Effects Of Botulinum Toxin Treatment Research Articles

Dystonia type 28 with early onset (DYT-KMT2B): a clinical case

This article presents a clinical observation of a patient with a rare form of primary dystonia – type 28 dystonia associated with a heterozygous mutation in the KMT2B gene (OMIM: 617284) for the first time in the Russian literature. The disease started at the age of 6 years with unilateral dystonia of the foot, acquired the features of generalized dystonia in the 1st year from the beginning. The mutation found in proband (chr19:36229249GC>G) was not described earlier. Dystonia was insensitive to levodopa, the effect of botulinum toxin treatment was insufficient; a notable clinical result has been achieved with deep brain stimulation (DBS).

DystoniaBoTXNet: Novel Neural Network Biomarker of Botulinum Toxin Efficacy in Isolated Dystonia.

Isolated dystonia is characterized by abnormal, often painful, postures and repetitive movements due to sustained or intermittent involuntary muscle contractions. Botulinum toxin (BoTX) injections into the affected muscles are the first line of therapy. However, there are no objective predictive markers or standardized tests of BoTX efficacy that can be utilized for appropriate candidate selection prior to treatment initiation. We developed a deep learning algorithm, DystoniaBoTXNet, which uses a 3D convolutional neural network architecture and raw structural brain magnetic resonance images (MRIs) to automatically discover and test a neural network biomarker of BoTX efficacy in 284 patients with 4 different forms of focal dystonia, including laryngeal dystonia, blepharospasm, cervical dystonia, and writer's cramp. DystoniaBoTXNet identified clusters in superior parietal lobule, inferior and middle frontal gyri, middle orbital gyrus, inferior temporal gyrus, corpus callosum, inferior fronto-occipital fasciculus, and anterior thalamic radiation as components of the treatment biomarker. These regions are known to contribute to both dystonia pathophysiology across a broad clinical spectrum of disorder and the central effects of botulinum toxin treatment. Based on its biomarker, DystoniaBoTXNet achieved an overall accuracy of 96.3%, with 100% sensitivity and 86.1% specificity, in predicting BoTX efficacy in patients with isolated dystonia. The algorithmic decision was computed in 19.2seconds per case. DystoniaBoTXNet and its treatment biomarker have a high translational potential as an objective, accurate, generalizable, fast, and cost-effective algorithmic platform for enhancing clinical decision making for BoTX treatment in patients with isolated dystonia. ANN NEUROL 2023;93:460-471.

Effect of botulinum toxin on improving quality of life in patients with chronic migraine

Introduction and purpose: Migraine is a chronic condition affecting up to 10% of the adult population in Poland. Migraine pain is severe and may be accompanied by nausea or vomiting, as well as hypersensitivity to light, sounds or smells. Chronic form of migraine means the occurrence of headache a minimum of 15 days per month, for a period of at least three months, of which eight days or more of pain meet the criteria for migraine pain. The chronic form of migraine is targeted for treatment with botulinum toxin, a neurotoxin secreted by the bacteria Clostridium botulinum.
 Brief description of the state of knowledge: The pathogenesis of migraine is still unknown. There are many hypotheses explaining the origin of migraine pain, of which the most plausible seems to be the theory involving the trigeminal nerve system, as well as trigger points in the head and neck area. Their activation leads to the triggering of pain. Botulinum toxin has been used to treat migraine for several years. The only registered drug is Botox, the effectiveness of which has been confirmed in clinical studies. The preparation is administered by injection into the muscles of the head and neck region in cycles with an interval of 12 weeks. Botulinum toxin works by blocking the release of inflammatory and pain mediators from the trigeminal nerve endings.
 Summary: Chronic migraine refers to the occurrence of headache for more than half of the month, which significantly reduces the quality of life of people worldwide. Migraine headaches often refractory to pharmacological treatment may respond well to botulinum toxin type A. Therapy should be under the supervision of a neurologist, who will familiarise the patient with the expected effects of botulinum toxin treatment before starting treatment.

Effects of Flexor Digitorum Longus Muscle Anatomical Structure on the Response to Botulinum Toxin Treatment in Patients with Post-Stroke Claw Foot Deformity.

(1) Background: The purpose of this retrospective case-control study was to determine the relationship between the control of toe movements by flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles and the response to treatment with botulinum toxin (BoNT) in post-stroke patients with claw toe. (2) Methods: Subjects with stroke-related leg paralysis/spasticity and claw toes received multiple injections of BoNT (onabotulinumtoxin A) into the FHL or FDL muscles. We investigated the relationship between the mode of transmission of FHL and FDL muscle tension to each toe (MCT) and treatment outcome using the data of 53 patients who received 124 injections with clinically recorded treatment outcome. We also dissected the potential variables that could determine the treatment outcome. (3) Results: The effectiveness of BoNT treatment was significantly altered by FDL-MCT (OR = 0.400, 95% CI = 0.162–0.987, p = 0.047). Analysis of the response to the first BoNT injection showed an odds ratio of FDL-MCT of approximately 6.0 times (OR = 0.168, 95% CI = 0.033–0.857, p = 0.032). The more tibial the influence of the FDL muscle on each toe, the better the treatment outcome on the claw toe. (4) Conclusions: The anatomic relation between FDL muscle and each toe seems to affect the response to treatment with BoNT in post-stroke patients with claw toes.

In vivo non-invasive near-infrared spectroscopy distinguishes normal, post-stroke, and botulinum toxin treated human muscles

In post-stroke hemiparesis, neural impairment alters muscle control, causing abnormal movement and posture in the affected limbs. A decrease in voluntary use of the paretic arm and flexed posture during rest also induce secondary tissue transformation in the upper limb muscles. To obtain a specific, accurate, and reproducible marker of the current biological status of muscles, we collected visible (VIS) and short-wave Infrared (SWIR) reflectance spectra in vivo using a portable spectroradiometer (350–2500 nm), which provided the spectral fingerprints of the elbow flexors and extensors. We compared the spectra for the affected and unaffected sides in 23 patients with post-stroke hemiparesis (25–87 years, 8 women) and eight healthy controls (33–87 years, 5 women). In eight patients, spectra were collected before and after botulinum toxin injection. Spectra underwent off-line preprocessing, principal component analysis, and partial least-squares discriminant analysis. Spectral fingerprints discriminated the muscle (biceps vs. triceps), neurological condition (normal vs. affected vs. unaffected), and effect of botulinum toxin treatment (before vs. 30 to 40 days vs. 110 to 120 days after injection). VIS-SWIR spectroscopy proved valuable for non-invasive assessment of optical properties in muscles, enabled more comprehensive evaluation of hemiparetic muscles, and provided optimal monitoring of the effectiveness of medication.

Oral health effects of botulinum toxin treatment for drooling: a systematic review.

Background Drooling is a major morbidity in several neurological diseases. Intraglandular botulinum neurotoxin (BoNT) injections have been used to manage this condition. However, by decreasing salivary flow, BoNT injections may result in an increased risk of caries and other oral adverse effects. In this study, we aimed to assess whether, in patients with drooling, intraglandular BoNT injections are associated with increased dental caries development, modifications on salivary composition (oral pH, buffering capacity and osmolality) and cariogenic bacterial load. Material and Methods We performed a systematic review, searching PubMed, CENTRAL, Web of Science, and Scopus for all experimental and observational studies reporting on adverse effects of intraglandular BoNT injections in patients with drooling. Primary study selection, quality assessment, and data extraction were independently performed by two researchers. No studies were excluded based on their language, publication status or date of publication. Studies’ quality was based on revised Cochrane Risk of Bias tools. Meta-analysis was not performed. Results We retrieved 1025 studies, of which 5 were included. Two studies were two randomized controlled trials and three quasi-experimental studies. None of the included studies found BoNT injections to be associated with dental caries development or with significant reductions in oral pH. One of the included primary studies even observed an increase in salivary buffer capacity. One study found an increase in Lactobacilli counts. As for the risk of bias, two studies were classified as having a critical risk, two as high risk and one as having some concerns. Conclusions Currently, there is no evidence that, in patients with drooling, BoNT injections associate with increased risk of dental caries or disturbances in oral pH or salivary buffering capacity. However, the included primary studies had important limitations and differences in their methodologies. Key words:Neurological diseases, drooling, sialorrhea, botulinum toxin, oral health, caries, saliva.

Does Botulinum Toxin Treatment Affect the Ultrasonographic Characteristics of Post-Stroke Spastic Equinus? A Retrospective Pilot Study.

Equinovarus/equinus foot is a pattern most commonly treated with botulinum toxin type A in patients with post-stroke spasticity involving the lower limbs; the gastrocnemius is the muscle most frequently injected. Spastic equinovarus/equinus can present a mixture of conditions, including spasticity, muscle/tendon shortening, muscle weakness and imbalance. In this study, we wanted to determine whether botulinum toxin treatment affects the ultrasonographic characteristics of post-stroke spastic equinus. The same dose of AbobotulinumtoxinA was injected into the gastrocnemius medialis and lateralis of 21 chronic stroke patients with spastic equinus. Clinical (Ashworth scale and ankle range of motion) and ultrasound (conventional and sonoelastography) evaluation of the treated leg was carried out before and 4 weeks after injection. No significant effects of botulinum toxin treatment on the ultrasonographic characteristics of spastic equinus were observed. As expected, there were significant improvements in ankle passive dorsiflexion range of motion and calf muscle spasticity at 1 month after treatment. There was a direct association between Achilles tendon elasticity and calf muscle spasticity at baseline evaluation. Larger studies with a long-term timeline of serial evaluations are needed to further investigate the possible effects of botulinum toxin injection on spastic muscle characteristics in patients with post-stroke spasticity.

Effect of botulinum toxin treatment in patients with bruxism and orofacial pain - randomized double-blind clinical trial

Introduction: Bruxism is defined as a parafunctional chewing activity characterized by the clenching and / or grinding of teeth that occurs both during sleep and during the surveillance period. Methods: Thirty female patients between 18 and 40 years old who had bruxism and orofacial pain were selected and randomized into two groups: control group (n = 15), where individuals received 0.05 ml of sterile saline solution that was applied to the bundle anterior temporal muscles and 0.2 ml for each masseter muscle, and an experimental group (n = 15), individuals received 20 units of A-botulinum toxin (Botox®) applied to each masseter muscle and 5 units of A-botulinum toxin applied to the anterior bundle of each temporal muscle. Patients were called back for reevaluation every thirty days. At these moments, they underwent an evaluation of the load force and electromyography. Results: At 30, 60, 90 and 120 days, a decrease in electromyographic activity was observed in the A-botulinum toxin group (p <0.001). In the experimental group, the left masseter muscle showed no significant difference between the variable load cell and time (p = 0.968), nor between electromyography versus load (p = 0.072), with a statistically significant difference between time and electromyography. (coef = 0.322; p <0.001). Conclusion: The intramuscular application of botulinum toxin type A in patients with bruxism has proved to be an effective method for hyperactivity of the masseter muscle in patients with bruxism, improving and decreasing the levels of muscle contraction.

Experienced consequences of spasticity and effects of botulinum toxin injections: a qualitative study amongst patients with disabling spasticity after stroke

Purpose Chronic spasticity poses a major burden on patients after stroke. Intramuscular botulinum toxin injections constitute an important part of the treatment for patients suffering from troublesome focal spasticity. This study explores the experienced consequences of chronic spasticity amongst patients after stroke regarding physical impairments and activities, the experienced effects of botulinum toxin treatment on these domains, and whether current spasticity management addresses patients’ needs. Materials and methods Fourteen participants with chronic spasticity after stroke who were treated with cyclical botulinum toxin injections in the upper and/or lower extremity muscles were interviewed. Inductive thematic analysis generated representative themes. Results Analyses of the interviews revealed three themes: (1) spasticity-related impairments and activity limitations; (2) fluctuations in spasticity related to botulinum toxin; (3) need for professional support and feedback. Besides motor impairments, participants experienced activity limitations in many domains of everyday life, with considerable day-to-day fluctuations. Moreover, treatment with botulinum toxin led to cyclical fluctuations in spasticity-related symptoms, which differed across participants. The participants called for shared responsibility for treatment, particularly regarding optimising the timing of injections. Conclusion Incorporating patient-relevant outcomes into the current assessment of spasticity and monitoring these outcomes may improve spasticity management, particularly regarding the timing of botulinum toxin injections. Implications for rehabilitation Because chronic spasticity after stroke impacts on almost all domains of everyday life, professionals should identify and target the most relevant problems in each individual patient. Monitoring patient-reported outcomes may help patients and professionals to get insight in the fluctuations of spasticity-related symptoms and may help to evaluate the effects of botulinum toxin injections from the patient's perspective. Patient education and providing insight in the fluctuations of spasticity-related symptoms may support self-management and shared decision-making in spasticity management.

White Matter Changes in Cervical Dystonia Relate to Clinical Effectiveness of Botulinum Toxin Treatment.

In a previous report showing white matter microstructural hemispheric asymmetries medial to the pallidum in focal dystonias, we showed preliminary evidence that this abnormality was reduced 4 weeks after botulinum toxin (BTX) injections. In the current study we report the completed treatment study in a full-size cohort of CD patients (n = 14). In addition to showing a shift toward normalization of the hemispheric asymmetry, we evaluated clinical relevance of these findings by relating white matter changes to degree of symptom improvement. We also evaluated whether the magnitude of the white matter asymmetry before treatment was related to severity, laterality, duration of dystonia, and/or number of previous BTX injections. Our results confirm the findings of our preliminary report: we observed significant fractional anisotropy (FA) changes medial to the pallidum 4 weeks after BTX in CD participants that were not observed in controls scanned at the same interval. There was a significant relationship between magnitude of hemispheric asymmetry and dystonia symptom improvement, as measured by percent reduction in dystonia scale scores. There was also a trend toward a relationship between magnitude of pre-injection white matter asymmetry and symptom severity, but not symptom laterality, disorder duration, or number of previous BTX injections. Post-hoc analyses suggested the FA changes at least partially reflected changes in pathophysiology, but a dissociation between patient perception of benefit from injections and FA changes suggested the changes did not reflect changes to the primary “driver” of the dystonia. In contrast, there were no changes or group differences in DTI diffusivity measures, suggesting the hemispheric asymmetry in CD does not reflect irreversible white matter tissue loss. These findings support the hypothesis that central nervous system white matter changes are involved in the mechanism by which BTX exerts clinical benefit.

Evidence-based Recommendations for Pediatric Orthopaedic Practice.

The evidence-based approach to guide clinical practice has gained great importance in the medical field. High-quality evidence is of paramount importance to inform clinical decision-making and optimize patient outcomes. The generation of high-quality evidence relies on sound methodology and study design to facilitate appropriate interpretation and subsequent application of the clinical findings. The purpose of this review is to objectively critique the methodological design and clinical findings of 2 pediatric orthopaedic studies on children with cerebral palsy (CP) to assess their potential to impact clinical practice. This is the second in a series of evidence-based reviews in pediatric orthopaedics. The pediatric orthopaedic literature was reviewed for randomized controlled trials (RCTs) published in 2015 and 2016. One RCT was selected from the journal Pediatrics, and one RCT was selected from the journal Developmental Medicine and Child Neurology, both investigating the use of botulinum toxin for the treatment of spastic equinus in children with CP. These RCTs were subjected to in-depth methodological review by orthopaedic surgeons with advanced research degrees and a PhD researcher. Two clinical experts then reviewed the articles to rate the clinical impact or value of each study. Methodological and clinical reviews were compiled, and a final recommendation on impact to change clinical practice was made based on both review components at the consensus of the panel. The first study reviewed investigated the single-dose efficacy and safety of botulinum neurotoxin type-A (1BoNT-A) in children with CP-associated spasticity and equinus foot deformity. The reviewers deemed the placebo-controlled study to be of sound design, and conclusions appropriate for the methodology used and clinical findings. Although findings suggest 1BoNT-A may provide benefit in treating equinus foot deformity, the optimal dose for achieving maximal impact on functional improvement remains undetermined. The second study reviewed investigated the impact of multiple dosing schedules on spastic equinus in CP. Although of relatively sound design, this study was limited by a small sample size and lack of justification for the chosen effect size. Without further study, no recommendation to change clinical practice could be made. Both RCTs reviewed were superiority studies, the first demonstrating efficacy of botulinum toxin over placebo, the second showing no significant difference in 4- and 12-monthly botulinum toxin injections. Despite a positive result demonstrating an effect of botulinum toxin treatment on spastic equinus in CP, the long-term functional impact and optimal dose remains to be determined. In addition, the negative result in the second study demonstrates the need for a noninferiority trial design to appropriately demonstrate no difference between 2 treatment options.

Pediatric extensor truncal dystonia treatment with botulinum toxin

Axial dystonia resulting in opisthotonus is observed in some children and adults with cerebral palsy and other brain disorders. This motor disorder results from involuntary activation of the trunk and cervical muscles and is associated with motor disability and pain. Usually opisthotonus does not respond to oral medications. The aim of this study is to examine the effect of botulinum toxin treatment in opisthotonus, and to objectify the patient's response and satisfaction. Six patients with opisthotonus were included in the study, the causes of dystonia being cerebral palsy (2 cases), traumatic brain injury (1 case), neurometabolic disease (2 cases) and autoimmune encephalitis (1 case). Interview with the patients and their caregivers determined the main problems in daily living resulting from opisthotonus and helped to define the goals of botulinum toxin therapy. The clinical examination performed by the injector identified the type of opisthotonus and the muscles to be injected in order to obtain the optimum effect. A set of goals by the patient, caregiver and rehabilitation team was decided for each patient. Each goal was rated on a five-point scale. Botulinum toxin was injected under electromyographic guidance into the chosen muscles of the neck and trunk (posterior and anterior muscles as needed). The Goal Attainment Scale (GAS) was used to evaluate treatment outcome. All individual baseline GAS scores were below 40. After BTX-A treatment, outcome GAS scores were above 60 in 5 cases and above 50 in one case. All individual GAS changes were positive, with a greater than 10 point-difference, which is considered to be of clinical importance. Botulinum toxin treatment of selected muscles of the neck and trunk is a promising solution in pediatric dystonic opisthotonus. The GAS instrument can depict the positive changes for the patient provided by this treatment.

Alterations in vestibular function in individuals with cervical dystonia and the effects of botulinum toxin treatment

IntroductionIndividuals with cervical dystonia (CD) often report difficulty with balance and an altered perception of vertical. Previous studies have suggested a decreased proprioceptive response to stretch of neck muscle spindles in these patients, and impaired dynamic balance changes in individuals with tremor. MethodsParticipants with CD were divided into three groups based on severity of tremor and dystonic position on the Toronto Western Spasmodic Torticollis Rating Scale 2 (TWSTRS2). Unaffected controls completed assessments including Fukuda, modified Romberg, and subjective visual vertical tests. Participants with CD completed the same assessments at baseline and 4 to 6 weeks following botulinum toxin treatment. ResultsCD participants with marked tremor and deviation had more difficulty perceiving what was vertical as demonstrated by a greater degree off midline on the subjective visual vertical test, compared to individuals with marked tremor with minimal deviation and controls, though this was not significant after adjustment for multiple comparisons. Individuals with CD also had more difficulty maintaining balance on a compliant surface with eyes closed compared to controls on the modified Romberg test. TWSTRS2 motor severity score was significantly associated with degrees off midline on the subjective visual vertical test at baseline for CD participants, but not after botulinum toxin treatment. ConclusionsIndividuals with more severe tremor and dystonic posture appear to have an altered perception of vertical associated with CD severity and that may improve following botulinum toxin treatment. Modified Romberg testing suggests that visual cues may also be important to compensate for tremor and dystonic positions found in CD.

74. Brainstem excitability in Hemifacial Spasm and Post-Facial Palsy Synkinesias and effects of botulinum toxin

Hemifacial Spasm (HFS) and Post-Facial Palsy Syndrome (PFPS) are characterised by synkinesias which electrophysiological hallmark is the lateral spread of the blink reflex, but functional and anatomical evidence of this phenomenon is lacking. To evaluate brainstem excitability in the facial and trigeminal pathways of the affected and unaffected side in HFS and PFPS and modifications induced by botulinum toxin treatment (BoNT-A). The Blink Reflex (BR), BR Recovery Cycle (BRRC) and Masseter Inhibitory Reflex (MIR) were assessed in HFS (n = 10) and PFPS (n = 7), before and after BoNT-A. Facial palsy (FP; n = 4), used as lesional model, and healthy controls (n = 8), were also assessed. BR and MIR were normal in all groups. In all patients BRRC analysis revealed a central hyperexcitability pattern following direct and indirect stimulation on both affected (p = 0.000007) and unaffected (p = 0.00007) sides, with highest effect at 500 ms interstimulus interval. BoNT-A injection did not affect this pattern in all patient groups. These preliminary results may indicate a brainstem compensatory attempt in response to a facial damage which is severe and temporary in PFPS and subtler but persistent in HFS. Central effects of BoNT-A should be searched at a higher level than the brainstem.

Utility of needle electromyography on evaluation of the “whack-a-mole” sign to improve effectiveness of botulinum toxin treatment for cervical dystonia

Utility of needle electromyography on evaluation of the “whack-a-mole” sign to improve effectiveness of botulinum toxin treatment for cervical dystonia

Treatment satisfaction with botulinum toxin: a comparison between blepharospasm and cervical dystonia.

BackgroundDifferential effects of botulinum toxin (BoNT) treatment in cervical dystonia (CD) and blepharospasm (BSP) treatment satisfaction and emotional responses to a life with a disabling condition were investigated. Special interest was drawn to the course within a BoNT treatment cycle and the effects of subjective well-being vs perceived intensity of motor symptoms and quality of life.MethodsA questionnaire was distributed among 372 CD patients and 125 BSP patients, recruited from 13 BoNT centers throughout Germany. Items were related to dystonic symptoms, BoNT treatment responses and treatment satisfaction, quality of life, working situation, and emotional reactions to a life with dystonia.ResultsCD patients and BSP patients were widely satisfied with BoNT treatment, but treatment satisfaction worsened significantly within the treatment cycle. Especially CD patients reported that both the dystonic symptoms and the effects of BoNT treatment were influenced by emotional factors. Despite good overall treatment effects, patients from both groups perceived marked persistence of motor symptoms, restrictions of everyday life functions, and reduced quality of life. Functional amelioration of motor symptoms and emotional well-being were only moderately correlated. About 22% of patients from both groups reported mental disorders or emotional disturbances prior to the onset of dystonia.ConclusionAs numerous psychological factors determine perceived outcome, BoNT treatment should be further improved by patient’s education strategies enhancing behavioral self-control. From the patient’s perspective, individual intervals, which may avoid exacerbation between injection points, should be considered. Moreover, patients at risk, with reduced adherence and poor BoNT outcome, should be identified and addressed within psychoeducation.

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin.

Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.

Effect of botulinum toxin treatment on quality of life in patients with isolated lingual dystonia and oromandibular dystonia affecting the tongue.

The purpose of this study was to investigate the impact of botulinum toxin (BoNT) treatment on the quality of life (QoL) for patients with prominent lingual dystonia (LD) using a disease-specific questionnaire, the oromandibular dystonia questionnaire-25 (OMDQ-25). This is a prospective, observational study of a cohort of 30 patients treated with BoNT injections for LD, with or without concurrent jaw dystonia. Primary efficacy outcome was the absolute difference between total OMDQ-25 baseline score and total OMDQ-25 scores 4 and 8weeks after the treatment. Safety outcome was the occurrence of adverse effects. The mean total OMDQ-25 baseline score was 46.8±17.8. After BoNT treatment, there was a significant reduction in the mean total OMDQ-25 score at 4weeks (38.2±17.6; p=0.004), as well as at 8weeks (39.6±18.1; p=0.008). At the multiple regression analysis, a jaw deviation pattern (JDD) and high questionnaire baseline total score were detected as predictors of a better outcome, whilst associated jaw tremor was a predictor of poor outcome. In patients with JDD, jaw-opening muscles were more frequently injected and genioglossus less frequently than in patients without JDD. No major adverse events were detected. A consistent and measurable improvement in QoL, with good safety and tolerability, can be achieved in patients with prominent LD by injecting BoNT into genioglossus and/or other muscles of the oromandibular region.

Quantitative Effects of Botulinum Toxin Treatment on the Modified Ashworth Scale and the Tardieu Scale: Results from a Randomized Controlled Study of AbobotulinumtoxinA in Children with Dynamic Equinus Foot Deformity due to Cerebral Palsy (S10.006)

Quantitative Effects of Botulinum Toxin Treatment on the Modified Ashworth Scale and the Tardieu Scale: Results from a Randomized Controlled Study of AbobotulinumtoxinA in Children with Dynamic Equinus Foot Deformity due to Cerebral Palsy (S10.006)

Quantitative Effects of Botulinum Toxin Treatment on the Modified Ashworth Scale and the Tardieu Scale: Results from a Randomized Controlled Study of AbobotulinumtoxinA in Children with Dynamic Equinus Foot Deformity due to Cerebral Palsy (I15.003)

Quantitative Effects of Botulinum Toxin Treatment on the Modified Ashworth Scale and the Tardieu Scale: Results from a Randomized Controlled Study of AbobotulinumtoxinA in Children with Dynamic Equinus Foot Deformity due to Cerebral Palsy (I15.003)