Efficacy Of Botulinum Toxin Therapy Research Articles

Does Botulinum Toxin Therapy Improve Quality of Life in Patients with Facial Palsy?

To review the current literature for the efficacy of botulinum toxin therapy to improve quality of life in patients with facial palsy. A comprehensive systematic literature search was performed of the Medline, EMBase, PubMed and Cochrane Library databases. The population of interest was patients with facial palsy and the intervention of interest was botulinum toxin injection. The primary outcome of this review was quality of life outcomes before and after treatment. Six studies were included for review. Outcome data were not amenable to meta-analysis due to the heterogeneity of outcome measures. There was an overall trend towards improvement in quality of life after botulinum toxin therapy with the majority of studies demonstrating a statistically significant benefit. The aspects of life in which patients saw benefit varied amongst studies. No patient factors were identified to predict which sub-cohort would likely have the greatest benefit from therapy. Two studies reported adverse effects to be common however minor in nature. This review presents contemporary evidence that botulinum toxin is of benefit to the quality of life of patients with facial palsy. Additional larger randomised control trials would aid clinicians in quantifying the benefit of such therapies for patients with facial palsy. 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 .

Botulinum toxin for the treatment of strabismus.

Botulinum toxin for the treatment of strabismus.

The features of botulinum therapy for different patterns of poststroke spasticity

To assess the efficacy of botulinum toxin therapy for different patterns of poststroke spasticity. Thirty-nine patients with poststroke spasticity were examined. Rehabilitation included 4 treatment courses of inpatient rehabilitation during 9 month usinga multidisciplinary team approach. Botulinum toxin therapy was included in the program. The individual program was developed taking into account the dynamics of a pathological spastic pattern. The transformation of the pathological movement pattern was observed during the rehabilitation using botulinum toxin. The best positive changes, including an improvement of the upper extremity function, walk and a decrease in the degree of paresis, was identified when botulinum toxin therapy was used in early stages of neurorehabilitation (1-3 month after stroke).

Efficacy of botulinum toxin therapy in treatment of myofascial pain.

The present study aimed to assess the efficacy of using botulinum toxin (BTX) in temporomandibular joint disorders, particularly pertaining to myofascial pain from masseter and temporal muscles. The study included 11 patients who were diagnosed with masseter and temporalis myofascial pain. Visual analog scale for pain and pressure algometry were conducted initially, after 1 month of conservative therapy (control group), and after 1 month of BTX type A injections (study group). Data were statistically analyzed (analysis of variance and Wilcoxon's test) to determine intergroup differences. Both conservative therapy and BTX injections showed reduction in pain scores and increase in pain threshold compared with baseline, and statistically significant differences were noted between both groups. Thus, BTX injections appear to be effective in management of chronic myofascial pain targeting masseter and temporalis muscles.

The efficacy of botulinum toxin therapy in patients with upper limb spasticity due to traumatic brain injury

Spasticity is a type of muscle hyperactivity that occurs in patients after focal lesions of the Central nervous system due to various diseases: stroke, traumatic brain injury or spinal cord injury, neurosurgical intervention, as well as multiple sclerosis and other diseases of the Central nervous system and is the most disability manifestation of the syndrome of upper motor neuron (UMNS). Focal spasticity of the upper limb requires a complex treatment. Botulinum toxin therapy is an effective treatment for focal/multifocal spasticity in reducing muscle tone and improving function with the highest level of evidence according to the latest American and European guidelines for treatment of spasticity. There are many publications devoted to BTA use in post-stroke patients. This article provides a review of the BTA use in patients with the upper limb spasticity due to severe traumatic brain injury. Some local data on the BTA efficacy in the cohort of patients with traumatic brain injury are also presented.

Very early reduction in efficacy of botulinum toxin therapy for cervical dystonia in patients with subsequent secondary treatment failure: a retrospective analysis

The objective of this study was to estimate the probability of development of partial secondary treatment failure (PSTF) in patients with cervical dystonia (CD) who had been treated over up to 9 years with repetitive intramuscular injections of botulinum neurotoxin type A (BoNT/A). The temporal course of treatment response in patients in whom PSTF was detected retrospectively was compared to patients with a normal clinical response. For this purpose, charts of all CD patients treated in our outpatient clinic between 1988 and 2001 were retrospectively analyzed. Extracted data included time of all injections, dose per visit, disease severity measured by TSUI scores, and time of determination of neutralizing antibodies. Final data analysis using a special formal definition of PSTF was based on charts of 568 patients having exclusively been treated with abobotulinumtoxinA. PSTF onset was observed in our CD cohort during the entire treatment period analyzed, with no clustering at any time point. Probability to develop PSTF was 14.5 % in 9 years. Thus, mean PSTF incidence was 1.6 % per year. The mean TSUI score of patients with retrospectively defined PSTF (n = 33) became already significantly worse after the second injection when compared with the group without PSTF (n = 535). Our data indicate that clinical response in patients developing PSTF later on differs from that of patients without PSTF already very early in the course of botulinum neurotoxin type A treatment, and that PSTF remains undetected at this early stage. Reduced response may therefore be present in a number of CD patients who think they still respond normally to continuous BoNT/A treatment.

Efficacy of botulinum toxin in treatment of spasmodic dysphonia

Spasmodic dysphonia (SD) is disabling speech disturbance caused by involuntary contractions of the vocal folds. Surgical treatment and oral medication provide unsatisfactory results. The first choice treatment is represented by local injections of botulinum toxin that provide improvement in up to 80% of the patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in a series of patients with SD followed at our center. We treated 10 patients with adductor SD. After diagnostic procedures, botulinum toxin was applied either unilaterally or bilaterally in the vocal folds, in doses of 12–16 units each. Voice and speech analysis was performed prior and after treatment using a structured scale for voice and speech abnormalities occurring in SD. The majority of patients experienced both subjective and objective improvement. Quality of life improvement was rated as highly significant ( t =3.562; p =0.006). Functional voice improvement was facilitated by speech therapy and psychotherapy. Speech therapy included structured vocal techniques to reduce the degree of vocal tension and rapid changes in voice power and pitch. Currently, there is no standardized procedure for a comprehensive treatment of SD that requires a multidisciplinary approach.

Safety and Efficacy of Botulinum Toxin Therapy in Otorhinolaryngology: Experience From 1,000 Treatments

The objective of this study was to analyze the safety and efficacy of botulinum toxin (BTX) therapy in a series of 1,000 treatments on 261 consecutive patients at the University Department of Otorhinolaryngology-Head and Neck Surgery, Cologne, Germany. A prospective computer database was analyzed, and all patient charts were reviewed retrospectively. In doing so, the main focus was put on patient characteristics, treatment methods, efficacy, unwanted side effects, and reinjection rate. A total of 16 different indications were treated with BTX belonging to the categories of focal dystonias, focal hyperhidrotic syndromes, and cosmetic dermatology. The overall morbidity was 1.3%, exclusively consisting of minor side effects. These were all reversible and mostly caused by paralysis of adjacent musculature. We did not observe any severe complications. Three (1.2%) patients developed a secondary nonresponse to BTX type A (BTX-A). Their treatment was continued with BTX type B. In 2.8% of treatments, patients thought the clinical effect was weak and returned for reinjection within 4 weeks after the first treatment. The experience from the largest patient series known confirms that BTX-A injections are the therapy of choice for many forms of focal hyperhidrotic syndromes, focal dystonia, and hyperfunctional lines. It is an effective and safe treatment with only minor side effects. For optimal individual results, a thorough documentation of each treatment is necessary. Dosages should be as low as possible to reduce the probability of a patient developing a secondary nonresponse.

Botulinum toxin efficacy in the treatment of patients with spasmodic dysphonia

Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80-100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12-16 units each. In our study we applied indirect technique originally developed by Hocevar and Pirtosek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index--(VHI) that was rated as rather significant one (t = 3.562; p = 0.006). Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation.

Botulinum Toxin Injections for Spasticity

Spasticity is velocity-dependent increase in the muscle tone and is usually accompanied by paresis and other signs collectively called the upper motor neuron syndrome. This syndrome results from damage to descending motor pathways at cortical, brainstem or spinal cord levels. Spasticity can vary in severity, can be static or dynamic in nature and may wax and wane over time. Spasticity can be very debilitating for the patient and therefore many therapeutic and medical interventions are used in combination to attenuate its effects. Botulinum toxin injections are safe and effective in the treatment of spasticity. This paper examines the clinical evidence of efficacy of botulinum toxin therapy in the treatment of spasticity, reviews the mode of action of botulinum and focuses on the practical aspects of the use of these injections in the management of spasticity.