Effect Of Botulinum Toxin Injection Research Articles

Effectiveness of Botulinum Toxin Injection on Bruxism: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

The present study compiled evidence on the efficacy of botulinum toxin A (BTX) for management of bruxism. A literature review that included randomized control, cohort, as well as observational studies published between January 2000 and November 2022 was conducted. All studies related to BTX injections administered into the masseters of patients with bruxism were included. Primary outcomes were measured by performing a meta-analysis of changes in maximal biting forces and pain severity and meta-regression of the effects of the BTX dose. Ten studies were included for quantitative analysis. The analysis of the maximal biting force after BTX injections demonstrated a significant reduction at 1 month or less compared with both oral splints (P < 0.000001) and saline injections (P = 0.01). BTX continued to outperform oral splinting (P = 0.001) and saline placebos (P = 0.03) at 3 months. Between 3 and 6 months, a significantly higher maximal biting strength was observed in the BTX group than the oral splinting group (P < 0.00001). No significant differences in the maximal biting force were observed between the BTX and saline placebo groups (P = 0.50). A similar trend was observed in the analysis of pain reduction after botulinum treatment. Additionally, for every unit increase in the BTX dose, pain severity decreased by 0.0831 points (P = 0.0011). BTX is effective in reducing biting strength and pain severity. BTX effects are evident at less than 4 weeks, peak between 5 and 8 weeks, and last for up to 24 weeks. Higher BTX doses result in greater improvement in pain. Although BTX benefits manifest earlier, they gradually diminish, and oral splinting exerts a more enduring effect, especially after 9-12 weeks. BTX injections into masseters are recommended as management options for bruxers, especially for those having difficulties complying with wearing oral splints or those seeking earlier symptom relief. However, future studies should determine BTX effects beyond 24 weeks and after repetitive injections and how bruxers of different ages or genders respond to treatment. 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 .

Effect of botulinum toxin injection on pain severity and quality of life among patients with postherpetic neuralgia

Background: Herpes zoster and postherpetic neuralgia (PHN) results from reactivation of varicella-zoster virus. Pain increases sharply with advancing age and the elderly are more inclined to suffer. If herpes zoster is not treated early, patients may develop PHN. For some, it can persist for 1–2 years. Botulinum toxin injection (BTX-A) has been useful for patients suffering from PHN pain. Objective: The objective of this study was to study the effect of botulinum toxin on pain severity and quality of life in patients with PHN. Methods: A hospital record-based follow-up study was carried out among 30 PHN patients treated with hypodermic injection of BTX-A. Before injection, we measured Visual Analog Score (VAS) for pain severity and the Quality of Life (QOL) Scale using short form survey-36 (SF-36) score. BTX-A injections were given, and patients were followed every month for 6 months. During follow-up, VAS, QOL, pain frequency, and analgesic use were measured. Results: Majority were 60–69 years (40%). The proportion of males and females was not much different. Mean pain severity reduced significantly from 8.9 to 5.8 at 6 months. QOL improved significantly in 6 months. Pain frequency decreased significantly from 22.33 to 18.56 at 6 months. Mean analgesics use was 87.43 which reduced significantly to 7 at 2 weeks after BTX-A and then slowly increased to 7.66 at 4 weeks, to 8.23 at 12 weeks, and 10.4 at 24 weeks. Conclusion: Using BTX-A for treating PNH is promising and gives long-lasting results. It can be considered a valid approach in the treatment of PNH, especially in nonresponsive patients.

Bladder Wall Structure Alterations in Patients Treated With Botulinum Toxin for Detrusor Overactivity - A Morphological Study.

The overactive bladder syndrome (OAB) is a bothersome condition that affects up to 33% of the population. In up to 69% of the cases, the underlying condition is an overactive detrusor (DO). Treatment options rely on behavioral changes, medical treatment, neuromodulation, and invasive treatment, such as injecting botulinum toxin (BoNT) in the detrusor or augmentation cystoplasty. The aim of this study was to evaluate, by morphological assessment on cold-cup biopsies of the bladder, the effect of botulinum toxin injections on the bladder wall, focusing on the histological structure and signs of inflammation and fibrosis. We evaluated consecutive patients with DO that received BoNT intradetrusor injections. We analyzed inflammation and fibrosis in 36 patients, divided into two groups based on their history of BoNT treatment. Our patients underwent at least one round of injections and specimens were compared individually, before and after each injection. A decrease in inflammation was found in 26.3% of the cases, a reactive increase in 31.5%, and no change in 42.1%. No de novo or increase in preexisting fibrosis was found. In some cases, fibrosis diminished after a second round of BoNT. In most cases, BoNT intradetrusor injections in DO patients showed no effect on bladder wall inflammation and actually improved the inflammatory condition of the muscle in a significant number of samples.

Evaluation of the effectiveness of botulinum toxin injection on reducing phantom pain in patients

ObjectivePhantom pain is very common in amputations and is associated with severe pain followed by distress and poor quality of life. The aim of this study is to evaluate the effectiveness of botulinum toxin injection in reducing phantom pain in patients referred to Imam Hossein Hospital. Materials and methodsIn this double-blinded placebo study, 30 patients with phantom pain referred to Imam Hossein Hospital were included. The participants were divided into two groups of 15 intervention and placebo. In the intervention group, botulinum toxin A was injected to reduce pain in patients and normal saline was injected in placebo group. Patients' pain relief was assessed at 0, 2, 4, 8, and 16 weeks of the treatment. Data were analyzed using SPSS 23 software. ResultsBotulinum toxin A injection significantly reduced phantom pain in intervention group at 0, 2, 4, 8, and 16 weeks of the treatment p < 0.05. This reduction was also seen in regard to the cause of amputation, such as war, accidents, and unknown causes. ConclusionThe use of botulinum toxin A seems to be effective in reducing pain in patients with phantom pain. Comparative studies and comparisons of the effect of botulinum toxin with common treatments are recommended.

The Use of Botulinum Toxin Injection For Post-Radiation Breast Cancer Survivors With Shoulder Pain

<h3>Research Objectives</h3> To evaluate the effectiveness of botulinum toxin injections for post-radiation breast cancer survivors with shoulder pain by physiatry. A secondary objective was to determine other physiatry interventions ordered. <h3>Design</h3> Retrospective Review. <h3>Setting</h3> National Cancer Institute Comprehensive Cancer Center. <h3>Participants</h3> 47 patients were referred by breast radiation oncology to PM&R from 1/1/2018-12/31/2021. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Physiatric (PM&R) interventions utilized. <h3>Results</h3> 2 out of 49 total patients referred to PM&R by breast radiation oncology were for reasons other than shoulder pain/dysfunction. After PM&R evaluation, 28/47 shoulder pain/dysfunction patients evaluated had botulinum toxin recommended, however, only 18/28 received the botulinum toxin injection. Out of the 10 patients who did not receive botulinum toxin injection, 2/10 preferred to get botulinum toxin by a physiatrist/neurologist closer to home, 1/10 decided on a trigger point injection instead, and 7/10 were lost to follow-up. 17/18 patients who received botulinum toxin injection voiced improvement in pain after injection. 24/28, 16/18, and 2/10 patients who had toxin injection recommended, toxin injection received, and toxin injection not recommended respectively, had spasms, cramping or Charley horses mentioned in their PM&R evaluations. <h3>Conclusions</h3> 17/18 patients reported improvement in pain with botulinum toxin injection. Most patients complained of muscle spasms before toxin injection was recommended. Additional research on the effectiveness of botulinum toxin injection in post-radiation breast cancer survivors with muscle spasm related pain is needed. <h3>Author(s) Disclosures</h3> N/A.

Efficacy of botulinum toxin injection versus bilateral medial rectus recession for comitant esotropia: a meta-analysis.

To compare the effectiveness of botulinum toxin injection (BTX) and bilateral medial rectus recession (BMR) in the treatment of comitant esotropia. An exhaustive search of the literature from Pubmed, EMBASE, Web of Science, and Cochrane Library databases was carried out until April 2022. No language restrictions were applied. The literature was rigorously screened against eligibility criteria. Odds ratios (ORs) and 95% confidence interval (CI) were calculated. A total of 9 articles with 1100 participants were included in this meta-analysis. Three studies compared the effects of BTX to BMR on infantile esotropia, five studies compared the effects of BTX to BMR on acute acquired comitant esotropia, and one study compared the therapeutic effects between BTX and BMR for partially accommodative esotropia. Our pooled results showed that BMR achieved higher overall success rate compared with BTX (OR, 0.49; 95%CI, 0.37-0.64; P < 0.001) and patients subjected to the BTX procedure had higher overall rate of undercorrection (OR, 2.27; 95%CI,1.71-3.02; P < 0.001). No statistical difference in the overall overcorrection rate was observed between the two groups (OR = 0.42, 95% CI: 0.17 ~ 1.03, P = 0.06). Further analysis found that BMR was more effective for infantile esotropia compared to botulinum toxin injections (OR, 0.40; 95%CI, 0.27-0.57; P < 0.001). Nevertheless, the same effect was observed for BMR and BTX in the treatment of acute acquired comitant esotropia (OR, 0.97; 95%CI, 0.50-1.87; P = 0.93). The present meta-analysis indicated that the BMR procedure achieved a higher success rate and a lower undercorrection rate in patients with comitant esotropia. However, BTX demonstrated similar treatment effects to BMR surgery in the treatment of acute acquired comitant esotropia.

A computed tomography study investigating the effects of botulinum toxin injections prior to complex abdominal wall reconstruction

ObjectiveTo explore how intramuscular injection of botulinum toxin A (BTA) affects the lateral abdominal wall (LAW) musculature, abdominal- and hernia dimensions, and muscle structure on computed tomography (CT) in patients scheduled for complex abdominal wall reconstruction (CAWR).MethodsRetrospective analysis of prospectively registered patients who received bilateral intramuscular BTA injections into all three muscles of the LAW. Only patients for which a CT was available before and 3–6 weeks after BTA treatment prior to surgery were analyzed.ResultsFifty-two patients were analyzed. Median hernia width in all patients decreased with 0.4 cm (IQR − 2.1;0.6) (p = 0.023). Median intra-abdominal transverse diameter increased with 0.9 cm (IQR − 0.2;3.3) (p = 0.001) and the intra-abdominal anterior–posterior diameter decreased with 0.5 cm (IQR − 1.3;0.5) (p = 0.017), making the abdomen more oval. Median LAW muscle length increased with 0.9 cm (IQR 0.0;2.4) per side (p < 0.001), muscle thickness decreased with 0.5 cm (IQR − 0.8;− 0.2) (− 25.0%) per side (p < 0.001), and muscle mass decreased with 3.9 cm2 (IQR − 6.4;-1.5) (− 15.8%) per side (p < 0.001). Median HU of the psoas muscles (density) increased with 4.8 HU (IQR 0.4;9.7) (10.3%) per side (p < 0.001). Effects of BTA were more pronounced in patients with a loss of domain (LoD) ≥ 20%.ConclusionsThe main effect of BTA injections is elongation and thinning of the LAW muscles, more than a decrease in hernia width. Concomitantly, the abdomen becomes more oval. An increase of psoas muscles density is seen, associated with offloading of the LAW muscles. Patients with large LoD have a proportionally higher effect of BTA.

Effects of Botulinum Toxin Injection on Reducing Myogenic Artifacts during Video-EEG Monitoring: A Longitudinal Study

ABSTRACT Medically refractory seizures affect one-third of patients with epilepsy (PwE), for whom epilepsy surgery is considered. Video electroencephalography (vEEG) monitoring is a fundamental tool for pre-operative seizure localization. Facial and cranial myogenic artifacts can obscure vEEG findings, thus interfering with seizure localization. Studies have shown the beneficial effects of botulinum toxin type A (BTX-A) injection into cranial muscles for reducing myogenic artifacts. This longitudinal study aimed to assess the effects of BTX-A injection on these artifacts. Twenty-two patients with medically refractory hypermotor seizures with daily seizure frequency and undetermined epilepsy localization were included in this study and underwent Dysport® injection (200 units) into the frontotemporal region. vEEG recordings were performed at baseline (one week before the injection), and at three days and six days post-injection. Before and after the injection, the amplitudes of myogenic artifacts were compared during various states (ictal, blinking, chewing, bruxism, head lateralization, scowling, talking, and yawning). BTX-A injection significantly reduced the amplitudes of EEG myogenic artifacts, except during blinking (day three) and talking (days three and six). On day six, significant reduction in EEG myogenic artifacts were noted during blinking, chewing, and bruxism for the greatest number of patients (95.5%, 90.9%, 81.8%), while significant reductions in EEG myogenic artifacts during talking, head lateralization, and ictal phase were associated with the least number of patients (22.7%, 36.3%, and 40.9%). Therefore, BTX-A injection could be a convenient method for filtering myogenic contamination, improving EEG interpretation, and facilitating seizure localization in patients with medically refractory seizures.

Effect of Botulinum Toxin Injection on EMG Activity and Bite Force in Masticatory Muscle Disorder: A Randomized Clinical Trial.

Botulinum toxin type A (BoNT-A) is increasingly used in treating masticatory muscle pain disorder; however, safe doses and reinjection intervals still need to be established. The purpose of this randomized clinical trial was to evaluate the degree and duration of the impairment of masticatory muscle performance. Fifty-seven subjects were randomly divided into two groups: one of which received BoNT-A first (n = 28) while the other received saline first (n = 29), with the cross-over being in week 16, and a total follow-up period of 32 weeks. A total dose of 50 U of BoNT-A was injected in the masseter and temporal muscles bilaterally. Electromyographic (EMG) activity and bite forces were assessed. A significant reduction in EMG activity was observed up to week 18 (p ≤ 001), with total recovery at week 33. A significant reduction in maximum bite force was observed up to week 11 (p ≤ 005), with total recovery at week 25. In conclusion, when treating masticatory muscle pain disorder with 50 U of BoNT-A, a reinjection interval of 33 weeks can be considered safe since the recovery of muscle function occurs by that time.

Combined Effects of Botulinum Toxin Injection and Oral Appliance Therapy on Lower Facial Contouring: A Randomized Controlled Trial.

(1) Background: Botulinum toxin (BoNT) injection is an esthetically effective and safe treatment for contouring the lower face. This study aimed to evaluate the combined effects of BoNT and supplementary oral appliance (OA) therapy on lower facial contouring. (2) Methods: We conducted a prospective randomized controlled trial from January 2015 to June 2016 at the Yonsei University Dental Hospital. Volunteers aged 20–45 years with masseter hypertrophy were randomly assigned to one of two groups: the non-OA group and the OA group. The non-OA group received BoNT injections alone, whereas the OA group received an OA in addition to BoNT injections. Changes in the bulkiest height of the lower face were evaluated by three-dimensional laser scanning before and 4, 8, 12, and 24 weeks after injections in both groups. (3) Results: In both groups, the bulkiest height reductions decreased, with a significant interaction between group (p = 0.046) and time (p < 0.001), although the overall reduction was at a similar level at 24 weeks. (4) Conclusions: The pattern of the bulkiest height reduction of the lower face after BoNT injection differed between standalone treatment and OA therapy, implying a normalizing effect of OA on masseter muscle activity.

The utilization of botulinum toxin for Hirschsprung disease

Patients with Hirschsprung disease (HD) can struggle with persistent obstructive symptoms even after a successful pull-through. These symptoms lead to stasis of stool and can result in Hirschsprung associated enterocolitis (HAEC). Recurrent episodes of HAEC warrant further workup; if there are no signs of mechanical obstruction or an aganglionic pull-through, the use of botulinum toxin injections to the internal anal sphincter has been utilized to relieve these symptoms.In this review, we describe the variations in botulinum toxin injection use and describe ongoing studies to prevent obstructive symptoms and Hirschsprung-associated enterocolitis (HAEC). Botulinum toxin injection utilization has been described for obstructive symptoms after HD pull-through, in the setting of active HAEC, and has been proposed to be part of the treatment algorithm for prevention of HAEC after pull-through. Dosing utilized for the injections, along with the complications, are also described.Prospective, multi-institutional trials are needed to identify the effectiveness of botulinum toxin injections in the outpatient/prophylactic setting as current data suggest some benefits in preventing future obstructive symptoms; however, other studies have conflicting results.

Botulinum toxin combined with rehabilitation decrease corticomuscular coherence in stroke patients

ObjectiveStroke results in limitation of active range of motion involving antagonist co-contraction. The analysis of brain-muscle connectivity can be used to deepen understanding of motor control alterations associated with the loss of motor function after stroke. This preliminary study aims to investigate the combined effects of botulinum toxin and rehabilitation on corticomuscular coherence to better understand the altered functional reorganization of the central-peripheral network. MethodsKinematic, electromyographic and electroencephalographic data were recorded during twenty active elbow extensions in eleven chronic stroke patients and nine healthy control subjects. Active range of motion, antagonist co-contraction and corticomuscular coherence were calculated. ResultsThe initial increase in corticomuscular coherence in stroke patients was significantly reduced five weeks after the first botulinum toxin injection and twenty weeks away from the third injection, in both agonist and antagonist muscles, with moderate to large effect sizes, concomitantly with a decrease in antagonist co-contraction and an improvement in the active range of motion. ConclusionsThis study highlights for the first time an effect of botulinum toxin injections combined with rehabilitation on corticomuscular coherence in stroke patients. SignificanceNotwithstanding the relatively small sample, the results provide original evidence supporting treatment-induced effective functional reorganization of the central-peripheral network.

Conventional surgery versus botulinum toxin injections for partially accommodative esotropia

To compare the effect of botulinum toxin injection (BTX) to bilateral medial rectus recession (BMR) in partially accommodative esotropia (PAET). The medical records of children 1-14 years of age treated for PAET with BMR or BTX between 2010 and 2020 at a single institution were reviewed retrospectively. PAET was defined as residual esotropia of at least 14Δ after 6 weeks of continuous wear of full cycloplegic refraction (> +2.5 D). Success was defined as esotropia of 0Δ-10Δ after a single surgery or ≥1 BTX injections. Of 224 patients, 121 received BTX and 103 underwent BMR. BMR showed a higher success rate than BTX (70.9% vs 53.7% [P = 0.006]). BMR was more successful in males, in patients >5 years of age, and when spherical equivalent was ≤ +5.00 D (79.2%, 74.3%, and 67.5%, resp. [P < 0.05]). Mean follow-up was shorter in the BMR group than in the BTX group (16.7 ± 14.7 vs 31.4 ± 29.5 months [P = 0.0001]). Mean duration of surgery was significantly shorter in the BTX group (5.2 ± 4.3 vs 70.5 ± 31.4 min [P = 0.0001]). Postoperative inferior oblique overaction was more common in the BTX group (7.4%; P = 0.02 [Fisher exact test]), and persistent ptosis was only seen in the BTX group (0.8%); consecutive exotropia was only seen in the BMR group (2%). In our study cohort, BMR had a higher success rate than BTX. Conventional surgery allowed for shorter follow-up and fewer complications than BTX in the treatment of PAET.

Effect of Botulinum Toxin Injection on the Progression of Hip Dislocation in Patients with Spastic Cerebral Palsy: A Pilot Study.

Hip adductor spasticity is a contributing factor to hip dislocation in patients with cerebral palsy (CP). We hypothesized that botulinum toxin injected into the hip adductor muscles would reduce spasticity and help prevent hip dislocation. Twenty patients with bilateral spastic CP aged 2 to 10 years with gross motor function classification system level IV or V were included. Botulinum toxin was injected into the hip adductor muscles at baseline and at 6-month follow-up. Muscle tone was measured with an eight-channel surface electromyography (EMG) recorder. A hip X-ray was performed, and Reimer’s hip migration index (MI) was measured. The Wilcoxon signed-rank test was used to compare the surface EMG values of the hip muscles at baseline and follow-up. The mean root mean square surface EMG value of the hip adductor muscles was significantly reduced at 1, 2, 3, and 7 months after the first injection, up to approximately 53% of the baseline. The 1-year progression of the hip MI was −0.04%. Repeated sessions of botulinum toxin injections at the hip adductor muscles significantly reduced muscle tone and hip displacement. A botulinum toxin injection may be used as an adjunctive treatment in the prevention of hip dislocation.

Comparative Effectiveness of Botulinum Toxin Injections and Extracorporeal Shockwave Therapy for Post-Stroke Spasticity: A Systematic Review and Network Meta-Analysis

BackgroundThe anti-spasticity efficacy of botulinum toxin (BoNT) injection has been well established for patients with chronic stroke; however, extracorporeal shock wave therapy (ESWT), i.e. focused shockwave (FSW) and radial shockwave (RSW), has recently been applied. We aimed to investigate the comparative effectiveness of BoNT vs. ESWT in the reduction of spasticity among stroke survivors.MethodsPubMed, EMBASE, MEDLINE and Cochrane CENTRAL were searched from the earliest record to September 2021 for randomized controlled trials. Weighted mean differences (WMDs) on the reduction of the Modified Ashworth Scale before or at the 6th post-treatment week (short-term) and between the 7th and 12th weeks (mid-term) after the intervention were calculated. Ranking probabilities of the WMD were simulated to determine which treatment had the potential to possess the best effectiveness. inplasy.com registration: INPLASY202170018.FindingsA total of 33 studies comprising 1,930 patients were enrolled. The network meta-analysis revealed that BoNT injections, FSW and RSW were better in spasticity reduction than the control treatment(s) at the short term, with WMDs of -0.69 (95% CI, -0.87 to -0.50), -0.36 (95% CI, -0.69 to -0.03) and -0.62 (95% CI, -0.84 to -0.40), respectively. Likewise, mid-term effects of BoNT injections, FSW and RSW also revealed superiority, with WMDs of -0.44 (95% CI, -0.62 to -0.26), -0.74 (95% CI, -1.26 to -0.23) and -0.79 (95% CI, -1.07 to -0.51), respectively. Ranking probability analysis revealed that RSW had the highest probability of being the best treatment for spasticity reduction at the short-term (62.2%) and mid-term (72.3%) periods during the follow up.InterpretationBoNT injections and ESWT are effective in alleviating post-stroke spasticity at the mid-term. The effectiveness of ESWT was comparable to BoNT injections, and RSW had the potential to be the best treatment for spasticity reduction among the three treatment options. More prospective trials incorporating head-to-head comparisons of BoNT injections vs. ESWT are needed to validate the role of ESWT in reducing post-stroke spasticity.FundingThe current research project was supported by (1) National Taiwan University Hospital, Bei-Hu Branch; (2) Ministry of Science and Technology (MOST 106–2314-B-002–180-MY3 and 109–2314-B-002–114-MY3); 3) Taiwan Society of Ultrasound in Medicine.

Postmarketing safety surveillance data reveals protective effects of botulinum toxin injections against incident anxiety

Randomized controlled trials (RCTs) have shown an antidepressant effect of glabellar botulinum toxin (BoNT) injections. In the FDA Adverse Event Reporting System (FAERS) database, BoNT injection is associated with reduced incidence rates of depression across various non-psychiatric indications, which confirms the previous findings independently of specific expectations to an antidepressant effect of BoNT. The rationale of using BoNT to treat depression is to interrupt proprioceptive body feedback that may reinforce negative emotions. Negative emotions also occur in other mental disorders, suggesting a transdiagnostic therapeutic potential of BoNT in psychiatry. Here we report an analysis of the FAERS database, in which we found that, compared to alternative treatments, BoNT injections were associated with lower incidence of anxiety symptoms and related disorders. Among seven indications/injection sites, we found this protective effect of BoNT in cosmetic use/facial muscles, migraine/facial and head muscles, spasms and spasticity/upper and lower limbs, torticollis and neck pain/neck muscles, and sialorrhea/parotid and submandibular glands (reporting odds ratios 0.79–0.27). These findings are encouraging for possible future RCTs on the use of BoNT as a treatment for anxiety and related disorders.

P.0132 Selective lesions of medial septal cholinergic and gabaergic neurons differentially affect spatial memory and various neurotransmitter markers in the hippocampus

To investigate the characteristics of oropharyngeal dysphagia in adults with dyskinetic cerebral palsy (DCP) and cervical dystonia (CD).Exploratory observational cross-sectional study.University hospital.Seventeen patients with DCP (8 men, 9 women; age, 45.7±6.3y) enrolled in a randomized controlled trial on the effects of botulinum toxin injection on CD.Not applicable.Baseline clinical assessments and videofluoroscopic swallowing studies (VFSSs) were conducted. VFSS findings were evaluated using the videofluoroscopic dysphagia scale (VDS) and the penetration-aspiration scale (PAS). The Gross Motor Function Classification System (GMFCS) and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were also assessed. Relationships between outcomes were evaluated using Spearman’s rank correlation.The clinical assessment revealed abnormalities in chewing (n=10, 58.8%), tongue movement (n=10, 58.8%), and laryngeal elevation (n=8, 47.1%). The most common abnormality on the VDS was inadequate mastication (n=13, 76.5%), followed by premature bolus loss, vallecular residue, and penetration/aspiration (all: n=10, 58.8%). A maximum PAS score of 8 was observed in 8 of 17 patients (47.1%). Total and pharyngeal VDS scores were significantly correlated with TWSTRS scores (ρ=0.543, P=.024 and ρ=0.539, P=.026, respectively); the VDS oral score did not correlate with the TWSTRS score (ρ=0.446, P=.073). There was no significant correlation between VDS score and GMFCS level (ρ=0.212, P=.414).This preliminary observational study presents the characteristics of oropharyngeal dysphagia in adults with DCP and CD. Pharyngeal stage difficulties were negatively correlated with severity of CD, but not with GMFCS level. Screening for dysphagia may be recommended in adults with DCP and severe CD.

G-POEM - Gastric Peroral Endoscopic Myotomy as a Therapy Option for Chronic Gastric Emptying Disorders

Many doctors and patients shy away from the surgical intervention of a pyloromyotomy using laparoscopy. The effectiveness of botulinum toxin injections into the pylorus has not been established 1 2. Pharmacological therapeutic approaches are unsatisfactory and show a wide range of side effects 3. G-POEM is a procedure that has proven its feasibility with a low complication rate. A relatively high response could be documented in previous publications 4. The long-term successes are still being discussed controversially 5. After the initial euphoria, the problem of patient selection comes to the fore. The symptoms, as well as the pathophysiology of gastric emptying disorder, are diverse 6. The diagnostic tests available do not reflect the variability of the disease 7 8 9 10. The postoperative gastric emptying disorder seems to be an exception. G-POEM can protect both therapists and patients from another invasive procedure.

Evaluating the Effects of Botulinum Toxin Injection and Physiotherapy on Post-Stroke Patients During One Year Observation - a Pilot Study

Introduction: Stroke is a serious health problem in the modern population. Spasticity is one of the consequences of stroke and affects about 30% of people. Increased muscle tone affects postural control disorders. Due to the specificity of spasticity, therapy in post-stroke patients is a challenge for neurological physiotherapy. Therefore, it requires the development of appropriate management standards . Study aim: The aim of the study was to evaluate the effectiveness of 3 combination therapy cycles based on botulinum toxin injection and physiotherapy for muscle tone, muscle strength and postural stability in post-stroke patients qualified for the spasticity treatment programme of the lower and upper limbs. Material and methods: The pilot study involved 12 patients (6 from the lower limb and 6 from the upper limb programme). The 1-year combination therapy programmes included 3 botulinum toxin injections and 3 weeks of physiotherapy after each injection. Clinical evaluation was conducted before and after the 1-year observation cycle. The results were evaluated using: MAS (Modified Ashworth Scale), MRC (Medical Research Council Scale) and posture stability test on a balance platform (BiodexSD). Results: A decrease was observed in muscle tone of the lower and upper limbs, as well as an increase in muscular strength of the upper limb. However, there were no noted statistical significance of the studied parameters. Conclusions: Physiotherapy in combination with the botulinum toxin is an important element of improvement in post-stroke patients. However, further research is needed to explicitly confirm its effectiveness.

Periorbital injections of botulinum toxin a: a novel therapeutic option for convergence spasm in neuropsychiatric disorders

PurposeConvergence spasm (CS, spasm of near reflex) is characterized by transient attacks of convergence, miosis and accommodation, often associated with functional neurological disorders. To date, no simple and efficient treatment option is available for CS. This study investigates whether periorbital botulinum toxin injections as used in essential blepharospasm are also a treatment option in these patients.MethodsAll patients with convergence spasm having been treated with periorbital BoNTA injections in the department of neuro-ophthalmology were identified. Data were extracted from patient files concerning details and subjective effectiveness of botulinum toxin injections and relation to psychiatric or neurological disorders. Patients reporting with a history of closed-head trauma or organic neurologic pathologies possibly causing CS were excluded. A telephone assessment with a standardized questionnaire was performed to evaluate mental health issues as a trigger, as well as the long-term effect and satisfaction with periorbital injections.ResultsOf 16 patients treated with periorbital botulinum toxin injections for convergence spasm, 9 patients reported depression and/or anxiety disorders ongoing or in the past. A median number of 3 injections (range 1–13) was administered with a variable effect (relief of symptoms) between no effect and effect of up to more than 12 weeks. A longitudinal follow-up revealed ongoing symptoms in five patients.ConclusionsPeriorbital botulinum toxin injections are less invasive than injections in the medial rectus muscle and can be a bridging therapeutic option in patients with CS. Mental health exploration is important due to psychiatric comorbidity.