Botulinum Toxin Injections For Treatment Research Articles

A Case of Botulinum Toxin Injection for Treatment of Functional Dyspepsia

Functional dyspepsia is a condition with chronic indigestion symptoms such as epigastric pain or discomfort, early satiety, and bloating without an alternative organic disease. The symptoms are similar to those of functional dyspepsia, but abnormal retention of food in the stomach should be identified in gastroparesis. In this case, botulinum toxin injection was performed for treatment in a patient who complained of symptoms such as nausea, early satiety, abdominal distension, and poor appetite without no abnormal findings in gastric emptying scan. Through this case, a possibility was found that antral and pyloric dysfunction may cause symptoms of functional dyspepsia, without gastric emptying abnormalities.

Assessment of Depression and Anxiety After Botulinum Toxin Injection Treatment in Patients with Hemifacial Spasm and Blepharospasm

Objective: The aim of this study was to investigate the relationship between depression and anxiety due to the current clinical situation, disease duration and age, and the change in post-treatment parameters in patients with hemifacial spasm (HS) and blepharospasm (BS) receiving botulinum toxin therapy (BTT). Materials and methods: 125 hemifacial spasm patients, 14 blepharospasm patients and 70 healthy volunteers were included in the study as control group. Beck depression and Beck anxiety scales were applied to the patient and control groups. The test was repeated in the patient group 4 weeks after BTT treatment. Results: The Beck anxiety and Beck depression scale scores of the case group were higher before treatment compared to the control group. Beck anxiety and Beck depression scores decreased after treatment in both HS and BS patients. Among the groups, the post-treatment Beck Anxiety score in the blepharospasm group was statistically significantly lower than in the hemifacial spasm group. The depression scale score increased with increasing disease duration in the case group. Anxiety and depression scores were lower in older patients. Beck depression and Beck anxiety scores of the patients improved with BTT treatment. Conclusion: Since HS and BS cause physical problems in the facial muscles, it also negatively affects the functional status and emotional state of the patients. This disease is often accompanied by anxiety and/or depression. After CT treatment, functional muscle problems are corrected in HS and BS patients, providing positive effects on mood as well as the treatment of the disease and correcting the anxiety and depression findings related to the disease.

Comparison study of Endoscopic-guided versus Electromyography-guided Botulinum toxin injection treatments in Adductor spasmodic dysphonia

Comparison study of Endoscopic-guided versus Electromyography-guided Botulinum toxin injection treatments in Adductor spasmodic dysphonia

Botulinum toxin injections for treatment of congenital double upper lip associated with gummy smile.

Botulinum toxin injections for treatment of congenital double upper lip associated with gummy smile.

Botulinum Toxin Injection versus Extraocular Muscle Surgery for Acute Acquired Comitant Esotropia.

To compare the success rate of extraocular muscle surgery and botulinum toxin injection for treatment in patients with acute acquired comitant esotropia (AACE). This is a retrospective cohort study in which we treated 34 patients of AACE with botulinum toxin compared with 80 patients who had been treated with surgery. The data included angle of deviation in prism diopter (PD) at baseline and one, three, and six months after treatment. The main outcome was the success rate in each treatment group. In the surgery group, mean esodeviation angles at baseline and one, three, and six months after treatment were 50.8 ± 18.3 PD, 4.9 ± 8.3 PD, 4.6 ± 9.5 PD, and 5.5 ± 10.3 PD, whereas those in the botulinum toxin group were 51.2 ± 14.3 PD, 13.9 ± 17.4 PD, 22.0 ± 19.3, and 31.3 ± 23.8 PD, respectively. There was a statistically significant difference in the deviation angles between the two groups (p < 0.001). The success rate in the surgery group at one, three, and six months was 81%, 84%, and 79%, whereas that in the botulinum toxin group was 50%, 27%, and 27%. Botulinum toxin injection was not as effective as conventional extraocular muscle surgery in AACE patients. However, the treatment is safe, fast-acting, and improves both cosmetic appearance and quality of life. This may be considered as a chance for patients not preferring surgery.

Physicians’ Use of Perioperative Botulinum Toxin Injections in Treatment of Spastic Limbs: A Cross-Sectional National Survey

Physicians’ Use of Perioperative Botulinum Toxin Injections in Treatment of Spastic Limbs: A Cross-Sectional National Survey

Pre-operative diagnosis importance of urodynamics in botulinum toxin injection treatment for patients with idiopathic overactive detrusor

In this research, there were obtained clinical data based on the necessity and importance of performing urodynamic tests up to the actual injection procedure with botulinum toxin type A of the detrusor muscle, at the patient diagnosed with overactive bladder and detrusor overactivity, offering a guarantee of an effective and long-term result of treatment and providing predictive parameters for some postoperative complications. Urodynamic diagnosis is suitable for patients with OAB refractory to conservative empirical therapy and for providing additional information about the cause of urinary symptoms by confirming the diagnosis of detrusor overactivity.

Botulinum Toxin Injections for Treatment of Drooling in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis.

Background: We aimed to review and analyse the effectiveness and safety of botulinum toxin type A (BoNT-A) injections for drooling in children with cerebral palsy. Data sources: We searched the EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) databases from inception to January 2020. Methods: We included randomized controlled trials and observational studies which (1) involved children with cerebral palsy, (2) used BoNT-A for control of drooling, and (3) provided quantitative evaluations of drooling before and after intervention with BoNT-A. Results: Twenty-one trials met the inclusion criteria. Most studies showed that BoNT-A injections are safe and efficacious as a treatment for drooling in children with cerebral palsy. Four trials had sufficient data to pool the results for the meta-analysis. Both the drooling quotient (p = 0.002) and drooling Ffrequency and severity scale (p = 0.004) supported this conclusion. Conclusion: BoNT-A injections are a safe, reversible, effective treatment for drooling control in children with cerebral palsy that can offer effectiveness for more than 3 months with few side effects. The dosage of BoNT-A should not exceed 4 units/kg. Further studies are required to determine the optimal dosage and target glands.

Anatomical locations of the motor endplates of sartorius muscle for botulinum toxin injections in treatment of muscle spasticity.

PurposeThis study aimed to detect the idyllic locations for botulinum neurotoxin injection by analyzing the intramuscular neural distributions of the sartorius muscles.MethodsAn altered Sihler’s staining was conducted on sartorius muscles (15 specimens). The nerve entry points and intramuscular arborization areas were measured as a percentage of the total distance from the most prominent point of the anterior superior iliac spine (0%) to the medial femoral epicondyle (100%).ResultsIntramuscular neural distribution were densely detected at 20–40% and 60–80% for the sartorius muscles. The result suggests that the treatment of sartorius muscle spasticity requires botulinum neurotoxin injections in particular locations.ConclusionsThese locations, corresponding to the locations of maximum arborization, are suggested as the most suggestive points for botulinum neurotoxin injection.

A comparative study between lateral internal anal sphincterotomy and botulinum toxin injection in the treatment of chronic anal fissure

Background and objective: The gold standard for the treatment of chronic anal fissure is lateral internal sphincterotomy. Botulinum toxin injection provides temporary alleviation of sphincter spasm and allows the fissure to heal. This study aimed to compare the outcomes of lateral internal sphincterotomy and botulinum toxin injection treatments in patients with uncomplicated chronic anal fissure. Methods: A prospective comparative study was carried out at the surgical unit of Erbil teaching hospital, Erbil, Kurdistan Region of Iraq, from January 2017 to February 2018. Fifty-five patients were enrolled in this study. Five patients were excluded, and the remaining 50 patients were equally divided into two groups. Group A was managed with lateral internal sphincterotomy and group B with botulinum toxin. Postoperative pain relief, bleeding, fissure healing, incontinence, and relapse after six weeks and three months of follow-up were compared. Results: One month after treatment, 12% of the lateral internal sphincterotomy group had bleeding, while none of the botulinum toxin group (P = 0.234). Two patients (8%) of the lateral internal sphincterotomy group had pain while one (4%) of the botulinum toxin group (P &gt;0.999).Three months after treatment, 4% of the lateral internal sphincterotomy group had bleeding, while none of the botulinum toxin group (P &gt;0.999). None of the lateral internal sphincterotomy group had pain while one (4%) of the botulinum toxin group (P &gt;0.999). Regarding healing, 96% of the lateral internal sphincterotomy group healed, while 92% in the botulinum toxin group (P &gt;0.999). Conclusion: The outcome of lateral internal sphincterotomy and botulinum toxin were nearly the same, but lateral internal sphincterotomy required hospitalization, period off work, and risk of anesthesia. These risks were absent in botulinum toxin injection. Keywords: Chronic anal fissure; Lateral internal sphincterotomy; Botulinum toxin; Complications.

Botulinum Toxin in Management of Benign Essential Blepharospasm

The objective of this study is to evaluate effectiveness of botulinum toxin injection in treatment of benign essential blepharospasm. It is a prospective interventional study conducted in Ispahani Islamia Eye Institute and Hospital within the period of June 2018 to May 2020. In this study 102 patients, suffering from benign essential blepharospasm, were included. After taking standard precaution, botulinum toxin injection was injected at 5 to 6 sites of each eye with 2.5 units per site. Patients were followed up routinely on the following day, after 7 day, then after 1 month and 3 months. 65.68% patients are of 50 years or more with mean age 54.91 years. 35.29% patients are male and 64.70% are female. 62.74% patient had bilateral blepharospasm while 37.25% patient presented with unilateral symptoms. Useful effect of injection appeared within 48 hours in all patients. According to Blepharospasm disability index, 13.72% patient had minor blepharospasm (mean BSDI score 1to 2), 34.31% patient had moderate (mean BSDI score >2 to 3) and 51.96% patient had severe blepharospasm (>3 to 4). Baseline mean BSDI score before injection of 102 patients was 2.62. 7 days after injection, the score reduced to 1.46 and after 1month, score was 0.95. Minor transient side effect like ptosis, dry eye and lagophthalmos was found in very few patients. The useful effect of injection lasted for 3-4 months in majority of patients. This study explored Botulinum toxin as the first line treatment of benign essential blepharospasm,however, there are few limitations of this agent, including short-term effect, repeated application, and high cost.

Anal Fissure in Children.

Anal fissure is a common clinical problem in children and is defined as a longitudinal tear in the anal canal. The typical presentation is painful defecation and rectal bleeding. The etiology of anal fissure is unknown, but passage of hard stools and increased internal anal sphincter pressure are considered important factors. The treatment is oriented to relieve the spasm of the internal anal sphincter, which prevents healing of the fissure. Conservative management with stool softeners, topical analgesics, and sitz baths is recommended as first-choice therapy. Surgical treatment has been replaced by nonoperative management as definitive therapy, which is associated with a marginally higher success rate than placebo. Most recent studies have focused on nonoperative treatment with glyceryl trinitrate, calcium channel blockers, or botulinum toxin injection treatment. There are a few controlled studies to compare the different nonoperative treatment options in children. Success rates vary between the studies, and there is no clear evidence about which is the optimal nonoperative treatment. A significant recurrence rate has been reported after nonoperative management of anal fissure. It is important to treat constipation to avoid recurrent tears in the anal canal.

Role of botulinum toxin injection in treatment of achalasia

Role of botulinum toxin injection in treatment of achalasia

A Study to Examine the Effect of Needle Gauge on Pain Perception in Patients Receiving Treatment With Botulinum Toxin in 2 Different Anatomical Areas

Botulinum toxin injection for treatment of rhytids is the commonest cosmetic intervention undertaken worldwide. It requires re-treatment at 3-month intervals for the effect to remain. Consequently, patient comfort is paramount in order for the procedure to remain acceptable. Intuitively, patients expect that smaller needles will be less painful, and this study examines the pain caused by needles of 2 gauges (31 and 32) when administering botulinum toxin in 2 anatomical areas. Patients were randomized into having the left or right side of their face treated with either a 31- or 32-gauge needle during botulinum toxin administration. Participants were asked to determine whether the left- or right-side treatment was most painful. The study was repeated in the glabellar and paraorbital regions. A total of 103 participants entered the study; 98 had the glabellar region treated and 76 the crow’s feet, and 72 patients had both regions treated. For the glabellar region, the smaller 32-gauge needle was significantly more painful than the larger 31-gauge needle ( P &lt; .01). There was no difference in patient’s pain perception between gauges of needle when treating the crow’s feet area ( P = .9). The 31-gauge needles produce significantly less pain than smaller 32-gauge needles when treating the glabellar region with botulinum toxin, but not in the periorbital region. We propose that this is due to differences in fascial adherence between the 2 areas. Consequently, we would recommend administering botulinum toxin with a 31-gauge needle in all areas.

Effectiveness of Botulinum Toxin for Treatment of Symptomatic Pelvic Floor Myofascial Pain in Women: A Systematic Review and Meta-analysis.

The aims of the study were to systematically review the literature and to synthesize the evidence for the effectiveness of botulinum toxin injection to the pelvic floor muscles for treating pelvic floor myofascial pain in female patients. This systematic literature search was performed in February 2018 and updated in September 2019. Articles were screened based on predefined criteria: (1) adult population, (2) female patients, (3) treatment of pelvic pain by transvaginal botulinum toxin injection into the pelvic floor, (4) published in English or English translation available, (5) study design including randomized controlled trials, cohort studies, and case series with more than 10 participants, and (6) quantitative report of pain scores. Nine studies were included in the primary analysis, and an unpublished study was included in a sensitivity analysis. A random effects model with robust variance estimation was used to estimate the pooled mean difference in patient-reported pain scores after botulinum toxin injection. A statistically significant reduction in patient-reported pain scores was noted at 6 weeks after botulinum toxin injection (mean difference, 20.3; 95% confidence interval, 11.7-28.9) and continued past 12 weeks (mean difference, 19.4; 95% confidence interval, 14.6-24.2). Significant improvement was noted in secondary outcomes including dyspareunia, dyschezia, and quality of life. This systematic review and meta-analysis support the conduct of future, large-scale randomized controlled trials to determine the efficacy and optimize administration of botulinum toxin injections for treatment of pelvic floor myofascial pain and associated symptoms in women.

Ultrasound guided intra-articular botulinum toxin injection for treatment of the osteoarthritic knee pain: expert opinion.

Osteoarthritis is the most common form of arthritis and cause of joint pain and disability [1]. The prevalence, burden and socioeconomic impact of osteoarthritis of the knee is considerable and growing [2]. Knee pain is the most cardinal symptom of the osteoarthritic knee and is associated with a high degree of impaired function and daily activities [3]. Intra-articular injection provides a safe and cost effective control of knee pain with improvement of function and activities of daily living [4]. Ultrasound guidance improves the accuracy of the intra-articular injection in knee joint and clinical outcomes and lowers health care costs [5]. Botulinum toxin targets many neuropeptides leading to reduction of pain, peripheral sensitization and in turn reduction of the central sensitization. Also, botulinum toxin plays an anti-inflammatory role by reduction of the neurogenic inflammation [6]. The following table summarizes how to use botulinum toxin in clinical practice according to authors experience. However, further large-scale multicenter randomized controlled trials are needed to confirm effectiveness and determine the exact position of this intervention in the therapeutic armamentarium for the osteoarthritic knee pain.

Effect of Botulinum Toxin Injection in Treatment of Upper Limb Spasticity in Childhood Cerebral Palsy: A Systematic Review

Abstract Cerebral palsy (CP) is the most common cause of childhood disability globally. It manifests in restricted functional mobility and impacts the quality of life negatively. Botulinum toxin injections are widely used to manage limb spasticity in children with cerebral palsy. In the upper limbs of CP children intramuscular botulinum toxin-A has been used to manage pre and post-operative pain, facilitate nursing and achieve functional and/or cosmetic improvement of hand position. These goals are achieved primarily through reduction of spasticity.. This review aims at providing the evidence for effect of botulinum toxin-A injections to manage upper limb spasticity in spastic cerebral palsy cases. The literature extraction process yielded 15 articles for inclusion in this review. After reviewing these articles we concluded that botulinum toxin-A had a positive effect on the degree of spasticity, motor functions and cosmetic appearance of the injected upper limb but its effect increased by addition of another regimen as O.T.,P.T, casting or splintage.

Evaluation of efficacy and safety of Botulinum toxin injection in treatment of epiphora

Purpose The aim of this study was to evaluate the efficacy and safety of Botulinum toxin injection in the palpebral lobe of the lacrimal gland for treatment of epiphora.Patients and methods A total of 20 patients with epiphora (crocodile tears syndrome, lower lid laxity, malposition of the lower lid, and obstruction of lacrimal drainage system in which lacrimal surgery was impossible) received intralacrimal gland injection of Botulinum toxin (2.5 IU/0.1 ml). Follow-up was performed on the first day, first week, first month, third month, and sixth month after injection to evaluate the efficacy, safety, and occurrence of any complications and to record the rate of recurrence.Results Cure was successfully achieved in 60% of the patients after the first injection and in 90% of patients after the second injection. There were 15% of recurrent cases after the first injection, and there were no recurrent cases after the second injection. Temporary ptosis occurred in 10% of this study group after the first injection and in 5% after the second injection. There was a highly significant decrease in Schirmer’s test and tear meniscus height among the study group regarding the pre-injection and follow-up values (P<0.01). In addition, there was a highly significant decrease in Munk scale and time of dye disappearance test among the study group regarding the pre-injection and follow-up values (P<0.01).Conclusion The injection of Botulinum toxin in the palpebral lobe of the lacrimal gland was effective and safe as a temporary measure to reduce excessive tearing until a more permanent measure can be taken.

Cost of Rehabilitation Treatment of Patients With Cerebral Palsy in Korea.

ObjectiveTo investigate rehabilitation treatment cost of patients with cerebral palsy (CP) according to age.MethodsWe analyzed the cost of rehabilitation treatment from 2007 to 2013 for patients diagnosed with CP by sourcing data from the National Health Information Database.ResultsWhile the number of recently born children requiring rehabilitation treatment has decreased, the number of patients requiring this treatment in other age groups has gradually increased. In addition, annual physical therapy, occupational therapy, hydrotherapy, and botulinum toxin injection treatment costs per person have increased. On the other hand, the number of orthopedic surgeries and selective dorsal rhizotomy performed has decreased.ConclusionThis study investigated trends in the cost of treatment for patients with CP. This study can be used as a basis to provide treatment support for patients with CP.

330 Patient acceptability of botulinum toxin injections for treatment of genito-pelvic pain/penetration disorder

Botulinum Toxin Injections (BTI) into the external pelvic floor muscles is used in some centers as part of a multimodal treatment approach to Genito-Pelvic Pain/Penetration Disorder (GPPPD). Little is known about the patient’s perceptions of BTI as a treatment option for GPPPD. It is the aim of this survey to evaluate patient acceptability, perceived efficacy and satisfaction with BTI a treatment for GPPPD. Structured online questionnaires where sent out to fifty (50) patients who received BTI under conscious sedation as part of a multimodal treatment approach for GPPPD between March 2013 and March 2017. All received medical treatment for any underlying conditions, physiotherapy, used vaginal dilators and some received psychotherapy. BTI was only offered to those patients who did not show a satisfactory response to conservative treatment. Thirty-six (36) patients completed the questionnaires and consented to being part of this survey. The average age of the participants was 33 years (23-58). Fourteen (14) patients had been suffering from GPPPD for more than five (5) years and nineteen (19) more had been suffering for more than one year. In exactly half of the participants, sex was impossible prior to BTI. One month after BTI sex was impossible in only three (3) cases and in twenty-four (24) cases it was mildly painful to not painful at all. These numbers were unchanged at the time of the survey (more than six months post-BTI for thirty (30) participants). Nine patients were not satisfied with the effect of the BTI (25%) but only four (4) would not do it again. Only six (6) patients found the procedure of getting the BTI traumatic. Seventy-eight percent (78%) of participants found BTI to be the most valuable part of their treatment for GPPPD. It should be noted that twenty-four (24) participants (66.6%) reported a strict religious upbringing and only five (5) participants reported sexual abuse (14%).