscles in the paretic limb. Percent muscle loss (PML) was significantly less (11.0%) in spastic TRI than in non-spastic TRI (22.1%). There was no statistically significant difference in muscle and fascia properties in spastic FCU with and without BoNTi. Spasticity did not correlate significantly with muscle loss, fascia thickness or echo intensity. Conclusion Our results provided evidence that muscles on the spastic-paretic side had less muscle mass, thicker fascia and greater echo intensity. Our results showed that spasticity helped maintain muscle mass, but failed to reveal additional muscle loss after botulinum toxin injection.

Predictors of outcomes after gastric peroral endoscopic myotomy for refractory gastroparesis: a systematic review

Background: Gastroparesis is a debilitating gastroduodenal disorder for which gastric peroral endoscopic myotomy (GPOEM) has emerged as an efficacious treatment option. However, response to GPOEM varies between 50-80%, such that preoperative predictors of treatment success are needed to guide patient selection. Methods: We performed a systematic review to identify predictors of clinical and functional response to GPOEM among adult patients with gastroparesis (PROSPERO: CRD42023457359). MEDLINE, Embase, and CENTRAL databases were searched systematically for studies reporting outcomes after GPOEM in September 2023. A narrative synthesis of predictive factors on univariable and multivariable analysis was performed with consideration of response rates via meta-analysis, and evaluation of discrimination if prognostic models were developed. ROBINS-E was used for risk of bias assessment. Results: Of 1899 articles reviewed, 30 were included. The GPOEM response rate was 63.1% (95% confidence interval 56.3%-69.5%) with most studies defining clinical success on the basis of improvement in gastroparesis cardinal symptom index (87%, 26/30). Older age, shorter duration of gastroparesis, non-diabetic etiology, lower body mass index, and response to intrapyloric botulinum toxin were associated with positive response to GPOEM on multivariable analyses. Predictors on physiological tests such as EndoFLIP or gastric emptying scintigraphy were inconsistent. No prognostic models underwent external validation. Conclusion: Currently, there are limited reproducible predictors of response to GPOEM among patients with refractory gastroparesis. Robust prospective studies investigating scalable, reproducible, and actionable biomarkers of treatment response are required.

A strategic approach of the management of sleep-disordered breathing in multiple system atrophy.

Multiple system atrophy (MSA) is a rare neurodegenerative disorder characterized by autonomic dysfunction associated with a combination of cerebellar, parkinsonian, or pyramidal signs. Sleep-disordered breathing (SDB) such as stridor, obstructive sleep apnea (OSA) and central sleep apnea (CSA) are common in MSA and can impact survival. Several studies have evaluated treatment modalities. However, the optimal strategy often remains unclear in these patients. This review aims to provide an overview of the current evidence on treatment of SDB in MSA. Systematic review of the current literature through combined keyword search in PubMed, Embase, the Cochrane Library and cited references: multiple system atrophy, stridor, sleep apnea syndrome, sleep-disordered breathing, Shy Drager syndrome. Twenty-nine papers were included, with a total of 681 MSA patients with SDB. Treatment modalities are: continuous positive airway pressure (CPAP); tracheostomy; tracheostomy invasive ventilation (TIV); non-invasive positive pressure ventilation (NPPV); adaptive servoventilation (ASV); vocal cord surgery; botulinum toxin injections; oral appliance therapy; cervical spinal cord stimulation; selective serotonin reuptake inhibitors (SSRIs). Conflicting results on survival are found for CPAP therapy. Tracheostomy has a proven survival benefit. Most beneficial outcomes are seen with TIV. CPAP, other types of PAP and tracheostomy can adequately control symptoms of OSA. However, CPAP may exacerbate central sleep apnea. There was a lack of sufficient data regarding ASV or NPPV. Some patients exhibit a floppy epiglottis and require a different approach. In conclusion, due to the complex characteristics of SDB in MSA, an individualized and multidisciplinary approach is mandatory.

Effectiveness and Personalized Approaches in the Correction of Gummy Smile: A Systematic Review of Orthodontic and Surgical Treatments

Background/Objectives: This systematic review seeks to assess the effectiveness of different orthodontic and combined orthodontic–surgical approaches for correcting gummy smile, with a focus on treatment efficacy, duration, and the potential for integrating various techniques. The objective is to offer evidence-based recommendations for the optimal management of gummy smile. Methods: A thorough search of the literature was conducted in the PubMed, Cochrane Library, Scopus, and Web of Science databases, covering publications from 1 January 1982 to 4 November 2024. Only randomized controlled trials involving adult human subjects with available full-text articles were included, while systematic reviews, editorials, case reports, and studies involving animals or in vitro experiments were excluded. Studies were selected based on their relevance to orthodontic or combined orthodontic–surgical treatments for correcting excessive gingival display (gummy smile), particularly in cases where residual growth does not impact treatment outcomes. The primary focus was on evaluating the efficacy of these interventions in improving smile aesthetics. Follow-up data were considered when available, though not required for inclusion. Results: The findings revealed that both orthodontic and surgical methods are effective in reducing gingival display. Orthognathic surgery offers lasting outcomes, particularly for patients with vertical maxillary excess, whereas orthodontic treatments, including the use of skeletal anchorage devices, are particularly effective for less severe cases. Minimally invasive approaches, such as botulinum toxin injections, provided temporary but promising results for patients reluctant to undergo surgery. Conclusions: Orthodontic and surgical techniques are viable options for treating gummy smile, with treatment choices depending on the condition’s severity. Future research, particularly long-term randomized studies, is required to further refine treatment protocols and improve patient outcomes.

The Efficacy of Botulinum Toxin A Injection in Pelvic Floor Muscles in Chronic Pelvic Pain Patients: A Double-Blinded Randomised Controlled Trial.

To evaluate and compare the efficacy and safety of Botulinum Toxin A (BTA) injections versus placebo injections, combined with pelvic floor muscle therapy (PFMT), in women with chronic pelvic pain (CPP). Randomised, double-blinded clinical trial (January 2020-April 2023). This multicentre study was conducted at four hospitals in the Netherlands. Ninety-four women with CPP and increased pelvic floor muscle tone despite previous PFMT, were enrolled. Participants received either BTA injections (100 units) or placebo injections into the pelvic floor muscle, followed by four PFMT sessions. Primary outcomes included the number of women with at least a 33% reduction in pain and those reporting (very) much improvement of their pain. Secondary outcomes covered quality of life and pelvic floor function. Follow-up visits were scheduled at 4, 8, 12, and 26 weeks post-treatment. Mixed models for repeated measurements were used for analysis. A 33% reduction or more in average pain score was reported by 15 participants (33%) after BTA treatment and 9 participants (20%) after placebo treatment (odd ratio placebo/BTA 1.88; 95% CI 0.72-4.90, p = 0.19). In both groups, 8 women (17%) reported their improvement as (very) much better (odd ratio placebo/BTA 0.947; 95% CI 0.32-2.80, p = 0.92). Pelvic floor resting activity decreased significantly after BTA treatment compared to placebo (p = 0.001). The results from this study do not support the use of BTA injections in the management of CPP in women.

Effectiveness of a Complementary Telehealth Education Program as a Preventive Treatment for Chronic Migraine: A Randomized Pilot Study

Background/Objectives: Chronic migraine (CM) is a neurological disorder that causes significant disability, loss of productivity, and economic burden. Preventive treatments, including pharmacological and educational interventions, are crucial for managing CM effectively. The aim of this study was to analyze whether adding a therapeutic telehealth education program (TTEP) to pharmacological treatment achieved a greater reduction in the number of headache days experienced by patients with CM. Methods: A randomized, double-blind, controlled pilot study with two parallel groups was performed. Patients with a diagnosis of CM and who were being treated with Botulinum Toxin were randomly assigned to either the EG (therapeutic education program about the neuroscience of pain, migraine, pain strategies, sleep habits, exercise, nutrition, postural habits, and relaxation strategies) or CG (general health recommendations with no specific content about migraine). The intervention lasted a total of eight weeks and was delivered via a telehealth application (APP). Headache frequency, migraine frequency, pain intensity, headache impact, allodynia, fear of movement, pain catastrophizing, chronic pain self-efficacy, anxiety and depression, sleep quality, and sedentary lifestyle were measured at baseline (M0), one month after the intervention started (M1), at the end of the intervention (M2), and one month after the intervention was completed for follow-up (M3). Results: In total, 48 patients participated. There were differences between the groups in the following outcomes in favor of EG for headache frequency at the one-month follow-up (p = 0.03; d = 0.681); chronic pain self-efficacy at post-treatment (p = 0.007; d = 0.885) and at the one-month follow-up (p &lt; 0.001; d = 0.998); and sleep quality at post-treatment (p = 0.013; d = 0.786) and at the one-month follow-up (p &lt; 0.001; d = 1.086). No differences existed between the groups for the other outcomes examined (p &lt; 0.05). Conclusions: The use of TTEP reduced the number of headache days, improved sleep quality, and increased self-efficacy in managing pain. This pilot study suggests that the addition of a specialized TTPE to pharmacological treatments may be more effective than a general health recommendation program for migraine.

INTEGRATING A VIRTUAL REALITY MASK IN FUNCTIONAL UROLOGICAL SURGERIES UNDER LOCAL ANESTHESIA: A PROSPECTIVE COHORT STUDY ON UTILITY AND SATISFACTION.

To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol. This is a single-centre prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VRTM virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, two questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient's reported intraoperative pain and anxiety. Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (p=0.01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (p=0.12), respectively. Preoperative and postoperative STAI index were 34.8+-10 and 32.8+-10.3 (p=0.88). Mean Likert anxiety scale value was 2.2+-1.1, mean intraoperative VAS score was 5.3+-2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative. Virtual reality mask may play a role in reducing pain and anxiety in minimally-invasive functional urological interventions.

Melasma Management: A Comprehensive Review of Treatment Strategies Including BTX-A.

Botulinum toxin A (BTX-A) is a widely utilized protein derived from the bacterium Clostridium botulinum, known for its effectiveness in treating various medical conditions involving muscle spasticity, involuntary muscle movements, and pain disorders. Beyond its therapeutic applications, BTX-A is also commonly used in cosmetic procedures to address dynamic wrinkles, hyperhidrosis, sebum production, pore size, and overall skin texture. While the use of neurotoxins like BTX-A for treating conditions such as UVB-induced hyperpigmentation, specifically melasma, is an emerging area of interest, it is not yet a widely recognized treatment for this dermatologic condition. This literature review serves to provide a consolidated overview of the current therapeutic implications of BTX-A treatment for melasma and explore its proposed mechanisms of action. This review aims to provide a comprehensive analysis of the current evidence base for the efficacy of BTX-A treatment on melasma. To gain a comprehensive understanding on the current theories regarding BTX-A treatment on melasma, a literature review was conducted on all the available information using PubMed. A combination of keywords was used to maximize the search results, including "botulinum toxin," "melasma," "melanogenesis," "neurotoxin," "cholinergic system," "BTX-A," and "UV-induced melasma." The search was not restricted by date, allowing for the inclusion of articles offering historical context and those providing the most recent findings. Ninety-eight articles were reviewed to provide a consolidated update on the effectiveness of botulinum toxin A in reducing the appearance of melasma and potential mechanisms of action involved in doing so. Melasma is a challenging dermatologic condition due to its chronicity and various intrinsic and extrinsic factors that influence its pathogenesis. While current treatment options for melasma include topical, oral, and light-based therapies, recent studies suggest that BTX-A may hold potential as a viable treatment modality for melasma. Despite the mechanism of action remaining unclear, it is hypothesized that BTX-A inhibition of Ach receptors on melanocytes could play a role in the reduction of melanogenesis. BTX-A treatment in melasma-affected skin demonstrates statistically significant reduction in hyperpigmented lesions associated with melasma.

THE EFFECT OF THE FIRST INTRADETRUSOR BOTULINUM TOXIN INJECTION ON FUNCTIONAL INDEPENDENCE, QUALITY OF LIFE, PAIN AND SPASMS IN INDIVIDUALS WITH SPINAL CORD INJURY

After a spinal cord injury (SCI) practically all patients experience neurogenic bladder dysfunction. The botulinum toxin type A is a procedure for treating urological complications in these patients. The objective this study was to analyze whether individuals with traumatic SCI have improved functionality, quality of life (QoL), pain, and spasms after the first application of intradetrusor botulinum toxin type A. A prospective longitudinal observational study was developed with twenty patients with traumatic SCI followed up in a rehabilitation center. The patients were evaluated before, one and four months after the first application of intradetrusor botulinum toxin type A. The instruments used were: Spinal Cord Independence Measure III (SCIM III) and Qualiveen-SF, to assess functionality and QoL, respectively; Numeric Rating Scale for pain assessment and the Penn Scale to assess the spasms. Descriptive and inferential (p &lt;0.05) statistics were perfomed. Of the patients evaluated, 90% were men, and 80% had paraplegia. In the first month after applying botulinum toxin type A, there was improvement in the domain related to sphincter control of SCIM III (p=0.02). There was no statistically significant difference in the QoL, pain intensity, frequency and severity of spasms before application of botulinum toxin and after 1 and 4 months (p&gt;0.05). The first application of intradetrusor botulinum toxin type A interfered positively functional independence related to sphincter control in the first month after application, but did not influence the pain, spasm and QoL.

Insights Into Minimally Invasive Aesthetic Procedures- Defining Demographic Factors and Impact of the Treatment on Self Perception: A Propensity Matched Cross Sectional Study

Abstract Background The lion´s share of the research on facial aesthetic procedures focuses on visual results and patient satisfaction. Objectives To characterize treated and untreated potential patients and the identification of determinants that influence the decision making as well as the impact of such treatments on patients’ self-perception. Methods A cross-sectional propensity-score-matched study on minimally invasive aesthetic procedures was performed through a survey comprising elements regarding demographics, conduct towards minimally invasive facial plastic interventions as well as psychological well-being and social self-esteem domains of the validated Face-Q module. Results Complete data was collected from 598 participants. Among those, 88% (n=529) were female and 12% (n=69) were male. Forty-six percent (n=277) of the participants were below the age of 30, and 39% (n=233) percent were between 30 and 45 years of age. Of the 598 participants, 22% (n=134) participants had undergone a minimally invasive aesthetic procedure of botulinum toxin and/or hyaluronic acid injection and 78% (n=464) participants had never received any aesthetical treatment. Female gender, 30-45 years of age, self-employment and an income over 75000€ were significant predictors of undergoing minimally invasive aesthetic procedures. Among treated participants, the overall Face-Q score as well as the scores for the social-esteem and the psychological well-being domains improved significantly with the aesthetic treatment. Conclusions This study highlights the major role of healthcare providers in better informing patients and the positive impact of facial aesthetic treatments on patients’ appearance as well as on psychological wellbeing and self-esteem.

Botulinum toxin A for the treatment of neurogenic bladder in children: a systematic review and meta-analysis.

We performed a systematic review and meta-analysis to assess the current evidence on the effectiveness of botulinum toxin A (BTX-A) intradetrusor injections in paediatric NB patients who are resistant to antimuscarinic treatments. A study was carried out on PubMed, Medline, and Embase with the search terms: ('neurogenic bladder' OR 'myelomeningocele') AND 'toxin' AND ('children' OR 'paediatric'). The PICOS framework guided the search strategy and selection of studies in line with the PRISMA guidelines. Research involving original data that examined BTX-A in paediatric patients with NB was included. Studies were independently chosen and data were extracted by two reviewers. Nineteen studies (one randomized controlled trial, six prospective studies, and 12 retrospective studies) that investigated the clinical application of BTX-A injections in children with NB were identified. None of the studies compared BTX-A to a placebo, and most lacked a control group. Results showed that maximal cystometric capacity increased by an average of 97.7 mL (34.1-162% increase) (95% confidence interval [CI] 59.6 to 135.8), while maximal detrusor pressure decreased by 25.2 cm H2O (95% CI -39.7 to -10.7). Bladder compliance improved by 5.3 mL/cm H2O (95% CI 2.9 to 7.8). After treatment, the average incontinence resolution rate among patients was 73.4%. Urinary tract infections were reported by 77 patients (13.6%). BTX-A administered intradetrusorally enhances cystometric capacity, compliance, and maximum neurogenic detrusor overactivity in paediatric patients suffering from neurogenic bladder. Nonetheless, this conclusion lacks support from studies with a high level of evidence.

Morphological and Histological Changes Following Triamcinolone Injection Alone or Mixed Injection of Triamcinolone and Botulinum Toxin in Upper Eyelid.

The purpose of this experiment was to evaluate the functional and histologic changes in the upper eyelid muscles after injection of triamcinolone acetonide (TA) alone or TA combined with botulinum toxin A (Botox or BTXA) in the cynomolgus monkey model. Twenty eyes of 10 cynomolgus monkeys were divided into 4 groups: 3 experimental groups (1, 2, and 3) and the control group (group 4) based on the injection type. In group 1, 0.5mL of TA (Kenalog 40mg/mL) was administered subconjunctivally (between the conjunctiva and the Müller muscle) with a 26 G needle to the inverted upper eyelid of one eye. In group 2, the same procedure was done with 0.5mL TA injected into the other upper eyelid. After that, 5UI/0.1mL Botox was injected transcutaneously into the suborbicularis oculi space in the middle third of the upper eyelid 3mm above the center of the superior tarsal border. In group 3, a subconjunctival of 0.5mL TA was administered to the inverted upper eyelid of one eye 3 times: the injection day, 2 weeks, and 6 weeks after the first injection, whereas a normal saline injection of the same volume was administered one time to the other eye at the injection day in group 4 (control group). Follow-up was done to evaluate the clinical changes in eyelid position at 2, 6, and 12 weeks after injection. Hematoxylin-eosin and Masson trichrome were used to assess the levator or Muller muscle histology and measure the fiber diameter. During the clinical follow-up, there were no major complications observed in any monkeys. The macroscopic appearance of the upper lid on the biopsy day did not differ among groups 1, 2, and 4. There were no cases in these groups that had subconjunctival TA deposit 3 months after injection. Conversely, in group 3, there were 3/5 eyes showing the subconjunctival TA deposit at the last examination.No specific changes in the marginal reflex distance 1, marginal reflex distance 2 (MRD2), and lid crease were noted in either TA alone injection groups 1, 3, and 4. In contrast, there was a significant decrease in marginal reflex distance 1 at 2 weeks (P = 0.003) and 6 weeks (P = 0.005) after TA injection in group 2 in comparison to the baseline.In terms of MRD2, while in group 2, there were significant differences between the pre-MRD2 and the post-MRD2 till the 2 weeks after injection (P = 0.006), then it became insignificant from the sixth week afterward. In contrast, at 2 weeks after injection, MRD2 was reduced in both TA-injected groups 1 and 3, but the observed difference was not significant in both groups. At 6 and 12 weeks, MRD2 fluctuation was not remarkable in these 2 groups and there were no significant differences in comparison to the baseline (P > 0.05).Histological evaluation showed that Müller muscle does not attach directly to the superior border of the tarsus, but it changes to the tendon before attaching to the tarsal plate. In addition, there were no statistical differences in levator muscle fiber diameter and Müller muscle fiber diameter between the 4 groups, with P = 0. 621 and P = 0.695, respectively. Triamcinolone acetonide combined with BTXA showed better results in decreasing upper eyelid height than TA alone in normal monkey eyelids due to its predictable effect. In addition, there were no differences between the side effects and the histology results between the 4 groups. Therefore, TA combined with BTXA may become a promising treatment for selective thyroid eyelid retraction and could offer an alternative to surgery and its complications.