Botulinum Research Articles

Botulinum toxin A dampened inflammatory response in BV-2 microglial cells

Our previous studies have demonstrated the analgesic effects of botulinum toxin type A (BoNT/A) in a pre-clinical model of rheumatoid arthritis of the temporomandibular joint, where we proposed that BoNT/A decreases the neurogenic milieu after reaching the subnucleus caudalis. However, it is unknown whether BoNT/A directly regulates microglial cell activity. Therefore, the present study investigates the effects of BoNT/A on a microglial murine cell lineage (BV-2) in different inflammatory conditions. Cellular viability and proliferation were carried out with different concentrations of BoNT/A (ranging from 0.3125 to 20 U/mL) for 24 h. Cells were primed with carrageenan (300 μg/mL) or Lipopolysaccharides (LPS) (20 ng/mL). The gene expression of IL-1β, IL-6, IL-18, TNF-α, Ikkβ, p65, Iba1 were quantified using PCR-RT. The supernatant was used to determine IL-1β, IL-6, and TNF-α levels. For all data, the significance level was set at 5%. Overall, data analysis revealed that BoNT/A 1.25 U/mL exhibited the greatest effect cell viability and proliferation. In addition, genes associated with inflammatory response in both stimuli (carrageenan and LPS) were downregulated in the presence of BoNT/A. Lastly, BoNT/A mitigates the protein levels of IL-1β and TNF-α in a time and dose-dependent manner. In conclusion, our results revealed that BoNT/A directly modulates the microglial cells' activities in an inflammatory context, opening new perspectives for using BoNT/A, considering its potential immunomodulatory effect.

Leveraging ChatGPT for Enhanced Aesthetic Evaluations in Minimally Invasive Facial Procedures.

In recent years, the application of AI technologies like ChatGPT has gained traction in the field of plastic surgery. AI models can analyze pre- and post-treatment images to offer insights into the effectiveness of cosmetic procedures. This technological advancement enables rapid, objective evaluations that can complement traditional assessment methods, providing a more comprehensive understanding of treatment outcomes. The study aimed to comprehensively assess the effectiveness of custom ChatGPT model, "Face Rating and Review AI," in facial feature evaluation in minimally invasive aesthetic procedures, particularly before and after Botox treatments. An analysis was conducted on the Web of Science (WoS) database, identifying 79 articles published between 2023 and 2024 on ChatGPT in the field of plastic surgery from various countries. A dataset of 23 patients from Kaggle, including pre- and post-Botox images, was used. The custom ChatGPT model, "Face Rating & Review AI," was used to assess facial features based on objective parameters such as the golden ratio, symmetry, proportion, side angles, skin condition, and overall harmony, as well as subjective parameters like personality, temperament, and social attraction. The WoS search found 79 articles on ChatGPT in plastic surgery from 27 countries, with most publications originating from the USA, Australia, and Italy. The objective and subjective parameters were analyzed using a paired t-test, and all facial features showed low p-values (<0.05). Higher mean scores on features such as the golden ratio (mean = 5.86, SD = 0.69), skin condition (mean = 3.78, SD = 0.73), and personality (mean = 5.0, SD = 0.79) indicate positive shifts after the treatment. The custom ChatGPT model "Face Rating and Review AI" is a valuable tool for assessing facial features in Botox treatments. It effectively evaluates objective and subjective attributes, aiding clinical decision-making. However, ethical considerations highlight the need for diverse datasets in future research to improve accuracy and inclusivity. 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 .

Correlation between blepharospasm and psychological diseases: the anxiety, depression and sleep disorder study.

To investigate the relationship between benign essential blepharospasm (BEB) symptoms and depression/anxiety/sleep disorder in a prospective manner and to determine whether treatment the BEB with botulinum toxin type A (BoNT/A) can impact psychological symptoms. This prospective interventional case series recruited 61 adults with evidence of BEB. Patients were administered the Jankovic Rating Scale (JRS), the Blepharospasm Disability Index (BSDI), Personal Health Questionnaire Depression Scale (PHQ-8), Generalized Anxiety Disorder 7-item scale (GAD-7) and the Athens insomnia scale (AIS) to evaluate the severity of BEB symptoms, depression, anxiety and sleep disorder before and 1wk, 1, 3mo after the BoNTA treatment. Statistical analysis was performed to assess the relationships between changes in the survey scores. The mean score for JRS, BSDI, PHQ-8, and GAD-7 improved significantly (P<0.0001), respectively, compared to the initial visit at follow-up. At baseline, worse BSDI scores were correlated with worse GAD-7 and PHQ-8, but not with worse AIS. At 1mo follow-up visit, there was no correlation between change in BSDI and PHQ-8/AIS, the change in GAD-7 showed a mild association with change in BSDI. The change in BSDI was correlated with the change in both PHQ-8 and GAD-7 in the subgroup of patients without a prior diagnosis of depression or anxiety. Patient satisfaction with BoNT/A treatment reached the highest at 1mo of follow-up (83.6%, 51/61). BEB may lead to psychological diseases. BoNT/A can significantly improve motor and non-motor symptoms of BEB, which emphasize the effectiveness of BoNT/A and therefore pave the way for its use in the field of psychiatry. However, further research is needed to confirm these findings and understand the underlying mechanisms.

Evaluating the Efficacy and Safety of Botulinum Toxin in Treating Overactive Bladder in the Elderly: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials.

Overactive bladder (OAB) significantly impairs quality of life in the elderly. Although the intradetrusor injection of botulinum toxin type A (BoNT-A) is a treatment option, its effects on older adults remain uncertain. This study aimed to evaluate the efficacy and safety of BoNT-A intradetrusor injections in elderly OAB patients through a systematic review and meta-analysis. A comprehensive literature search was conducted using the PubMed, Embase, Cochrane Library, Scopus, and CINAHL databases from inception to 30 May 2024. The primary outcomes were improvements in daily urinary incontinence (UI) episodes and patient-reported outcomes, while the secondary outcomes focused on potential adverse events. Four randomized controlled trials with 803 participants were included. BoNT-A injections significantly reduced daily UI episodes at 4-6 weeks (mean difference [MD]: -3.82; 95% confidence interval [CI]: -6.29 to -1.35) and at 12 weeks (MD: -2.17; 95% CI: -3.22 to -1.12). However, BoNT-A was associated with an increased risk of elevated post-void residual (Risk Difference [RD]: 0.154; 95% CI: 0.058 to 0.251) and urinary tract infection (RD: 0.111; 95% CI: 0.005 to 0.217), with no significant difference observed in the initiation of catheterization or hematuria. Trial sequential analysis confirmed a sufficient sample size and statistical power. In conclusion, while BoNT-A effectively manages OAB in the elderly, careful post-injection monitoring is warranted due to its potential risks.

Efficacy and safety of sequential treatment with botulinum toxin type A, fractional CO2 laser, and topical growth factor for hypertrophic scar management: a retrospective analysis

Hypertrophic scars arise from aberrant wound healing and can lead to functional and aesthetic impairments. One of the common interventions for treating hypertrophic scars is fractional carbon dioxide (CO2) laser, which employs narrow laser beams to stimulate dermal collagen deposition. Recent studies and reports have suggested that combining laser therapy with other interventions such as botulinum toxin type A (BTX-A) and topical growth factors may enhance treatment outcomes. Here, we examine the efficacy and safety of a sequential combination of BTX-A, fractional CO2 laser, and topical growth factors, referred to as combined therapy, for treating hypertrophic scars compared with only using fractional CO2 laser and topical growth factors, referred to as monotherapy. Our retrospective study includes 128 patients with hypertrophic scars (56 underwent monotherapy and 72 underwent combined therapy), which were followed-up for up to 15 months after the initiation of treatment to collect demographic and clinical data. Our analysis showed that the combined therapy significantly outperformed monotherapy in improving Vancouver scar scale scores (P < 0.05) and in the reduction of scar thickness (P < 0.05), without increasing adverse complications. Repeated treatments further augmented the efficacy of the combined therapy. Subgroup analysis revealed that combined therapy was notably more effective in reducing Vancouver scar scale scores and scar thickness in early-stage scars compared to late-stage (P = 0.023 and P = 0.045, respectively). Our study suggests that including BTX-A treatment before fractional CO2 laser and topical growth factors offers superior efficacy in reducing hypertrophic scars. We encourage early intervention and repeated treatments for optimal treatment outcomes.

Botulinum Toxin for the Treatment of Raynaud's Conditions of the Hand: Clinical Practice Updates and Future Directions.

Raynaud's conditions of the hand, referred to commonly as Raynaud's phenomenon, both primary and secondary, represents a spectrum of disorders affecting the digits, characterised by recurrent episodes of vasospasm that result in a triad of symptoms: pain, pallor, and cyanosis. Various therapies, ranging from conservative hand therapy techniques to surgical sympathectomy, have been explored with inconsistent results. Recently, the local administration of botulinum toxin type-A (BTX-A) has re-emerged as a treatment option for this condition. This review delves into the mechanistic pathways of BTX-A therapy, optimal dosing concentrations, administration techniques, and its safety profile. A critical analysis of published studies to date demonstrates varied clinical efficacy of BTX-A in Raynaud's conditions based on patient-reported outcome measures and objective measures of outcomes assessment. Thus, in order to accurately assess the clinical effectiveness of BTX-A in future robust studies, this review emphasises the importance of streamlining patient selection to minimise heterogeneity in disease severity, optimising recruitment to ensure adequate statistical power, and establishing sensitive outcome measures to monitor response and discern treatment efficacy. Additionally, addressing concerns such as minimising antibody resistance, extending the duration of treatment effects on tissues, and exploring new modalities to assess hand perfusion will be focal points for future research and BTX-A drug development.

Systematic Review: Keloid and Hypertrophic Scar Management Updates

Keloids and hypertrophic scars pose significant challenges in clinical management due to their propensity for recurrence and their impact on patient’s quality of life. This systematic review evaluates the efficacy of various treatment modalities for these scars, with an emphasis on clinical outcomes, symptom alleviation, and recurrence rates. A comprehensive literature search identified studies published between 2014 and 2024, encompassing randomized controlled trials and observational studies. Results indicate that advanced therapies, such as botulinum toxin type A (BTX-A) and platelet-rich plasma (PRP), exhibit superior outcomes compared to traditional treatments, including triamcinolone acetonide (TAC), particularly concerning scar appearance and safety profiles. Furthermore, combination therapies, such as intralesional cryotherapy and CO2 fractional laser with intense pulsed light (IPL), demonstrated promising results in enhancing scar reduction and patient satisfaction. This review underscores the necessity of personalized treatment strategies tailored to individual patient requirements, taking into account factors such as scar characteristics and skin types. Future research should concentrate on optimizing treatment regimens to maximize efficacy while minimizing adverse effects, thereby ensuring long-term success in the management of keloids and hypertrophic scars.

Longitudinal Goal Attainment With Repeat Injections of AbobotulinumtoxinA in Adults With Lower Limb Spasticity: Results From a Prospective Observational Study

ObjectiveTo assess longitudinal goal attainment with repeat abobotulinumtoxinA (AboBoNT-A) injections for lower limb spasticity (LLS) over 16 months. DesignProspective, longitudinal, international, multicenter, observational study (NCT04050527). SettingSpecialist neurorehabilitation centers. ParticipantsAmbulatory adults with unilateral LLS able to take ≥5 steps with/without assistance (effectiveness population, N=384). InterventionsParticipants received ≥1 AboBoNT-A treatment cycle administered in accordance with local prescribing guidelines to achieve individualized treatment goals. Main Outcome MeasuresThe primary endpoint was goal attainment as assessed using the cumulated Goal Attainment Scaling-Leg (GAS-leg) T score, across all treatment cycles for each patient. ResultsOverall, participants underwent a median of 5 lower limb injection cycles (median dose 600U, range 100-1475U) with a mean±SD injection interval of 18.3±6.1 weeks. Participants generally achieved their goals as expected over repeated cycles; the mean (95% CI) GAS-leg T score at cycle 1 baseline was 38.0 (37.7, 38.3) and the mean cumulated GAS-leg T score at 16 months was 48.2 (47.4, 48.9) (mean change from a baseline of 9.9 [9.1, 10.7]). Participants injected with a guidance technique at baseline were more likely to attain their cycle 1 primary treatment goals (odds ratio: 1.9 [95% CI 1.1, 3.1], P=.02). Overall, 56 (13.5%) participants reported ≥1 adverse event, of which 6 participants (1.4%) had a treatment-related adverse event. ConclusionsFindings from this large, international study provide evidence for the benefit of repeated cycles of AboBoNT-A for LLS. Multivariate analyses indicated that goal attainment during the first cycle was better with those injected using injection guidance than those injected without guidance.

MANEJO DO SORRISO GENGIVAL ATRAVÉS DO USO DA TOXINA BOTULÍNICA TIPO A

An aesthetically pleasing smile results from the combination of several factors, such as the position, size, shape, and color of the teeth, as well as the exposure and characteristics of the gingival tissue. When evaluating the gingival tissue in a smile, several important factors must be considered: excessive vertical growth of the maxilla, reduced length of the upper lip, excessive contraction of the upper lip, and disproportion between the length and width of the clinical crown of the anterior teeth. A minimally invasive approach that can be used as a complement to dental treatment is the application of botulinum toxin, a neurotoxin produced by the anaerobic bacterium Clostridium botulinum. This toxin blocks the release of acetylcholine in the presynaptic vesicles of neuromuscular junctions, inhibiting muscle contraction. The aim of this literature review was to analyze the use of botulinum toxin type A (BTX-A) in the management of gummy smile. The search was conducted in the databases Google Scholar, PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO). The descriptors used for the search were "botulinum toxin," "gingiva," "periodontology," and "dental aesthetics," combined using the boolean operators AND and OR. Although the evidence demonstrates favorable results, the use of botulinum toxin to correct gummy smile has limitations. It is a temporary solution, and patients should be informed about the need for periodic reapplications and the potential side effects, such as facial asymmetries. The reviewed studies indicate that this technique is particularly effective in cases of gummy smile resulting from hyperactivity of the upper lip elevator muscle, providing a significant reduction in gingival exposure, with results lasting up to 12 weeks. The combination of different therapeutic approaches, along with a careful evaluation of the causes of gummy smile, allows dental professionals to offer more integrated and personalized solutions for each patient.

Efficacy and Complications of Full Dose versus Half Dose of Botulinum Toxin Type A Injection in Benign Essential Blepharospasm

Objective: To compare the effectiveness, patient satisfaction, and complications associated with pretarsal botulinum toxin type A (BTX-A) injections using half versus full doses of benign essential blepharospasm (BEB). Materials and Methods: A prospective double-masked randomized control trial was conducted in 20 patients. Each patient was randomized to receive either 40 or 80 units of BTX-A injections at Thammasat Hospital between April 2022 and August 2023. The primary outcome measures were frequency and severity using the Jankovic Rating Scale (JRS), latency to response, self-response scale, and patient satisfaction scale at four weeks and 12 weeks post-injection. The secondary outcome measures were complications of injection in each visit. Results: There were no significant differences between the groups receiving half-dose and full-dose BTX-A injections in the self-response scale at 2.60±0.52 versus 2.00±1.15, (p=0.277), patient satisfaction scale at 8.30±1.57 versus 7.00±1.49, (p=0.063) at four weeks and JRS frequency at 1.00±0.82 versus 1.20±0.92, (p=0.687), JRS severity at 1.30±1.16 versus 1.40±0.97, (p=0.784), latency to response at 5.80±1.99 versus 6.80±1.93, (p=0.214), self-response scale at 2.70±0.48 versus 2.20±0.63, (p=0.067), and patient satisfaction scale at 8.10±1.60 versus 8.30±1.49, (p=0.776) at 12 weeks. Complications, including epiphora, dry eye, and lagophthalmos, were observed in both groups. Conclusion: The present study indicated no significant differences between half-dose and full-dose BTX-A injections. Either dose showed comparable efficacy and safety in treating BEB. Trial registration: The present study protocol was registered at the Thai Clinical Trials Registry (TCTR20240320002; date March 20, 2024).

Dysphagia and Muscle Weakness Secondary to Botulinum Toxin Type A Treatment of Cervical Dystonia: A Drug Class Analysis of Prescribing Information.

The first-line management of cervical dystonia (CD) symptoms is intramuscular injection of botulinum toxin type A (BoNTA). However, a comparison of safety among BoNTAs is difficult because, per regulatory authorities, units of BoNTA activity are not interchangeable. Dysphagia and muscle weakness are widely considered two key adverse events to monitor closely in the treatment of CD. This integrated analysis compared the safety of BoNTAs approved for CD in the US by evaluating relationships between the incidence of dysphagia and muscle weakness in prescribing information and the core neurotoxin content. Coefficients The coefficients of determination (R2) and trendlines were estimated via regression-based lines of best fit. Adverse drug reaction (ADR) rates were strongly correlated with core neurotoxin amounts for conventional BoNTAs (slope coefficients: dysphagia = 0.048, R2 = 0.74; muscle weakness = 0.096, R2 = 0.82). The published ADR rates at approved doses for conventional BoNTAs were higher compared with DaxibotulinumtoxinA (DAXI; DAXXIFY®, Revance Therapeutics, Inc., Nashville, TN, USA) by core neurotoxin content. The use of a core neurotoxin amount was found to be an effective method for comparing the safety of BoNTA products. Current clinical trials suggest that DAXI, a novel BoNTA formulation, provides a potentially wider safety margin compared with other approved BoNTAs for CD. The lower amount of core neurotoxin administered at approved doses compared with conventional BoNTAs may explain low on-target ADRs like muscle weakness, whereas reduced diffusion from the injection site is thought to be responsible for low off-target ADRs like dysphagia.

Dose-Effect Relationship of Botulinum Toxin Type A in the Management of Strabismus: A Review.

Botulinum toxin type A (BTXA) is a well-accepted non-surgical therapy for strabismus. However, its dose and technique vary widely. We reviewed published evidence on the dose effect of BTXA in treating various types of strabismus.Articles on BTXA therapy outcomes were reviewed to study doses and brands of BTXA used and their efficacy for specific types of strabismus. Researchers indicated that greater dosages may be used safely without increasing the risk of complications.The review suggested a positive dose-response relationship of BTX to success but with a higher risk of complications. No single dose of BTX could be recommended for strabismus management.

OnabotulinumA toxin injections: A novel option for management of refractory nocturnal enuresis

While not entirely understood, nocturnal enuresis (NE) has been considered pathophysiologically distinct from other non-neurogenic voiding disorders. We believe that a significant component of the pathology is due to bladder overactivity. Intravesical Onabotulinumtoxin A (OBTA) injections are utilized in overactive bladder management. We hypothesized that OBTA injections would be efficacious for NE management in pediatric patients with symptoms refractory to conventional therapies. A retrospective cohort analysis of patients <18-years-old with primary NE who underwent OBTA injections was performed. Injections were performed by a single surgeon at a single tertiary referral center per standardized protocol. Treatment response was defined as no improvement, greater than 50% improvement in nightly accidents, or complete resolution of accidents. The primary outcome was treatment success, defined as greater than 50% improvement in nightly accidents or complete resolution. Secondary outcomes included treatment response duration and complication data. Descriptive and bivariate statistics were performed as indicated. A Kaplan Meier analysis was performed to assess failure free survival following OBTA injection. Fifty patients met inclusion criteria for this analysis. All patients had trialed at least one lifestyle modification, a bowel regimen, and at least two medications with symptom persistence. The median post-procedure follow-up time was 9.5 months (range 2-82). Improvement in incontinence symptoms compared to pre-operative baseline was seen in 94.0% of patients, with 58.0% demonstrating complete resolution of incontinence through most recent follow up. There was no difference in improvement rates or resolution rates in male vs female gender. The median failure free survival identified on Kaplan Meier analysis was 12.5 months (Figure1) Minor post-operative complications (4 urinary tract infections; 1 retentive episode necessitating catheterization) were identified in five patients. There were no major post-operative complications. Efficacy of OBTA injections was high, with treatment success demonstrated in 94% of patients and failure free survival of 12.5 months. This procedure also demonstrated a favorable safety profile, with few minor post-operative complications identified. These results indicate that this procedure may be a beneficial therapeutic option for patients with NE refractory to multiple lines of conventional therapy. This study is limited by its retrospective design with short median follow up and potential for recall bias. It is strengthened by its large sample size and novelty. To our knowledge, this is the first analysis of the efficacy of OBTA injections for management of primary NE. A follow up clinical trial is essential to further understand this association.

Reduced Injection Site Pain with Altered pH in 24-h Reconstituted Botulinum Toxin: Findings from a Randomized Controlled Study on Cosmetic Applications.

Botulinum toxin (BTX) injections are widely recognized for many cosmetic applications, but still commonly encounter a challenge: injection site pain (ISP). This discomfort can impact the overall patient experience and satisfaction, highlighting a need for innovative solutions to this problem. This randomized controlled study aimed to determine whether adjusting the pH levels in a 24-h reconstituted botulinum toxin can serve as a strategy to mitigate ISP. A controlled trial involving 24 volunteers was executed. Participants received incobotulinum toxin A. One side of each participant's face was treated with fresh toxin, while the other received a 24-h reconstituted version. Pain perceptions post-injection were assessed using the visual analogue scale (VAS). pH values of the fresh toxin were more acidic (6.17) than the 24-h reconstituted toxin (7.17). Out of 24 patients, 13 reported reduced ISP with the 24-h reconstituted toxin. The mean VAS score for the fresh toxin was 5.92, in contrast to 4.17 for the reconstituted toxin, indicating a significant difference (p<0.01). Limitations include the use of a VAS and a relatively small sample size. Altering the pH of BTX demonstrates potential in ISP reduction. However, broader, large-scale investigations are important for comprehensive validation. 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 management of bruxism: an overview of reviews protocol

IntroductionBruxism is characterised by a repetitive activity in the masticatory muscles that involves teeth clenching or grinding and/or forceful mandibular movements. Its management is typically initiated when individuals start experiencing...

The Efficacy of Botulinum Toxin Type A (BTA) in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Hypertrophic scars cause significant physical and emotional discomfort. Botulinum toxin type A (BTA) has shown promising outcomes in reducing scar formation. Research suggested its effectiveness in managing hypertrophic scars and keloids. This systematic review and meta-analysis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including randomized controlled trials (RCTs). The included studies involved patients with hypertrophic scars treated with BTA. Five databases were searched from inception to August 2024. Studies were screened and selected by two independent reviewers.Data on study design, patient demographics, and interventions was extracted. The risk of bias (ROB) was assessed using the ROB revised tool developed by Cochrane (ROB2). Meta-analysis was performed using RevMan Web (The Cochrane Collaboration, London, UK) with a random-effects model due to high heterogeneity, calculating mean differences for the primary and secondary outcomes. Outcomes included VancouverScar Scale (VSS) scores, scar thickness, vascularity, pliability, and pigmentation. The systematic review identified 182 records from five databases. The screening process resulted in seven studies included in the final analysis after assessment for eligibility. The efficacy of BTA in treating hypertrophic scars and keloids was assessed. The meta-analysis showed that BTA significantly improved VSS scores, with a pooled mean difference of -1.69 (P = 0.01). However, BTA did not show a statistically significant effect on reducing scar height/thickness or improving vascularity. Scar pliability was significantly improved by BTA, with a pooled mean difference of -0.76 (P = 0.002), while there was no significant effect on pigmentation. High heterogeneity was observed across the studies. BTA could be used as an effective treatment for the components of hypertrophic scars and keloids, especially regarding their pliability and improving scar quality. However, for functions such as the change in scar height, vascularity, and pigmentation, more research is still required among larger RCTs. Future research should focus on refining the treatment regimens and the mode of action of BTA to the scar tissue.

Peculiarities of the botulinum toxin type A injection technique and its effectiveness in the surgical treatment of large ventral hernias

Ventral hernias (VH) continue to be one of the most common surgical pathologies in planned and emergency surgery. Surgical treatment of large VH (≥10 cm) requires the use of traumatic surgical techniques in order to align the edges of the hernia defect and restore the integrity of the anterior abdominal wall. Objective — to assess the effectiveness of the botulinum toxin type A (BTA) injections and to study the peculiarities of their administration into the muscles of the anterior abdominal wall in patients with large VH in the preoperative period. Materials and methods. A prospective cohort study included 66 patients with large VH, primary (PVH), and incisional (IH). From June 2017 to August 2024, all patients underwent treatment and received injections of 100 units of BTA into the anterior abdominal wall muscles in the preoperative period. The patients’ average age was 58.98±9.48. There were 23 men (34.8%) and 43 women (65.2%). Before BTA, the average width of the hernial defect in PVH patients was 12.29±1.93 cm, whereas IH was 13.46±2.06 cm. All patients underwent surgical intervention for their hernias 4—5 weeks after the injection of BTA. Results. No complications were detected throughout the BTA administration or the 4—5 weeks of observation before the surgical hernia repair. After injection, the length of the anterior abdominal wall muscles increased by an average of 1.7 cm (min 0.1 cm, max 4.01 cm) on each side. Patients with PVH had an average hernial defect width reduction of 4.17±0.68 cm, whereas those with IH had an average reduction of 5.14±0.75 cm (p &lt;0.001). After BTA administration, the volume ratio of the hernia sac to the abdominal cavity decreased from 4.97±3.55% to 3.70±2.77% in patients with PVH (p=0.008) and from 5.59±3.71% to 4.21±2.88% in patients with IH (p=0.008). Conclusions. The administration of 100 units of botulinum toxin type A in the preoperative period consistenly increases the length of the abdominal wall muscles, reduces the width of the hernial defect, and enhances the possibilities of further surgical treatment of large VH using laparoscopic technologies.

Evaluating the Impact of BoNT-A Injections on Facial Expressions: A Deep Learning Analysis.

Botulinum Toxin Type A (BoNT-A) injections are widely used for facial rejuvenation, but their effects on facial expressions remain unclear. This study aims to objectively measure the impact of BoNT-A injections on facial expressions using deep learning techniques. 180 patients aged 25-60 years who underwent BoNT-A application to the upper face were included. Patients were photographed with neutral, happy, surprised, and angry expressions before and 14 days after the procedure. A Convolutional Neural Network (CNN)-based Facial Emotion Recognition (FER) system analyzed 1440 photographs using a hybrid dataset of clinical images and the Karolinska Directed Emotional Faces (KDEF) dataset. The CNN model accurately predicted 90.15% of the test images. Significant decreases in the recognition of angry and surprised expressions were observed post-injection (p<0.05), with no significant changes in happy and neutral expressions (p>0.05). Angry expressions were often misclassified as neutral or happy (p<0.05), and surprised expressions were more likely to be perceived as neutral (p<0.05). Deep learning can effectively assess the impact of BoNT-A injections on facial expressions, providing more standardized data than traditional surveys. BoNT-A may reduce the expression of anger and surprise, potentially leading to a more positive facial appearance and emotional state. Further studies are needed to understand the broader implications of these changes.

Advancements in pediatric headache.

To provide an update on advancements in pediatric headache. The symptomatology associated with primary headache disorders has been compared with ICHD-3 criteria. Primary stabbing headache pain lasts longer than 3 seconds in over half of patients. Persistent posttraumatic headache or new daily persistent headache have significant overlap in pain character and nonpain-related symptoms with migraine. In a large cohort with continuous headache at first follow-up, 47% reported resolution of their continuous headache and 19.4% had a 50% or greater reduction in frequency with improvements in fluid intake, sleep, not skipping meals, and exercise. There was no correlation with improved lifestyle habits and clinical outcomes despite the overall improvement. Studies noted significant improvement in headache scores with onabotulinum toxin A and incobotulinum toxin A injections with limited side effects. Intranasal sumatriptan without concurrent intravenous therapies found a clinically meaningful decrease in pain score prior to discharge with shorter lengths of stay and lower emergency department costs compared with the those who received intravenous therapies. Newer studies have suggested changes to symptomatology and duration of pediatric headache syndromes. Onabotulinum toxin A and incobotulinum toxin A injections, and emergency department intranasal sumatriptan are well tolerated therapies in pediatric headache.

Onabotulinumtoxin A for the Treatment of Post-Traumatic Headache: Is It Better than Anti-CGRP Antibodies?

Post-traumatic headache (PTH) is a common and debilitating consequence of traumatic brain injury (TBI), often resembling migraine and tension-type headaches. Despite its prevalence, the optimal treatment for PTH remains unclear, with current strategies largely extrapolated from other headache disorders. This review evaluates the use of onabotulinumtoxin A (ONA) and anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) in the treatment of PTH. A comprehensive literature search was conducted on PubMed, including studies published up to September 2024, focusing on the efficacy, safety, and mechanisms of onabotulinumtoxin A and anti-CGRP mAbs in PTH. Both clinical trials and observational studies were reviewed. ONA, widely recognized for its efficacy in chronic migraine, has shown limited benefits in PTH with only one trial involving abobotulinumtoxin A in a cohort of 40 subjects. A phase 2 trial with fremanezumab, an anti-CGRP monoclonal antibody, failed to demonstrate significant efficacy in PTH, raising questions about the utility of targeting CGRP in this condition. ONA may offer advantages over anti-CGRP mAbs, not only in terms of its broader mechanism of action but also in cost-effectiveness and higher patient adherence. Both ONA and anti-CGRP mAbs are potential options for the management of PTH, but the current evidence is insufficient to establish clear guidelines. The negative results from the fremanezumab trial suggest that CGRP inhibition may not be sufficient for treating PTH, whereas onabotulinumtoxin A's ability to target multiple pain pathways may make it a more promising candidate.