Botulinum Toxin Group Research Articles

Botulinum Toxin versus Placebo: A Meta-Analysis of Prophylactic Treatment for Migraine.

The purpose of this study was to assess the efficacy of botulinum toxin in reducing the frequency of migraine headaches. The MEDLINE, Embase, and Cochrane Library databases were searched to identify randomized, double-blind, placebo-controlled trials that compared patients receiving botulinum toxin versus placebo injections in the head and neck muscles, for the preventive treatment of migraine. The primary outcome was change in the number of headache episodes per month from baseline to 3 months. There were 17 studies including a total of 3646 patients. Overall analysis reported a tendency in favor of botulinum toxin over placebo at 3 months, with a mean difference in the change of migraine frequency of -0.23 (95 percent CI, -0.47 to 0.02; p = 0.08). The reduction in frequency of chronic migraines was significant, with a mean differential change of -1.56 (95 percent CI, -3.05 to -0.07; p = 0.04). Analysis of chronic migraine frequency was also significant after 2 months. The findings also highlighted an improvement of the patient's quality of life at 3 months in the botulinum toxin group (p < 0.00001). Further adverse events were traced in the botulinum toxin type A group with a statistically significant risk ratio of 1.32 (p = 0.002). This meta-analysis reveals that botulinum toxin type A injections are superior to placebo for chronic migraines after 3 months of therapy. For the first time, a real benefit in patient quality of life is demonstrated with only few and mild adverse events. Therapeutic, II.

Randomized Clinical Trial Comparing Botulinum Toxin Injection with Nitroglycerine Ointment for Treatment of Chronic Anal Fissure

Background and Objectives: Although surgery is the gold standard treatment for anal fissure, the main concern remains its side effects and complications in terms of permanent incontinence. In recent years, treatment of chronic anal fissure has shifted from surgical to medical. This study compares the efficacy and safety of two non-surgical treatments- botulinum toxin (BTX) injection with nitroglycerine (NTG) ointment for the treatment of chronic anal fissure. &#x0D; Methods: One hundred and twelve adults were assigned randomly to receive treatment with either type A botulinum toxin (15 units) injected into internal anal sphincter or 0.2% nitroglycerine ointment applied thrice daily for 8 weeks. &#x0D; Results: After 2 months, the fissures were healed in 50 (89.3%) of 56 patients in botulinum toxin group and in 39 (69.6%) of 56 patients in nitroglycerine group (P= 0.01). Seventeen (23%) patients in nitroglycerine group complained of headache while none of the patients in botulinum toxin group had any forms of adverse effects. The recurrence rate of nitroglycerine group was higher than botulinum toxin group at 3 months (4.3% in BTX vs 16.7% in NTG, P = 0.057) and at 6 months (8.5% in BTX vs 36.1% in NTG, P = 0.002). &#x0D; Conclusion: Although treatment with either topical nitroglycerine or botulinum toxin is effective as an alternative to surgery for patients with chronic anal fissure, botulinum toxin is the more effective option.

Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: Three-year follow-up of a randomized study

Botulinum toxin (BTX) injections into epicardial fat pads in patients undergoing coronary artery bypass grafting (CABG) has resulted in suppression of atrial fibrillation (AF) during the early postoperative period through 1-year of follow-up in a pilot program. The purpose of this study was to report 3-year AF patterns by the use of implantable cardiac monitors (ICMs). Sixty patients with a history of paroxysmal AF and indications for CABG were randomized 1:1 to either BTX or placebo injections into 4 posterior epicardial fat pads. All patients received an ICM with regular follow-up for 3 years after surgery. The primary end point of the extended follow-up period was incidence of any atrial tachyarrhythmia after 30 days of procedure until 36 months on no antiarrhythmic drugs. The secondary end points included clinical events and AF burden. At the end of 36 months, the incidence of any atrial tachyarrhythmia was 23.3% in the BTX group vs 50% in the placebo group (hazard ratio 0.36; 95% confidence interval 0.14-0.88; P = .02). AF burden at 12, 24, and 36 months was significantly lower in the BTX group than in the placebo group: 0.22% vs 1.88% (P = .003), 1.6% vs 9.5% (P < .001), and 1.3% vs 6.9% (P = .007), respectively. In the BTX group, 2 patients (7%) were hospitalized during follow-up compared with 10 (33%) in the placebo group (P = .02). Injection of BTX into epicardial fat pads in patients undergoing CABG resulted in a sustained and substantial reduction in atrial tachyarrhythmia incidence and burden during 3-year follow-up, accompanied by reduction in hospitalizations.

Botulinum toxins for the prevention of migraine in adults.

Botulinum toxins for the prevention of migraine in adults.

Condylar Degradation from Decreased Occlusal Loading following Masticatory Muscle Atrophy.

Objective The masticatory muscles are the most important contributor to bite force, and the temporomandibular joint (TMJ) receives direct occlusal loading. The present study aimed to investigate condylar remodeling after masseter muscle atrophy in rats. Methods Sixty 5-week-old female Sprague-Dawley rats were divided into the following 3 groups: the control group, soft diet (SD) group, and botulinum toxin (BTX) group. The cross-sectional area (CSA) of the masseter muscles was investigated as well as atrogin-1/MuRF-1 expression. Changes in the condylar head were evaluated by H-E, toluidine blue staining, and contour measurements. The biomechanical sensitive factors PTHrP Ihh, Col2a1, and ColX of condylar cartilage were detected by immunohistochemical staining and western blotting. Furthermore, micro-CT and tartrate-resistant acid phosphatase (TRAP) staining were performed to determine the osteopenia in subchondral bone. Results The histological and protein analysis demonstrated muscle hypofunction in the SD and BTX groups. Condylar cartilage contour was diminished due to different treatments; the immunohistochemistry and protein examination showed that the expressions of PTHrP, Ihh, Col2a1, and ColX were suppressed in condylar cartilage. A steady osteoporosis in subchondral bone was found only in the BTX group. Conclusion The current results suggested that a steady relationship between muscular dysfunction and condylar remodeling exists.

Contrast enhancement with uranyl acetate allows quantitative analysis of the articular cartilage by microCT: Application to mandibular condyles in the BTX rat model of disuse

Microcomputed tomography (microCT) is well adapted to quantitative analysis of calcified tissues but soft tissues (such as cartilage) are radiolucent and need a contrast enhancement procedure for microCT. We developed a “staining” method allowing microCT imaging of articular cartilage using uranyl acetate (UA). The method was used to see whether adult rats with a botulinum toxin (BTX) injection in masticatory muscles present a change at the condylar cartilage of the mandible in association with a localized trabecular bone loss.Human femoral head samples were used to develop the enhanced contrast method using UA or lanthanides (recently proposed as a substitute for UA). The method was then applied to the condylar cartilage of rat mandibles. Mature male rats (n=11) were randomized into 2 groups: control (CTRL; n=4) and BTX group (n=7). Rats of the BTX group received a single injection of BTX into the right M. Masseter and M. Temporalis. Rats of the CTRL group were similarly injected with saline. Rats were sacrificed 4 weeks after injection. Condyles were harvested, fixed in formalin and immersed in UA. MicroCT was performed for bone and cartilage measurements.After UA impregnation, articular cartilage of human femoral head samples was clearly seen on its full thickness whereas lanthanides produced a much less pronounced contrast, with a faint labeling at the upper layer. In BTX rats, microCT analysis showed a significant bone loss at the right condyles. After UA, the whole thickness of articular cartilage was clearly evidenced. Cartilage thickness measurement showed no difference when comparing the right with the left sides of the BTX group nor between the two sides of the CTRL group.Contrast enhancement with UA is a simple technique allowing quantitative analysis of cartilage by microCT.290 words.

Effects of botulinum toxin on electrophysiological monitoring the lateral spread response in the facial nerve microvascular decompression surgery

Objective To investigate the effects of facial injecting botulinum toxin on electrophysiological monitoring indicator lateral spread response (LSR) in patients with hemifacial spasm in microvascular decompression surgery. Methods Ninety patients with facial spasm underwent microvascular decompression surgery in Guangdong No 2 Provincial People's Hospital from July 2013 to December 2014 were enrolled retrospectively. They were divided into either a botulinum toxin group (n=18) or a non-botulinum toxin group (n=72) according to whether they injected botulinum toxin or not. The effect of botulinum toxin on the changes of intraoperative LSR and the role of LSR changes in prognostic evaluation were observed. Results The mean LSR latency of the zygomatic branch in the botulinum toxin group was 11.4±2.1 ms, and in the non-botulinum toxin group was 9.3±1.4 ms. There was significant difference (P 0.05). The LSR amplitude of the zygomatic branch in botulinum toxin group was 116.1±61.1 μV, and in mandibular branch was 116.1±54.5 μV; the zygomatic branch was 125.9±52.1 μV, and the mandibular branch was 125.9±52.1 μV in the non-botulinum toxin group. There was no significant difference between the 2 groups. After implantation of shims, the LSR disappear rates of zygomatic branchs, and mandibular branch were 16/18and 17/18 respectively in the botulinum toxin group; the zygomatic branch disappear rate in the non-botulinum toxin group was 90% (65/72) and that in the mandibular branch was 96% (69/72). There was no significant difference between the 2 groups (P>0.05). The sensitivity of the disappearance of zygomatic branch LSR for prognostic judgment in the botulinum toxin group was 94% (15/16), and in the non-botulinum toxin group was 98% (64/65). There was significant difference (P<0.05). The mandibular branch LSR, and the sensitivities of both zygomatic branch and mandibular branch disappeared simultaneously for prognostic judgment in the botulinum toxin group were 94% (16/17) and 94% (15/16) respectively; and in the non-botulinum toxin group were 92% (64/69) and 96% (59/61) respectively. There was no significant difference between the 2 groups. Conclusions Botulinum toxin has influence on intraoperative LSR. It is expressed as the prolonged LSR latency of zygomatic branch. The way of monitoring with mandibular branch or in combination with zygomatic branch LSR may be better than simply monitoring zygomatic branch LSR. Key words: Microvascular decompression surgery; Nervous system physiological processes; Hemifacial spasm; Botulinum toxins; Lateral spread response

Long-Term Suppression of Atrial Fibrillation by Botulinum Toxin Injection Into Epicardial Fat Pads in Patients Undergoing Cardiac Surgery: One-Year Follow-Up of a Randomized Pilot Study.

Animal models suggest that the neurotransmitter inhibitor, botulinum toxin, when injected into the epicardial fat pads can suppress atrial fibrillation inducibility. The aim of this prospective randomized double-blind study was to compare the efficacy and safety of botulinum toxin injection into epicardial fat pads for preventing atrial tachyarrhythmias. Patients with history of paroxysmal atrial fibrillation and indication for coronary artery bypass graft surgery were randomized to botulinum toxin (Xeomin, Merz, Germany; 50 U/1 mL at each fat pad; n=30) or placebo (0.9% normal saline, 1 mL at each fat pad; n=30) injection into epicardial fat pads during surgery. Patients were followed for 1 year to assess maintenance of sinus rhythm using an implantable loop recorder. All patients in both groups had successful epicardial fat pad injections without complications. The incidence of early postoperative atrial fibrillation within 30 days after coronary artery bypass graft was 2 of 30 patients (7%) in the botulinum toxin group and 9 of 30 patients (30%) in the placebo group (P=0.024). Between 30 days and up to the 12-month follow-up examination, 7 of the 30 patients in the placebo group (27%) and none of the 30 patients in the botulinum toxin group (0%) had recurrent atrial fibrillation (P=0.002). There were no complications observed during the 1-year follow-up. Botulinum toxin injection into epicardial fat pads during coronary artery bypass graft provided substantial atrial tachyarrhythmia suppression both early as well as during 1-year follow-up, without any serious adverse events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01842529.

Prevention of unfavourable effects of cigarette smoke on flap viability using botulinum toxin in random pattern flaps: An experimental study

Background There are numerous clinical and experimental studies reporting unfavourable effects of cigarette smoke on skin flaps. Objective To investigate whether unfavourable effects of cigarette smoke on flap survival could be reduced by botulinum toxin type A. Methods Twenty-eight male Wistar albino rats (15 months of age, mean weight 210 g [range 180 g to 230 g]) were included. They were divided into four groups of seven animals each. The control group underwent the surgical procedure alone. Surgical procedure was performed after administration of botulinum toxin type A in the botulinum toxin (BTX) group, after exposure to cigarette smoke in the cigarette smoke (CS) group, and after BTX type A administration and exposure to CS in the CS+BTX (CS+BTX) group. Random pattern cutaneous flaps (3 cm × 9 cm) were elevated from the dorsum of all rats. Necrosis area was calculated in percentages (%) using Image J computer software. Tissue samples were examined histopathologically. Results The mean necrotic area in the control group (26%) and in the BTX group (21%) were similar (P=0.497), whereas administration of BTX type A significantly decreased flap necrosis area in the rats exposed to CS (the mean necrosis areas were 41.5% in the CS group, and 26% in the CS+BTX group; P&lt;0.001). Histopathological examination findings corroborated the unfavourable effects of CS and preventive effects of BTX type A. Conclusion Preoperative administration of BTX significantly enhanced flap viability in the rats exposed to CS. Further human studies are warranted to verify whether BTX type A could be used as an agent to reduce the risk of flap necrosis in patients who smoke.

Prevention of unfavourable effects of cigarette smoke on flap viability using botulinum toxin in random pattern flaps: An experimental study.

There are numerous clinical and experimental studies reporting unfavourable effects of cigarette smoke on skin flaps. To investigate whether unfavourable effects of cigarette smoke on flap survival could be reduced by botulinum toxin type A. Twenty-eight male Wistar albino rats (15 months of age, mean weight 210 g [range 180 g to 230 g]) were included. They were divided into four groups of seven animals each. The control group underwent the surgical procedure alone. Surgical procedure was performed after administration of botulinum toxin type A in the botulinum toxin (BTX) group, after exposure to cigarette smoke in the cigarette smoke (CS) group, and after BTX type A administration and exposure to CS in the CS+BTX (CS+BTX) group. Random pattern cutaneous flaps (3 cm × 9 cm) were elevated from the dorsum of all rats. Necrosis area was calculated in percentages (%) using Image J computer software. Tissue samples were examined histopathologically. The mean necrotic area in the control group (26%) and in the BTX group (21%) were similar (P=0.497), whereas administration of BTX type A significantly decreased flap necrosis area in the rats exposed to CS (the mean necrosis areas were 41.5% in the CS group, and 26% in the CS+BTX group; P<0.001). Histopathological examination findings corroborated the unfavourable effects of CS and preventive effects of BTX type A. Preoperative administration of BTX significantly enhanced flap viability in the rats exposed to CS. Further human studies are warranted to verify whether BTX type A could be used as an agent to reduce the risk of flap necrosis in patients who smoke.

Effect of neurectomy and chemodenervation of the masseter muscle on mandibular bone mineral density

Objective To evaluate the effect of neurectomy and chemodenervation of the masseter muscle on mandible bone mineral density.Methods Thirty 28-day-old Wistar rats were divided into four groups:operation groups 1 and 2,botulinum toxin group and control group.The main trunk and initial branches of masseteric nerve on the right side were resected in the operation group 1.The nerve was exposed,but not resected in the operation group 2.The right side of masseter muscle was injected with botulinum toxin type A and the left side was injected with sterile saline in botulinum toxin group when the rats were 28 days old.The control group was only anaesthetised.Bilateral mandibles of all four groups were scanned by GE lunar prodigy bone densitometer when the rats were 75 days old.Results BMD was (0.184±0.012) g/cm2 on the left side and (0.184±0.026) g/cm2on the right side in operation group 1.BMD was (0.179±0.022) g/cm2 on the left side and (0.173±0.019) g/cm2 on the right side in operation group 2.BMD was (0.165±0.061) g/cm2 on the left side and (0.158±0.051) g/cm2 on the right side in botulinum toxin group.BMD was (0.196±0.026) g/cm2 on the left side and (0.185±0.022) g/cm2 on the right side in control group.The variance of BMD between two sides of each group was not significant difference.The variances of BMD among the right side of the four groups were not significant difference.Conclusions No pathological changes in mandibular bone mineral density after denervation and chemodenervation of the massetermuscle are observed in this study. Key words: Mandible; Neurectomy; Botulinum toxin type A; Bone mineral density(BMD)

THU0560 Hyaluronan Alone, Combined with Botulinus Toxin or Placebo Injection Therapy for Athletic Patients with Patellar Tendinopathy (Jumpers Knee)

BackgroundPatellar tendinopathy produces activity-related pain and focal tenderness at the attachment of the patellar tendon at the lower pole of the patella. Despite its frequency and negative impact on athletics,...

Comparison Between Botulinum Injection and Removable Covered Self-Expanding Metal Stents for the Treatment of Achalasia

Intrasphincteric injection of botulinum toxin (BTX) and removable self-expanding metal stents (SEMS) have both been used for the treatment of achalasia. To compare the effectiveness and long-term outcome of SEMS placement and BTX injection in patients with achalasia. A total of 110 patients with newly diagnosed achalasia were enrolled in the study between July 2003 and December 2009. The patients received either BTX injection (n = 51) or SEMS placement (n = 59). Clinical symptoms, objective parameters, and long-term clinical outcomes were evaluated after 7 and 30 days and then every 6 months until withdrawal from the study. The mean duration of follow-up was 28 months (range 10-36 months). Improvements in global symptom and dysphagia scores and in basal lower esophageal sphincter pressure were significantly more marked in the SEMS group than in the BTX group (all P < 0.05). After 12 months, the remission rate in the SEMS group (81.28 %) was statistically significantly higher than that in the BTX group (64.58; P < 0.05). At 36 months, the remission rates in the two groups were 49.1 and. 4.2 %, respectively (P < 0.01). The symptom-free interval was 831 ± 46 days in the SEMS group and 522 ± 42 days in the BTX group (P < 0.01). No side effects were reported with BTX treatment. In the SEMS group there were 13 episodes of chest pain, nine cases of regurgitation, and four stent migrations. No serious complications occurred. Removable SEMS was associated with better long-term outcomes than BTX injection in patients with achalasia.

Secondary spasmodic torticollis and balance in hemiplegic stroke patients

Objective To observe the influence of secondary spasmodic torticollis on the balance of hemiplegic stroke survivors and to compare the effects of different treatment protocols.Methods Fifty-six secondary spasmodic torticollis patients after stroke were randomly divided into three groups based on the type of treatment.The botulinum toxin (BTX) group received BTX-A injections and common support treatment plus rehabilitation training (n =19),the medication therapy group received oral baclofen and common support treatment plus rehabilitation training (n =18),and the routine rehabilitation group received only routine rehabilitation therapy (n =19).In addition,19 stroke cases without spasmodic torticollis served as a control group.They also were treated with routine rehabilitative treatment alone.Before and after 2 months of treatment,balance was assessed using Berg's balance scale,and spasmodic torticollis was evaluated using Tsui's scale.Results Before treatment the balance of the control group members was significantly better than that of the other three groups.After 2 months of therapy,balance function had improved significantly in all four groups.The balance of the botulinum toxin group was better than that of the medication and routine rehabilitation groups.After treatment,Tsui scale scores in the medication and botulinum toxin groups were significantly lower than before treatment,and the scores in the botulinum toxin group were significantly lower than in the medication and routine rehabilitation groups.There was no significant difference in Tsui scale scores before and after treatment in the control group.Conclusions Spasmodic torticollis inflaences the recovery of balance function in hemiplegic patients after stroke.Treating the spasmodic torticollis can improve their balance.Treatment with BTX-A combined with common support treatmcnt and rehabilitation training showed significant curativeeffect. Key words: Secondary spasmodic torticollis; Stroke; Balance; Hemiplegia

Efficacy of Botulinum Toxin A Intradetrusor Injections for Non-neurogenic Urinary Urge Incontinence: A Randomized Double-Blind Controlled Trial

ObjectiveTo determine the efficacy of intradetrusor injections of botulinum toxin A for non-neurogenic urinary urge incontinence. MethodsWe conducted a six-month, randomized, double-blind controlled trial involving women with urinary urge incontinence. Participants received intradetrusor injections of either botulinum toxin (100U in 10mL) via cystoscopy or a placebo control (saline injection). The primary outcome was maximum bladder capacity at cystoscopy. Secondary outcomes included quality-of-life measures, 24-hour leakage rate, patients' subjective assessment, and safety data. ResultsThere were 21 participants: 11 in the botulinum toxin (treated) group and 10 in the placebo (control) group. There were no significant differences between the groups at baseline. After six months the mean maximum bladder capacity at cystoscopy was 161.6mL greater in the treated group than in the control group (P=0.018). There were no differences in diary data or quality-of- life measures. The 24-hour pad test (a measure of leakage) after three months showed significant improvement in the treated group (difference 272.12g, P=0.016); treated subjects also showed subjective benefit at three months (difference 1.29, P=0.007) and at six months (difference 1.16, P=0.01). There was no significant difference in rates of urinary tract infection between groups. There was one serious adverse event (a perioperative cardiac event) in the botulinum toxin group. ConclusionBotulinum toxin increased bladder capacity at cystoscopy and reduced urinary incontinence on 24-hour pad testing in adult females with urinary urge incontinence. There was one adverse event in the group treated with botulinum toxin.

Botulinum toxin injection versus lateral internal sphincterotomy for the treatment of chronic anal fissure: randomized prospective controlled trial

Lateral internal sphincterotomy has been the gold standard treatment for chronic anal fissure, but it still carries the risk of permanent damage of the anal sphincter, which has led to the implementation of alternative treatment like botulinum toxin injection. The aim of this randomized prospective controlled trial was to compare the efficacy and morbidity of botulinum toxin injection and lateral internal sphincterotomy in the treatment of chronic anal fissure. Fifty consecutive adults with chronic anal fissure were randomly treated with either lateral internal sphincterotomy or botulinum toxin (BT) injection with 50 U BT into the internal sphincter. The complications, healing and recurrence rate, and incontinence score were assessed 2, 3, 6, 12 months after the procedure. Inspection at the 2-month visit revealed complete healing of the fissure in 11 (44 %) of the patients in the BT group and 22 (88 %) of the patients in the lateral internal sphincterotomy (LIS) group (p = 0.001). At the 3-month visit, there was no significant difference between the two groups in healing. The overall recurrence rate after 6 months in the BT group was higher than in the LIS group (p < 0.05). In the 3-month follow-up, the LIS group had a higher rate of anal incontinence compared to the BT group (p < 0.05). The final percentage of incontinence was 4 % in the LIS group (p > 0.05). The treatment of chronic anal fissure must be individualized depending on the different clinical profiles of patients. Botulinum toxin injection has a higher recurrence rate than LIS, and LIS provides rapid and permanent recovery. However, LIS carries a higher risk of anal incontinence in patients.

Strontium Ranelate Prevents Bone Loss in a Rat Model of Localized Muscle Paralysis

Twenty-one 3.5-month-old female Sprague-Dawley rats were randomly assigned to three groups: BTX group, in which each rat received a single intramuscular injection of 2 U of Clostridium botulinum toxin (BTX) in the quadriceps femoris muscle of the right hind limb; BTX + SR group, in which each rat received a BTX injection and a dose of strontium ranelate (dose level of 625 mg/kg/day); and the control group. All the rats were killed at 9 weeks post-treatment. It was showed that BTX-induced rats a rapid loss of body weight in the first 3 weeks, after which their body weight showed a slow increase similar to that observed in the control rats. The net body weight loss was mainly attributed to muscle atrophy. BTX caused remarkable bone degradation in either the trabecular bone or the cortical bone of the disuse femur. The deteriorations in the bone mass and bone microstructure were locally limited and could be prevented by strontium ranelate treatment. Biomechanical analysis showed that strontium ranelate treatment improved the mechanical performance of the tibia in BTX-treated rats. It was showed that a clinical-corresponding dose of strontium ranelate could prevent bone loss in long-term immobilized rats.

Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months

Objective: To determine the efficacy of botulinum toxin type A in chronic plantar fasciitis compared to the local injection of a corticosteroid plus local anaesthetic. Methods: Patients with a clinical diagnosis of plantar fasciitis made at least six months earlier were selected to enter a randomized, single-blind study of treatment with injections of botulinum toxin type A or corticosteroid. There were 28 patients in each treatment group. Patients were evaluated at one month using the Foot Health Square Questionnaire and those with no clinical response subsequently received a second injection with the drug of the other arm of the study, creating two new treatment groups. Re-evaluation was performed at six months. Results: One month after injection there was a clear clinical improvement in both treatment groups but it was greater in the botulinum toxin group, with a significant difference for the pain item (P = 0.069), though not in other items. At six months, patients treated with botulinum toxin type A had continued to improve in all items, whereas the corticosteroid group lost part of the improvement achieved at one month (improvement with botulinum toxin vs. corticosteroid: pain 19.10/–6.84 (P = 0.001), function 16.00/–8.80 (P < 0.001), footwear 13.48/–7.95 (P = 0.004), self-perceived foot health 25.44/–5.41 (P < 0.001). Conclusion: Botulinum toxin type A should be considered for the treatment of chronic plantar fasciitis in view of the improvement found at one month, and particularly at six months, when this treatment clearly has better results than corticosteroid injections. Further studies with larger samples are necessary to confirm these results.

Clinical Effectiveness of Botulinum Toxin Type B in the Treatment of Subacromial Bursitis or Shoulder Impingement Syndrome

Subacromial steroid injections are used as a treatment method in subacromial bursitis (SB) or shoulder impingement syndrome (SIS). However, the steroid effect is relatively restricted to the short-term and repeated injections are frequently required, which contributes to unwanted side effects. As an alternative, botulinum toxin (BT) has recently been used for pain relief. This study aimed to investigate the clinical effectiveness of BT type B and to compare this with the effectiveness of steroids. Sixty-one patients diagnosed with SB or SIS were divided into 2 groups and treated with BT type B (BT group) and trimacinolone injection (TA group) under ultrasound guidance, respectively. Numeric Rating Scale (NRS), active shoulder abduction angle, and the Korean version of the score on the Disability of Arm, Shoulder, and Hand (DASH) were measured before the treatment, and at 1 and 3 months after the treatment. Both groups obtained a significant improvement of NRS, DASH, and active shoulder abduction at 1 and 3 months follow-up. BT group showed significantly better outcomes in terms of reduction of NRS and DASH at 3 months than TA group. BT group showed strong trend toward the larger degree of active shoulder abduction than the TA group at 3 months follow-up, as well. Whereas, no significant difference was found in NRS, DASH, and active shoulder abduction between the 2 groups at 1 month follow-up. BT type B can be a useful strategy and has great potential for replacing steroids as a treatment for SB or SIS.

A pilot study of botulinum toxin for interstitial cystitis/painful bladder syndrome

Preliminary studies using botulinum toxin (BTX) have demonstrated some benefits in treating interstitial cystitis (IC)/painful bladder syndrome (PBS) pain. The purpose of this study was to investigate the efficacy of a periurethral injection of BTX to block urethral visceral and somatic afferent fibers, for the treatment of IC/PBS. Twenty adult women with IC/PBS were identified from the Female Urology Clinic at our hospital. Symptom evaluation was performed using a female modification of the Chronic Prostatitis Symptom Index (CPSI), AUA Symptom Index, Graded Chronic Pain Scale, Perceived Stress Scale, and symptom improvement Visual Analog Scale (VAS). All patients were randomized to receive either botulinum toxin A (BTX-A) or placebo (normal saline). Patients randomized to BTX-A received 50 U diluted in 2 cm(3) normal saline injected periurethrally. The physician and patient were blinded to the treatment. BTX was administered to nine women. There were no complications or side effects reported. There was no improvement between placebo and BTX-A groups in the CPSI score at 3-month follow-up (P=0.97). Additionally, there were no improvements in the other symptom indices. At follow-up, the mean VAS for the BTX group was -0.3, indicating the subjects' symptoms were the same as at the start of the study. Periurethral injection of botulinum toxin in women did not effectively treat the pain of IC/PBS. While the results from this study are negative, there is still a valid rationale for further investigations of novel injection protocols given the dearth of current effective treatments.