Botulinum Toxin Injection In Patients Research Articles

Use of a ticket punch and adhesive transparent dressings for injecting botulinum toxin in hyperhidrosis

This article describes a novel modification in marking the sites of botulinum toxin injection in patients with axillary hyperhidrosis using a ticket punch and an adhesive occlusive sticker.

172 - Selective Bladder Denervation with Radiofrequency Ablation vs Intramuscular Botulinum Toxin Injection in Patients with Refractory Overactive Bladder: A Preliminary Report of Prospective Randomized Comparative Study

172 - Selective Bladder Denervation with Radiofrequency Ablation vs Intramuscular Botulinum Toxin Injection in Patients with Refractory Overactive Bladder: A Preliminary Report of Prospective Randomized Comparative Study

The long-term response to botulinum toxin injections in patients with blepharospasm undergoing upper eyelid surgery

The long-term response to botulinum toxin injections in patients with blepharospasm undergoing upper eyelid surgery

Effect of intraoperative botulinum toxin injection on delayed gastric emptying and need for endoscopic pyloric intervention following esophagectomy: a systematic review, meta-analysis, and meta-regression analysis.

The aim of this study was to evaluate the effect of intraoperative botulinum toxin (BT) injection on delayed gastric emptying (DGE) and need for endoscopic pyloric intervention (NEPI) following esophagectomy. In compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses statement standards, a systematic review of studies reporting the outcomes of intraoperative BT injection in patients undergoing esophagectomy for esophageal cancer was conducted. Proportion meta-analysis model was constructed to quantify the risk of the outcomes and direct comparison meta-analysis model was constructed to compare the outcomes between BT injection and no BT injection or surgical pyloroplasty. Meta-regression was modeled to evaluate the effect of variations in different covariates among the individual studies on overall summary proportions. Nine studies enrolling 1070 patients were included. Pooled analyses showed that the risks of DGE and NEPI following intraoperative BT injection were 13.3% (95% confidence interval [CI]: 7.9-18.6%) and 15.2% (95% CI: 7.9-22.5%), respectively. There was no difference between BT injection and no BT injection in terms of DGE (odds ratio [OR]: 0.57, 95% CI: 0.20-1.61, P = 0.29) and NEPI (OR: 1.73, 95% CI: 0.42-7.12, P = 0.45). Moreover, BT injection was comparable to pyloroplasty in terms of DGE (OR: 0.85, 95% CI: 0.35-2.08, P = 0.73) and NEPI (OR: 8.20, 95% CI: 0.63-105.90, P = 0.11). Meta-regression suggested that male gender was negatively associated with the risk of DGE (coefficient: -0.007, P = 0.003). In conclusion, level 2 evidence suggests that intraoperative BT injection may not improve the risk of DGE and NEPI in patients undergoing esophagectomy. The risk of DGE seems to be higher in females and in early postoperative period. High quality randomized controlled trials with robust statistical power are required for definite conclusions. The results of the current study can be used for hypothesis synthesis and power analysis in future prospective trials.

Utilization of shear wave elastography to quantify and predict response to upper extremity botulinum toxin injections in patients with cerebral palsy: A pilot study

ObjectiveShear wave elastography (SWE) was used to quantify change in upper extremity muscle stiffness in patients with unilateral spastic cerebral palsy (USCP) following botulinum toxin A (BTX-A) therapy. We hypothesized that SWE measures would decrease following ultrasound-guided BTX-A injection, and correlate with functional improvement. MethodsSWE measures of BTX-A treated muscles were recorded immediately pre-injection, and at 1-, 3- and 6-months post-injection. At the same timepoints, functional assessment was performed using the Modified Ashworth Scale (MAS), and passive and active range of motion (PROM and AROM) measures. Correlation of SWE with MAS, PROM and AROM, as well as the relationship between change in SWE and change in MAS, PROM and AROM was determined using Spearman’s rank correlation coefficient and generalized estimating equation modeling. Results16 muscles were injected and longitudinally assessed. SWE and MAS scores decreased following BTX-A injection (p = 0.030 and 0.004, respectively), reflecting decreased quantitative and qualitative muscle stiffness. Decreased SWE reached statistical significance at 1- and 3-months, and 1-, 3- and 6-months for MAS. When comparing relative change in SWE to relative change in AROM, larger change in SWE strongly correlated with positive change in AROM (p-value range:<0.001–0.057). BTX-A responders also demonstrated lower baseline SWE (1.4 m/s) vs. non-responders (1.9 m/s), p = 0.035. ConclusionUltrasound-guided BTX-A injections in patients with USCP resulted in decreased quantitative and qualitative muscle stiffness. Strong correlation between change in SWE and AROM, as well as the significant difference in baseline SWE for BTX-A responders and non-responders, suggests SWE may provide a useful tool to predict and monitor BTX-A response.

Effects of the periocular botulinum toxin on the ocular surface and anterior chamber: a prospective study in patients with hemifacial spasm and blepharospasm

PurposeTo analyze using Pentacam®, the corneal and anterior chamber changes following periocular botulinum toxin injection in patients with facial dystonia.MethodsProspective study that included patients with facial dystonia that were going to receive a periocular botulinum toxin injection for the first time or six months or more after the previous injection. A Pentacam® examination was carried out in all patients before and 4 weeks after the injection.ResultsThirty-one eyes were included. Twenty-two had a diagnosis of blepharospasm and nine of hemifacial spasm. Analysis of corneal and anterior chamber parameters revealed a significant decrease in iridocorneal angle after botulinum toxin injection (from 35 ± 10º to 33.8 ± 9.7º, p = 0.022). No other corneal or anterior chamber parameters changed significantly after the injection.ConclusionsPeriocular botulinum toxin injection causes narrowing of the iridocorneal angle.

MP52-15 EXTERNAL URETHRAL SPHINCTER BOTULINUM TOXIN INJECTION TO TREAT PSEUDODYSSYNERGIA IN PATIENTS WITH CEREBRAL PALSY

You have accessJournal of UrologyCME1 Apr 2023MP52-15 EXTERNAL URETHRAL SPHINCTER BOTULINUM TOXIN INJECTION TO TREAT PSEUDODYSSYNERGIA IN PATIENTS WITH CEREBRAL PALSY Ryan Haggart, Christopher J Loftus, Molly DeWitt-Foy, Valencia Henry, Joseph Pariser, and Sean Elliott Ryan HaggartRyan Haggart More articles by this author , Christopher J LoftusChristopher J Loftus More articles by this author , Molly DeWitt-FoyMolly DeWitt-Foy More articles by this author , Valencia HenryValencia Henry More articles by this author , Joseph PariserJoseph Pariser More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cerebral palsy (CP) is an upper motor neuron disorder that typically results in spasticity of striated muscle, which can include the external urinary sphincter. Symptomatic urinary dysfunction in the form of intermittent retention and flooding may result from tonic spasticity of the external urinary sphincter (pseudodyssynergia). Botulinum toxin (BTX) may be injected to the external urinary sphincter to allow for more facile, regular voiding. In the only study examining the use of sphincter BTX injections, a reduction in chronic catheter dependence and urinary tract infection (UTI) rates in the 15 patients studied was reported. The objective of this study is to evaluate urinary outcomes following cystoscopic external urinary sphincter BTX injections in patients with CP. METHODS: In this retrospective cohort study, we reviewed patients with a diagnosis of CP seen in urology clinic from 2016-2022. Patients included were 18 years or older and had undergone a urethral external sphincter BTX injection. Injections were performed with either 100 units or 200 units in 4 cc of saline injected to the anterolateral external urethral sphincter. Data was collected via chart review and entered into a REDCap database. Outcomes included: retention, lower urinary tract symptoms (LUTS), hydronephrosis, and recurrent UTIs recorded as better, no change, or worse based on caregiver or patient feedback and repeat imaging. Urodynamics was performed pre-BTX but often not repeated as many patients are unable to void on command so a proper voiding phase could not be captured. RESULTS: 37 patients met inclusion criteria. The median age was 29 years (IQR 25-39), 57% were male, most (54%) lived at home with or without assistance, and 30% resided in a group home. Prior to BTX, most used a combination of a toilet (59%) and diapers (59%) for bladder management. The most common indication for BTX was retention (92%), followed by LUTS (38%), hydronephrosis (24%), and recurrent UTIs (22%). Post-BTX subjective improvement was seen in 71% (24/34) of patients with retention, 79% (11/14) with LUTS, 75% (6/8) with recurrent UTIs, and 78% (7/9) with hydronephrosis. The majority (68%) of patients underwent repeat injections, typically every 3-6 months. There were no significant complications associated with injections. CONCLUSIONS: External urethral sphincter BTX is a safe, effective option for treating urinary dysfunction in adults with CP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e708 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Haggart More articles by this author Christopher J Loftus More articles by this author Molly DeWitt-Foy More articles by this author Valencia Henry More articles by this author Joseph Pariser More articles by this author Sean Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

KinesioTaping after botulinum toxin type A for cervical dystonia in adult patients.

IntroductionStudies explored physiotherapeutic approaches in cervical dystonia (CD) patients with or without botulinum toxin (BoNT) injections, however the results are varying. There are no clinical trials investigating the effects of kinesiology taping in CD patients. The objective of this study is to investigate the efficacy of kinesiology taping as an adjunct to the BoNT injections in patients with CD.MethodsTwenty‐five patients were enrolled to the study. Patients were randomly assigned to the experimental 1 (BoNT + KinesioTaping), experimental 2 (BoNT + ShamTaping) or control (BoNT) treatment. After 12 weeks they were moved to the next experimental group and finally every patient received all 3 proposed treatment options. The severity of CD was quantified with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) including Torticollis severity, Disability, and Pain scales. Quality of life was evaluated using Craniocervical dystonia questionnaire (CDQ4).ResultsIn all treatment groups, there was a significant improvement in dystonia symptoms measured with TWSTRS (total score) after BoNT injection regardless of the allocation to the experimental treatment (p < .05). ANOVA analysis revealed no differences in any of the TWSTRS variables after the intervention. Quality of life was significantly improved after application of taping (p < .05, p = .03).ConclusionsApplication of KinesioTaping after BoNT injection provided no additional effect on the severity of dystonia, although the quality of life was improved in patients with CD. Further research investigating the effect of KinesioTaping prior to BoNT injection is required.

Botulinum Toxin for the Treatment of Nystagmus Associated with Exotropia

Purpose: Nystagmus can severely impact the visual function, lifestyle and quality of life of patients. Patient with Nystagmus may assume an abnormal compensatory head position and it can result in posture disorders. Botulinum toxin is an important treatment for much pathology of the eye, in particular for blepharospasm, strabismus and nystagmus. The mechanism of action is to prevent lease of acetylcholine in the neuromuscular junction getting the neuromuscular blockade and transient flaccid paralysis. The objective of this work is to evaluate the efficacy of botulinum toxin injection in patients with Nystagmus. Methods: n. 6 patients, (3 females and 3 males) aged 17 - 35 years, exhibiting exotropia (XT) associated with Nystagmus received an injection of Botulinum Toxin A Dysport (Ipsen) in the Lateral Muscles of each eye with a 27-gauge retrobulbar needle. Patients underwent an orthoptic and ophthalmic eye exam before and after surgery. Results: A significant reduction of the nystagmus in primary position was reported in all patients; the abnormal position of the head was noticeably reduced. Side-effects were limited and well tolerated by the patients. Conclusion: Botulinum toxin injection is a valuable treatment of Nystagmus associated with exotropia.

Evaluation of the efficacy of constraint-induced movement therapy combined with botulinum toxin injection in patients with cerebral palsy – a scoping review

Introduction: Both constraint-induced movement therapy and botulinum toxin injection are well-researched and described therapeutic interventions in the group of patients with cerebral palsy. One of the main symptoms of damage to the central nervous system is excessive muscle tension, which may limit, among many other things, the manipulative and grasping skills of the upper limb. The most appropriate approach in patients with hemiplegia seems to be one that is aimed at enabling and then facilitating the use of the less functional limb. The aim of this study is to evaluate the efficacy of constraint-induced movement therapy combined with botulinum toxin injection in paediatric patients with cerebral palsy. Methods: In order to determine the efficacy of botulinum toxin injection combined with constraint-induced movement therapy, the PubMed medical database was searched using the following keywords: “botulinum toxin” and “constraint-induced movement therapy.” The inclusion criteria were the following: only papers in English and relating to paediatric patients. The literature review was based on the PRISMA Statement guidelines. Results: As a result of the database search, a total of 32 articles were found, of which four met the inclusion criteria. The protocols of all studies varied both in terms of the daily dose of training and the duration of therapy. Discussion: The combination of constraint-induced movement therapy with botulinum toxin injection allows for more frequent and effective use of the directly affected hand in children with cerebral palsy. A longer-lasting constraint-induced movement therapy with a lower intensity brings better results than a shorter-lasting therapy with a higher intensity. A significant improvement was observed for the grip assessment (functional assessment and Quality of Upper Extremity Skills Test – QUEST scale) and in the Goal Attainment Scaling – GAS results.

Botulinum toxin for chronic parotid sialadenitis: A case series and systematic review.

ObjectiveTo evaluate salivary gland chemodenervation with botulinum toxin in chronic parotid sialadenitis.MethodsPatients who underwent parotid gland chemodenervation for chronic sialadenitis due to duct stenosis refractory to siaendoscopy were reviewed (case series). Additionally, a systematic review of the literature on botulinum toxin injection for chronic parotid sialadenitis was performed. Inclusion criteria included studies containing original data on botulinum toxin injections in patients with chronic sialadenitis symptoms.ResultsSialadenitis symptoms from 10 patients with 13 affected parotid glands were examined. All had duct stenosis diagnosed on sialendoscopy, refractory sialadenitis symptoms, and received parotid onabotulinum toxin injection(s) (median dose 65U). Of patients with 3‐month follow‐up, 78% reported significant improvement in symptoms. Mean Chronic Obstructive Sialadenitis Symptoms (COSS) Score improved at 3 months post‐injection (47‐25.9, P = .039) with significant reduction in gland pain frequency and gland swelling severity. No patients had a facial nerve paralysis or increased xerostomia. With the systematic review, 518 abstracts were reviewed and 11 studies met inclusion criteria and included case series or case reports with a total of 40 patients treated with botulinum toxin for chronic parotitis. Thirty‐four out of a total of 35 patients in the studies (97%) reported complete (9, 26%) or partial (25, 71%) improvement in sialadenitis symptoms with minimal complications.ConclusionParotid gland chemodenervation with botulinum toxin is a minimally invasive treatment option for symptomatic chronic sialadenitis refractory to medical treatment or sialendoscopy. Botulinum toxin injections alleviate gland pain and swelling associated with salivary obstruction and provide an alternative to parotidectomy for recurrent sialadenitis.Level of evidence: 4.

Analgesic injection of botulinum toxin in anal fissures is efficient and can be performed safely in patients actively receiving chemotherapy.

Injection of botulinum toxin into the internal anal sphincter is a well-documented intervention to reduce anal hypertonia in the treatment of anal fissures. In patients receiving chemotherapy, painful anal conditions are frequent, secondary to change in bowel habits and reduced immunity. However, injection of botulinum toxin is often not offered due to fear of complications. In this retrospective longitudinal observational study, performed in a tertiary hospital setting, we analysed patient characteristics, outcome and complication rates of botulinum toxin injection in patients actively receiving chemotherapy. Twenty-six patients were treated with 20-50 IU botulinum toxin while actively receiving chemotherapy because of intractable pain and hypertonia. The fissure was located dorsally in 69% (n = 18) and ventrally in 19% (n = 5), while in 3 patients (12%), no fissure was documented. The majority of the patients (88%, n = 23) had complete (54%, n = 14) or partial (35%, n = 9) relief of pain. In three patients, additional anal pathology developed in the weeks following botulinum toxin injection: thrombosis of grade IV haemorrhoids, perianal haematoma and an intersphincteric abscess. Injection of botulinum toxin in the anal sphincters is a safe and effective analgesic option in patients with anal fissure while actively receiving chemotherapy.

Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation

Chronic anal fissure’s (CAF) etiopathogenesis remain unclear. CAF of the posterior commissure (CAPF) are often characterized by internal anal sphincter (IAS) hypertonia. The treatment of this disease aimed to reduce IAS hypertonia. Due to the high rate of anal incontinence after LIS, the employment of sphincter preserving surgical techniques associated to pharmacological sphincterotomy appears more sensible. The aim of our study is to evaluate the long-term results of fissurectomy and anoplasty with V–Y cutaneous flap advancement associated to 30 UI of botulinum toxin injection for CAPF with IAS hypertonia. We enrolled 45 patients undergone to fissurectomy and anoplasty with V–Y cutaneous flap advancement and 30 UI botulinum toxin injection. All patients were followed up for at least 5 years after the surgical procedure, with evaluation of anal continence, recurrence rate and MRP (Maximum resting pressure), MSP (Maximum restricting pressure), USWA (Ultrasound wave activity). All patients healed within 40 days after surgery. We observed 3 “de novo” post-operative anal incontinence cases, temporary and minor; the pre-operative ones have only temporary worsened after surgery. We reported 3 cases of recurrences, within 2 years from surgery, all healed after conservative medical therapy. At 5 year follow-up post-operative manometric findings were similar to those of healthy subjects. At 5 years after the surgical procedure, we achieved good results, and these evidences show that surgical section of the IAS is not at all necessary for the healing process of the CAPF.

Sonographically guided botulinum toxin injections in patients with neurogenic thoracic outlet syndrome: correlation with surgical outcomes.

We examined the role of botulinum toxin (BTX) injections of anterior scalene (AS) and pectoralis minor (PM) muscles in patients undergoing surgery for neurogenic thoracic outlet syndrome (NTOS). We hypothesized that symptomatic improvement from BTX injections correlates with favorable long-term response to surgery for NTOS. This Health Insurance Portability and Accountability Act compliant study was approved by the institutional review board and prior informed consent requirement was waived. We retrospectively analyzed prospectively acquired data in NTOS patients who underwent sonographically guided chemodenervation of AS and PM using BTX type A followed by scalenectomy and first rib resection. Overall responses to BTX injections and surgery were recorded after each procedure. Statistical analyses were performed to determine correlation between responses to BTX injections and surgery. In 157 patients, 178 BTX injections followed by surgery were identified (114 females; mean age 38 ± 13 years). Responders and non-responders to BTX injections and surgery had similar preoperative symptom duration and age (P > 0.14). Better response to BTX injections correlated positively with better response to surgery (P = 0.003), persisting after adjustment for age, gender, and symptom duration (P = 0.03). A high proportion of responders to BTX injections also responded to surgery (positive predictive value of 99%), and BTX injections showed high specificity (90%). BTX injections were moderately sensitive (66%) and accurate (67%) to determine surgical response and had low negative predictive value (14%). Response to BTX injections correlates positively with long-term surgical outcome in subjects with NTOS, potentially playing an important role in patient management.

Selection process for botulinum toxin injections in patients with chronic-stage hemiplegic stroke: a qualitative study

BackgroundBotulinum toxin (BT) injection is a new treatment for spasticity with hemiplegia after stroke. How a patient decides to receive BT injections after becoming aware of the treatment remains unclear. In this exploratory qualitative study, we aimed to investigate patients’ decision-making about treatment strategies in collaboration with family and health professionals and to identify conflicts in patients’ feelings about BT treatment.MethodsThe study included six patients with stroke sequelae. Data were collected using comprehensive interviews and were analyzed using the grounded theory approach and trajectory equifinality modeling.ResultsAfter patients learned about BT treatment, they clearly exhibited the following two concurrent perceptions: “the restriction of one’s life due to disabilities” and “the ability to do certain things despite one’s disabilities.” Some patients reported a “fear of not being able to maintain the status quo owing to the side effects of BT.” To alleviate this fear, timely support from family members was offered, and patients overcame anxiety through creative thinking. However, there were also expressions that revealed patients’ difficulties dealing with negative events. These factors influenced the patients’ development of “expectations of BT” or “hesitations about BT.”ConclusionsTo establish treatment strategies in collaboration with patients, healthcare professionals should show supportive attitudes and have discussions with patients and their family members to help patients resolve their conflicts and should establish treatment strategies that maintain the positive aspects of patients’ lives.

Quality of Life After Botulinum Toxin Injection in Patients With Adductor Spasmodic Dysphonia; a Systematic Review and Meta-analysis

Adductor spasmodic dysphonia is an extremely disabling voice disorder that negatively impacts a patient's quality of life (QOL). We performed a systematic review to determine if Botulinum Toxin (BT) injections improved voice related QOL in patients with this disorder. PubMed, EMBASE, Web of Science, Cochrane Library, ProQuest, and Scopus from 2000, to and including November 1st, 2018, were searched. We identified randomized controlled trials, controlled trials, and observational studies of the effects of BT injections on the QOL in patients with adductor spasmodic dysphonia. The two authors, separately and individually chose the studies based on inclusion criteria, assessed study quality, and relevant extracted data. Nine studies used the Voice Handicap Index (VHI). The results showed significant changes pre- to post-BT injection (SMD = -0.357; 95% CI: -0.579, -0.136; z = 3.16; P = 0.002; I-squared = 0.000%). Five studies used the Voice-Related QOL; their results also showed a significant improvement pre- to postinjection (SMD = -2.99; 95% CI: -3.27, -1.32; z = 4.61; P < 0.001; I-squared = 87%). Three other studies used other, shortened versions of the VHI, VHI-10. They also showed significant results (SMD = -0.145; 95% CI: -0.349, 0.06; z = 1.38; P = 0.17; I-squared = 0.000). BT injections positively affect patients' QOL. However, patients' QOL scores may never be normalized, in line with perceptual voice quality and acoustic parameters.

Botulinum toxin injections after surgery for Hirschsprung disease: Systematic review and meta-analysis

BACKGROUNDA large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective surgery. Persistent obstructive symptoms may result in faecal stasis that can develop into Hirschsprung-associated enterocolitis, a potential life-threatening condition. Important treatment to improve faecal passage is internal anal sphincter relaxation using botulinum toxin injections.AIMTo give an overview of all empirical evidence on the effectiveness of botulinum toxin injections in patients with Hirschsprung disease.METHODSA systematic review and meta-analysis was done by searching PubMed, EMBASE and the Cochrane Library, using entry terms related to: (1) Hirschsprung disease; and (2) Botulinum toxin injections. 14 studies representing 278 patients met eligibility criteria. Data that were extracted were proportion of patients with improvement of obstructive symptoms or less enterocolitis after injection, proportion of patients with adverse effects and data on type botulinum toxin, mean dose, average age at first injection and patients with associated syndromes. Random-effects meta-analysis was used to aggregate effects and random-effects meta-regression was used to test for possible confounding factors.RESULTSBotulinum toxin injections are effective in treating obstructive symptoms in on average 66% of patients [event rate (ER) = 0.66, P = 0.004, I2 = 49.5, n = 278 patients]. Type of botulinum toxin, average dose, average age at first injections and proportion of patients with associated syndromes were not predictive for this effect. Mean 7 duration of improvement after one botulinum toxin injections was 6.4 mo and patients needed on average 2.6 procedures. There was a significant higher response rate within one month after botulinum toxin injections compared to more than one month after Botulinum toxin injections (ER = 0.79, vs ER = 0.46, Q = 19.37, P < 0.001). Botulinum toxin injections were not effective in treating enterocolitis (ER 0.58, P = 0.65, I2 = 71.0, n = 52 patients). There were adverse effects in on average 17% of patients (ER = 0.17, P < 0.001, I2 = 52.1, n = 187 patients), varying from temporary incontinence to mild anal pain.CONCLUSIONFindings from this systematic review and meta-analysis indicate that botulinum toxin injections are effective in treating obstructive symptoms and that adverse effects were present, but mild and temporary.

Improvement in quality of life after botulinum toxin injection for temporomandibular disorder

BackgroundTemporomandibular disorders (TMDs) cause chronic pain and interfere with quality of life (QoL). Botulinum toxin is one of the treatment modalities popularly used for TMDs. The primary objective of this retrospective study was to evaluate improvement in QoL after botulinum toxin injections in patients with TMD. MethodsTwenty-eight patients diagnosed with TMD were included in this study. In accordance with the Research Diagnostic Criteria for Temporomandibular Disorders, all patients had myofascial pain. They received botulinum toxin A (BTX-A) injections in temporalis and masseter muscles. QoL was measured using a French translated version of the validated Oral Health Impact Profile-14 (OHIP-14) and a second questionnaire, which was an adaptation of the temporomandibular joint replacement QoL questionnaire (TMJ-QoL). Patients answered both questionnaires and a visual analogue scale (VAS) before the injection, at 1 month after the injection and at 3 months after the injection. Relationship between QoL and factors such as bruxism, age, sex and body mass index (BMI) were also evaluated. ResultsAll patients reported significant improvements in QoL (OHIP-14 and TMJ-QoL) and VAS Scores at 1 and 3 months after BTX-A injections (P < 0.0001). A significant moderate positive correlation was noted between TMJ-QoL before BTX-A injections and BMI (P = 0.016). ConclusionOverall, QoL in patients with TMD improved significantly at 1 and 3 months after BTX-A injections. BTX-A injection in masticatory muscles of patients with TMD can be a useful supportive therapy to control pain and improve QoL.

An effective approach for botulinum toxin injection in patients with stroke for focal spasticity: dual guidance

Objective: This study has aimed to compare the efficacy of botulinum toxin (BTX) injections, applied to the upper limb muscles of the stroke patients in our clinic who have being diagnosed with focal spasticity, that are performed via ultrasonography and ultrasonography + electrical muscle (EM) stimulator guidance. Literature didn’t include detailed crosscheck of ultrasound guided BTX and EM treatment applications for upper limb focal spasticity patients Materials and Methods: Electronic data on 62 hemiplegic stroke patients with grade 2 and 3 focal spasticity who had received botulinum toxin injections into their upper limb muscles by the same physician, who used similar protocol and recorded the results, were scanned retrospectively. The spasticity of the patients in both groups was assessed with the Modified Ashworth Scale at the end of two weeks and three months. Results: A statistically significant difference was found between the Modified Ashworth Scale values of both groups in terms of all muscles, compared to the values seen in the pre-treatment period (p<0.05). The Modified Ashworth Scale values at 3 months posttreatment in ultrasonography + electrical muscle stimulator group were not statistically different from those at 2 weeks posttreatment, with respect to wrist flexion and finger flexion. In intergroup comparison, there was no statistically significant difference between the Modified Ashworth Scale values of at pretreatment and 2 weeks posttreatment. However, statistically significant difference in all muscle groups was found in favor of the ultrasonography + electrical muscle stimulator group at 3 months posttreatment controls (p<0.05). Conclusion: Upper limb spasticity due to stroke can be substantially recovered with botulinum toxin injections that are applied via only ultrasonography guidance or via ultrasonography + electrical muscle stimulator guidance.. According to data from the assessment at 3 months posttreatment, the botulinum toxin injection performed via ultrasonography + electrical muscle stimulator guidance had more positive effects .

An effective approach for botulinum toxin injection in patients with stroke for focal spasticity: dual guidance

Objective: This study has aimed to compare the efficacy of botulinum toxin (BTX) injections, applied to the upper limb muscles of the stroke patients in our clinic who have being diagnosed with focal spasticity, that are performed via ultrasonography and ultrasonography + electrical muscle (EM) stimulator guidance. Literature didn’t include detailed crosscheck of ultrasound guided BTX and EM treatment applications for upper limb focal spasticity patients&#x0D; Materials and Methods: Electronic data on 62 hemiplegic stroke patients with grade 2 and 3 focal spasticity who had received botulinum toxin injections into their upper limb muscles by the same physician, who used similar protocol and recorded the results, were scanned retrospectively. The spasticity of the patients in both groups was assessed with the Modified Ashworth Scale at the end of two weeks and three months.&#x0D; Results: A statistically significant difference was found between the Modified Ashworth Scale values of both groups in terms of all muscles, compared to the values seen in the pre-treatment period (p&lt;0.05). The Modified Ashworth Scale values at 3 months posttreatment in ultrasonography + electrical muscle stimulator group were not statistically different from those at 2 weeks posttreatment, with respect to wrist flexion and finger flexion. In intergroup comparison, there was no statistically significant difference between the Modified Ashworth Scale values of at pretreatment and 2 weeks posttreatment. However, statistically significant difference in all muscle groups was found in favor of the ultrasonography + electrical muscle stimulator group at 3 months posttreatment controls (p&lt;0.05).&#x0D; Conclusion: Upper limb spasticity due to stroke can be substantially recovered with botulinum toxin injections that are applied via only ultrasonography guidance or via ultrasonography + electrical muscle stimulator guidance.. According to data from the assessment at 3 months posttreatment, the botulinum toxin injection performed via ultrasonography + electrical muscle stimulator guidance had more positive effects .