An 80-year-old woman presented with inspiratory stridor after eating. Imaging revealed a decompensated esophagus. Endoscopy showed food retention and a narrowed lower esophageal sphincter. Achalasia, a rare motility disorder, was diagnosed and a botulinum toxin injection was administered. Treatment options include botox, pneumatic dilation, or surgery, the patient opted to await botox effects.

RCPD is a condition characterized by the inability to belch. Our study aims to assess the prevalence of anxiety and depression within this population while evaluating the impact of cricopharyngeal botulinum toxin injection (CPBTI) on associated symptoms. RCPD patients selected for treatment with CPBTI were given three validated questionnaires for anxiety (GAD-7, ASQ) and depression (PHQ-9) before CPBTI, as well as 6 weeks and 6 months after. The changes were assessed with ANOVA, and minimal clinically important differences (MCID) of the surveys were used to qualify improvement in scores. Seventy-seven patients completed the pretreatment questionnaire. Of the 69 patients who ultimately received treatment, 45 completed at least one follow-up questionnaire and 32 completed all three. Mean age was 30.9% and 61% self-reported a diagnosed mental health comorbidity (MHC). GAD-7 identified at least mild anxiety in 73%, 50%, and 46% of patients at each timepoint, respectively. PHQ-9 identified at least mild depression in 68%, 52%, and 34%, respectively. Mean pretreatment, 6-week, and 6-month scores were 8.16, 5.04, and 4.4, respectively, for GAD-7 (p < 0.001); 7.87, 5.71, and 4.20, respectively, for PHQ-9 (p = 0.002); and 112.4, 75.6, and 65.20, respectively, for ASQ (p = 0.001). Using MCID values for GAD-7 and PHQ-9, 64% showed significant improvement in anxiety and 60% showed significant improvement in depression after treatment. RCPD patients have a high prevalence of comorbid anxiety and depression. Treatment with CPBTI correlates strongly with a sustained reduction in these symptoms beyond the duration of botulinum toxin.

To investigate intraoperative findings as predictors for favorable outcomes following Botox injection in patients diagnosed with retrograde cricopharyngeus muscle dysfunction (RCPD). A retrospective review was performed on patients who underwent 70-80 U botulinum toxin injection (BT) for treatment of RCPD by a single surgeon between 2018 and 2023. Patient characteristics, intraoperative findings of cricopharyngeus muscle (CPM), symptoms, treatment response, and side effects were identified during preoperative and 1-month postoperative follow-up. A total of 71 patients were included in the study. A majority of the patients were Caucasian (n = 59 [83.1%]), female (n = 37 [52.1%]), with a mean age of 29.2 years (SD = 8.3). Of those, 68% (n = 48) of patients had a complete response to the initial Botox injection at 1-month follow-up. Compared to the mild thickness CPM, the moderate thickness CPM was 7.2 times less likely to have a full response to treatment (odds ratio [OR]: 7.24, confidence interval [CI]: 1.13-46.37, p = 0.037). Similarly, compared to the mild thickness CPM, thick CPM was 38.5 times less likely to have a full response to treatment (OR: 38.5, CI: 4.4-336.5, p = 0.001). Moderate and thick CPMs were less likely to have resolution of symptoms after initial injection with 70-80 U of Botox injection. Further research is needed to establish recommendations regarding dosing for patients with RCPD, especially in those with moderate and thick CPMs.

International consensuses and guidelines on clinical practices on abducens nerve palsy by the Asia-Pacific Strabismus and Pediatric Ophthalmology Society (APSPOS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO).

Neurogenic voiding dysfunction caused by neurological diseases is frequently encountered in clinical practice. This study aimed to evaluate the clinical efficacy and identify urodynamic predictors of a successful outcome following urethral sphincter botulinum toxin A (BoNT-A) injection in women with this condition. This is a retrospective cohort study. Women diagnosed with non-spinal cord neurogenic voiding dysfunction who presented with difficulty voiding and significant post-void residual (PVR) urine volume received 100 units of BoNT-A via urethral sphincter injection. The primary outcome was assessed 3months posttreatment. Treatment success was defined as improved voiding function with voiding efficiency (VE) > 67% and elimination of catheterization. Patients not meeting these criteria were classified as treatment failures. Baseline videourodynamic parameters were analyzed to identify differences between successful and unsuccessful treatment groups. Multivariate logistic regression was employed to determine independent predictors of treatment success. A total of 158 women were enrolled, including 35 with cerebrovascular disease, 22 with Parkinson's disease, 10 with dementia, and 91 with peripheral nervous system disorders. Among them, only 28.5% achieved a successful outcome, while 40.5% showed partial improvement but continued to experience high PVR and required catheterization. Women in the success group exhibited significantly higher baseline voiding pressures, maximum flow rates, and VE, along with lower PVR volumes, compared with those in the failure group. Urethral sphincter discoordination was associated with higher success rates, whereas detrusor underactivity, tight bladder neck, and poor external sphincter relaxation were linked to poorer outcomes. Higher baseline voiding pressure and lower PVR were predictive of successful response to urethral sphincter BoNT-A injection in women with non-spinal cord neurogenic voiding dysfunction. The result highlights that a woman with true urethral sphincter dysfunction could benefit from urethral BoNT-A injection. Proper patient selection based on urodynamic parameters may optimize therapeutic outcomes.

Indications, Trends, and Outcomes of Nerve Blocks for Spasticity Management: A Systematic Review.

Background: Botulinum toxin injections are widely used in the orofacial region for cosmetic and therapeutic purposes. Recently, interest has grown in combining Botulinum toxin A injection with facial exercises to enhance or sustain aesthetic and functional outcomes. Objective: To examine the efficacy of Botulinum toxin injections with facial exercise on orofacial disorders. Methods: A comprehensive electronic literature search was conducted across databases. Studies were screened for eligibility, and reviewers independently assessed quality and bias. Results: An electronic search of databases up until Feb 2026 revealed 164,916 Articles. Seven studies met the inclusion criteria, including four RCTs and three prospective clinical studies conducted in a hospital-based setting. Different Botulinum toxins have been used in these studies. Two studies used Onabotulinumtoxin A, two used botulinum toxin (Dysport), and two RCTs used botulinum A toxin (Botox). Additionally, the presented studies performed various myofunctional therapy. Conclusion: The current evidence suggests that facial exercise following Botulinum toxin A injections may enhance treatment outcomes in the orofacial area by sustaining muscle tone and prolonging aesthetic benefits. Further research with larger sample sizes and standardized protocols must establish the effectiveness and best practices of this combined approach.

P0501 Dual-site botulinum toxin injection for lifelong premature ejaculation: A prospective randomized controlled trial

In pediatric pelvic or perineal rhabdomyosarcoma, organ preservation rates are high following neoadjuvant chemotherapy. We assessed the impact of combining external beam radiation therapy (EBRT) and brachytherapy (BT) on local control and functional outcomes. We retrospectively analyzed records of all children who received both EBRT and a BT boost in our department from 2005 to 2023. Data collected included tumor relapse, local control, survival and late toxicity rates. Treatment was administered as part of a multimodal conservative radio-surgical approach. Eighteen patients were identified, with a median age of 4years (range, 2.9 - 8.6years). According to the Intergroup Rhabdomyosarcoma Study (IRS) risk groups, 10 patients were classified as IRS-III and 8 as IRS-IV. Seven patients had metastases at diagnosis. The median number of chemotherapy cycles prior to local treatment was 8 (range, 5-10). Nine patients (50%) underwent prior conservative surgery, followed by radiation therapy consisting of both BT and EBRT. This combination was indicated for at least one the following reasons: nodal invasion (n=11, 61%), risk of peritoneal dissemination (n=3, 17%) and/or local extension (n=7, 39%). The median prescribed dose was 20Gy (range 12-30Gy) for BT and 50.4Gy (range, 18.8-55Gy) for EBRT. Two patients were treated with HDR BT, while the remaining received LDR (n=4) or PDR (n=12).The median follow-up period was 4.6years (range, 2.9-6.6years). At the last follow-up, failure free-survival was 67%, local control was 78% and overall survival was 83%. Four patients experienced grade II late urinary toxicities, including dysuria or incontinence in two patients. One patient required secondary cystectomy, and another received botulinum toxin injections in the bladder neck. Organ preservation with favorable functional outcome can be achieved in pelvic and perineal rhabdomyosarcoma by combining BT and EBRT, with or without prior surgery. This approach requires close collaboration to develop customized radiation therapy plans. Extended follow-up is necessary to assess long-term functional outcomes.

Editorial Comment on "Quality and Reliability of YouTube Videos on Intravesical Botulinum Toxin Injections: A Provider-based Evaluation".

Far Medial Lower Eyelid Botulinum Toxin Injections for Blepharospasm: Enhanced Efficacy and Reduced Dry Eye

Transversus abdominis release (TAR) versus preperitoneal repair (PPR) in complex, open abdominal wall reconstruction.

To examine the effects of botulinum toxin inoculation into the deep digital flexor (DDF) muscle on foot biomechanics. 6 healthy horses were injected with botulinum toxin in the DDF of 1 forelimb. The opposite forelimb was untreated. Ground reaction forces (GRF) were measured using a pressure sensor in regions of interest, including the dorsal hoof wall (toe). The location of the center of pressure (COP) was measured relative to the dorsal hoof wall during static standing and at peak stance during walking. Repeat measurements 3, 7, 14, 28, and 42 days after injection were compared to baseline (pretreatment) using Friedman tests with Dunn multiple comparisons. There was a median 122-N (IQR, 66 to 254) reduction in the peak GRF at the toe at 7 days after Botox injection. The COP was shifted palmarly by 10 mm (IQR, 8 to 16) during stationary stance and by 6 mm (IQR, 3 to 7) during ambulation at day 7 compared to baseline. These changes were no longer significantly different to control by 14 days. No significant changes were seen in untreated limbs. Treatment with botulinum toxin transiently reduced peak GRF at the toe and caused a palmar shift in COP at rest and during ambulation. These biomechanical effects of DDF botulinum toxin inoculation would be expected to reduce mechanical stress on the dorsal lamellae and could be useful for treatment of acute laminitis to help reduce distal phalangeal rotation.

Background: Hirschsprung disease (HD) is associated with substantial postoperative morbidity, particularly due to Hirschsprung-associated enterocolitis (HAEC), despite definitive surgical treatment. Postoperative outcomes may vary according to the length of the aganglionic segment and the surgical technique used, and optimal management of recurrent HAEC remains a significant clinical challenge. Methods: The medical records of patients who underwent corrective surgery for HD between 2011 and 2023 were retrospectively reviewed. Demographic characteristics, disease segment length, surgical technique, postoperative complications, and HAEC episodes were recorded. HAEC diagnosis and follow-up assessments were conducted in accordance with the Delphi criteria. Patients with recurrent HAEC and obstructive symptoms refractory to standard conservative management were evaluated for botulinum toxin injection (BTI). Results: A total of 72 patients were included in the study. The majority of the patients were male (83.3%), with a mean age at diagnosis of 11 months. The Duhamel procedure was the most frequently performed surgical technique. Although the rate of anastomotic leakage was greater in patients who underwent the Swenson procedure compared with the Duhamel group, this difference did not reach statistical significance when the appropriate statistical methods were used because the small sample size. No significant difference in the incidence of HAEC was observed among the different surgical techniques. BTI was administered to 13 patients, and regression of enterocolitis episodes according to the Delphi criteria was observed in 11 patients (84.6%). Most postoperative complications are observed in patients with long-segment Hirschsprung disease. Conclusions: Postoperative complications and HAEC remain major clinical challenges in the management of Hirschsprung disease, particularly in patients with long-segment involvement. Although the surgical technique may influence certain complication rates, HAEC appears to be a multifactorial condition. Botulinum toxin injection may serve as a supportive treatment option in selected patients with refractory HAEC; however, prospective controlled studies are needed to further clarify its role.

Comparison of the therapeutic effects of endoscopic botulinum toxin (BTX) injection and semaglutide (SME) injection in treatment of patients with obesity and weight regain after laparoscopic sleeve gastrectomy (LSG). The injection method for botulinum toxin is to dilute 300 U of type A botulinum toxin with 20 mL of physiological saline. Injections were made in a grid pattern throughout the antrum and body (20 injection points total), with 1 mL of drug injected at every point. The application method for semaglutide injection is to start at 0.25 mg once a week and increase by 0.25 mg every 3 weeks until the patient can tolerate the maximum dose (1.0 mg qw), for a total of 6 months. The weight loss effect of the SME group was significantly better than that of the LSG+SME group because the SME group achieved significantly greater weight loss at 2 months than the LSG+SME group. No significant difference was seen between any other pair of groups. Endoscopic botulinum toxin injection can be a safe and effective treatment for weight regain after LSG.

Targeted Myofascial Release in Oromandibular Dystonia: A Case Report on Non-Invasive Tremor Reduction and Functional Recovery.

Botulinum toxin A (BTA) is increasingly used for preoperative conditioning in patients with large or complex abdominal wall hernias. Injection into the lateral abdominal muscles 4-6 weeks before surgery induces temporary muscular relaxation and facilitates primary fascial closure, even in extensive defects (EHS W3), potentially reducing the need for component separation. While surgical outcomes are well documented, data on patient-reported experiences during the preoperative period remain limited. This retrospective study evaluated patient-reported symptoms between BTA injection and surgery and analyzed surgical results in this cohort. Between 2018 and 2024, 50 patients with complex abdominal wall hernias received preoperative BTA treatment followed by surgical repair. Demographic and surgical data, as well as BTA-related complications, were analyzed descriptively. A retrospective questionnaire assessed subjective experiences from injection to surgery, focusing on pain, physical changes (e.g., abdominal contour, trunk stability), and functional impairments (e.g., breathing, urination, defecation). The study included 31 men and 19 women (mean age 63.5 years, BMI 28kg/m2). The mean transverse defect width was 12.06 cm, with an average area of 170.24cm2. Thirty eight patients had W3 hernias according to EHS (≥10cm), while BTA was also used in selected cases with smaller defects with complicating factors. No major BTA-related complications occurred; minor hematomas were observed. The mean interval between injection and surgery was 39 days. Primary fascial closure was achieved in all patients. Mesh reinforcement was used in all cases, most commonly in sublay position (n = 47). A transversus abdominis release was performed in 28 cases (52%), and anterior component separation in five. Twenty-two patients (44%) completed the questionnaire. Injection pain ranged from NRS 1-8, typically resolving within 1-3 days; three patients reported no pain. Eight noticed abdominal contour changes, and two reported altered trunk function. One patient experienced mild shortness of breath and another constipation; no urinary issues occurred. Preoperative BTA conditioning is a safe and effective adjunct for abdominal wall reconstruction in complex hernias. The treatment facilitates fascial closure, avoids major complications, and causes only minor, short-lived discomfort or functional limitations, maintaining overall quality of life in the preoperative phase.

This study investigates the prevalence of vocal tremor in specific vocal tract locations to provide insights that refine botulinum toxin injection treatments. A retrospective analysis was conducted on clinical data from 36 patients diagnosed with vocal tremor who received botulinum toxin injections at the University of Pittsburgh Medical CenterVoice, Airway & Swallow Center between 2006 and 2024. Tremor locations (true vocal folds, false vocal folds, palate, strap muscles, tongue) were assessed using dynamic flexible laryngoscopic imaging. Vocal tremor frequently involved multiple sites, with the most common locations being the true vocal folds (33 patients), palate (24 patients), and false vocal folds (23 patients). On average, patients exhibited tremor in 3 locations. Comprehensive laryngeal evaluation is crucial for tailoring botulinum toxin treatments. Future research should explore advanced diagnostic techniques and alternative therapies to address tremor in harder-to-treat locations.

Patients with cerebral palsy (CP) experience complex gait disorders that change with age, leading to reduced activity and social participation. This study aimed to analyse how gait patterns developed over five years and to examine the relationships between the Observational Gait Scale (OGS), Amsterdam Gait Classification (AGC), Gross Motor Function Classification System (GMFCS), and the Functional Mobility Scale (FMS) at 5 and 50 m (FMS 5/50) during treatment. This retrospective, single-centre observational study involved annual assessments over a five-year period, which were analysed. Patients underwent a rehabilitation programme including physiotherapy, orthotics, multilevel botulinum toxin type A injections (BoNT-A), and serial casting. Data regarding BoNT-A treatment, casting, physiotherapy, orthoses, GMFCS levels, and FMS 5/50 scores were obtained from medical records. OGS and AGC were evaluated through two-plane clinical video recordings conducted in the same gait laboratory for all children. A cohort of 200 pediatric subjects (120 boys and 80 girls) diagnosed with bilateral cerebral palsy, predominantly classified as GMFCS II (48%) and III (36%), was analyzed. The average initial age was 32.23 months (±6.96), and GMFCS levels improved in 33. 5% of children and worsened in 2% (p < 0.001). Improvements were observed in 50% of children with GMFCS III and 40% with GMFCS IV levels. FMS 5 and 50 improved by 54% and 52%, respectively. OGS scores showed improvement in 74% and 76% of patients, respectively, while deterioration was observed in 5% and 7% for the right and left lower limbs, respectively. Most changes in OGS scores ranged from 1 to 4 points. A negative correlation was found between OGS and GMFCS (p < 0.001), and a positive correlation was found between OGS scores and FMS 5 and FMS 50 (p < 0.001). Additionally, significant relationships were identified between AGC and GMFCS, as well as FMS at 5 and 50 m. Complex gait disorders identified by the AGC are associated with higher GMFCS E&R scores and lower FMS scores. During the five-year follow-up, relationships were observed among GMFCS, FMS, OGS, and AGC. Our findings indicate that integrated treatment has a positive effect on functional mobility and gait patterns in patients with CP.

Conventional botulinum toxin type A (BoNT/A) products include non-therapeutic accessory proteins vary in composition and manufacturing processes, which may contribute to differences in purity and biochemical characteristics. YY001（Retoxin） is a novel recombinant BoNT/A manufactured via E. coli expression to reduce impurities, improve purity, and minimize immunogenic risk. To evaluate the efficacy, safety, and immunogenicity of YY001, a recombinant botulinum toxin type A (Chongqing Claruvis Pharmaceutical Co., Ltd., Chongqing, China), in the treatment of moderate to severe glabellar lines. In this multicenter, randomized, double-blind, vehicle- and active-controlled Phase III trial, 529 adults aged 18-65 with moderate to severe glabellar lines were randomized 4:2:1 to receive a single 20 U injection of YY001, Botox®(Allergan Pharmaceuticals Ireland, Westport, Ireland), or vehicle. The primary endpoint was composite response rate (CRR) at Week 4, defined as a ≥2-grade improvement of glabellar line severity assessed by both investigator and participant. Secondary endpoints included onset time, duration, satisfaction, and safety. YY001 achieved a CRR of 86.7% at Week 4, significantly outperforming Botox® (66.7%, P < 0.0001) and vehicle (1.3%, P < 0.0001). It showed faster onset, longer median duration (97 days), and high participant satisfaction. Adverse events were mild and comparable across groups. Only one case of anti-drug antibody was observed; no neutralizing antibodies were detected. A 12-week follow-up and ethnically homogenous population may limit generalizability. YY001 demonstrated strong efficacy and a favorable safety profile than Botox®. Longer-term and multicenter studies are needed to assess durability, immunogenicity, and applicability across broader populations.