Duration Of Therapeutic Effect Research Articles

Pharmacokinetics and contact lenses: Drug release, delivery and fate

Topical ocular instillation is the most common route of administration for ophthalmic drugs. Despite being an easy way of drug administration, the ocular drug bioavailability is low (<4% in the anterior chamber), and the duration of therapeutic effect is short, requiring frequent instillations.Controlled drug delivery systems such as contact lenses allow drug release onto the ocular surface for a longer time, which may improve ocular drug bioavailability and duration of action. Furthermore, such topical formulations may have the potential to deliver the drug to the posterior segment of the eye. Nevertheless, the ocular drug pharmacokinetics is not very well known, with a few studies published on contact lens delivery systems. In this presentation, we will take a closer look at this, describing the drug absorption and disposition processes in the eye, and clarifying some wrong assumptions. Research on drug release in tear fluid, corneal and non‐corneal absorption routes, and ocular drug disposition in the anterior and posterior segments are considered along with the quantitative pharmacokinetic data available up to now.Overall, this talk aims to provide better understanding on ocular pharmacokinetics and on the key aspects to consider when designing in vivo pharmacokinetics studies using contact lens delivery systems.Keywords: ocular pharmacokinetics, topical ophthalmic administration, non‐corneal absorption, contact lenses.

A Systematic Review of Musculoskeletal Mobilization and Manipulation Techniques Used in Veterinary Medicine.

Simple SummaryNeck and back pain are common ailments in animals. While there are medical and surgical treatment options available for select patients, conservative care is the most common form of management of pain, stiffness and muscle spasms. Physical therapists, osteopaths and chiropractors use mobilization and manipulation techniques to evaluate and treat muscle and joint problems in both humans and animals, but there seems to be little scientific evidence available to support their use in veterinary medicine. This study reviews the scientific literature with the goal of identifying the clinical indications, dosages, outcome parameters, and efficacy of mobilization and manipulation techniques in dogs and horses. Fourteen articles were included in this review of which 13 were equine and one was a canine study. There was a large variability in the quality of evidence that supports the use of joint mobilization or manipulation in treating pain, stiffness and muscle hypertonicity in horses. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Future studies need to establish standardized methods to evaluate the optimal dosages of mobilization and manipulation for use in animals.Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A bibliographic search was performed to identify peer-reviewed publications from 1980 to 2020 that evaluated the clinical effects of musculoskeletal mobilization and manipulation techniques in dogs, cats and horses. The search strategy identified 883 papers for review. Inclusion and exclusion criteria were applied. The clinical indications, dosages, outcome parameters, and reported efficacy within each publication were recorded and categorized for comparison with scientific quality assessed according to a standardized grading system. Fourteen articles were included in this systematic review of which 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. The canine study involved carpal immobilization-remobilization and all equine studies focused on the effects of passive mobilization (n = 5) or manipulation (n = 8) of the axial skeleton. Study quality was low (n = 4), moderate (n = 7), and high (n = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.

An integrated approach to the treatment of pelvic pain associated with adenomyosis

Dysmenorrhoea and intermenstrual pelvic pain are the most common symptoms of clinical manifestations of adenomyosis, which significantly impair the quality of women’s life. Adequate and long-term pain correction and alternative therapeutic approaches became extremely important for patients with adenomyosis during the COVID-19 pandemic. Research objective: to examine the clinical efficacy of nitric oxide donor (L-arginine) in the complex treatment of pelvic pain syndrome associated with adenomyosis.Materials and methods. The study included 63 women diagnosed with adenomyosis. Patients were divided into 2 groups by simple randomization: I (D) group (n = 31) received dydrogesterone 30 mg from 5 to 25 days of the menstrual cycle, II (D+T) group (n = 32) in addition to dydrogesterone received a nitric oxide donor L-arginine (Тivortin) according to the scheme. Pelvic pain was assessed before treatment with a Visual Analogue Scale and a McGill Pain Questionnaire, and an assessment of the overall pain impact on women's well-being was based on the SF-36 Health Status Survey. The effectiveness of pelvic pain therapy was assessed after the first and third months of treatment, as well as three months after the end of therapy with the above methods.Results. Researchers achieved a therapeutic effect in the treatment of chronic pelvic pain in both study groups, but in group II (D + T) after 3 months of treatment there was a significant reduction in pelvic pain, while patients of the standard therapy group have prolonged progestogen intake. There was a further improvement in the clinical condition in group I (D) after 6 months of follow-up, as well as no recurrence of pain in group II (D + T).Conclusions. The results of study demonstrate a significant effect of Tivortin as part of complex therapy on the rate of achievement and duration of therapeutic effect in the treatment of pelvic pain associated with adenomyosis.

Antibiotic use monitoring in feedlots and dairies

Antibiotic use monitoring suffers from a lack of uniformity in the metrics used and the related terminology. There are 8 key concepts which can help guide veterinarians through the initial steps of deciphering antibiotic use data. First, there is no one perfect metric. It is also critically important to understand the granularity of the data from which the antibiotic use is calculated. Weight of antibiotics is confounded by different potencies. Regimens can help normalize antibiotic use, but be sure to know the difference between a documented regimen and estimated defined daily doses (DDDs) and Defined Course Doses (DCDs). When using the number of reported regimens or estimated number of animals exposed as a proxy for disease incidence, be sure to understand how multiple exposures for the same disease incident were addressed. Kilograms of product sold for each food animal species has a unique relationship to the production cycle and time at risk for antibiotic use. Duration of antibiotic administration may be quite different from the duration of therapeutic effect and the duration of selection for antibiotic resistant bacteria. And, lastly, comparison of antibiotic use between food animal species by any antibiotic use metric is poorly advised.

(136) Dual Targeted Theranostic Nanomedicines for Local and Systemic Non-Opioid Analgesia in Trauma

Acute neuropathic pain (ANP) resulting from civilian and combat traumatic injuries has dramatic impact on society at large as it poses with significant personal and economic burden. With opioid abuse epidemic currently in public eye across all levels of society, it is pertinent new therapeutic modalities are needed to effectively treat and resolve ANP. Neuroinflammation is recognized as one of the primary drivers of acute neuropathic to chronic pain transition leading to prolonged disability and loss of productivity. We hypothesize that the lack of molecular and cellular targeting specificity to effectively engage key cellular players in the neuronal injury milieu leads to non-opioid and local analgesia pain control failures in some patients. Here we present novel nanomedicine strategies for targeted non-opioid drug delivery directly to the key cells at the site of injury, immune cells and nerves. Since drug delivery is cell targeted, smaller drug doses are expected to produce similar or improved therapeutic effects over non-targeted therapies. Further we achieve overall dramatically decreased systemic exposure (up to 1000 fold), which can diminish unwanted side effects. Presented nanomedicine formulations provide sustained drug release leading to dosing frequency decrease and extended duration of therapeutic effects (up to 30 days or longer). As designed, these pain directed nanomedicines could improve patient response to treatment while minimizing systemic exposure/overdose risk, tolerance and/or dependency. To the best of our knowledge this is the first example of dual administration (systemic and local) nanomedicine design for acute post-trauma pain applicable to both civilian and military settings. We present fabrication and optimization of immune cell and nerve targeted nanoformulations. Evaluation for controlled release kinetics and safety of the these systems with optimized drug payloads in vivo in rat models of nerve injury and mouse inflammatory pain models following local and systemic administration is also presented.

Comparative analgesic efficacy of ultrasound-guided nerve blocks induced by three anesthetics with different duration of action in the treatment of resistant neuropathic pain in the lower extremities

Background/Aim. The neuropathic pain (NP) treatment is a big medical and socioeconomical problem. The new sorts of the NP treatment was developed and are applied in case of a medical treatment failure. The aim of this work was to investigate the efficacy of the ultrasound-assisted treatment of the resistant and chronic peripheral neuropathic pain with the local anesthetic nerve blocks. Due to the inefficacy of conventional treatment, three local anesthetics (shortacting, medium-term and long-acting) were administered in a series of the same minimal dose on a daily basis. Complications, side effects, the execution time of procedure and the onset time of local anesthetic were also investigated. Methods. In this prospective, randomized and doubleblinded study, 108 patients (of which 53 were diagnosed with diabetes and 55 with radiculopathy) with the resistant and chronic peripheral neuropathic pain in the lower extremities were treated with a series of ultra-sound assisted peripheral nerve blocks. The conventional treatment was exhausted. The presence of this neuropathic pain was confirmed by, at least, one of the three scales ? the Leeds Assesment of Neuropathic Simptoms and Signs (LANSS) scale, the Dolour Neuropathic 4 questions (DN4) scale and the pain DETECT(PD-Q) scale. Other therapies were not applied. The nerve blocks were administered on a daily basis until the relief of pain (visual analogue scale ? VAS < 30), and after that, two additional nerve blocks were given. The three local anesthetics of the different duration of therapeutic effect were given at the same minimal dose: the schortacting (1% procaine-chloride solution), medium-term (1% lidocaine-chloride solution) and long-acting (0.25% levobupivacaine-chloride solution) local anesthetics were used. The therapeutic efficacy was measured with the percentage reduction in the pain intensity on the VAS scale before and after the therapy and one month after the treatment: > 50% ? excellent results; 31?49% ? good results; < 30% the therapy did not work. The side effects, complications, the execution duration of procedure, the onset time of numbness, the number of corrections of the needle direction were recorded as well. Results. For all three groups: nerve blocks took 5.4 ? 1.48 minutes to do (withouth difference among the groups), the onset of numbness occured, on average, within 3.75 ? 2.62 minutes (withouth differences among the groups), and the need for corrections of needle direction was minimal (1.03 ? 0.17 corrections). All the patients experienced a loss of pain sensation (VAS < 30); when a long-acting anesthetic was used, the number of required nerve blocks was significant (p < 0.001) smallest (4.33 ? 0.63 blocks), than in other two groups, and the percentage pain reduction was highest (73.13%) (p < 0.001). The pain relief lasted one month after the therapy without the application of any other therapy. Neither complications nor side effects were observed. Conclusion. The procedure dercibed is a safe, efficient and easy-to-perform and does not lead to any complications and side effects. The pain relief is achieved most effectively and rapidly with the longacting local anesthetics, and maintained even for one month without the introduction of any additional therapy.

Impact of botulinum toxin injections on quality of life and self-esteem in patients with blepharospasm

ABSTRACTTo determine the effects of botulinum toxin type A (BoNT-A) injections on self-esteem and quality of life (QOL) in blepharospasm patients, we enrolled 87 patients into the study. Patients completed the WHOQOL-BREF questionnaire, the Self-Esteem Scale (SES), and the Ocular Surface Disease Index (OSDI) before treatment on the date of enrollment and again after 4 weeks of treatment with BoNT-A. The overall QOL, general health status, the physiological and psychological domain scores of the WHOQOL-BREF, and the SES score significantly improved after treatment. The motor symptoms improved, and the OSDI score increased after treatment. Overall QOL and SES scores were correlated with disease duration, while psychological domain scores were correlated with mean duration of therapeutic effect. All variables correlated with OSDI scores. In conclusion, BoNT-A injections improved QOL and self-esteem in blepharospasm patients.

Botulinum toxin type A and ethyl alcohol for treating lower extremity spasticity after stroke

Objective To compare the effectiveness of botulinum toxin type A (BTXA) and ethyl alcohol (EA) in treating lower extremity spasticity after stroke. Methods This was a randomized, case-control study. A total of 92 eligible stroke survivors completed the study. They were randomly divided into a BTXA group of 48 and an EA group of 44 according to a random number table. The gastrocnemius, soleus and posterior tibial muscles of the affected limb were chosen as injection sites. The BTXA group was injected with 50 to 200 IU of BTXA (at 50 U/ml) at one to four sites in each muscle, with a total injection dose of less than 600 U. The EA group was injected with less than 10 ml of 50% EA (0.1 to 0.5 ml at each site). Before and 2, 4 and 12 weeks after the injection, both groups were evaluated using the modified Ashworth scale (MAS), a 3 m timed up and go test (TUG), a timed 10 meter walk (10m-WT) and each was asked to assess their pain level using a visual analogue scale (VAS). Any adverse reactions were also observed. Results Two weeks after the injection, the average MAS score of both groups had improved significantly compared to that before the injection. The average improvement in the BTXA group was significantly less than in the EA group. No significant differences were found in other measurements. After four weeks the average MAS score of the BTXA group was still significantly different from that before injection or from 2 weeks previously, but the EA group now showed no significant difference from before the injection. The average TUG, 10m-WT and VAS scores of both groups had improved significantly compared to those of the earlier time points. Twelve weeks after the injection, the average MAS, TUG, 10m-WT and VAS scores of the BTXA were still significantly improved compared to before the injection, but in the EA group only the average score VAS reading was significantly improved. There were then significant differences between the two groups in all of the measurements. Conclusions Both BTXA and EA can relieve muscle spasticity. Both take effect within 2 weeks, but the former has fewer side effects than the latter and a longer duration of therapeutic effect. Key words: Botulinum toxin, type A; Ethyl alcohol; Stroke; Lower limb spasticity; Neuromuscular blockade

Intraarticular slow-release triamcinolone acetate reduces allodynia in an experimental mouse knee osteoarthritis model

Intraarticular steroid injection has been the mainstay of short-term treatment of knee osteoarthritis (OA) pain. However, the duration of therapeutic effect from a single injection is not as long as desired. In this study we use a viscous formulation of triamcinolone acetate (TCA) in hyaluronic acid to prolong the anti-allodynia effect of that steroid. OA was induced in mice by a partial medial meniscectomy. Over time the animals' developed a mechanical allodynia in the injected leg. Mice were then given a single intraarticular injection of TCA in a short-acting DMSO formulation, or a standard commercial suspension, or the drug formulated in 5% hyaluronic acid for slow-release. Control injections in OA mice were PBS or 5% hyaluronic acid vehicle. Mechanical allodynia was then monitored over the therapeutic period. Organotypic spinal cord slices and DRG culture were performed to assess whether TCA attenuates expressions of pain mediators induced by interleukin 1β. TCA 40μg in a fast-releasing DMSO formulation produced relief from mechanical allodynia for a few days compared to PBS control injections (P=0.007). Similarly, the commercial suspension of TCA 40μg also produced relief from mechanical allodynia for a few days compared to PBS control injections (P=0.001). However, TCA 100μg in 5% hyaluronic acid produced relief from mechanical allodynia for at least 28days compared to PBS control or 5% hyaluronic acid vehicle injections (P=0.0005). Furthermore, TCA significantly suppressed expression of pain mediators induced by interleukin 1β in spinal cord and DRG organotypic culture. Intraarticular TCA in a sustained release formulation of viscous 5% hyaluronic acid will produce a long-term attenuation of mechanical allodynia in the OA knees of mice.

ChemInform Abstract: Emerging Frontiers in Drug Delivery

AbstractReview: 265 refs.

Emerging Frontiers in Drug Delivery.

Medicine relies on the use of pharmacologically active agents (drugs) to manage and treat disease. However, drugs are not inherently effective; the benefit of a drug is directly related to the manner by which it is administered or delivered. Drug delivery can affect drug pharmacokinetics, absorption, distribution, metabolism, duration of therapeutic effect, excretion, and toxicity. As new therapeutics (e.g., biologics) are being developed, there is an accompanying need for improved chemistries and materials to deliver them to the target site in the body, at a therapeutic concentration, and for the required period of time. In this Perspective, we provide an historical overview of drug delivery and controlled release followed by highlights of four emerging areas in the field of drug delivery: systemic RNA delivery, drug delivery for localized therapy, oral drug delivery systems, and biologic drug delivery systems. In each case, we present the barriers to effective drug delivery as well as chemical and materials advances that are enabling the field to overcome these hurdles for clinical impact.

Targeted endothelial nanomedicine for common acute pathological conditions

Endothelium, a thin monolayer of specialized cells lining the lumen of blood vessels is the key regulatory interface between blood and tissues. Endothelial abnormalities are implicated in many diseases, including common acute conditions with high morbidity and mortality lacking therapy, in part because drugs and drug carriers have no natural endothelial affinity. Precise endothelial drug delivery may improve management of these conditions. Using ligands of molecules exposed to the bloodstream on the endothelial surface enables design of diverse targeted endothelial nanomedicine agents. Target molecules and binding epitopes must be accessible to drug carriers, carriers must be free of harmful effects, and targeting should provide desirable sub-cellular addressing of the drug cargo. The roster of current candidate target molecules for endothelial nanomedicine includes peptidases and other enzymes, cell adhesion molecules and integrins, localized in different domains of the endothelial plasmalemma and differentially distributed throughout the vasculature. Endowing carriers with an affinity to specific endothelial epitopes enables an unprecedented level of precision of control of drug delivery: binding to selected endothelial cell phenotypes, cellular addressing and duration of therapeutic effects. Features of nanocarrier design such as choice of epitope and ligand control delivery and effect of targeted endothelial nanomedicine agents. Pathological factors modulate endothelial targeting and uptake of nanocarriers. Selection of optimal binding sites and design features of nanocarriers are key controllable factors that can be iteratively engineered based on their performance from in vitro to pre-clinical in vivo experimental models. Targeted endothelial nanomedicine agents provide antioxidant, anti-inflammatory and other therapeutic effects unattainable by non-targeted counterparts in animal models of common acute severe human disease conditions. The results of animal studies provide the basis for the challenging translation endothelial nanomedicine into the clinical domain.

Long-term follow-up of ultrasound-guided botulinum toxin-A injections for sialorrhea in neurological dysphagia.

Literature provides reports only of a limited follow-up single injection of botulinum toxin-A (BoNT-A) in patients with sialorrhea. The aim of our study is to evaluate the long-lasting efficacy and safety of ultrasound-guided BoNT-A injections for severe sialorrhea secondary to neurological dysphagia. We enrolled 38 severe adult sialorrhea patients referred consecutively to the neurology unit and performed bilateral parotid and submandibular gland BoNT-A injections under ultrasound guidance. The outcomes of the study were reduction of sialorrhea, duration of therapeutic effect, and subjective patient- and caregiver-reported satisfaction. A total of 113 BoNT-A administrations were given during the study period with a mean duration of follow-up of 20.2±4.4months. We observed a significant decrease from baseline in mean number of daily aspirations and a significant improvement in patient- and caregiver-reported outcomes following ultrasound-guided BoNT-A injections (p<0.001 vs baseline for all comparisons) and the mean duration of the efficacy was 5.6±1months. No major treatment-related adverse events occurred and a low incidence of minor adverse events was reported. This study confirms the long-lasting efficacy and safety of ultrasound-guided BoNT-A injections for sialorrhea, regardless of the causative neurological disorder. These results should encourage the use of BoNT-A in the treatment of severe sialorrhea and highlight the role of ultrasound guidance to obtain optimal results in terms of safety and reproducible outcomes.

Акупунктура и нейростимуляционная терапия эректильной дисфункции у больных метаболическим синдромом

There were 40 patients with a metabolic syndrome with erectile dysfunction under observation. All patients received physiotherapy exercises, psychotherapeutic correction of a sex disadaptation, epicutaneous electrical stimulation of cavernous bodies of a penis and muscles of a pelvic bottom, and acupuncture according to specially developed scheme. It is proved that the combination of medical methods provides duration of therapeutic effect after course of treat-ment. Normalization of integrated indicators of the International index of erectile function came at 72,5% of patients. Vegetative indicators reached values of norm at 72,5% of patients, normalization of volume of a prostate came at 72,5% of patients, a prostate hemodynamic – at 70% of patients. The penil hemodynamic was normalized at 72,5% of patients. Normalization of functional activity hypothalamic – adrenal and testicular system came at 70% of patients. Components of a copulative cycle reached values of norm at 70% of patients. Carbohydrate metabolism was normalized at 75%, lipide – at 72,5%, biochemical markers of endothelial dysfunction – at 72,5% of patients, the index of exacerbations of a metabolic syndrome decreased by 1,9 times. The remote results of therapeutic effect in 1 year after treatment showed that appreciable improvement was observed at 55%, improvement – at 25%, without improvement – at 20% of patients.

СКОРАЯ МЕДИЦИНСКАЯ ПОМОЩЬ ПРИ ПОВЫШЕНИИ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ - ОРИГИНАЛЬНЫЙ ПРЕПАРАТ ИЛИ ДЖЕНЕРИК?

On pre-hospital period, 179 patients with hypertension were evaluated for efficacy, safety, and duration of therapeutic effect after administration of Mocsonidine and two Mocsonidine generics. Moconidine and both generics were effective for hypertensive. Potency of Mocsonidine, as well as the development of antihypertensive effect was higher than that one of both generic medications. The profile of the adverse effects was similar in the three groups.

64. Botulinum neurotoxin therapy of cervical dystonia: duration of therapeutic effects

64. Botulinum neurotoxin therapy of cervical dystonia: duration of therapeutic effects

Botulinum toxin therapy of cervical dystonia: duration of therapeutic effects.

We sought to explore the therapeutic effect of botulinum toxin (BT) therapy by analysing the time between the BT application and the onset of its decrease (treatment duration, TD), the inter-injection interval (II), and the excess time (ET, ET = II-TD). For this we studied 59 patients (37 females, 22 males, age 52.6 ± 10.9 years) with cervical dystonia (CD, Tsui score 9.0 ± 4.1) and BT therapy with Botox(®) and/or Xeomin(®) sequentially. Altogether 1,289 treatment cycles were evaluated. On average 21.8 ± 14.0 (4-66) treatment cycles were recorded for each patient. TD was 11.8 ± 2.7 weeks (7.8 ± 1.4 to 21.0 ± 3.9 weeks), II 15.4 ± 3.4 weeks (11.3 ± 1.3 to 27.8 ± 11.6 weeks) and ET 3.5 ± 2.4 weeks (23% of II). TD and II were stable throughout the treatment course. In 36% of the patients we found TD ≤10 weeks, in 83% TD ≤12 weeks. In 17% of the patients we saw treatment delays due to appointment difficulties, due to the patient's attempts to explore TD or his actual CD severity, from fear of adverse effects or due to psychiatric comorbidity. 19% of the patients showed prolonged treatment effects probably due to CD fluctuations. 0.38% of the injection series produced singular unexplained therapy failure (SUTF). Antibody-induced therapy failure did not occur. TD and II are stable on long-term monitoring. SUTF, treatment delays, and CD fluctuations can occur. 23% of the time patients are treated suboptimally. Our data suggest to reduce II. If II is to be reduced to ≤12 weeks, use of low antigenicity BT drugs might be useful.

Botulinum Toxin A Injections for Non-neurogenic Overactive Bladder

Intravesical botulinum toxin A (BoNT-A) injection is effective and has been approved in the treatment of overactive bladder (OAB) syndrome in patients who are refractory or intolerable to antimuscarinic therapy. Intravesical BoNT-A injection increases bladder capacity, decreases detrusor pressure, and reduces the urgency sensation in OAB patients. Although clinical experiences have demonstrated a dose-dependent therapeutic effect of BoNT-A, the adverse events such as acute urinary retention, voiding difficulty, large post-void residual, and subsequent urinary tract infection remain problematic and increase with higher doses in frail elderly patients. Currently, 100 U of onabotulinumtoxinA has been approved by many countries for the treatment of patients with non-neurogenic OAB. The duration of therapeutic effect is around 6 to 9 months and usually remains the same after repeat treatments. The injection sites can involve the bladder wall with or without sparing the trigone. Gathered experience has also shown that BoNT-A injection is also effective in the treatment of OAB symptoms in children and in patients with stroke or Parkinson’s disease. Before BoNT-A injection, physicians should learn the injection technique and inform the potential adverse events to patients who desire this treatment.

Long-term therapy of benign essential blepharospasm and facial hemispasm with botulinum toxin A: retrospective assessment of the clinical and quality of life impact in patients treated for more than 15 years

Botulinum toxin type A (BoNT-A) is recognized as the treatment of choice for patients with blepharospasm and facial hemispasm. We report the results of long-term BoNT-A therapy (15-20years) in a group of patients with blepharospasm (9 patients) and hemifacial spasm (18 patients). We evaluated the number of treatment sessions, duration of therapeutic effects, side effects and their frequency during long-term therapy, and the differences between these two groups of patients. We used patient self-assessment and a patient questionnaire to evaluate the influence of the treatment on their quality of life. We have concluded that BoNT-A is an effective and safe long-term treatment of these facial dyskinesias. Despite the different pathophysiology of blepharospasm and facial hemispasm, the therapy effectiveness is comparable. The only differences were in the side effects. In patients with blepharospasm, the side effect frequency was higher and manifested by double vision or eyelid ptosis. In patients with facial hemispasm, the most frequent side effect was lower facial weakness. No association between therapy duration and side effect frequency was determined. Based on patient questionnaires, all patients believed that the treatment was safe and effective with a positive impact on their quality of life, especially in social communication.

47. Botulinum toxin for the upper limb after stroke: Comparison between incobotulinumtoxin A, botulinum toxin drug free of complexing proteins, and conventional botulinum toxin formulation. A preliminary study

Botulinum toxin type A (BoNT/A) provides a valuable tool in the multi-modal treatment of spasticity. Incobotulinumtoxin A (InBoNT/A) is a highly purified BoNT/A agent, free of any complexing clostridial proteins.Clinical experience suggests that InBoNT/A is identical from efficacy, duration of therapeutic effect and tolerability profile. Our aim was to compare the effect of the CBoNT/A vs InBoNT/A on spasticity of the upper limb, evaluated with Modificated Aswhort Scale (MAS), and on amplitude of compound motor action potentials (CMAP) of biceps muscle in patients after brain stroke. A randomized, double-blind, parallel-group pilot single-centre study. Clinical and neurophysiological evaluation were performed at enrollment (T0), to 24 h (T1),one (T2) and three (T3) months from toxin injection. We recruited 9 subject. Both BoNTA reduced MAS scores but with no statistically significant difference. At T1 patients treated with IBoNT/A showed a greater reduction in CMAP compared with those treated with CBoNT/A. This difference is reduced at T2 but is again evident at T3. These data seem to indicate a tendency of IBoNT/A to present a more precocious and a longer duration effect respect to CBoNT/A. The low power of the statistical analysis, however, suggests to recruit a larger sample of patients.