Botulinum Toxin Type A Treatment Research Articles

Experimental study on the effect and mechanism of adipose stem cell-derived exosomes combined with botulinum toxin Aon skin trauma in rats.

Adipose stem cell-derived exosomes (ADSC-EXO) and botulinum toxin type A (BTX-A) individually showed a therapeutic effect on skin wound repair. This study investigated their synergistic effect on promoting skin wound healing in vitro and in vivo and the underlying molecular events. ADSCs were isolated from Sprague-Dawley (SD) rats to obtain ADSC-EXO by ultrafiltration and ultracentrifugation and were confirmed using nanoparticle tracking analysis and transmission electron microscopy. Human skin fibroblasts (HSF) were cultured and treated with or without ADSC-EXO, BTX-A, or their combination. Changes in cell phenotypes and protein expression were analyzed using different in vitro assays, and a rat skin wound model was used to assess their in vivo effects. The isolated ADSC-EXO from primarily cultured ADSCs had a circular vesicle shape with a 30-180 nm diameter. Treatment of HSF with ADSC-EXO and/or BTX-A significantly accelerated HSF migration in vitro and skin wound healing in a rat model. Moreover, ADSC-EXO plus BTX-A treatment dramatically induced VEGFA expression but reduced COL III and COL I levels in vivo. ADSC-EXO and/or BTX-A treatment significantly upregulated TGF-β3 expression on Day 16 after surgery but downregulated TGF-β1 expression, suggesting that ADSC-EXO plus BTX-A promoted skin wound healing and reduced inflammatory cell infiltration. The ADSC-EXO plus BTX-A treatment demonstrated a synergistic effect on skin wound healing through upregulation of VEGF expression and the TGF-β3/TGF-β1 and COL III/COL I ratio.

Botulinum toxin in the treatment of sialorrhea in severe neurological patients with tracheotomy.

To observe the clinical effect of botulinum toxin type A (BTA) injection into the salivary glands of the severe neurological patients with tracheotomy METHODS: Seven patients with severe neurological disorders after tracheotomy and obvious drooling symptoms were enrolled. BTA was injected into bilateral parotid glands and submandibular glands under the guidance of ultrasound. Unstimulated salivary flow rate (uSFR) and Drooling Severity and Frequency Scale (DSFS) were used to evaluate drooling before injection, 1 week, and 4 weeks after injection. We compared the extubation time, time of changing from balloon cannula to metal cannula, hospitalization time and incidence of recurrent pulmonary infection between these patients and other patients accepted conventional curation. (1) The drooling severity scale (DSFS-S), the drooling frequency scale (DSFS-F), the drooling frequency and severity scale total score (DSFS-T) were significantly lower at 4 weeks after BTA injection compared to prior-treatment (p<.001). (2) uSFR of 1 week and 4 weeks were both statistically decreased than the untreated condition (p<.001). (3) Compared with the conventional group, the time of changing from balloon cannula to metal cannula was shortened obviously (p<.05) and incidence of recurrent pulmonary infection was clearly decreased (p<.05) after BTA treatment CONCLUSION: Ultrasound-guided BTA injection into salivary glands can effectively reduce saliva secretion. We also found that the time of changing cannula was shortened obviously and the incidence of recurrent pneumonia infection was reduced. BTA injection of salivary glands to cure drooling could advance to the clinical therapy in severe neurological patients after tracheotomy.

A retrospective study on the use of Botulinum toxin as part of first line of management in the treatment of myogenous TMD

Statement of the problem Temporomandibular disorder (TMD) represents a common group of disorders related to the impairment of the temporomandibular joints and the associated neuro-muscular system, which commonly present with features such as pain in the orofacial region, headache, joint sounds, and disturbances in jaw movements. Recently, botulinum toxin type-A (BTX-A) has increasingly been used as an adjuvant treatment for TMD. Purpose of the study This retrospective study aims to evaluate the effectiveness of BTX-A for the management of myogenous TMD and its potential to be included as a first line of treatment. Materials and methods A retrospective search was carried out through the Oral and Maxillofacial Department’s logbook from January 1, 2016, to December 31, 2020. Patients who received BTX-A for the management of myogenous TMD were identified and their hospital electronic records were accessed. Results From January 1, 2016, to December 31, 2020, 60 patients were diagnosed with myogenous TMD and treated conservatively together with intramuscular injections of BTX-A. Forty-five patients (75%) reported improvement in pain levels, of whom 10 (17%) reported complete resolution of pain. Fifteen patients (25%) reported no improvement in pain levels, of whom four (7%) reported transient improvement in pain levels lasting four weeks. A mean improvement of 50% was reported in terms of self-perceived pain levels. No adverse effects from BTX-A treatment were reported. Conclusion Although BTX-A shows great potential to be included as a first line of treatment for myogenous TMD, more high-quality research with larger sample sizes, minimal bias, and longer follow-up periods is needed.

Botulinum toxin type A in treatment of chronic migraine, spasticity and bruxism

Introduction: Nowadays, botulinum toxin has found use in many disease entities such as chronic migraine, spasticity, bruxism and many others. Among serotypes A-E, type A is mainly used in treatment. For the therapeutic effect to be maintained, injections need to be repeated most often after 12 weeks. More frequent injections of the toxin may result in the production of neutralizing antibodies. Aim of the study: The aim was to collect and analyze publications of application of botulinum toxin type A (BT-A) in the treatment of chronic migraine, spasticity and bruxism. Methods and materials: We reviewed the literature available in the PubMed database using the key words: “botulinum toxin”; “migraine”; “spasticity”; “bruxism”. Results: The use of botulinum toxin type A in patients with chronic migraine reduces the frequency of pain episodes and alleviates the symptoms. BT-A therapy reduces increased muscle tension, resulting in improved function of the upper or lower limb, facilitating the rehabilitation process, reducing pain associated with spasticity and protecting against the development of muscle contractures and secondary joint deformities. BT-A treatment of patients with bruxism reduces the level of pain and the maximum generated bite force, resulting in an improved quality of life for patients. Conclusion: Intramuscular administration of botulinum toxin is a safe, effective and minimally invasive method of treating chronic migraine, spasticity and bruxism. The botulinum toxin type A is the most studied serotype used for therapeutic purposes. Future research on botulinum toxin will certainly allow wider use.

Botulinum Toxin Type A Injection for Correction of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy.

Upper lid retraction (ULR) is the most common and earliest symptom in thyroid-associated ophthalmopathy (TAO) patients. Surgical correction is effective for ULR in stable diseases. However, non-invasive treatment is also required for the TAO patient in active phase. Here, we reported a complex case with TAO and unilateral ULR simultaneously. The patient had a history of progressive ptosis in the left eyelid and underwent anterior levator aponeurotic-Muller muscle resection to correct the ptosis. However, the patient gradually developed bilateral proptosis and ULR, mainly in the left eyelid. The patient was finally diagnosed with TAO with left ULR. Then, the patient was treated with botulinum toxin type A (BTX-A) injection in the left eyelid. The effect of BTX-A treatment started 7 days after injection, peaked at one month, and lasted for approximately 3 months. This study highlighted the therapeutic effect of BTX-A injection for the treatment of ULR-related TAO.

Management of spasticity in individuals with spinal cord injury in the era of COVID-19 pandemic societal restrictions.

Cross-sectional telephone interviews. The coronavirus disease (COVID-19) pandemic placed unprecedented pressure on healthcare systems worldwide. Here, we aimed to investigate the disruptions in management of spasticity and activities of daily living (ADL) in individuals with spinal cord injury (SCI) during the COVID-19 pandemic. Two university hospitals in Istanbul, Turkey. Twenty-four individuals with SCI exhibiting moderate and severe spasticity were enroled. All participants underwent ultrasound-guided botulinum toxin type A (BoNT-A) injections at two centres. A self-rated spasticity survey prepared by the authors was conducted. We questioned whether there was an increase in spasticity and the need for new BoNT-A injections during the societal restrictions of the COVID-19 pandemic. Spasticity severity in the previous week was rated using a numeric rating scale (NRS). ADL disrupted by spasticity were assessed by asking open-ended questions. In total, 75% participants reported a moderate increase in spasticity, 12.5% reported a severe increase, and 12.5% reported no difference. The mean spasticity NRS score was 6 (standard deviation = 2). Further, 87.5% (21) participants reported the need for BoNT-A treatment because of symptom re-emergence. When spasticity-induced deterioration in ADL was assessed, individuals mostly reported difficulties in walking, sitting on a wheelchair, and sleep disturbance due to spasticity. Most (87.5%) individuals with SCI reported a moderate or severe increase in spasticity during COVID-19 restrictions. Individuals with disabilities are an especially sensitive group and require specialised care during extraordinary circumstances, such as pandemics, hurricanes, or earthquakes. None.

Trends in Botulinum Toxin Use among Patients with Multiple Sclerosis: A Population-Based Study

There are limited real-world data on the use of botulinum toxin type A (BoNT-A) in patients with multiple sclerosis (MS). Accordingly, this nationwide, population-based, retrospective cohort study aimed to describe BoNT-A treatment trends in patients with MS between 2014 and 2020 in France. This study extracted data from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d'Information, PMSI) covering the entire French population. Among 105,206 patients coded with MS, we identified those who received ≥1 BoNT-A injection, administered within striated muscle for MS-related spasticity and/or within the detrusor smooth muscle for neurogenic detrusor overactivity (NDO). A total of 8427 patients (8.0%) received BoNT-A injections for spasticity, 52.9% of whom received ≥3 BoNT-A injections with 61.9% of the repeated injections administered every 3 to 6 months. A total of 2912 patients (2.8%) received BoNT-A injections for NDO, with a mean of 4.7 injections per patient. Most repeated BoNT-A injections within the detrusor smooth muscle (60.0%) were administered every 5 to 8 months. There were 585 patients (0.6%) who received both BoNT-A injections within striated muscle and the detrusor smooth muscle. Overall, our study highlights a broad range of BoNT-A treatment practices between 2014 and 2020 in patients with MS.

Clinical efficacy of botulinum toxin type A in patients with traumatic brain injury, spinal cord injury, or multiple sclerosis: An observational longitudinal study.

NCT04673240.

PD42-06 EFFECTS OF INTRAVESICAL BOTULINUM TOXIN TYPE-A INJECTION LOCATION ON SYMPTOM SCORES AND SEXUAL FUNCTIONS IN FEMALE PATIENTS WITH A DIAGNOSIS OF REFRACTORY BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS: A RANDOMIZED, PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023PD42-06 EFFECTS OF INTRAVESICAL BOTULINUM TOXIN TYPE-A INJECTION LOCATION ON SYMPTOM SCORES AND SEXUAL FUNCTIONS IN FEMALE PATIENTS WITH A DIAGNOSIS OF REFRACTORY BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS: A RANDOMIZED, PROSPECTIVE STUDY Murat Karaburun, Eralp Kubilay, Derya Gökmen, Mehmet İlker Gökçe, Evren Süer, and Ömer Gülpınar Murat KaraburunMurat Karaburun More articles by this author , Eralp KubilayEralp Kubilay More articles by this author , Derya GökmenDerya Gökmen More articles by this author , Mehmet İlker GökçeMehmet İlker Gökçe More articles by this author , Evren SüerEvren Süer More articles by this author , and Ömer GülpınarÖmer Gülpınar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine the effect of Intravesical Botulinum Toxin type-A (BTX-A) treatment with trigon included and trigone sparing on symptoms and sexual function in female patients diagnosed with Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) who did not benefit from conventional treatments. METHODS: Patients with BPS/IC who were treated with hydrodistension+BTX-A were enrolled in the study between January 2020 and April 2022. Using the stratified randomization technique, patients were randomly randomized to one of two groups: hydrodistension+trigone sparing injection (Group-1) or hydrodistension+trigone-included injection (Group-2). The study comprised a total of 27 patients. The patients were evaluated with VAS, ICSI, ICPI, FSFI questionnaires, and 3-day voiding diaries, voiding tests, and residual urine tests (uroflowmetry and residue determination) in the preoperative period and in the postoperative first and third months. RESULTS: The study comprised a total of 27 patients, 14 from Group-1 with a mean age of 40,9 (±9,25) and 13 from Group-2 with a mean age of 41.7 (±10.3). Preoperative VAS, ICSI, ICPI, and FSFI scores for 27 patients were 8.95±1.39; 16.21±2.94; 14.38±2.27 and 15.92±3.73, respectively. VAS, ICSI, ICPI, and FSFI scores were 3.47±2.94; 7.14±3.97; 6.47±3.95 and 22.41±5.02 at the first postoperative month, respectively. It was 2.69±3.18; 5.79±5.08; 5.79±4.95 and 24.41±6.06 in the third month postoperatively. Treatment led to statistically significant improvements in all four variables (p<0.001). While significant improvement was observed with treatment in both groups, no difference was found between the two groups in terms of treatment results (p: 0.89; p: 0.341; p: 0.488 and p: 0.706, respectively). In total, two patients had urinary tract infection in the postoperative period and one patient had retention, but there was no difference between the two groups in terms of adverse effects (p>0.05). CONCLUSIONS: Intravesical BTX-A treatment is an effective and safe treatment in female patients with BPS/IC unresponsive to conventional treatments. The treatment also contributes positively to sexual functions. The inclusion of trigone in the injections makes no difference to the treatment response. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1113 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Murat Karaburun More articles by this author Eralp Kubilay More articles by this author Derya Gökmen More articles by this author Mehmet İlker Gökçe More articles by this author Evren Süer More articles by this author Ömer Gülpınar More articles by this author Expand All Advertisement PDF downloadLoading ...

Health-related quality of life of daily-life-affected benign essential blepharospasm: Multi-center observational study.

To compare Thais' health-related quality of life (HRQOL) and severity grading, efficacy and safety in daily-life-affected benign essential blepharospasm (BEB) patients at baseline and after Botulinum toxin type A (BTX-A) treatment. Prospective-observational study. BEB patients with Jankovic rating scale (JRS) at least 3 in both severity and frequency graded from 14 institutes nationwide were included from August 2020 to June 2021. Demographic data, HRQOL evaluated by the Thai version of EQ-5D-5L and NEI-VFQ-25 questionnaires, and severity grading score evaluated by Jankovic rating scale (JRS) at baseline, 1, and 3 months after the treatment were collected. The impact of the BTX-A injections and their complications were recorded. 184 daily-life-affected BEB patients were enrolled; 159 patients (86.4%) had complete data with a mean age of 61.40±10.09 years. About 88.05% were female, and 10.1% were newly diagnosed. Most of the patients had bilateral involvement (96.9%) and 12.6% had history of BEB-related accident. After BTX-A treatment, HRQOL improved significantly in 4 dimensions of EQ-5D-5L, except self-care. The EQ_VAS (mean±SD) was 64.54±19.27, 75.13±15.37, 73.8±15.85 (p<0.001) and EQ-5D-5L utility score was 0.748±0.23, 0.824±0.19 and 0.807±0.19 at baseline, 1, 3 months after treatment, respectively. From NEI-VFQ-25, HRQOL also improved in all dimensions, except eye pain. The JRS improved in all patients. Self-reported minor adverse events were 22.6%, which mostly resolved within the first month. Daily-life-affected BEB impacted HRQOL in most dimensions from both generic and visual-specific questionnaires. BTX-A treatment not only decreased disease severity, but also improved quality of life.

Unparallel improvement patterns of dynamic wrinkles and skin quality after botulinum toxin type A treatment on the upper face.

Botulinum toxin type A (BoNT-A) can not only reduce the dynamic wrinkles but also improve the skin quality. This study aims to quantitaively and comprehensively assess the improvement of dynamic wrinkles and skin quality following BoNT-A treatment on the upper face. Patients were recruited to receive BoNT-A treatment of the glabellar, frontal, and lateral periorbital wrinkles. Antera 3D camera was used to evaluate the skin quality and dynamic wrinkle severity. Follow-up visits were at 1week, 1 month, 3 months, and 6 months after treatment. Different filters were utilized to quantitatively detect the severity of fine wrinkles (FWS), the volume of pores (PV), the roughness of skin texture (STR), and the severity of dynamic wrinkles (DWS). Twenty-four participants (average 30.5±7.2 years) were recruited. The significant improvement of PV, FWS, and STR in different areas usually maintained from 1 to 6 months after injections but of DWS only existed within 3 months. For each area, the improvement rates of FWS, PV, and STR peaked at 3 months or 6 months after treatment while the maximal improvement of DWS was observed at 1 month posttreatment. After BoNT-A treatment for dynamic wrinkles on the upper face, the skin quality of target regions can also be ameliorated. The improvement of skin quality and dynamic wrinkles presented unparallel patterns. The former is with a slower onset but longer duration while the latter exhibits a more rapid onset but shorter duration.

Microtoxin for Improving Pore Size, Skin Laxity, Sebum Control, and Scars: A Roundtable on Integrating Intradermal Botulinum Toxin Type A Microdoses Into Clinical Practice.

In aesthetic clinical practice, botulinum toxin type A (BoNT-A) is best known for its use as a neuromodulator for the treatment of dynamic facial lines; however, when injected intradermally as microdroplets, BoNT-A can improve skin quality and overall skin appearance. To discuss key aspects of microtoxin use in clinical practice and provide expert guidance on utilization. As part of a continuing medical education lecture series and roundtable, the authors discussed key aspects of microtoxin patient selection, injection technique, and safety. The experiences of expert faculty are shared here. Clinical experience is consistent with reported data. Microtoxin can be used to reduce pore size, sebum production, rosacea, acne, and fine lines, and to improve jawline and neck definition. Intradermal injection can also be employed for the improvement of transverse neck lines as well as for the safe prevention and management of scars and keloids. Expanding the use of BoNT-A, a predictable, minimally invasive, and affordable treatment to address commonly encountered complaints is appealing. The authors have found that making patients aware of microtoxin as a treatment option results in an increased interest in and utilization of BoNT-A, and high satisfaction among appropriately selected patients.

Effect of botulinum toxin type A on non-motor symptoms and quality of life in Meige syndrome.

It has been shown in previous studies that botulinum toxin type A (BTX-A) can effectively relieve the motor symptoms of Meige syndrome. However, its effect on non-motor symptoms (NMS) and quality of life (QoL) has not been comprehensively studied. This study aimed to explore the effects of BTX-A on NMS and QoL and to clarify the relationship between changes in motor symptoms, NMS, and QoL after BTX-A. Seventy-five patients were recruited for the study. All patients were assessed by a series of clinical assessments before, one, and 3 months after BTX-A treatment. Dystonic symptoms, psychiatric disturbances, sleep disorders, and QoL were evaluated. After 1 and 3 months of BTX-A treatment, the scores of motor symptoms, anxiety, and depression were significantly decreased (P < 0.05). Except for general health, the scores of the other 36-item short-form health survey QoL subitems were significantly improved after BTX-A (P < 0.05). After 1 month of treatment, the changes in anxiety and depression were not correlated with changes in motor symptoms (P > 0.05). Still, they were negatively correlated with changes in physical functioning, role-physical and mental component summary QoL (P < 0.05). BTX-A effectively improved motor symptoms, anxiety, depression, and QoL. Anxiety and depression improvement did not correlate with motor symptom changes after BTX-A, and QoL improvements were strongly associated with psychiatric disturbances.

Shear Wave Velocity to Evaluate the Effect of Botulinum Toxin on Post-Stroke Spasticity of the Lower Limb.

(1) Background: The evaluation of muscles with spasticity using ultrasound elastography has attracted attention recently, and the shear wave velocity (SWV) technique can measure the mechanical properties of tissues objectively and quantitatively. The purpose of this study was to evaluate the effect of using SWV to assess the effect of Botulinum toxin type A (BoNT-A) treatment in adult patients with post-stroke lower limb spasticity. (2) Methods: We assessed the modified Ashworth Scale, the modified Tardieu Scale, and SWV at rest and after stretching before and at 1 month after BoNT-A treatment in 10 adult participants with post-stroke lower limb spasticity. (3) Results: Significant changes in SWV of the ankle joint in maximum dorsiflexion to the extent possible (SWV stretched) were observed after BoNT-A treatment. SWV stretched was positively correlated with joint range of motion. Participants whose joint range of motion did not improve (i.e., gastrocnemius medialis muscle (GCM) extension distance did not change) had significantly more reductions in SWV stretched after BoNT-A treatment. (4) Conclusions: Our results suggest that the SWV measurements may serve as a quantitative assessment to determine the effect of the BoNT-A treatment in adult stroke patients. SWV measurements to assess GCM spasticity should consider the effects of tension, material properties and activation level of muscles. The challenge is to measure SWV with matching limb positions in patients without contractures.

Botulinum Toxin as an Effective Treatment for Trigeminal Neuralgia in Surgical Practices

Background: Trigeminal neuralgia (TN) is a common cause of craniofacial pain with many medical and surgical therapies, all of which are imperfect. We examine the use of botulinum toxin type-A (BTX-A) as an intermediary approach in surgical practices. Methods: We retrospectively identified TN patients seen by both pain neurology and neurosurgery at our center. Demographics were collected. Pain intensity was assessed using the numerical rating scale (NRS) and compared from baseline to after BTX-A treatment via paired t test. Responder status was assessed, and success of BTX-A was determined for each cohort. Doses of common medications were compared between baseline visit and the most recent BTX-A administration visit. Results: Thirty-one patients underwent BTX-A therapy for TN, 24 (77%) female and 7 (23%) male. Mean age was 62.5 ± 3.1 years and 29 (94%) identified as white. When divided into cohorts according to indication, 11 (35%) failed prior TN surgery, 9 (29%) either declined surgery or were poor surgical candidates, 4 (13%) had multiple sclerosis, 4 (13%) had trigeminal neuropathic pain, and 3 (10%) had atypical TN with pain in additional dermatomes outside the trigeminal distribution. Significant reductions in NRS from baseline to following initial BTX-A treatment were seen in the declined/high risk for surgery (p = 0.004) and those who failed prior TN surgery (p = 0.035) groups. No significant variation in demographics was found between any two groups (p > 0.05 for all). Finally, there was no significant reduction in total daily dose of gabapentin, carbamazepine, oxcarbazepine, baclofen, or lamotrigine in BTX-A responders (p > 0.05 for all). Discussion: Indication is an important predictor for BTX-A, with classical TN patients exhibiting the highest response rates. This research highlights the viability of BTX-A as an important tool in the arsenal of providers seeking to treat TN in a minimally invasive manner.

Influence of COVID-19 mRNA vaccination on the efficacy and safety of Botulinum toxin type A injections.

BackgroundConcerns have been raised recently regarding the efficacy and safety of Botulinum toxin type A (BTA) injections following COVID‐19 vaccination.AimsTo assess the influence of BNT162b2 mRNA vaccine on the safety and efficacy of BTA injections performed for aesthetic indications.MethodsA retrospective cohort study followed patients undergoing periodic BTA treatments who completed two doses of BNT162b2 vaccine. The latency between BTA injections before and after getting vaccinated was assessed for all study participants. Efficacy and longevity of BTA was reflected and evaluated by the latency between BTA injections. Patients were longitudinally monitored for the development of adverse events.ResultsForty‐five patients were eligible for inclusion in the current study. The mean (standard deviation [SD]) age of patients was 48.3 (8.9) years and 40 (88.9%) patients were females. The mean (SD) number of pre‐ and post‐ COVID‐19 vaccination BTA injections was 5.1 (2.6) and 3.1 (0.4), respectively. The average (SD) interval between BTA injections after COVID‐19 vaccination (96.0 [12.3] days) was significantly shorter than before it (118.6 [22.7]; P<0.001). No severe BTA‐associated adverse events were registered after the administration of BNT162b2 vaccine.ConclusionsOur findings indicate that BTA might be less effective after COVID‐19 vaccination. Further research is required to delineate the pathomechanism underlying this observation.

Ultrasound-guided injection of botulinum toxin type A blocks cardiac sympathetic ganglion to improve cardiac remodeling in a large animal model of chronic myocardial infarction

Strategies to improve various cardiovascular diseases by blocking cardiac sympathetic ganglion have been increasingly available currently. Botulinum toxin type A (BTA), a typical neurotoxin, has been shown to block neural transmission in a safe and long-lasting manner. The aim of the present preclinical study was to assess the efficacy of BTA microinjection to alleviate cardiac remodeling after chronic myocardial infarction (MI) by blocking cardiac sympathetic ganglion in a canine model. Beagles were randomly divided into a control group (saline microinjection with sham surgery), an MI group (saline microinjection with MI), and an MI + BTA group (BTA microinjection with MI). Ultrasound-guided percutaneous BTA or saline injection into the left stellate ganglion (LSG) was performed followed by MI induction via left anterior descending artery occlusion (LADO) or sham surgery. After 30 days, electrocardiography, Doppler echocardiography, LSG function, neural activity, and ventricular electrophysiological detection were performed in all experimental dogs. At the end, LSG and ventricular tissues were collected for further detection. BTA treatment significantly inhibited LSG function and neural activity and improved heart rate variability. Additionally, BTA application alleviated ventricular remodeling, ameliorated cardiac function, and prevented ventricular arrhythmias after 30-day chronic LADO-induced MI. Ultrasound-guided percutaneous microinjection of BTA can block cardiac sympathetic ganglion to improve cardiac remodeling in a large animal model of chronic LADO-induced MI. Ultrasound-guided BTA microinjection has potential for clinical application as a novel cardiac sympathetic ganglion blockade strategy for MI.

A preliminary trial of botulinum toxin type A in patients with vestibular migraine: A longitudinal fMRI study.

ObjectiveThis study aims to investigate the efficacy of botulinum toxin type A (BTX-A) in the prophylactic management of vestibular migraine (VM) and to determine whether this treatment modulates intrinsic functional brain network.MethodsVestibular migraine patients (n = 20, mean age 45.4 years) who were resistant to conventional prophylactic therapies had BTX-A injection and rs-fMRI before and 2 months after the injection. We also measured the changes in the frequency of vertigo and migraine attacks, symptomatic functional disability scores, and neuropsychiatric inventories.ResultsAfter BTX-A injection, the mean monthly frequencies of migraine and vertigo episodes decreased significantly compared with the baseline (p < 0.01, paired t-test). The Headache Impact Test-6 score and the Migraine Disability Assessment, and the vertigo parameters, measured by the Dizziness Handicap Inventory and the Vertigo Symptom Scale, showed an improvement, as did the anxiety and depression scores 2 months after BTX-A treatment. The low-frequency fluctuation analysis of the rs-fMRI data found significant changes in the functional connectivity of the right superior temporal gyrus. Adoption of this cluster as the seed region increased the functional connectivity with the left post-central gyrus, right supramarginal gyrus, and right middle temporal gyrus after BTX-A treatment.ConclusionThis prospective study suggests that BTX-A treatment is effective at ameliorating migraine and vertigo symptoms in VM patients who were resistant to conventional therapies. Along with symptomatic improvements, changes in the functional connectivity within the multisensory vestibular and pain networks suggest a dysmodulation of multimodal sensory integration and abnormal cortical processing of the vestibular and pain signals in VM patients.

Is Botox Right for Me: When to Assess the Efficacy of the Botox Injection for Chronic Migraine in Pediatric Population.

Botulinum toxin type A (BoNT-A) has shown to be a safe and effective treatment for children with chronic migraines. Our study was to assess the efficacy of the Onabotulinum toxin type A at different intervals after initiation of therapy. We conducted a retrospective and prospective analysis of 34 patients at a children's hospital where children received four rounds of the BoNT-A therapy for the treatment of chronic migraine. Among the 34 patients, 25 patients (age range: 13-21 years), who responded to the BoNT-A therapy, were included in the analysis. Patients received standard 31 injection, 155 unit's protocol. Patients were assessed every 3 months after their initial injection. Reasons for discontinuation of therapy were analyzed. After the first two BoNT-A sessions, significant improvement was observed with a decrease in headache frequency and intensity (p < 0.001). There was further reduction in headache frequency and intensity with the fourth round of BoNT-A therapy, with comparative analysis between the second and fourth round showing a p-value of <0.001. In terms of reduction of emergency room visits and hospitalization, a significant improvement was seen after the third round of BoNT-A therapy (p < 0.01). A significant decrease in the number of abortive and preventive medications was seen after the second round of BoNT-A therapy (p < 0.001). The efficacy of BoNT-A treatment in decreasing headache frequency, intensity, and the number of abortive and preventive medications can be assessed effectively after two treatment sessions. This trend continued to be observed with additional third and fourth sessions.

Subjective Outcome after Discontinuation of Botulinum Toxin-A Detrusor Injection for Lower Urinary Tract Disorders: The Majority Suffers!

Introduction: According to the EAU guidelines, botulinum toxin type A (BoNT-A) detrusor injections are one of the last options in the management of overactive bladder before opting for invasive surgery. So far, there have been no studies dedicated exclusively to such patients who have undergone this treatment and in whom this treatment has presumably failed. From the patient’s point of view, there are questions regarding what reasons led to discontinuation, how patients perceive their BoNT-A treatment in hindsight, what further treatment do these patients receive, and how satisfied such patients are with their current situation. Methods: A database of clinical and inpatient records was searched, and 695 records from 406 patients were identified in a 6-year period, who had received BoNT-A detrusor injections. There were 255 cases that were treated with BoNT-A injections into the detrusor muscle where the therapy was not repeated for at least 12 months (= suspected treatment failures). Interviews with these patients were conducted by mail and phone, and 115 questionnaires could be included in the analysis. Results: From the subjective and prospective points of view of the patients, the most common reason for stopping the therapy was a lack of efficacy of BoNT-A injections (39.1%). For 26.1% of all patients, side effects were a reason for dissatisfaction but never a reason for discontinuation. For 10.4%, the reason for stopping the therapy was spontaneous improvement. 35.6% of the respondents had no follow-up therapy. Those with a follow-up therapy mostly returned to anticholinergic treatment (33%). Operations were carried out on 13%, of which about half were highly invasive. For 71.3% of those patients, who were under any current therapy, this therapy led to no improvement or only some improvement of the symptoms. Surprisingly, 50.4% of the respondents would choose to undergo BoNT-A injection therapy again. Discussion/Conclusion: The majority of patients who did not continue BoNT-A therapy are still suffering from lower urinary tract symptoms. The lack of efficacy was the reason for stopping the BoNT-A injection therapy for less than half of the patients. From the patient’s point of view, reasons other than the effectiveness also seem to be relevant in the choice of the treatment. When changing therapy, most returned to drug treatment. However, for the majority of patients with any follow-up therapy, this therapy could not improve the symptoms.