Botulinum Toxin Infiltration Research Articles

Analysis of Predictive Factors for the Poor Prognosis of Peripheral Facial Paralysis.

The aim of the study is to evaluate the predictive factors for a poor prognosis in patients with facial paralysis evaluated in the rehabilitation department of a tertiary hospital. We have conducted a prospective cohort study. Patients who required elective botulinum toxin infiltration, surgical treatment, or follow-up appointments longer than 6 months due to incomplete recovery were considered to have a poor prognosis. Descriptive and analytical analyses of clinical and epidemiological variables were performed. The follow-up period was 6 mos. A total of 47 adult patients were analyzed, 54.2% of whom were women. The mean age was 53.2 yrs (SD, 15.5 yrs). Twenty-five percent had an unfavorable prognosis. A statistically significant association with prognosis was observed for neurophysiological results and the scores of the House-Brackmann scale and the Sunnybrook Facial Grading System. Neurophysiological tests are especially useful when evaluating prognosis. Likewise, Sunnybrook Facial Grading System is a useful and accessible tool with prognostic value, especially within a month of initial diagnosis, when a score lower than 65 indicates a poor prognosis with high sensitivity and specificity. These tools can be especially useful to reduce the clinical and psychological impact and to provide patients with early therapeutic management.

P-126 GIANT UMBILICAL HERNIAS: EMERGENCY SURGICAL TREATMENT AND DEFINITIVE SURGERY. A CLINICAL CASE

Abstract Aim Complex hernias with loss of domain are a challenge for the surgeon, especially when presenting with complications in the emergency room. The emergency treatment differs from definitive surgery, as the patient's scenario is very different and they often present hemodynamic instability, intestinal perforation, etc.. Clinical Case 58-year-old male patient who underwent emergency surgery for septic shock due to intestinal perforation secondary to intestinal occlusion from a primary umbilical hernia, with loss of domain. Through a median laparotomy on the hernia, intestinal resection was performed. Abdominal wall closure wasperformed directly with the hernia sac, without abdominal wall repair. The patient was discharged for outpatient follow up. We planned the definitive surgery. Prehabilitation of the patient begins with botulinum toxin infiltration one month prior to surgery and by creating a progressive pneumoperitoneum. The definitive surgical procedure consists in performing retromuscular umbilical hernioplasty with a posterior component separation technique with placement of four 30×30 cm polypropylene meshes in the retromuscular space and closure of the anterior wall, associated with dermolipectomy. The patient evolved favorably and was discharged. Conclusions The treatment of this type of hernia in the emergency room must be personalized in each case, prioritizing damage control, and followed up by a definitive repair of the hernia. For this repair, it is advisable to perform prehabilitation with botulinum toxin, associated or not, with progressive pneumoperitoneum depending on the characteristics of the patient and the hernia, to avoid an increase in intra-abdominal pressure and the consequent compartment syndrome.

Dry Needling and Antithrombotic Drugs.

Many clinicians increasingly use dry needling in clinical practice. However, whether patients' intake of antithrombotic drugs should be considered as a contraindication for dry needling has not been investigated to date. As far as we know, there are no publications in analyzing the intake of antiplatelet or anticoagulant agents in the context of dry needling techniques. A thorough analysis of existing medications and how they may impact various needling approaches may contribute to improved evidence-informed clinical practice. The primary purpose of this paper is to review the current knowledge of antithrombotic therapy in the context of dry needling. In addition, reviewing guidelines of other needling approaches, such as electromyography, acupuncture, botulinum toxin infiltration, and neck ultrasound-guided fine-needle aspiration biopsy, may provide specific insights relevant for dry needling. Based on published data, taking antithrombotic medication should not be considered an absolute contraindication for dry needling techniques. As long as specific dry needling and individual risks are properly considered, it does not change the risk and safety profile of dry needling. Under specific circumstances, the use of ultrasound guidance is recommended when available.

P010 FEASIBILITY OF MIDLINE RECONSTRUCTION WITHOUT MYOFASCIAL RELEASE (COMPONENT SEPARATION) AFTER PREOPERATIVE INFILTRATION OF LATERAL ABDOMINAL WALL MUSCULATURE WITH BOTULINUM TOXIN

Abstract Aim Aim of the analysis was to evaluate whether preoperative botulinum toxin infiltration may facilitate anatomical midline reconstruction without the need for – otherwise pre-operative assumed – surgical component separation. Material and Methods Total of 58 patients with complex abdominal wall hernias were included in our single-center retrospective analysis between 03/2015 and 12/2020. Size of the defect, HSV/ACV-ratio, rectus-to-defect-width-ratio (“Carbonell-Index”) as well as risk factors were analyzed. In all patients muscles of the lateral abdominal wall were infiltrated with 300-500 IE of botulinum toxin 4 weeks prior to the abdominal wall reconstruction. CT scans were performed before and 4 weeks after the botulinum toxin infiltration. Results Total of 58 patients (M/F-ratio 36:22), with a mean age of 63.8 years were included in our analysis. Mean BMI was 29.5 kg/m². Total of 50 incisional, 3 umbilical, 2 posttraumatic diaphragmatic hernias and 3 scrotal hernias were analyzed. Surgical component separation after the infiltration with botulinum toxin was necessary in 43% of the cases. Conclusions Preoperative infiltration of the lateral abdominal wall musculature with botulinum toxin facilitated midline reconstruction of the abdominal wall without the need for myofascial release in 57%. Reduction of surgical trauma could therefore be achieved in several patients.

Italian botulinum toxin network recommendations for safe treatment of botulinum toxin infiltration during the COVID-19 pandemic: A video presentation

Overview the physician and the patient come into close contact during treatments with botulinum toxin, increasing the chances of infection with the SARS-CoV-2 virus. What do we need to do to make the treatment safe and reduce the risk of contagion?

Ultrasound and Electromyography as Guidance Tools for the Botulinum Toxin Therapy in Cervical Dystonia

Cervical Dystonia (CD) is the most common type of focal dystonia in the movement disorders units of any specialized hospital around the world. Botulinum Toxin (BT) infiltration is the treatment of choice for CD, according to most of the experts around the world, however the efficacy and tolerance of BT therapy in CD depend on the accuracy when BT is released into the muscles. We reviewed the medical literature in regard to the use of guiding tools for the BT infiltration in CD patients. Results: The use of guiding tools such as Ultrasound or EMG definitely improves the accuracy for releasing the BT into the muscles involved according to some authors. Conclusion: the use of Ultrasound and EMG improves the efficacy and reduce the adverse effects in the BT therapy in CD patients.

Novel use of CT guided Botulinum toxin infiltration for Pyriformis syndrome –A single centre prospective study from southern India

Introduction: We describe the short term and intermediate efficacy of direct intra-muscular injection of Botulinum toxin in Pyriformis Syndrome, along with its safety profile. Materials and Methods: A diagnosis of pyriformis syndrome was made by exclusion, only after careful clinical assessment & MR Imaging. Patients were selected for Botox infiltration if adequate symptom relief was not noted after conservative management. Patients were placed prone on the CT table with a pillow placed under the lower pelvis for elevation of the hip joints. Subsequently a total of 03 spinal needles (22 G) were placed in the pyriformis muscle belly, at a distance of 1 to 1.5 cm apart. Finally, freshly reconstituted 50U of Botox was injected through each of the needles into the muscle belly (total dose of 150 U). Results: A total of 26 procedures were performed on 25 patients (15 male, 10 female) with one patient receiving a second procedure 15 months after the initial treatment. The mean age of the patient population was 48.6 years. 88.5% (23/26) patients reported very good pain relief when assessed on a Visual analogue scale (VAS) at 3 months, which was sustained at 6 months in 77% (20/26) patients. No procedure related complications were noted. Conclusion: CT guided Botox infiltration into the pyriformis is a safe and effective modality for pain relief in pyriformis syndrome. Three needle technique with infiltration across the length of the muscle appears be more effective in symptom alleviation, as compared to the conventional single site injection. Keywords: Botox, Pyriformis.

Encuesta de satisfacción del paciente con secuelas de parálisis facial periférica en tratamiento con toxina botulínica A

IntroductionTreatment of peripheral facial palsy with botulinum toxin A is safe and effective. Although its beneficial impact on patients’ quality of life is known, to date, there have been no studies specifically analysing patients’ subjective perceptions. Patients and methodWe performed a prospective study in a random sample of patients with sequels of peripheral facial palsy treated with botulinum toxin in the Physical Medicine and Rehabilitation Service of our hospital.We created a simple questionnaire to assess both patient satisfaction and subjective perception of improvement after botulinum toxin treatment. ResultsAfter infiltration, 95% of the patients felt good or very good. More than 80% noted improvement in the sensation of tightness in the cheek and neck. Around 75% of patients perceived an improvement in the range of voluntary movement and approximately 80% reported improvement in synkinesis.Almost all the patients would repeat the treatment, if proposed, and 100% would recommend botulinum toxin infiltration to other patients with facial palsy. ConclusionsPatients treated with botulinum toxin experience substantial subjective improvement in the sequels of peripheral facial palsy, both in repose and in the control of synkinesis. Satisfaction was higher than 8/10 in 99% of patients in this study.

Software Suite Training Tool for MSK Exploration and Botulinum Toxin Infiltration Based on Ultrasound Imaging for the Spasticity Treatment.

Nowadays, one of the choice techniques for the spasticity treatment is the ultrasound-guided infiltration of Botulinum Toxin, because it is safe and effective. In order to medical professionals can carry out this technique, they need training and education. One of the safest and most time-free ways to facilitate the acquisition of practical medical skills is through simulators. In this paper we present an innovative technological environment, which includes an ultrasound simulator for training in muscle exploration and infiltration. The simulation platform will guide health professionals, with great realism and high degree of interactivity, in the autonomous training of all the tasks involved in the spasticity treatment procedure by infiltration of Botulinum Toxin, without the need for a real patient or costly phantoms.

Direct infiltration of botulinum toxin into the pterygoid lateral muscle for repositioning of the disc during arthroscopy of the temporomandibular joint

Direct infiltration of botulinum toxin into the pterygoid lateral muscle for repositioning of the disc during arthroscopy of the temporomandibular joint

Analyze the effects of botulinum toxin infiltration in the shortening of the aquiles-calcaneal-plantar system as a treatment for plantar fascitis

The aquiles-calcaneal-plantar system shortening (ACPSS) is a frequent cause of ankle/foot pain. Pain can be located in the Achiles tendon or in the calcaneal insertion of the plantar fascia (PF), is the most frequent cause of chronic heel pain. Diagnosis is clinical given by heel pain that may vary in location, although calcaneus anteromedial region is the most common point. At physical examination it's important to evaluate the ankle range of motion. Silverskiold test informs about the relationship between the origin of the shortening if it's the gastrocnemius muscle or the soleus. Prospective study, from December 2016–December 2017, were selected 41 patients but 56 infiltrated legs, with PF resistant to conservative treatment, who had performed 2 or more of this treatments, without improvement: analgesics, insoles, physiotherapy and corticosteroids infiltration. All had clinical criteria for ACPSS. Patients were infiltrated in the gastrocnemius intern muscle with 100–150 IU of botulinum toxin, associated with triceps sural eccentric stretching 3/day, from the 4th day postinfiltration. Visual Analog Scale for pain (VAS) and the Foot Function Index - Spanish version (FFI) were evaluated. Patients were reviewed after 1, 4 and 6 months. The results were analyzed through the SPSS program; 66% (27 patients) were women between 40–60 years of age; 73% (30 patients) had received more than 3 treatments at the beginning of the study; 46% (19 patients) showed a treatment adherence of 2–3 times a day. Initial VAS was 7, one month later was 5 and 6 months after infiltration was 4. FFI scale one month after infiltration was 38% and sixth month was 28%; 78% (32 patients) recommended the treatment. Infiltration with botulinum toxin, allow to improve the length of the posterior compartment in patients with ACPSS as well as decrease in VAS, and the improvement in the functionality and limitation of the activities according to the FFI scale.

Painful tic convulsif: Case series and literature review

Abstract Background The coexistence of hemifacial spasm and trigeminal neuralgia, a clinical entity known as painful tic convulsive, was first described in 1910. It is an uncommon condition that is worthy of interest in neurosurgical practice, because of its common pathophysiology mechanism: Neuro-vascular compression in most of the cases. Objective To present 2 cases of painful tic convulsive that received treatment at our institution, and to give a brief review of the existing literature related to this. The benefits of micro-surgical decompression and the most common medical therapy used (botulin toxin) are also presented. Clinical cases Two cases of typical painful tic convulsive are described, showing representative slices of magnetic resonance imaging corresponding to the aetiology of each case, as well as a description of the surgical technique employed in our institution. The immediate relief of symptomatology, and the clinical condition at one-year follow-up in each case is described. A brief review of the literature on this condition is presented. Conclusion This very rare neurological entity represents less than 1% of rhizopathies and in a large proportion of cases it is caused by vascular compression, attributed to an aberrant dolichoectatic course of the vertebro-basilar complex. The standard modality of treatment is micro-vascular surgical decompression, which has shown greater effectiveness and control of symptoms in the long-term. However medical treatment, which includes percutaneous infiltration of botulinum toxin, has produced similar results at medium-term in the control of each individual clinical manifestation, but it must be considered as an alternative in the choice of treatment.

BOTULINUM IN MODERN UROLOGY

The advent of botulinum toxin (BT) in healthcare has revolutionized the treatment of several diseases and the aesthetic medicine. Botulinum toxin is a powerful neurotoxin with a paralytic/muscle relaxant effect. The most potent substance has been successfully used for the treatment of pathological conditions that can not be effectively managed and provide a stable effect with other known methods. Many disorders of the lower urinary tract function are associated with muscle hypertonia or spasms and can be treated with accurate infiltration of BT in the concerned area. Treatment of idiopathic overactive bladder using BT is also effective and safe. Efficacy and safety of BT administration for neurogenic and idiopathic DO were investigated and confirmed in large multicenter trials.

Tratamiento de la sialorrea en niños con patología neurológica

Drooling is the inability to retain saliva in the mouth and its progression to the digestive tract, being a common problem in pediatric patients with neurological disorders. Three different treatment options are available. To assess the effectiveness and safety of trihexyphenidyl, scopolamine and botulinum toxin infiltration in the treatment of drooling in children with neurological disorders. This is an open and prospective type study. We include patients treated in the Neurology Service that present excessive drooling, affecting their quality of life, between 2009 and 2013. We enrolled 46 patients in the study. The treatment with oral trihexyphenidyl was indicated in 46, obtaining good result in 15 (32.6%), three with temporary effect and the rest with lasting effect. Three patients presented side effects (6.5%). Four out of 11 (36.36%) patients treated with scopolamine patch had beneficial effects. One was withdrawn due to lack of efficacy and six due to side effects. Twenty-five patients were infiltrated with botulinum toxin, with a significant decrease of drooling in 16 patients (64%) after the first injection. We observed no significant changes in nine patients. Only one out of 25 showed side effects (mild dysphagia). Currently there is not a fully effective therapeutic option for drooling. We recommend starting treatment with trihexyphenidyl. A second option could be the scopolamine patch and botulinum toxin as a third option. Botulinum toxin infiltration in salivary glands is shown as an effective and safe alternative in our study.

Midcheek mass: 10 year of clinical experience

This is a literature review and retrospective chart review of ten years experience on the treatment of midcheek masses in our department. The purpose of this study is to provide the reader with an overview of the pathology of this complex anatomic area focusing the attention on the differential diagnosis and the recent surgical strategies.From May 2002 to December 2012 we enrolled 22 consecutive patients studied for masses located in the midcheek area. Only four studies were found in the literature describing the experience of individual centres reporting few cases of midcheek masses. Combined with the previously reported 37 cases, we describe 22 lesions for a total of 59 cases. Patients were evaluated with a head and neck clinical and instrumental examination. Apart from 4 cases treated with intramuscular infiltration of botulinum toxin for masseter hypertrophy, surgical approach to the lesions was varied: 10 patients received an external approach (standard parotidectomy approach or face-lift-type approach); 6 patients had the lesion removed through an intraoral approach; in 2 cases a direct skin incision was performed. In our series we found a significant rate (55.5%) of temporary complications in all the procedures performed (external, intraoral, direct skin approach). This study aims to emphasize the role of endoscope assisted surgery as a possible alternative to the traditional approaches for the management of well selected benign midcheek masses.It would be advisable to increase the study of the endoscopic anatomy of the midcheek area in order to standardize the procedure and better define the surgical indications.

Computerized-Aid Medical Training

The application of new technologies in training environments allows the development of new teaching modalities that enable knowledge and ability acquisition in healthcare professionals. Simulation has proven to be an effective method to favor and improve learning as well as to attain the necessary skills to perform a specific technique with greater reliability and security for the patient. We present a new tool or technological development in medical training, through an ultrasound simulator, valid for the knowledge and necessary ability acquisition in the proper infiltration of botulinum toxin guided by ultrasound. This tool benefits from the advantages that new technologies bring when applied in medical training, offering a virtual setting, comfortable and accessible, that does not require the user to move or have access to an ultrasound machine, allowing ultrasound explorations without the existence of a real patient.

Treatment of Frey's syndrome after parotidectomy using botulinum toxin infiltration

Introduction: Frey's Syndrome (gustatory sweating) has been drescribed as a secretory alteration of the eccrine sweat glands located in the facial area due to an inappropriate response to cholinergic stimulus from the auriculotemporal nerve fibers. It is most frequently encountered as a complication of parotidectomy (12.5–62% by subjective methods, 22–98% using Minor's starch–iodine test). Clinically it results in sweating and flushing of facial skin during salivation.

Influence of botulinum toxin therapy on postural control and lower limb intersegmental coordination in children with spastic cerebral palsy.

Botulinum toxin injections may significantly improve lower limb kinematics in gait of children with spastic forms of cerebral palsy. Here we aimed to analyze the effect of lower limb botulinum toxin injections on trunk postural control and lower limb intralimb (intersegmental) coordination in children with spastic diplegia or spastic hemiplegia (GMFCS I or II). We recorded tridimensional trunk kinematics and thigh, shank and foot elevation angles in fourteen 3–12 year-old children with spastic diplegia and 14 with spastic hemiplegia while walking either barefoot or with ankle-foot orthoses (AFO) before and after botulinum toxin infiltration according to a management protocol. We found significantly greater trunk excursions in the transverse plane (barefoot condition) and in the frontal plane (AFO condition). Intralimb coordination showed significant differences only in the barefoot condition, suggesting that reducing the degrees of freedom may limit the emergence of selective coordination. Minimal relative phase analysis showed differences between the groups (diplegia and hemiplegia) but there were no significant alterations unless the children wore AFO. We conclude that botulinum toxin injection in lower limb spastic muscles leads to changes in motor planning, including through interference with trunk stability, but a combination of therapies (orthoses and physical therapy) is needed in order to learn new motor strategies.

Walking assessment with instrumented insoles in patients with lower limb spasticity after botulinum toxin infiltration

IntroductionBotulinum toxin A (BTA) improves the kinematic parameters of gait in patients with spasticity of lower limbs, but there are no studies in which kinetic parameters are measured with instrumented insoles. We therefore used instrumented insoles to perform a functional assessment of therapeutic results in patients with lower limb spasticity after brain injury or spinal cord infiltration indicating BTA. Material and methodsTen patients (11 lower limbs) were seen in a Neurorehabilitation Unit. The tests carried out included clinical examination, gait assessment (Functional Ambulation Categories (FAC); Hospital de Sagunto Gait Scale), and biomechanical assessment (Biofoot/IBV version 5.0), before and three weeks after infiltration with BTA. Statistics: t-test for related samples of clinical variables, functional variables and biomechanical variables before and after infiltration. Level of significance P<.05. Qualitative method was used to assess whether changes in the biomechanical variables tended towards normal values. ResultsBTA improves muscle tone, joint arch and frequency of spasms (P<.01). The patient sample showed a high level of satisfaction with the improvement in symptoms. There were no changes in walking ability after injection. There were no statistically significant changes in biomechanical parameters, but there was improved gait cadence. The relatively small statistical significance close to P=.1 of the peak pressure in the heel after injection indicates the need for further studies with instrumented insoles in people with spasticity due to central nervous system injury. ConclusionsWith the decrease in muscle tone after infiltration with BTA the clinical symptoms associated with muscle tone improved without any functional changes in gait scales. The changes in the biomechanical parameters show that larger studies using instrumented insoles should be performed in the population with spasticity after a central nervous system injury is treated with BTA infiltration.

Frey Syndrome—An Underreported Complication to Closed Treatment of Mandibular Condyle Fracture? Case Report and Literature Review

The most common hypothesisis that regenerating parasympathetic fibers to sali-vary glands connect in error with the sweat glandsand subcutaneous blood vessels of the skin. Theonset has usually been 12 to 18 months after sur-gery. The most effective treatment has been subcu-taneous infiltration of botulinum toxin into the af-fected area.