Combined Botulinum Toxin Research Articles

A Combined Treatment Proposal for the Empty Deep Pyriform Space.

Deepening of the nasolabial fold (NLF), drooping of the nasal tip, and facial expressions perceived as angry face, are common esthetic concerns. However, no studies have correlated this set of signs and symptoms with common anatomical causes. We review anatomical considerations of the region and propose a combined treatment modality. We performed a retrospective analysis of cases treated with combined botulinum toxin (abobotulinumtoxinA) using an injection pattern encompassing the nasal muscles and hyaluronic acid (HA) fillers in the deep pyriform space. Photographs were taken at rest and during motion (frontal and oblique views), before and after treatment. Results demonstrated effacement of the NLF, improved nasal tip positioning during smiling, and generally more favorable facial expressions. Combined treatment with HA in the deep pyriform space and abobotulinumtoxinA in the nasal muscles can improve angry expression and aging stigma in patients with deep empty pyriform space, both in the static and dynamic conditions of facial mimic. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The synergistic effect of combining botulinum toxin with polydioxanone threads on the upper face static wrinkles.

With aging, facial lines on the forehead and glabella are sometimes converted from dynamic to static giving an aged appearance. Polydioxanone sutures are popular now as a management option in correcting deep static wrinkles on the upper face.This work was conducted to assess the synergistic efficacy of combining Botulinum toxin injection with Polydioxanone threads on the upper face static wrinkles. 30 adult patients with static wrinkles on forehead were included in this work. They were randomly distributed to one of two groups; threads insertion either alone or with Botulinum toxin injection. Treatment efficacy was evaluated after 2 months by using a Global Aesthetic Improvement Scale. Our results displayed a statistically significant improvement in forehead wrinkles in group II compared to group I (P=0.001). There was a trend toward improvement that did not reach significance in glabellar wrinkles in group II compared to group I, but this improvement did not reach the statistical significant level (P<0.112). Absorbable polydioxanone threads can be considered as a third line procedure for wrinkle correction beyond Botulinum toxin and soft tissue fillers. Threads alone don't fit all situations but their combination with Botulinum toxin can give a better natural-looking appearance with more patient satisfaction.

FISIOTERAPIA NO PÓS CIRÚRGICO DE MASTECTOMIA: UMA REVISÃO DE LITERATURA

Introduction: Cancer is a growing global concern, affecting nearly 40% of people in North America and more than one million in Australia. Breast cancer is the second most common cancer in the world, with significant rates also in Brazil, especially in the Southeast and South regions. Early diagnosis is crucial, influenced by factors such as gynecological history and heredity. After treatment, patients face significant side effects, including pain and loss of functional capacity. Oncology physiotherapy plays a vital role in rehabilitation, with techniques such as complex decompression physiotherapy and early exercise proving beneficial. New approaches, such as combining botulinum toxin A with physical therapy, offer hope in post- treatment management. Background: The increasing prevalence of cancer highlights the need to integrate rehabilitation with cancer care to minimize patient suffering. The comprehensive approach is essential for breast cancer, with post-treatment rehabilitation being crucial for managing complications and improving quality of life. Physiotherapy plays an essential role, with techniques such as complex decompression physiotherapy and combinations of therapies emerging as promising. These multidisciplinary and personalized approaches aim to improve patients' physical and emotional well-being. Objectives: To investigate the role of physical therapy interventions in breast cancer rehabilitation, identifying studies, analyzing procedures, summarizing findings, assessing quality, and formulating recommendations for future research. Method: This comprehensive review explores the role of physical therapy in the treatment of breast cancer by analyzing 16 clinical trials selected after strict application of exclusion criteria. The objective is to understand the effectiveness of physical therapy interventions in improving the quality of life of patients. The search focuses on articles obtained from academic sources and uses relevant keywords to optimize the selection of studies. Results and Discussion: Recent studies on physical therapy interventions in the treatment of breast cancer highlight a range of approaches and outcomes. While some interventions, such as botulinum toxin A infiltration, have not shown efficacy, others, such as kinesiotherapy, have demonstrated improvements in quality of life. The research highlights the importance of updating physical therapy practices to improve clinical outcomes and quality of life for patients.

Efficacy and Safety of Hyaluronic Acid Combined with Botulinum Toxin Type A in the Treatment of Midcheek Groove: A Prospective Study.

The midcheek groove, a diagonal wrinkle in the infraorbital and infrazygomatic regions, disrupts the entire midface smooth lines and impacts facial aesthetics. Despite current treatments' limited effectiveness, including hyaluronic acid fillers and surgical risks, and the neglect of the medial orbicularis oculi muscle, this study explores the efficacy and safety of combining botulinum toxin type A with sodium hyaluronate injection for midcheek groove treatment, considering anatomical and clinical factors. In this prospective study, healthy participants with midcheek grooves (depth >3 mm) were treated with botulinum toxin type A combined with hyaluronic acid injections. Data were collected at baseline, 4, 12, and 32 weeks as well as 30 min after treatment, and at 1, 3, and 6 months follow-up. Changes in the depth of the midcheek groove were measured using a three-dimensional scanner and assessed using the Patient Satisfaction Assessment Scale. Subgroup analyses were performed to assess the impact of different clinical subtypes on treatment outcomes. Thirty-six volunteers completed this study, and the midcheek groove depth was significantly reduced at 30 min after treatment and at 1, 3, and 6 months of follow-up (p < 0.001). The medial half of the midcheek groove had the best efficacy at 1 month after treatment, while the lateral half responded best at 30 min after treatment. Subgroup analyses showed that clinical subtypes affected treatment efficacy. No complications or severe adverse reactions were observed. Botulinum toxin type A combined with hyaluronic acid injection effectively improved the midcheek groove. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures - a systematic review.

Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non-surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter-sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures. A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter-sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re-intervention and incontinence rates. Fifteen non-randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re-intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long-term follow up 23 months (range: 5-60 months). Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.

The Multispecialty Toxin: A Literature Review of Botulinum Toxin.

Background:Botulinum toxin (BoNT) is a potent biological exotoxin produced from Clostridium botulinum. Although it was first used therapeutically to treat strabismus, its clinical role has since expanded rapidly over the years to include treatment of a variety of head and neck, gastrointestinal, urogenital, musculoskeletal, neurological, dermatological, and cosmetic disorders. The main purpose of this review is to provide a brief updated overview of the history, mechanism of action, and clinical applications of BoNT therapy across multiple medical specialties, including the most common adverse effects and recommended Botox dosages.Methods:A literature review was conducted in the PubMed database limited to English language articles. Specific search terms related to botulinum toxin in combination with various subspecialty fields were used, and relevant articles were identified and analyzed. The reference section for each article was also searched to find additional articles.Results:BoNT is a powerful therapeutic tool and has a vast array of clinical uses in many specialties, including ophthalmology, neurology, plastic surgery, dermatology, orthopedic, gastrointestinal, gynecology, urology, and rheumatology. Due to its chemodenervation effects at the presynaptic nerve terminal, it is useful in treatments of disorders characterized by abnormal inappropriate muscle contractions.Conclusions:BoNT has many clinical applications in several medical specialties. Future studies should focus on any additional indications of BoNT therapy as they arise and on any novel product developments.

P008 SYNCHRONOUS SURGICAL TREATMENT OF MORBID OBESITY AND COMPLEX VENTRAL HERNIA AFTER PROGRESSIVE PNEUMOPERITONEUM AND BOTULINUM TOXIN A INJECTION

Abstract Aim the worldwide increase in morbidly obese patients with complex hernia raises controversies in the choice of the appropriate treatment timing: synchronous bariatric and abdominal wall surgery versus delayed abdominal wall surgery. We report an innovative tailored surgical treatment carried out at our Institution. Material and Methods the approach provided the injection, six weeks before surgery, of 500 international units of botulinum toxin A on either side of the large abdominal wall muscles. Four weeks before surgery pneumoperitoneum was inducted and out-patient daily sessions of progressive insufflation with ambient air were then carried out. Surgery was scheduled 48 days after botulinum injection. Sleeve gastrectomy and simultaneous posterior component separation with transversus abdominis release were performed. Two prosthetic meshes were placed sublay. Results Postoperative superficial surgical site infection was successfully treated with negative pressure wound therapy. At one year follow up no hernia recurrence was recorded while total body weight loss was 31%. Conclusions a delay in ventral hernia repair could worsen quality of life of morbidly obese patients. In such high risk patients, the choice of the best surgical strategy remains controversial. There is great concern in performing bariatric surgery simultaneously to hernia repair, although there is lack of evidence on which is the ideal treatment modality. Synchronous bariatric surgery and complex ventral hernia repair should be approached in high volume centres where a consolidated experience of multidisciplinary team-work is available. Combined botulinum toxin A and preoperative progressive pneumoperitoneum administration allow for a safe resolution of loss of domain.

Combination therapy with botulinum toxin and bulking agent-An efficient, sustainable, and safe method to treat elderly women with mixed urinary incontinence.

AimsTo evaluate the efficacy, sustainability and safety of combined botulinum toxin and polyacrylamide hydrogel (PAHG) therapy to treat urgency and stress components of therapy‐refractory mixed urinary incontinence (MUI) in an elderly study population.MethodsFifty‐five women with therapy‐refractory MUI were treated with botulinum toxin and PAHG in one surgical procedure. Urgency urinary incontinence (UUI) and stress urinary incontinence (SUI) outcomes were separately assessed after 4 and 12 months by objective UUI episodes/24 h and cough test, subjective impact of UUI and SUI on quality of life, and subjective International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐UI SF). MUI outcome was calculated by combining UUI and SUI outcomes. Complications were monitored throughout the study.ResultsAt 4 months, objective cure rates were 73%, 53%, and 42%, and subjective cure rates were 71%, 52%, and 50% for SUI, UUI, and MUI. At 12 months, objective cure rates were 73%, 56%, 50% and subjective cure rates were 78%, 42%, and 40% for SUI, UUI, and MUI. The ICIQ‐UI SF score decreased by 9.0 and 8.7 points after 4 and 12 months. All complications were transient and included 22% clean intermittent catheterization immediately after surgery, 33% postvoid residual volumes >100 ml at 14 days, and 13% symptomatic urinary tract infection within the first postoperative month.ConclusionsThe combination of botulinum toxin and PAHG is effective, sustainable and safe to treat therapy‐refractory MUI, even in an elderly and frail study population. Patients benefit from the short surgical procedure without the need for general anaesthesia or discontinuation of anticoagulation.

Synchronous Surgical Treatment of Morbid Obesity and Complex Ventral Hernia After Progressive Pneumoperitoneum and Botulinum Toxin A Injection

The worldwide increase in morbidly obese patients with complex hernia raises controversies in the choice of the appropriate treatment timing: synchronous bariatric and abdominal wall surgery versus delayed abdominal wall surgery. We report an innovative tailored surgical treatment carried out at our Institution. The approach provided the injection, 6 weeks before surgery, of 500 IU of botulinum toxin A on either side of the large abdominal wall muscles. Four weeks before surgery, pneumoperitoneum was inducted and out-patient daily sessions of progressive insufflation with ambient air were then carried out. Surgery was scheduled 48 days after botulinum injection. Sleeve gastrectomy and simultaneous posterior component separation with transversus abdominis release were performed. Two prosthetic meshes were placed sublay. Postoperative superficial surgical site infection was successfully treated with negative pressure wound therapy. At a 1-year follow-up, no hernia recurrence was recorded while total body weight loss was 31%. A delay in ventral hernia repair could worsen the quality of life of morbidly obese patients. In such high-risk patients, the choice of the best surgical strategy remains controversial. There is great concern in performing bariatric surgery simultaneously to hernia repair, although there is lack of evidence on which is the ideal treatment modality. Synchronous bariatric surgery and complex ventral hernia repair should be approached in high-volume centres where a consolidated experience of multidisciplinary teamwork is available. Combined botulinum toxin A and preoperative progressive pneumoperitoneum administration allow for a safe resolution of loss of domain.

Combined botulinum toxin type A and electrical stimulation in individuals with C5\u2013C6 and C6\u2013C7 tetraplegia: a pilot study

Study designSingle-blind pilot study.Objectives(1) To evaluate combined BoNT-A injection of spastic antagonistic muscles and ES of wrist extensors in order to improve hand function in incomplete cervical SCI patients. (2) To identify prognostic indicators of hand improvements, as a function of motor levels of injury.SettingTen incomplete asymmetric SCI tetraplegics admitted to San Camillo Hospital (Venezia, Italy), who were not able to perform automatic grasping, were enrolled in the study. A better motor level (BML) C6–C7 and worse motor level (WML) C5–C6 were assigned to take into account asymmetric motor strength.MethodsAdministration of 100–200 UI BoNT-A per limb into flexor carpi radialis (FCR), extensor digitorum communis (EDC), brachial biceps (BB), and pectoralis major (PM) was performed. This was in conjunction with 6 weeks of 30-min ES sessions repeated three times a day for 6 days a week in wrist extensor muscles, and 6 weeks of 30-min hand rehabilitation for 6 days a week. Assessments included wrist Range of Motion (w-RoM), Modified Ashworth Score (MAS), Functional Independence Measure motor scores (FIM motor), and Nine Hole Peg Test (NHPT).ResultsTreatments produced a significant reduction in motor spasticity (MAS) and better dexterity (NHPT) in the C6–C7 BML with respect to the WML cases (p level = 0.007; p = 0.01, respectively). FIM motor scores improved more in BML (median: 20; range 20/22) than in WML (median: 10; range 8/17).ConclusionsHand function improvement, determined by combined BONT-A and ES, was better in C6–C7 than in C5–C6 SCI patients.

Correction to: Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial.

HomeStrokeVol. 51, No. 2Correction to: Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial Originally published27 Jan 2020https://doi.org/10.1161/STR.0000000000000219Stroke. 2020;51:e45This article corrects the followingEffect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic StrokeIn the article by Lannin et al, “Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial,” which published online on December 9, 2019 and appears in the February 2020 issue (Stroke. 2020;51:556–562. doi: 10.1161/STROKEAHA.119.027602), a correction is needed.The title mistakenly reads “Effect of Additional Rehabilitation After Botulin Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial.” The word “Botulin” should be “Botulinum.”This correction has been made to the current online version of the article, which is available at https://ahajournals.org/doi/10.1161/STROKEAHA.119.027602. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Saito K, Saito Y, Hirota K, Matui H and Hase K (2021) Long-term effects of combined botulinum toxin treatment and rehabilitation on upper limb muscle spasms: a case report, Journal of Physical Therapy Science, 10.1589/jpts.33.307, 33:3, (307-311), . Related articlesEffect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic StrokeNatasha A. Lannin, et al. Stroke. 2020;51:556-562 February 2020Vol 51, Issue 2 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/STR.0000000000000219PMID: 31986111 Originally publishedJanuary 27, 2020 PDF download Advertisement

Rejuvenation of periocular region in Koreans: A multimodal approach combining botulinum toxin, fillers, and micro-focused ultrasound with visualization for optimal results.

Periorbital aging involves all layers of the skin, fat, and the bony orbit. Therefore, a multimodal approach is necessary. Twenty Korean subjects who required periorbital rejuvenation were enrolled in this study. First, micro-focused ultrasound with visualization (MFU-V) was performed across the supra-brow area, lateral canthus, and the infraorbital area. Next, the filler was injected into the sunken upper eyelid, lateral eyebrow, and the infraorbital area. Lastly, botulinum toxin was administered into the forehead, glabella, crow's feet, and the lateral orbital rim below the brow on the same day. Photographs were taken at baseline; immediately after treatment; and at 1, 4, and 12 weeks of follow-up. The average eyebrow height was increased by 3.5 mm, and the maximum height was elevated by 3.9 mm at week 12. Physician visual analogue scale (VAS) scores regarding the whole periorbital area and eyebrow ptosis were continuously improved throughout the observation period. Physician VAS scores for infraorbital hollow and superior sulcus deformity improved immediately after the procedure and were maintained at week 12. Adverse events were mild and transient. We believe that a multimodal approach combining MFU-V, fillers, and botulinum toxin results in significant periocular rejuvenation.

Upper limb motor improvement in chronic stroke after combining botulinum toxin A injection and multi-joints robot-assisted therapy: a case report.

Spasticity is one of the major complications after stroke. Botulinum toxin type A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve activities of daily living function of paretic arm. The recovery of functions of the affected arm is also the aim of robotic upper limb (UL) therapy. The motorized exoskeleton assists the patient in a large 3D work environment by promoting movement for the UL (shoulder, elbow, wrist, hand). The combination of the BoNT-A injection and the robotic therapy might enhance functional recovery after stroke. We reported the case of a chronic stroke patient in which the injection of BoNT-A was combined with multi-joint exoskeleton training. The patient showed improvement in the motor control of the UL, supporting the feasibility of this approach.

High-efficiency Combination Treatment of Submental Neck Fullness.

Background:Fat accumulation, skin laxity, and muscle contraction cause aging cervical fullness. Combining botulinum toxin to treat muscle contraction, and technique-oriented microfocused ultrasound for skin laxity, can improve cervical fullness without requiring lipolysis. Gel-assisted depth adjustment (GADA) is a depth-targeting, image-guided approach using an appropriate gel volume to precisely heat tissue layers during real-time visualization.Methods:A 41-year-old woman presented with moderate submental neck fullness and saggy cheeks. An appropriate gel volume was applied as determined by the targeted tissue layer’s distance from the skin. The submental and submandibular areas received 112 lines of 0.9 J/cm2 microfocused ultrasound with visualization (MFU-V) from a 4.5-mm transducer and 0.3 J/cm2 from a 3-mm transducer to treat the SMAS and dermosubcutis, respectively. For concomitant jowling, these transducers delivered 111 MFU-V lines to the lower cheek. Six units of incobotulinumtoxinA was injected in 1 point at the mandible to modulate hyperactive mentalis muscles. The platysma received 10U of incobotulinumtoxinA per cheek, whereas downturned mouth corners received 4U of incobotulinumtoxinA.Results:One-month posttreatment, submentum improvements included changes of the vertical pogonion position, more mandible angularity, and a straighter mandibular line. Anterior chin projection was more pronounced and the pogonion had more inferior displacement, creating a younger appearance in the chin-neck complex. Patients followed-up for 3 months also demonstrated these changes.Conclusions:Delivering MFU-V using the GADA technique effectively tightens submental and submandibular soft tissues. When combined with incobotulinumtoxinA, muscles in the chin and perioral area are relaxed. Thus, GADA yields significant clinical improvement and patient satisfaction.

Use of Combined Botulinum Toxin and Physical Therapy for Treatment Resistant Congenital Muscular Torticollis.

Physical therapy (PT) alone is not always effective for treatment of congenital muscular torticollis (CMT). The adjunctive use of botulinum toxin (BTX) injection into the sternocleidomastoid, followed by PT, could provide correction and avoid more invasive surgery. Aims of the study were to review clinical and caregiver-reported outcomes of children with resistant CMT treated by BTX injection combined with a guided-PT program. Medical records of consecutive children with resistant CMT treated by our protocol between 2010 and 2015 were reviewed. A minimum 2-year follow-up was required. Demographic parameters, numbers of BTX required and pre-BTX and post-BTX head tilt and range of neck rotation were recorded. A univariate analysis test was conducted to identify variables related to the need of repeated BTX injections. A phone interview with the caregivers was done regarding their satisfaction. A cohort of 39 patients with treatment resistant CMT were identified that had an average age of 14 (range, 6.5 to 27.6) months at initiation of BTX treatment. Multiple BTX injections were utilized in 21/39 (54%) of patients. No patient required tendon lengthening surgery. At the final evaluation, there was improvement in both head tilt (18.7±6.8 degrees vs. 1.7±2.4 degrees, mean difference (95% CI) 16.9 (14.6-19.3); P<0.001) and range of neck motion (56.0°±11.7 degrees vs. 86.0±3.8 degrees, mean difference (95% CI) 30.0 (26.1-33.9), P<0.001). Pre-BTX parameters were not associated with the requirement of repeated BTX injections (P>0.05). Caregivers were satisfied with the treatment protocol. No untoward effect was observed during the study period. The proposed minimally invasive protocol provided correction of resistant CMT and obviated the need for more invasive surgical procedures. Level IV.

Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke

Spasticity, a common impairment after stroke, has profound negative impact on outcomes in patients with stroke. Botulinum toxin type A (BoNT-A) injection combined with rehabilitation training is suggested for spasticity treatment. However, there is no recommendation about what kind of rehabilitation training is more appropriate than others following BoNT-A injection. The purpose of this study was to compare the effects of combining BoNT-A injection with bilateral robot-assisted (RT) or mirror (MT) or task-oriented (TT) therapy for upper extremity (UE) spasticity in patients with chronic stroke. Participants were randomly assigned to RT, or MT, or TT group after BoNT-A injection. The participants received 45 minutes of intervention per day, 3 days/week, for 8 weeks according the allocated results. In addition, all participants received 30 minutes of functional practice training. At pre-intervention, post-intervention and 3-month follow-up a blinded research assistant did outcome measures, including body function and structures by Fugl-Meyer Assessment (FMA), and Modified Ashworth Scale (MAS); activity and participation measures by Motor Activity Log (MAL), and Nottingham Extended Activities of Daily Living Scale (EADLS). Thirty-seven subjects met the inclusion criteria and underwent randomization, 13 were assigned to the RT; 12 to MT; and 12 to TT group. The 3 groups were well matched with regard to baseline characteristics and functional status. All groups had significant improvement in FMA, MAS and MAL post-intervention. There were no group differences in FMA, MAS, EADLs either post-intervention or at follow-up. There was a trend that TT group had higher quality of movement (QOM) in MAL post intervention than the other 2 groups ( P = 0.07), at follow-up TT group had significantly higher QOM in MAL than the other 2 groups ( P = 0.03). Combining BoNT-A injection with TT resulted in better quality of UE movement in patients with spastic stroke than with RT or MT.

Effect of combined rehabilitation program with botulinum toxin type A injections on gross motor function scores in children with spastic cerebral palsy.

[Purpose] To examine whether combining botulinum toxin type A with physiotherapy is better than botulinum toxin type A alone in reducing muscle tone and improving gross motor function in spastic diplegia. [Subjects and Methods] Forty-six ambulatory children with spastic diplegia (age: 25–154 months) were recruited. Patients were assigned to Groups 1 (n=18) and 2 (n=28). After baseline assessment, all children received botulinum toxin type A injections (6 units/kg) into the lower limb muscles. A second botulinum toxin type A injection was given 6 months later. The ankles were placed in plaster casts for 2 weeks after the first injection and an orthosis was prescribed after cast removal. Group 2 received 2 weeks of intensive physiotherapy. The gross motor function scores for the 2 groups were recorded at baseline, 4, 6, and 52 weeks. [Results] The improvement in gross motor function scores was significant for Group 2 and non-significant for Group 1. After 4, 6, and 52 weeks, Groups 1 and 2 showed 2.6% and 6.3% improvement, 4.8% and 12% improvement, and 5.5% and 19.4% improvement, respectively. [Conclusion] The addition of a 2-week physiotherapy programme after the initial botulinum toxin type A injections produced significantly greater improvements in gross motor function scores.

Treatment of hypermetric tremors using motor strengthening combined with muscle weakening with botulinum toxin

Essential tremor and other cerebellar tremors are characterized by iterative hypermetria, which causes limb oscillations triggered by the slightest voluntary muscle activity. Classically, these tremors are treated with synaptic depressors (e.g. propranolol). However, questions are raised whether such systemic depressors may not actually worsen tremors in the long-term. We combined botulinum toxin injections and motor strengthening programs directed to the muscles involved in the tremor, with gradual systemic synaptic depressor withdrawal. In this retrospective study, inclusion criteria were: hypermetric upper limb tremor followed for ≥ 1 year with handwriting speed, maximal frequency of small alternating movements, and 30-s and five-hand-and-mouth volumetric tests (90-mm cup) performed at each clinic visit. Patients were treated with motor strengthening program (guided self-rehabilitation contract) associated with repeated botulinum toxin injections in the muscle groups responsible for the tremor. Twelve patients were included. The level of water remaining in the cup on the 30-s volumetric test improved from 34.1 mm to 47.0 mm ( P = 0.035, Wilcoxon) on the more affected side and from 45.4 to 67.3 mm ( P = 0.02) on the less affected side, with similar results on the five-hand-and-mouth volumetric test improved. Other changes included +0.6 mm/s ( P = 0.22) in handwriting speed and +0.2 Hz ( P = 0.8) on the more affected side and +2.6 Hz ( P = 0.21) on the less affected side in the frequency of small alternating movements. In cases of hypermetric tremors, volumetric tests improved after one year of treatment combining motor strengthening and botulinum toxin injections in the muscles involved with systemic depressor withdrawal.

Architectural changes of the gastrocnemius muscle after combined botulinum toxin type A injection and intensive passive-stretching exercise in children with hemiplegic cerebral palsy

Architectural changes of the gastrocnemius muscle after combined botulinum toxin type A injection and intensive passive-stretching exercise in children with hemiplegic cerebral palsy

Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on upper and lower limb spasticity in post-stroke patients

Objectives. The purpose of this study was to examine the effects of combined botulinum toxin type A (BoNT-A) and inpatient multidisciplinary (MD) rehabilitation therapy on the improvement of upper and lower limb function in post-stroke patients. Methods. In this retrospective study, a 12-day inpatient treatment protocol was implemented on 51 post-stroke patients with spasticity. Assessments were performed on the day of admission, at discharge, and at 3 months following discharge. Results. At the time of discharge, all of the evaluated items showed a statistically significant improvement. Only the Functional Reach Test (FRT) showed a statistically significant improvement at 3 months. In subgroup analyses, the slowest walking speed group showed a significantly greater change ratio of the 10 Meter Walk Test relative to the other groups, from the time of admission to discharge. This group showed a greater FRT change ratio than the other groups from the time of admission to the 3-month follow-up. Conclusion. Inpatient combined therapy of simultaneous injections of BoNT-A to the upper and lower limbs and MD may improve motor function.