Botulinum Toxin Therapy Research Articles

Botulinum Toxin Therapy for Psychiatric Disorders in Clinical Practice: A Retrospective Case Study.

Inhibiting the facial expression of negative emotions via botulinum toxin A (BTX) has been shown to mitigate symptoms of clinical depression in randomized controlled trials. This retrospective case study sought to reproduce the beneficial effects of BTX in a naturalistic setting for major depressive disorder and collect casuistic data on its effect on other mental disorders. Moreover, we describe symptom development across multiple treatment cycles with BTX, and assess the implementation of additional injection targets in the lower face region. Participants were N = 51 adult psychiatric outpatients mainly seeking treatment for depression. Over 50% suffered from comorbid psychiatric conditions, predominantly generalized anxiety disorder (GAD) or borderline personality disorder (BPD). A pre-post case series design was adapted. All participants received BTX-injections in the glabellar region on at least one occasion. Some received additional injections in the mouth region and over multiple treatment cycles. Treatment response was followed up by self-rated scales at varying time intervals post treatment. The results showed that BTX may yield favorable outcomes across multiple and comorbid mental disorders, especially, however, for patients suffering from depression. It potentially prevents the recurrence of clinical symptoms if applied regularly. Adding additional regions of the face does not seem to be superior over applying it to the glabellar region alone. The results add to the growing evidence that BTX therapy is effective in alleviating symptoms of depression. Positive effects can be sustained and reinstated, when applied over multiple treatment cycles. Observed symptom reduction in other psychiatric disorders was less pronounced. Further research is needed to understand the mechanisms by which BTX therapy reduces psychiatric symptoms.

PCR164 Adherence to Botulinumtoxin Treatment: A 2-Year Retrospective Claims Database Analysis

Understanding the use of botulinumtoxin (BoNT) in clinical practice is essential for improving clinical care. Real-world evidence for long-term persistence with BoNT therapy is limited. We conducted a retrospective longitudinal study to describe treatment dynamics and persistence with BoNT over 2 years.

Strabismus and myopia: a challenge for the ophthalmologist

Myopia is a condition widely spread throughout the world, and it is expected to affect almost half of the population within 2050. Its correlation with many ocular pathologies, such as retinal detachment, retinal degeneration, maculopathy, glaucoma and cataract, is already well known. Strabismus associated with myopia is more likely to develop as exotropia; however it can also show different clinical features, and thus therapeutic needs, which often make it a challenge for the ophthalmologist to be detected and treated. Heavy eye syndrome is a pathology related to high degenerative myopia, and it is characterized by a wide range of deviation, which goes from a small angle esotropia to a large angle of eso-hypodeviation. Bielschowsky esotropia, ore AACE type III esotropia, is a condition spreading rapidly among population, mainly in association with the use of electronic devices. It is characterized by onset of diplopia for distance vision, followed by the involvement of near vision, and for the preservation of binocular vision. Treatment options include prisms and botulinum toxin therapy; however surgery remains the best curative alternative. Myopia is a predisposing factor for rhegmatogenous retinal detachment, which often can be treated with the positioning of scleral buckling. This surgery is related to the development of strabismus, due to the extraocular motility restriction and subsequent diplopia. Finally, refractive surgery for the treatment of myopia may result in different type of strabismus and diplopia, through many different mechanisms. This review aims to describe clinical features and therapeutic approaches for all these conditions.

Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs.

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.

Adherence to Botulinumtoxin Treatment: A 2-year Retrospective Claims Database Analysis (P12-11.008)

<h3>Objective:</h3> To describe treatment dynamics and persistence with botulinumtoxin (BoNT) over 2 years in a retrospective longitudinal study. <h3>Background:</h3> Understanding the use of BoNT in clinical practice is essential for improving clinical care. Real-world evidence on long-term persistence with BoNT therapy is limited. <h3>Design/Methods:</h3> This study assessed medical claims data from the IBM MarketScan database among patients with a first medical claim for BoNT (not product specific) between October 2016 and October 2019. The index date was the day of the first BoNT administration, and a 1-year washout period before this date was used to identify incident BoNT use. On-label indications were defined as those approved for abobotulinumtoxinA. Six cohorts were analyzed: 1, all patients; 2, all patients, excluding those with off-label indications at the index date; 3, all patients with on-label diagnosis during the study period; and 4, 5 and 6, all patients with diagnosis of stroke, migraine and bladder dysfunction, respectively, before the index date. The number of treatments in the 2-year follow-up period and persistency (120-day look forward from treatment date; 80th percentile value of days to next treatment) were evaluated. <h3>Results:</h3> Across all cohorts (cohort [n]: 1 [19 711], 2 [5741], 3 [3238], 4 [611], 5 [7778] and 6 [1791]), 18.8–46.9% of patients received only one injection. Proportions of patients receiving three to eight injections remained consistent, with 0.3–15.7% receiving eight injections. Mean number of treatments across cohorts was 2.1–4.7, and time between treatments (80th percentile) was 105–319 days. <h3>Conclusions:</h3> In this retrospective longitudinal real-world study, there was a large drop-off in the proportion of patients receiving BoNT treatment after first injection, with few patients receiving eight injections over 2 years in accordance with the standard treatment regimen. These data are limited in providing the underlying reasons for the drop-off; further research is warranted. <b>Disclosure:</b> Dr. Simpson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Allergan. Dr. Simpson has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Mr. Bouchard has received personal compensation for serving as an employee of Ipsen. Mr. Bouchard has stock in Ipsen. Dr. Page has received personal compensation for serving as an employee of Ipsen. Dr. Page has received stock or an ownership interest from Ipsen. Dr. Spurden has received personal compensation for serving as an employee of IPSEN. Mr. Goldfarb has nothing to disclose. Atul T. Patel, 15908 has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Revance. Atul T. Patel, 15908 has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan. Atul T. Patel, 15908 has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ipsen. Atul T. Patel, 15908 has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Allergan/Abbvie. Atul T. Patel, 15908 has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for IPSEN. The institution of Atul T. Patel, 15908 has received research support from Allergan. The institution of Atul T. Patel, 15908 has received research support from Revance. The institution of Atul T. Patel, 15908 has received research support from IPSEN.

Different Experiences in Chronic Migraine Etiology, Treatment and Comorbidities of Hawaii’s Ethnic Groups (P14-12.006)

<h3>Objective:</h3> To determine racial disparities in CM treatment and comorbidities of patients in Hawaii, a state characterized by its a majority-minority patient population. We hypothesize that minority populations are under-treated. <h3>Background:</h3> Chronic migraine (CM) is a debilitating condition with negative repercussions on the socioeconomic status of patients; compounded by under-diagnosis and treatment in minority populations. Identifying treatment and comorbidity characteristics of CM patients in Hawaii will guide treatment of migraines. <h3>Design/Methods:</h3> We performed a retrospective chart review on patients diagnosed with CM at a headache and facial pain center in Honolulu, Hawaii. 743 patients with a clinic visit from January 27, 2022 to April 27, 2022 were retrieved from <i>eClinicalWorks</i>. Patients without sufficient data were excluded, yielding 298 patients fulfilling inclusion criteria of a) ICD-10 code diagnosis of CM b) lack of secondary migraine etiology and c) fulfilling IHCD-3 standards of CM. Socioeconomic demographic variables were collected including self-reported race, age, obesity, number of medications and public/private health insurance. Patient treatment modalities were recorded: botulinum toxin (BoNT), pharmacologic treatment, monoclonal antibodies, and physical therapy. <h3>Results:</h3> Native Hawaiian/Pacific Islander (NHPI) patients reported the highest prevalence of obesity (60.9%) at &gt;30% compared to other race groups (p&lt;0.001). History of diabetes was low across all race groups (7.7%). However, NHPI patients had a higher history of diabetes (14.5%) (p= 0.004), hypertension (37.7%), &gt;13% higher than other race groups (p= 0.01). Significantly more white patients received BoNT as therapy (73.9%), &gt;25% compared to other race groups (p= 0.02). Public insurance was significantly more common in NHPI patients (59.4%) followed by other minorities (57.1%), with a 9–11% difference compared to other race groups. (p=0.02) <h3>Conclusions:</h3> Our findings suggest barriers to BoNT treatment in minority patients. Comorbidities in NHPI patients, such as obesity, diabetes and hypertension, differ from other ethnic groups. <b>Disclosure:</b> Miss Lu has nothing to disclose. Ms. Yamane has nothing to disclose. Mr. Keahi has nothing to disclose. Mr. Tong has nothing to disclose. Mr. Goo has nothing to disclose. The institution of an immediate family member of Ms. Prabhudesai has received research support from National Eye Institute. An immediate family member of Ms. Prabhudesai has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr. Chen has received research support from NIH. Dr. Vajjala has nothing to disclose. Enrique Carrazana has received personal compensation for serving as an employee of Neurelis. Enrique Carrazana has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Neurelis, Alexza, Zogenix. Enrique Carrazana has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Hawaii-Biotech, CND Life Sciences. Enrique Carrazana has stock in Neurelis, Marinus, . Dr. Viereck has nothing to disclose. The institution of Dr. Liow has received research support from UCB. The institution of Dr. Liow has received research support from Livanova. The institution of Dr. Liow has received research support from Biogen. The institution of Dr. Liow has received research support from Novartis. The institution of Dr. Liow has received research support from Eisai. The institution of Dr. Liow has received research support from Engage Therapeutics. The institution of Dr. Liow has received research support from SK Lifescience. The institution of Dr. Liow has received research support from Cerevel. The institution of Dr. Liow has received research support from Xenon. The institution of Dr. Liow has received research support from NeuroDerm. The institution of Dr. Liow has received research support from Avanir. The institution of Dr. Liow has received research support from Annovis. The institution of Dr. Liow has received research support from Acadia.

Hiccups, Hypersalivation, Hallucinations in Parkinson's Disease: New Insights, Mechanisms, Pathophysiology, and Management.

Parkinson's disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. We report three common but overlooked symptoms in PD-hiccups, hypersalivation, and hallucinations-in terms of their prevalence, pathophysiology, and up-to-date evidence-based treatment strategies. Whilst all these three symptoms do occur in many other neurological and non-neurological conditions, early recognition and treatment are paramount. Whilst hiccups affect 3% of healthy people, their rate of occurrence is higher (20%) in patients with PD. Hypersalivation (Sialorrhea) is another common neurological manifestation of many neurological and other neurodegenerative conditions such as motor neuron disease (MND), with a median prevalence rate of 56% (range: 32-74%). A 42% prevalence of sialorrhea is also reported in sub-optimally treated patients with PD. Hallucinations, especially visual hallucinations, are commonly reported, with a prevalence of 32-63% in PD, and a 55-78% prevalence is noted in patients with dementia with Lewy bodies (DLB), followed by tactile hallucinations, which are indicated by a sensation of crawling bugs or imaginary creatures across the skin surface. Whilst mainstay and primary management strategies for all these three symptoms are carried out through history taking, it is also essential to identify and treat possible potential triggers such as infection, minimise or avoid causative (such as drug-induced) factors, and especially carry out patient education before considering more definitive treatment strategies, such as botulinum toxin therapies for hypersalivation, to improve the quality of life of patients. This original review paper aims to provide a comprehensive overview of the disease mechanisms, pathophysiology, and management of hiccups, hypersalivation, and hallucinations in Parkinson's disease.

Botulinum Toxins for the Treatment of Raynaud Phenomenon: A Systematic Review With Meta-analysis.

Botulinum toxin (Btx) therapy has emerged as a potential treatment for patients with Raynaud phenomenon (RP) in recent years. This study aimed to investigate the efficacy and safety of Btx treatment for RP. Databases of PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from their inception up to August 2022. Studies that reported Btx use for the treatment of RP were included. A meta-analysis was conducted for the Shortened version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) score and visual analog scale pain score using a random-effects model. Thirteen full-text studies were included. The pooled standard mean changes for the visual analog scale pain score and QuickDASH score were -3.82 (95% confidence interval, -6.62 to -1.02) and 0.83 (95% confidence interval, -1.47 to -0.19), respectively. The 2 most common complications were injection site pain and intrinsic hand weakness. The effect of Btx treatment on RP is promising based on current evidence. Nevertheless, more studies and randomized clinical trials with larger sample sizes are needed to confirm the current results.

Postural stability in blepharospasm: the effects of dual-tasking and botulinum toxin therapy

BackgroundBlepharospasm is a focal dystonia that presents as involuntary, intermittent, continuous contractions of the eyelids. Abnormal eyelid contractions in blepharospasm are expected to cause balance problems, but there is no...

Botulin therapy for chronic migraine

This article presents a review of current modern research on the use of botulinum toxin therapy for the prevention and treatment of patients with chronic migraine, as well as briefly outlines current views on the pathogenesis of migraine, its impact on quality of life and patients' ability to work. Botulinum toxin A is currently the drug of first choice for the treatment of chronic migraine. Numerous studies confirm the effectiveness and safety of its use in clinical practice.

Personality and psychopathological profile of patients and botulinum therapy for blepharospasm

Background. Blepharospasm (BS) includes non-motor symptoms manifested by psychopathological disorders. The impact of these disorders on patients' quality of life and therapy of motor symptoms with botulinum toxin is poorly understood.&#x0D; Aim. To analyze the correlation of different characterological personality abnormalities (CPA) with the BS severity and the response to botulinum toxin therapy (BT).&#x0D; Materials and methods. Forty-six BS patients (29 females, 17 males) aged 30 to 85 years (6111.5) with BS were examined. The control group included 46 healthy individuals (39 females and 7 males, with a mean age of 56.49.67). Patients were examined before and after BT (after 12 months) using the BS severity scale (BSDI), EQ-5D (EQ-5D-3L) quality of life assessment scales, General Anxiety Disorder (GAD-7) scale, Brief Fear of Negative Evaluation Scale (BFNE-S), and SCID-II-PD structured personality questionnaire.&#x0D; Results. In the BS group of patients, unemployed and non-married were more common (p0.05) than in healthy individuals. In the BS patient group, there was an increase in anxiety (15.525.6 vs 4.283.5 control group by GAD-7 scale) and fear of negative evaluation (42.449.2 in the main group vs 21.347.3 in the control group). Quality of life was lower in BS patients (65.43, median 62 vs 88.2, median 92, p0.05). The prevalence of cluster C CPA (anxiety disorders) in patients with BS and, in particular, the obsessive-compulsive disorder was revealed. Patients with different personality profiles showed no differences in the BS severity before BT. The BT efficacy was higher in patients with cluster C CPA.&#x0D; Conclusion. BS patients often have anxious type CPA; in these patients, BT is more effective than in other CPAs.

Quality of life in patients with hemifacial spasm after microvascular decompression and botulinum toxin therapy

To analyze QOL in patients with HPS before and after MVD and BT including HFS-7 score and regression of HFS. We analyzed data of patients (n=80) divided into two groups: group I - MVD of the facial nerve (n=66), group II - BT (n=14). Mean age of patients was 52.4 (range 28-76) and 58.1 years (range 23-73), respectively. QOL was assessed using a questionnaire enrolling clinical and anamnestic data, as well as HFS-7 scale. Clinical severity of HFS and effect on daily activity were assessed using the Tan scale. We analyzed the results of MVD and BT considering clinical improvement (regression of spasm) and HFS-7 score. A four-level gradation of clinical regression of spasm was used. Patients with mild course of disease and higher QOL prefer BT. In our sample, 3 (21%) patients from the 2nd group preferred surgery a year after BT, and 13 (20%) patients from the 1st group had previously undergone BT in other hospitals. Changes in HFS-7 score before and after treatment were significant in both groups (p<0.005, t-test). Spearman's coefficient (R= -0.66) shows the correlation between clinical effect and HFS-7 score. MVD and BT significantly improve QOL in patients suffering from HFS. Patients with less severe hemispasm prefer BT, but conversion to surgery is possible as disease progresses. Both treatment methods should be available for HFS patients. Treatment outcomes should be assessed using specialized scales designed for HFS.

Rehabilitation of patients with complications of facial nerve neuropathy

To compare the effectiveness of physical rehabilitation (PR) and botulinum therapy in the treatment of facial nerve neuropathy (FNN) complications. Sixty-eight patients with FNN of various etiologies, including 70 women and 6 men aged 38 [31; 46] years, were studied. Time to seek medical help was 717 [256; 1638] days. Diagnosis of the motor pattern included determining the strength of facial muscles, identifying complications - muscle hypertonicity and synkinesis, assessment with the House-Brackmann Grading System, the Facial Nerve Grading System 2.0 and the Sunnybrook facial grading system. All patients were prescribed a standard PR complex, additionally muscle relaxation was performed on both sides by injections of Incobotulinumtoxin A (BTA) - BTA group (n=34; 44.7%) or special PR techniques - physiotherapy group (n=42; 55.3%). The both groups are comparable by age, sex, etiology and duration of treatment, however, patients in the BTA group have more severe stage of FNN (U=534.5; p=0.031). There is a limitation in the volume of active movements in patients with muscles hypertonicity of the affected side, which was associated with insufficient muscle strength. In the BTA group, the severity of complications (muscles hypertonicity and synkinesis) is decreased on the affected side, and in 1/4 of the cases it is accompanied by an increase of muscles strength. In the physiotherapy group, the decrease in the severity of complications is less significant, but is associated with an increase of muscles strength (χ2=45.505; p<0001). PR and botulinum toxin therapy are effective methods of treating FNN complications. Special PR techniques for relaxing and stretching muscles are applicable for the prevention and treatment of mild disorders. Botulinum therapy allows achieving a significant stable clinical effect in the treatment of moderate and severe complications (muscle hypertonicity and synkinesis).

Effects of delay in botulinum toxin treatment on patients with hyperkinetic facial disorders

Objective: Hyperkinetic facial disorders include Benign Essential Blepharospasm (BEB) and Hemifacial Spasm (HFS), which involve involuntary facial muscle contractions. Botulinum toxin (BTX) is essential for relieving symptoms. The Coronavirus-19 (COVID-19) pandemic-related restrictions have led to delays in receiving BTX treatment. This study aims to assess the impact of BTX treatment delays of affected patients. Materials and Methods: This study retrospectively examined the data of 84 patients (68 HFS and 16 BEB) whose BTX appointments were delayed due to COVID-19 restrictions. Patient status was evaluated using Jankovic disability rating scale (JRS) scores, and administered BTX doses were documented and compared before and after lockdown. Results: After the BTX treatment delay, the JRS scores significantly increased from an average of 2.15±0.98 before the lockdown to 3.10±1.01 after the lockdown (p&lt;0.001). Furthermore, there was a noticeable increase in the average BTX treatment dose after the lockdown, from 36.45±1.32 units to 39.25±1.28 units (p&lt;0.001). Conclusion: Longer intervals between injections may increase disease severity and the effective BTX doses in patients with HFS and BEB. The COVID-19 pandemic has highlighted the importance of timely BTX therapy in managing hyperkinetic facial disorders.

Recombinant botulinum toxin as a new stage in the development of botulinum toxin therapy. Possibilities and perspectives of use in neurological practice

Currently, eight natural serotypes of botulinum neurotoxin (BNT-A-G, -X) are known. The mechanism of action of all BNT serotypes is presynaptic blockade of SNARE transport proteins (Soluble N-ethylmaleimide-sensitive factor [NSF] Attachment Protein Receptor), as a result of which the release of acetylcholine into the synaptic cleft is disrupted and neuromuscular transmission is blocked. Each botulinum toxin serotype selectively binds to its own presynaptic membrane receptor and causes cleavage of its own SNARE protein. These differences determine the neuronal specificity and activity of botulinum toxins, which leads to their unique pharmacological properties, such as activity, duration of action, and time to onset of action. In the international clinical practice, only two BNT serotypes (A and B) are allowed to be used, however, in recent years, a large number of studies on the efficacy and safety of other BNT serotypes (E, C, F) have been carried out, and technologies for changing their natural properties have been developed. One of the indications for the use of botulinum therapy in neurology is the correction of post-stroke spasticity. Currently, BNT-A is used for this purpose, clinical improvement after its injection occurs after 2 weeks, the therapeutic effect persists for 3 months, and then the symptoms of spasticity increase again, which worsens the patient's quality of life and reduces the possibility of medical rehabilitation. The use of fast-acting recombinant botulinum toxins for this purpose could help overcome this disadvantage of BNT-A therapy. Currently the LANTIMA study, supported by IPSEN company, is going on to evaluate the safety profile and level of efficacy of modified recombinant botulinum toxin type AB in the treatment of upper limb spasticity in adults.

Functional Electrical Stimulation for home use in patients after stroke

Aim: The aim of this pragmatic observational study was to identify for which purposes Functional electrical stimulation (FES) has been prescribed in University Rehabilitation Institute of Republic of Slovenia – Soča (URI-Soča) for long term treatment at home and whether prescribing practice has been changed over time in the last 10 years. Methods: A pragmatic cohort retrospective study included 373 stroke patients that performed inpatient rehabilitation at the Department for rehabilitation of patients after stroke URI-Soča between January 2010 and December 2019, and used FES at home after discharge. Results: FES was most often prescribed to patients with mild disability and severely affected upper extremity after stroke. Half of the patients used FES on the paretic upper extremity, 46.9% on the hemiparetic upper and lower extremity and only minority (2.9%) on the affected lower extremity alone. The upper limb stimulation predominated almost in the whole observational period. 22.3% of the patients used FES for more than 1 year, on average 3.5 years. A combination of FES and botulinum toxin therapies was used as a spasticity treatment of affected upper extremity in almost one third of patients (29.8%). In a group that used FES for more than one year, botulinum toxin therapies were statistically significantly more frequent (P&amp;lt;0.001). Conclusions: Almost one-third of patients included in this study got FES for home use to manage spasticity. More than a half of those who used FES at home for years used combination of botulinum toxin and FES therapies which suggests they felt effectiveness of combined treatment approach.

Botulinum toxin antibody titres: measurement, interpretation, and practical recommendations

Botulinum toxin (BT) therapy may be blocked by antibodies (BT-AB) resulting in BT-AB induced therapy failure (ABF). BT-AB may be detected by the mouse lethality assay (MLA), the mouse diaphragm assay (MDA) and the sternocleidomastoid test (SCMT). For the first time, we wanted to compare all three BT-AB tests and correlate them to subjective complaint of complete or partial secondary therapy failure in 37 patients with cervical dystonia (25 females, 12 males, age 51.2 ± 11.4 years, disease duration 12.4 ± 6.3 years). Complaint of therapy failure was not correlated with any of the BT-AB tests. MDA and MLA are closely correlated, indicating that the MDA might replace the MLA as the current gold standard for BT-AB measurement. The SCMT is closely correlated with MDA and MLA confirming that BT-AB titres and BT's paretic effect are in a functional balance: low BT-AB titres are reducing BT's paretic effect only marginally, whereas high BT-AB titres may completely block it. When therapy failure is classified as secondary and permanent, BT-AB evaluation is recommended and any BT-AB test may be applied. For MDA > 10 mU/ml, MLA > 3 and SCMT < 25%, ABF is highly likely. MDA < 0.6 mU/ml are therapeutically irrelevant. They are neither correlated with pathologic MLA nor with pathologic SCMT. They should not be the basis for treatment decisions, such as switching dystonia therapy to deep brain stimulation. All other results are intermediate results. Their interactions with therapy efficacy is unpredictable. In these cases, BT-AB tests should be repeated or one or two additional test methods should be applied.

Patient-reported outcomes following a break in ophthalmic botulinum toxin therapy during the COVID-19 pandemic

ObjectifÉvaluer l'effet de l'interruption de l'administration de la toxine botulique, en raison de la pandémie de COVID-19, sur la qualité de vie des patients. MéthodesÉtude de cohorte prospective de tous les patients qui recevaient la toxine botulique de type A à notre département dans le traitement du blépharospasme essentiel bénin (BEB), du spasme hémifacial (SHF), de la régénération faciale aberrante (RFA) ou du syndrome des larmes de crocodile et qui ont subi les effets de l'interruption de l'administration de la toxine (18 mars au 17 juin 2020). Tous les patients qui avaient reçu le traitement avant et après l'interruption ont été inclus. Au nombre des données recueillies, citons la mesure subjective autodéclarée par le patient quant au « délai avant l’échec du traitement » et les scores aux échelles d’évaluation suivantes: échelle d’évaluation de l'invalidité fonctionnelle liée au blépharospasme et à la dystonie (BDFDAS, utilisée dans le BEB, le SHF et la RFA); échelle d’évaluation de Jankovic (JRS, utilisée dans le BEB et le SHF); et échelle d’évaluation du larmoiement (TEARS scale, pour le syndrome des larmes de crocodile). RésultatsIl s'est produit un retard moyen de 3,9 mois (fourchette : 0–9,8 mois) de l'administration du traitement chez les 72 patients inclus. Après avoir profité des effets bénéfiques de leur traitement, tous les patients ont constaté un échec de ce dernier, le délai moyen avant l’échec se chiffrant à 3,9 mois (fourchette : 0,5–12,0 mois). Toutes les mesures autodéclarées par les patients ont augmenté, l'effet le plus marqué s’étant manifesté dans la RFA (hausse de 178 % des scores à la BDFDAS) et le BEB (hausse de 41 % des scores à la JRS). Au moins 2 patients ont recherché et obtenu un traitement ailleurs dans le secteur privé en raison de la gravité de leurs symptômes. ConclusionsLes patients qui présentent une RFA ou un BEB sont le moins susceptibles de bien tolérer une interruption de leur traitement, contrairement aux patients qui avaient un syndrome des larmes de crocodile et qui ont semblé avoir été moins touchés par cette interruption. Cette expérience en contexte réel a permis de quantifier les torts causés par une interruption ou un retard de l'administration de la toxine botulique. Notre étude apporte des données précieuses pour les situations où l'on envisagerait d'autres interruptions ou retards de l'administration de la toxine, qu'il s'agisse d'une future vague de la COVID-19 ou pour toute autre raison.

Effect of combination of botulinum toxin and electromyographic biofeedback therapy on post-stroke patients with lower limb muscle spasticity

Purpose: To investigate the clinical effect of combined use of botulinum toxin type A and electromyographic biofeedback therapy (EMGBFT) on post-stroke patients with lower limb muscle spasticity.&#x0D; Methods: The data of 91 post-stroke patients with lower limb muscle spasticity who were admitted to Shanghai Seventh People’s Hospital (January 2020 -January 2021) were retrospectively analyzed, and they were divided into control group (COG, n = 45) and study group (STG, n = 46) based on the treatments given. All patients received conventional rehabilitation and training. Patients in COG were treated with EMGBFT, whereas those in STG received botulinum toxin type A as well as EMGBFT. The parameters determined in the two groups were degree of spasticity, lower limb motor function [3m-Timed Up and Go (3m - TUG) and 10m - Walk Test (10 m - WT)], active range of motion (AROM) of ankle dorsiflexion, ability of daily living (based on Barthel Index, BI), and adverse reactions before and after treatment.&#x0D; Results: The effectiveness of the treatments on spasticity was higher in STG than in COG (p &lt; 0.05). After treatment, the times taken for 3m-TUG and 10m-WT were significantly shorter in STG than in COG (p &lt; 0.05). The AROM of patients in both groups was expanded, but the expansion was significantly greater in STG than in COG (p &lt; 0.05).&#x0D; Conclusion: Combined therapy using botulinum toxin and EMGBFT effectively relieved lower limb muscle spasticity of post-stroke patients, and also improved their lower limb motion function and daily living ability. Thus, the combined therapy provided better management of lower limb spasticity. However, further clinical trials are required prior to its adoption in clinical practice.

S420 In Esophagogastric Junction Outflow Obstruction, More Severe Lower Esophageal Sphincter Obstruction May Be Associated With a Greater Likelihood of Response to Botulinum Toxin Injection

Introduction: Features of manometric esophagogastric junction outflow obstruction (EGJOO) that denote clinical relevance towards symptom generation are unclear. We aimed to test whether lower esophageal sphincter (LES) physiological properties measured on high-resolution manometry (HRM) and functional lumen imaging probe (FLIP) are different in patients with EGJOO based on symptomatic improvement after Botulinum toxin (Botox) therapy. Methods: This was a single-center prospective study conducted over an 18-month period. Adult patients with non-obstructive dysphagia or non-cardiac chest pain who were diagnosed with EGJOO per Chicago Classification 4.0 HRM criteria received treatment with 100 units of Botox to the LES. Patients reported the % improvement in symptoms 2 weeks after Botox injection. Symptomatic response to Botox was denoted by 70% or greater improvement in symptoms. HRM metrics, FLIP indices, and esophageal symptom questionnaires were compared between Botox responders vs. non-responders. Results: Forty-three patients (ages 32-87, 74% female) were included. Symptomatic response to Botox at 2 weeks occurred in 16 (37.2%) patients. Table shows physiologic features based on the Botox response. Although the differences in HRM and FLIP metrics were not significantly different between groups, HRM supine integrated relaxation pressure (IRP) and upright IRP, and the FLIP distensibility index (DI) show a trend towards a higher degree of LES obstruction in the Botox-responsive group. Conclusion: EGJOO which responds to Botox therapy seems to demonstrate a more severe obstructive physiology at the LES. These findings support the CC 4.0 criteria for EGJOO. If results in a larger sample are significant, these findings could support the application of more stringent thresholds (for IRP and DI) for the diagnosis of clinically relevant EGJOO. Table 1. - Clinical Features in EGJOO based on response to LES Botox therapy. Count with % or mean with standard deviation are shown as relevant Botox responders (N = 16) Botox non-responders (N = 27) P value Age [range] 65.3 [45-87] 55.5 [32- 76] 0.01* No. Female (%) 12 (75%) 21 (77.8%) 0.83 BMI (kg/m2) 28.4 (7.9) 31.5 (8.2) 0.23 Narcotic use (%) 4 (25%) 4 (14.8%) 0.41 Supine IRP (mmHg) 25.1 (8.5) 22.2 (5.8) 0.20 Upright IRP (mmHg) 23.8 (15.8) 19.3 (7.5) 0.27 Basal LES (mmHg) 53.3 (18.9) 49.8 (22.9) 0.61 DL (s) 7.3 (2.0) 7.4 (1.6) 0.85 DCI (mmHg-s-cm) 3771.6 (2863.1) 3372.3 (4036.0) 0.73 FLIP EGJ DI (mm2/mmHg) 0.83 (0.43) 1.4 (1.3) 0.11 BEDQ 15.3 (12.0) 19.8 (18.4) 0.42 GERDQ 8.1 (2.9) 9 (3.0) 0.41 Eckardt Score 4.9 (3.0) 4.1 (2.1) 0.28 Abbreviations: BMI – body mass index, Brief Esophageal Dysphagia Questionnaire – BEDQ, DCI – distal contractile integral, DL – distal latency, DI – distensibility index, Eckardt Score – ES, EGJ – esophagogastric junction, FLIP – functional lumen imaging probe, Gastroesophageal Reflux Disease Questionnaire – GERDQ.