Effect Of Botulinum Toxin Injection Research Articles

Depressive symptoms and quality of life in patients with benign essential blepharospasm under long-term therapy with botulinum toxin.

Regular and long-term injections of botulinum toxin (BoNT) are considered the first line therapy for essential blepharospasm (BEB), but no data exists on the long-term effect of this therapy on depressive symptoms and quality of life. This study aims to prospectively evaluate the long-term effects of BoNT therapy on depressive symptoms as well as on daily activities, emotional well-being and quality of life using validated questionnaires (BEB-scale, Beck`s Depression Inventory (BDI)). 86 patients diagnosed with BEB were followed up for a median of 4 years. Clinical symptoms improved significantly after BoNT-injections. Everyday activities and subjective assessment of the overall situation improved gradually under long-term BoNT therapy. Significant correlations (p < 0.0001; r-values between 0.498 and 0.706) were found between the BDI and items of the BEB-scale. No significant antidepressive effect of long-term BoNT therapy was found with a low median BDI total score (5/max. 63), but up to 31.3% of BEB patients had a BDI score ≥ 11, indicating clinically relevant depressive symptoms. Of these, 65.4% had no known history of depression. Although, several studies reported an antidepressant effect of botulinum toxin injections in patients with major depression, this effect does not seem to be present in patients with BEB despite clinical improvement of symptoms. A high prevalence of previously undetected depressive symptoms was found in BEB patients. As this may influence BoNT therapy success, identifying potential depressive symptoms at the time of BEB diagnosis and initiating appropriate treatment seems important.

Use of Botulinum Toxin in Upper-Limb Tremor: Systematic Review and Perspectives.

Tremor is the most common movement disorder, with significant functional and psychosocial consequences. Oral medications have been disappointing or limited by side effects. Surgical techniques are effective but associated with risks and adverse events. Botulinum toxin (BT) represents a promising avenue but there is still no double-blind evidence of efficacy on upper limb function. A systematic review on the effects of BT in upper-limb tremor was conducted. A systematic search of the literature was conducted up to July 2023, including the keywords "botulinum toxin" and "tremor". All randomized controlled trials (RCTs) and open-label studies were analyzed. Independent reviewers assessed their methodological quality. There were only eight published RCTs and seven published open-label studies, with relatively small sample sizes. This review suggests that BT is more effective when injections are patient-tailored, with analyses based on clinical judgement or kinematics. Subjective and objective measures frequently improve but transient weakness may occur after injections, especially if wrist or fingers extensors are targeted. A number of studies had methodological limitations. The authors discuss how to optimize tremor assessments and effects of BT injection. Controlled evidence is still lacking but it is suggested that distal "asymmetric" BT injections (targeting flexors/pronators while sparing extensors/supinators) and proximal injections, involving shoulder rotators when indicated, may avoid excessive weakness while optimizing functional benefit.

52137 The Effects of Botulinum Toxin Injections on Mood and Mood Disorders: A Systematic Review of Randomized Controlled Trials

52137 The Effects of Botulinum Toxin Injections on Mood and Mood Disorders: A Systematic Review of Randomized Controlled Trials

The Effectiveness of Botulinum Toxin Injections to the Extremities in the Pediatric Population with Severe Cerebral Palsy: A Systematic Review

AbstractThe purpose of this review was to examine the effectiveness of botulinum toxin injections to the upper and lower extremities reported in studies of pediatric participants with severe cerebral palsy on improving ease of care, pain, and motor function. PubMed, CINAHL, and Web of Science were searched using combinations of cerebral palsy and various types and abbreviations of botulinum toxin. Additionally, reference lists and citations of reviewed studies were searched. The results of 25 studies were reviewed: three randomized controlled trials (RCTs) and 22 nonrandomized studies of interventions involving only a botulinum toxin-treated group. Seven studies focused solely on the targeted population while the remainder included participants of a wider range of severity. Ease of care was generally reported as improved. The effect on pain was variable: postoperative pain was significantly reduced in one RCT but not in another; nonspecific pain was improved in some cases; and joint specific pain was decreased in one study. Motor function changes were the most frequently evaluated in the studies without a comparison group; however, only a few used standardized assessment tools, e.g., Gross Motor Function Measure, and found pre- to postinjection improvement. The described findings need to be viewed cautiously due to the low level of rigorousness of most of the reviewed studies.

Anatomy, Etiology, Management, and Medico-Legal Implications of Botulinum-induced Blepharoptosis

Abstract: Botulinum toxin injections, a popular aesthetic treatment, have over 7.4 million beneficiaries in the U.S. Despite their safety record, these injections pose potential complications. It is essential for aesthetic practitioners to manage these complications with the least impact on the patient. Upper eyelid ptosis, though rare, is a significant side effect of botulinum toxin injections. Through our study, we have identified the etiology, anatomy, and therapeutic management of botulinum- induced blepharoptosis. Hence, the goal of this study was to identify the basic aetiology of blepharoptosis and manage this complication, as well as discuss the basis of medico-legal implications involving this popular drug. The complex medico-legal implications of botulinum toxin-induced blepharoptosis call for continuous discourse, education, and clarity on drug-use legal standards. With evolving global and Italian legislation, practitioners must ensure they meet care standards, weighing treatment benefits against potential legal and ethical outcomes. Blepharoptosis is a rare but significant complication of botulinum-type injections. Etiology and thorough anatomy are crucial for avoiding this complication and handling it with the least impact on the patient. Medico-legal implications are currently not fully established, but the basis of aesthetic treatment standards, as well as continuing medical education, will ensure correct medico-legal coverage of such complications.

Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study.

Acquired deforming hypertonia (ADH) affects the daily care of numerous nursing home residents. The aim of this study was to analyze the practice, aims, and effectiveness of botulinum toxin injections (BTxis) in the treatment of older patients with contractures, an indication for which BTxis are still underused. Data were extracted retrospectively from medical records regarding population, contractures, and injections. A prospective analysis was conducted to evaluate treatment goals set by goal attainment scaling (GAS) at T0 and at T1, to evaluate the therapeutic effects. We also recorded the occurrence of side effects, using a telephone questionnaire. This study included 41 patients older than 70 years who had received one or more BTxis for the first time between January 2018 and December 2021. Most of the older people we included lived in an institution (66%), manifested severe dependence, and presented significant morbi-mortality (37% of the patients died in the year after the last injection). The main objectives of these injections were purely comfort, without any functional goals. The GAS scores suggested effectiveness for comfort GAS scores. No complications were recorded. This study highlights the BTxis potential to address the needs of a larger number of older patients with ADH.

The effectiveness of botulinum toxin injection for reducing hypertrophic scar after cleft lip surgery

Introduction: The most frequent complication after cleft lip surgery is HTS. This condition leads to lip asymmetry as the scar contracts, leading to a shortened lip and nasal deformity on the affected side, impaired speech development, and psychological stress. Botulinum toxin injection is known as HTS treatment. Therefore, this systematic review aims to postoperatively establish the physical outcome of cleft lip scar in patients injected with botulinum toxin. Method : The systematic review was conducted based on the PRISMA guidelines and PICO criteria. The experimental group was patients given botulinum toxin injections, and the control group was a placebo group. The results were based on the physical effects. This study was assessed with Cochrane risk-of-bias assessment tools. Five studies met the criteria. Results: Physical outcomes were significantly improved using the Vancouver Scar Scale criteria, while two studies explained no significant difference in the scar scale. The consistent results were from the scar width measurement. The experimental group's scar was narrower than that of the control group. Two studies added a visual analog scale with better results in the experimental groups. Compared with standard saline injection, botulinum toxin injection has a better outcome. This result was aligned with the results found in several previous studies. Conclusions: Botulinum toxin can promote wound healing pre or postoperatively and has narrower effects than in control groups. This study showed that overall physical outcome improved in botulinum injection for the cleft lip’s surgical scars. However, there is still a need for broader-scale studies on this topic for more reliable results.

Onabotulinum toxin injections for shoulder and chest wall muscle pain in breast cancer survivors: retrospective study – preliminary report

ObjectivesThe primary objective of this retrospective review is to describe patient-reported improvement in muscular pain after initial treatment with onabotulinum toxin. A secondary objective was to determine other physiatry (physical...

Functional and esthetic effects of botulinum toxin injection into the masseter muscles: evaluation of 80 patients from a dermatological perspective.

Masseter muscle hypertrophy is characterized by a symmetrical or asymmetrical increase in muscle volume. Although it can be asymptomatic, it may be associated with bruxism. Therefore, patients may seek intervention for esthetic and/or functional concerns. This study aimed to establish patient characteristics, purpose of undergoing botulinum toxin injection into the masseter muscles, efficacy, and side effects of the procedure at a dermatology clinic. A retrospective chart review was carried out over a period of one year from January 2022 to January 2023 for the patients who underwent botulinum toxin injection into the masseter muscles. The general characteristics of patients, the purpose of botulinum toxin treatment, relief levels regarding bruxism according to the Visual Analog Scale (VAS), side effects, and complications were recorded. The study group comprised 74 female and 6 male patients with a mean age of 31.20 ± 6.71 years. Eighteen (22.5%) patients were treated only for narrowingthe lower face contour, 28 (35%) patients were treated only for the relief of bruxism, and 34 (42.5%) patients were treated for both indications. Fifteen (18.8%) patients experienced 16 treatment-related side effects, including two (2.5%) with smile asymmetry and two (2.5%) with paradoxical bulging. Botulinum toxin injection into the masseter muscles with the intention of lower face contouring and/or relieving bruxism offers a minimally invasive, safe, and effective treatment option. Although it has a favorable safety profile, the risks of significant side effects or complications remain.

Effectiveness of Botulinum Toxin Injection With Casting in Children With Spastic Cerebral Palsy: A Randomized Controlled Trial.

The most common form of movement disorder presented in children with cerebral palsy is spasticity, and dynamic equinus is the most common spastic ankle deformity. Botulinum toxin (BT) injection is now an established first-line treatment for focal spasticity. To assess the effects of BT injection with casting in the treatment of dynamic equinus in children diagnosed with cerebral palsy with spastic diplegia. A prospective randomized controlled trial was conducted among patients aged 2-12 years with cerebral palsy and spastic diplegia, attending the general outpatient department and admitted to the indoor facility of the Department of Physical Medicine and Rehabilitation and the Department of Pediatric Orthopedics at King George's Medical University, Lucknow. Two groups of 19 patients each were formed. Group A received BT injection with casting, whereas in group B, only a cast was applied. Outcome measures including spasticity by Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), range of motion (ROM), passive ankle dorsiflexion, and Gross Motor Function Measure (GMFM-66) (dimensions D and E) were assessed before and after the intervention. The participants in groups A and B were age-matched. A statistically significant difference was seen within group A and group B for MAS, passive ROM-dorsiflexion (PROM-DF), and passive ROM-plantarflexion (PROM-PF) at various follow-ups. In the 3rd week, MAS in each group was statistically insignificant (p-value> 0.05). There was a significant improvement in tone and a significant increase in the passive range of motion in both groups.

Three-Dimensional Photography for Evaluating the Effectiveness of Botulinum Toxin Injection for Masseter Hypertrophy.

Masseter hypertrophy is a common condition that causes a undesirable square face, and often treated with botulinum toxin type A (BoNTA). Subjective assessments of BoNTA effectiveness vary from physician to patient, necessitating an objective approach for evaluation. This study introduces three-dimensional photography (3DP) for the first time in clinical assessment to evaluate BoNTA treatment for masseter hypertrophy. Ten patients received 36U of BoNTA at three injection points on each side masseter muscle. 3DP scanner using Artec Eva® was taken at the first, third, and sixth postoperative months for objective evaluation. Patient's self-perceived prominence, patients self-rated satisfaction, and physicians provided 5-grade scores were the subjective indicators. A significant decrease in left masseter volume at the sixth month (P = 0.002, P = 0.004 at rest and clenching, respectively) was observed. Patient's self-perceived prominence decreased at the first (P = 0.021) and third (P = 0.039) months. Physicians' scores significantly decreased at all postoperative months. No significant changes were noted in the right masseter volume and patients self-rated satisfaction. Patient self-rated satisfaction did not consistently correlate with objective measures, except for left masseter with clenching at the sixth month. Three-dimensional photography accurately quantifies facial changes post-BoNTA treatment. Despite objective improvements, patient satisfaction may not align consistently. Reliable assessment tools are crucial in cosmetic surgery to manage expectations and prevent disputes. 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 botulinum toxin injections into the obliquus capitis inferior muscle for spasmodic torticollis

Effectiveness of botulinum toxin injections into the obliquus capitis inferior muscle for spasmodic torticollis

Effect of Botulinum Toxin Injections in the Treatment of Spasticity of Different Etiologies: An Umbrella Review.

Spasticity is a very common neurological sequelae that significantly impacts the quality of life of patients, affecting more than 12 million people worldwide. Botulinum toxin is considered a reversible treatment for spasticity, but due to the large amount of available evidence, synthesis seems necessary. Therefore, we conducted an overview of existing systematic reviews and meta-analyses to evaluate the effect of botulinum toxin injections in the treatment of spasticity of different etiologies. A systematic search of different databases, including Pubmed, Scopus, the Cochrane Library, and Web of Science, was performed from inception to February 2024. Standardized mean differences (SMDs) and their respective 95% confidence intervals (CIs) were calculated to assess the effect of botulinum toxin compared to that of the control treatment using the Modified Ashworth Scale (MAS). All the statistical analyses were performed using STATA 15 software. 28 studies were included in the umbrella review. The effect of botulinum toxin injections on spasticity, as measured by the MAS, was significantly lower in all but three studies, although these studies also supported the intervention. The SMDs reported by the meta-analyses ranged from -0.98 to -0.01. Botulinum toxin injections were effective at treating spasticity of different etiologies, as indicated by the measurements on the MAS. This implies an improvement in muscle tone and, consequently, in the patient's mobility and quality of life.

Ultrasound-guided botulinum toxin injections of salivary glands in cerebral palsy children with sialorrhea

Objective: Excessive salivation and drooling are distressing problems that affect both children and their families. Salivary gland botulinum toxin injection is a widely studied therapeutic method for treating sialorrhea. The proper protocol for such treatment modality is an area of interest for researchers. This study set out to assess the success of ultrasound-guided botulinum toxin injections in either the submandibular or combined with parotid salivary glands for children with cerebral palsy suffering from sialorrhea, while also identifying factors that predict a positive treatment outcome. Method: This cross-sectional study included 30 children with cerebral palsy who have Sialorrhea. Ultrasound-guided botulinum toxin injections of submandibular salivary glands alone or combined with parotid glands were done. Drooling was evaluated using Drooling Rating Scale, Drooling Impact Scale, and 5-minute Drooling Quotient. Children were followed up weekly for 12 weeks after botulinum toxin injections. Result: All children showed a significant decline in drooling and sufficient caregivers’ satisfaction for the first 8 weeks after botulinum toxin injections, with gradual worsening of drooling later in 60% of children. Assessment scores were significantly lower in those who received combined parotid and submandibular injections than those who received submandibular gland injections alone. Changes in drooling scores have a significant negative correlation with the severity of motor disabilities. Conclusion: Submandibular salivary gland injection alone has a satisfactory response in decreasing drooling in children with cerebral palsy. However, a combined injection of both parotid and submandibular salivary glands gives a better response for at least 8 weeks without complications. This study not only addresses the clinical effectiveness of botulinum toxin injections in managing sialorrhea in children with cerebral palsy but also opens avenues for improved dietary strategies. Keywords: botulinum toxin; salivary gland; sialorrhea; cerebral palsy

The Effectiveness of Botulinum Toxin Injections to Treat Post-Stroke Arm Dysfunction

This review was written to determine the effectiveness of Botulinum Toxin (BoNT) as a treatment for upper extremity dysfunction in post-stroke patients. As most patients survive a stroke, many are burdened with disability and impaired limb function. Seventy percent of stroke patients experience motor dysfunction in the arm, with thirty percent of patients suffering from upper extremity spasticity. Spasticity is a speed-dependent condition where certain muscles are abnormally stiff, resulting in involuntary contraction when the spastic muscle is used. BoNT treatment includes injections in localized muscles and is primarily used to treat spasticity by temporarily paralyzing the injected muscle. Seven systematic reviews/meta-analyses and ten randomized-controlled trials were used to determine the effectiveness of BoNT in post-stroke patients. Overall, BoNT is effective in reducing spasticity and may be effective in reducing pain. However, its ability to improve motor function is still unclear. In addition, there is mixed evidence on the most effective way to administer BoNT treatment, such as the proper dosage or combining BoNT with another therapy. The treatment’s effectiveness is well documented in the chronic stage of stroke but less so in the acute and subacute stages. More research is needed to determine the potential adverse effects of long-term exposure to BoNT and the most appropriate dose to administer.

Effect of botulinum toxin injection on clinical and instrumental measures of walking ability in post-stroke patients with equinus foot deviation. A prospective cohort study

Effect of botulinum toxin injection on clinical and instrumental measures of walking ability in post-stroke patients with equinus foot deviation. A prospective cohort study

Comparison of the Effect of Botulinum Toxin Injection Under Ultrasound Guidance and Oral Propranolol in the Treatment of Moderate to Severe Essential Hand Tremor

Comparison of the Effect of Botulinum Toxin Injection Under Ultrasound Guidance and Oral Propranolol in the Treatment of Moderate to Severe Essential Hand Tremor

The Effect of Botulinum Toxin Injection in Cleft Lip Repair

Background &amp; Objectives: Cleft lip and palate are common congenital anomalies that require precise management with main component of repairing lip is the aesthetic outcome. Using botulinum toxin is new method to optimize the resultant scar. The aim of this study is to evaluate the effect of botulinum toxin type A following cleft lip repair on resultant quality of scar. Methods: This is a comparative study conducted in Rizgary teaching hospital and private hospitals in Erbil – Kurdistan region/Iraq between July 2018 and April 2021. A total of 38 patients with cleft lip were included; bilateral and unilateral, complete and incomplete, isolated cleft lip and cleft lip and palate, 20 of them received botulinum toxin injection. Preoperative and postoperative photos were documented. Scars were analysed one year following repair. Results: Among 38 patients, in comparison of outcome of using botulinum toxin (31.6%) following cleft lip repair to patients did not receive the injection (68.4%), the scar quality was better; linear scar in botox group 100%, non-botox group 80.8%, complications were less; early complications in botox group 8.3%, non-botox group 11.5% and late complications in botox group 0% non-botox 7.7% and satisfaction was better; parents of botox group were 100% highly satisfied while for those of non-botox group 84.6% highly satisfied, 7.7% satisfied and 7.7% unsatisfied. There was significant difference between the two groups but statistically not significant. Conclusion: Botulinum toxin injections into the subjacent orbicularis oris muscle following cleft lip repair produced better appearing and narrower cheiloplasty scars.

A review on bigonial width reduction by botulinum toxin injections in masseter.

It is of interest to study the efficacy of botulinum toxin injection in masseter reducing bigonial width of the face. Online databases such as PubMed, Cochrane Library, Google Scholar, Science Direct database and ResearchGate were searched from initiation until October 2022 using keywords such as "masseter muscle injections", "botulinum toxin," "bigonial width reduction," "masseter muscle hypertrophy," and "lower face contouring" All available retrospective as well as prospective studies, were included with specific weightage to the efficiency of Botulinum Toxin (BT) injection in masseter muscle and the technique, unfavorable events, and the extent of its effects. A total of 20 publications were acknowledged. All prospective studies were included. Relevant data on patient selection, injection methods, efficiency, dose, rate of recurrence, and significant side effects of BT injections in masseters were collected. All excluding one were prospective studies. Bilateral injections were used in all the studies. Follow up period was 3-48 months. This systematic review focuses on the effectiveness of Botulinum toxin injection in lowering the bigonial width by decreasing the volume of the masseter. Repeat treatment at regular intervals is advisable to maintain desired results. The procedure was carried out in an office environment and was completed within 15 mins. There are no permanent adverse events related to the procedure. Further studies involving randomized control trials with larger sample sizes are warranted to optimize the dose and frequency of BT injection.

Can medical aesthetic treatments improve mental health?

Can medical aesthetic treatments improve mental health?