Injections Of BTX Research Articles

Repeated unilateral injections of botulinum toxin in masticatory muscles in adult rats do not amplify condylar and alveolar bone loss nor modify the volume of the hypertrophic bone proliferation at enthesis

ObjectivesBotulinum toxin is used in human in repeatedly masticatory muscles injections. A single BTX injection in animal induces mandibular bone loss with a muscle enthesis hypertrophic metaplasia. Our aim was to evaluate mandibular bone changes after unilateral repeated injections of BTX in adult rats. Study designMature male rats were randomized into 3 groups: one, two or three injections. Each rat received injections in right masseter and temporalis muscles. The left side was the control side. Microcomputed tomography was used to perform 2D and 3D analyses. ResultsBone loss was evidenced on the right sides of alveolar and condylar bone. Alveolar bone volume increased in both control left side and injected right side whereas condylar bone volume remained constant in all groups, for both sides. Enthesis bone hypertrophic metaplasias were evidenced on the BTX injected sides without any modification with the number of injections. ConclusionBTX repeated injections in masticatory muscles lead to major mandibular condylar and alveolar bone loss that does not worsen. They lead to the occurrence of an enthesis bone proliferation that is not dependent on the number of injections. These results are an argument for the safety of BTX injections in masticatory muscles in human.

Expression of Ki67 in submandibular salivary glands of rabbits after BTX injection: Histological and immunohistochemical study

This study aimed to examine the possible histological effects of local injections of BTX in rabbits submandibular SGs and to find the dose-dependent and time relationship between injections and study immunohistochemistry expression of Ki67. Thirty male rabbits randomly divided into 3 groups (10 rabbits for Each) 1st group: control (without treatment), 2nd group treated with 5U of BTX and 3rd group treated with 10U of BTX, five animals of each group were sacrificed in 1st week of treatment and another five animals sacrificed in 4th week of treatment. The rabbit was anesthetized then injected with the BTX in the gland. The histopathological changes in Group 5, 10 Unit BTX (1st week) were vacuolar degeneration of mucous acini cells, degeneration of serous acini cells, while the lesions showed hyperplasia and necrosis of epithelial cells lining striated ducts, necrosis of serous acini epithelium. The Diameter of mucous acini were found to be significantly increased in 10 Unit BTX groups. During the 1st and 4th weeks, the surface area of the striated ducts in the 5- and 10-unit BTX groups increased significantly, and the number of striated ducts in the 10 Unit BTX group decreased significantly when compared to the 1st week period of the same group. BTX groups revealed moderate to weak positive cytoplasmic reactivity for Ki67 protein in the parenchymal tissue of the glands. We conclude that BTX causes histological changes in the salivary gland as well as affecting Ki67. This data could be used in a future study to investigate the usage of BTX in cancer treatment.

Efficacy of Botulinum Toxin A for Scar Prevention After Breast Augmentation: A Randomized Double-Blind Intraindividual Controlled Trial.

Botulinum toxin A benefits postsurgical scar prevention by reducing wound edge tension and inhibiting in vitro scar tissue fibrosis. To investigate the efficacy of botulinum toxin Type A (BTX) in improving inframammary scar appearance after primary breast augmentation. A prospective, double-blinded, randomized controlled trial was performed with 27 participants receiving primary augmentation mammoplasty with inframammary incisions. After skin closure, intradermal injections of BTX were administered to 1 (treated) side of the inframammary incision. The contralateral side was the control. Scars were evaluated at 3 months, 6 months, and 9 months using the Patient and Observer Scar Assessment Scale and multispectral imaging analysis. Overall, 22 patients completed the study. There were no significant subjective differences between the treated and control sides except the patient's treated side had significantly higher scores than the control side at 9 months. The treated side showed significantly smaller scar widths at 6 months and 9 months (p < .001) and better scar surface textures at 9 months (p = .003) than the control side. Subjectively, intradermal BTX injection immediately after breast augmentation skin closure caused no significant differences. Objectively, scar width and texture significantly improved at 6 months and 9 months.

Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

BackgroundAdverse effects of masticatory muscle injections of Botulinum Toxin (Btx) have been noted in animal and, less dramatically, human studies.ObjectiveAmong women treated in multiple community‐based private practices, to compare TMJ bone density and mandibular condylar volume between patients with myofascial TMJD receiving multiple masticatory muscle Btx treatments and similarly diagnosed women not receiving such treatment.MethodsCohorts consisted of women whose treatment charts indicated a diagnosis of myofascial TMJD: 35 received at least 2 Btx treatment cycles; 44 received none. Bone density at pre‐specified regions of interest (ROI) was defined by grey scale values from Cone Beam CT, adjusting for a fixed density phantom included in each scan. Mean bone density and mandibular condyle volume were compared between groups. Dose‐response effects were tested within the Btx‐exposed group.ResultsThe mean density of primary and secondary ROIs was similar between exposure groups, as was condylar volume. Among Btx‐exposed women, increasing dose of Btx to the temporalis muscle was inversely proportional to the density of the trabecular area of the mandible body. Many Btx‐exposed women received smaller doses of Btx to the masseter muscles than in most TMJD Btx clinical trials.ConclusionMasticatory muscle injections of Btx failed to produce clinically significant TMJ bone‐related changes. Should Btx receive regulatory approval for treatment of myofascial TMJD, a phase IV study is recommended to evaluate potential adverse effects of Btx on bone and muscle when administered at higher doses and/or for more treatment cycles.

The impact of botulinum toxin type A in the treatment of drooling in children with cerebral palsy secondary to Congenital Zika Syndrome: an observational study

ABSTRACT Objective The main aim of this study was to determine the impact of botulinum toxin A (BTX-A) on severity and frequency of drooling in children with Cerebral Palsy (CP) secondary to Congenital Zika Syndrome (CZS). Methods This is a prospective longitudinal observational study including 23 children who received bilateral injections of BTX in the parotid and submandibular glands. The Thomas-Stonell & Greenberg Drooling Severity and Frequency Scale was applied by a multidisciplinary team including Speech, Language and Hearing professionals. The Global Impression of Improvement (GII) Scale was also applied to assess parents’ subjective perceptions of therapeutic response. Swallowing was assessed using Doppler ultrasonography. Univariate logistic regression was used to analyse differences between responders and non-responders. Results Participant age varied from 27 to 38 months (mean 31.78, SD = 2.61) all presented with Gross Motor Function Classification System (GMFCS) V. Drooling Severity and Frequency Scale scores ranged from 7 to 9 points (median = 9) prior to BTX administration and from 4 to 6 (median = 6) after. Pre- and post-treatment reduction in drooling severity occurred (Z = −3.746; p < 0.001). No cases of drooling worsening were reported. Only two subjects presented adverse effects attributed to BTX administration. Correlation was only confirmed with GII. Discussion This article presents the safe and positive impact of BTX-A administration guided by anatomical references described in the literature, even on children with microcephaly. Further studies are needed to facilitate the use of Doppler ultrasonography as a tool to characterize changes in sensory processing and motor response following intraoral input in children with CP.

A treatment protocol for botulinum toxin injections in the treatment of pachyonychia congenita‐associated keratoderma

Severely debilitating plantar keratoderma pain is the most distressing clinical feature of pachyonychia congenita (PC). Several earlier publications have reported therapeutic success with plantar injections of botulinum toxin (Btx). To describe our 4-year experience during which we administered a total of 30 plantar Btx injections to five patients with PC following an optimized protocol. Five patients with PC (age 21-54 years) who were treated at our medical centre from April 2015 to June 2018 were included in the study. After an ultrasound-guided nerve block performed by an anaesthesiologist, the patients received plantar intradermal injections of Btx A. To ascertain the effect of the treatment, we used a dedicated quality-of-life questionnaire for patients with PC (PCQoL) and asked the patients to evaluate the intensity of eight parameters pertaining to their symptoms at baseline and before every treatment session. At study closure, patients were asked to evaluate the maximal improvement in the same eight parameters throughout the study period. All patients demonstrated a decrease in PCQoL scores during the follow-up period. All patients showed a significant improvement in PCQoL after the first treatment session and at the last evaluation (P = 0·043). The scores with the best improvement concerned morning feet burning and long-distance walking (> 500 m). The scores were significantly lower if the intervals between Btx injections were <100 days. Btx treatment of PC-associated keratoderma following an optimized protocol leads to a major change in patients' quality of life. What's already known about this topic? Plantar pain is considered by patients to be the most severe and debilitating manifestation of pachyonychia congenita (PC). Over the past few years, a number of reports have shown that plantar injections of botulinum toxin (Btx) reduce or even eliminate pain, blistering and callosities in patients with PC. However, the injection technique, doses of Btx and methods of anaesthesia varied between reports and patients. What does this study add? Here we report our 4-year experience in providing 30 treatments to five patients following an optimized protocol. Btx was found to provide a quantifiable improvement in all patients treated. What is the translational message? Btx treatment of PC-associated keratoderma using a structured approach, which includes the use of a sufficient dose of Btx (200-400 U of onabotulinumtoxinA or 500-1000 U of abobotulinumtoxinA), and regular intervals between treatment sessions (of < 100 days), leads to a major change in patients' quality of life.

Effects of masticatory muscle function affected by BTX on maxillofacial bone growth through the sutural modification.

To evaluate the effect of botulinum toxin type A (BTX)-induced masticatory muscle hypofunction on the maxillofacial suture bone growth of growing rats. Department of Orthodontics at Taipei Medical University. Forty-eight male 4-week-old Wistar rats were divided into four groups. The N group received injections of normal saline into each of the masseter and temporalis muscles. The M group received injections of normal saline into each of the temporalis muscle and injections of BTX into each of the masseter muscle. The T group received injections of normal saline into each of the masseter muscle and injections of BTX into each of the temporalis muscle. The MT group received injections of BTX into each of the masseter and temporalis muscles. Rats were sacrificed after 42days of growth. Changes in body and muscle weight were measured. Anthropometric measurements of the maxillary arch, sutural bone mineral density and sutural bone deposition distances were recorded. Statistical comparisons were performed using analysis of variance. No significant change in body weight was found across groups. However, significant decreases were observed in muscle weight, anthropometric measurements, sutural bone mineral density and bone apposition distance in the BTX-injected group. Reduced masticatory muscle function in growing rats can affect maxillofacial suture bone growth.

Does Adjunctive Botulinum Toxin A Reduce Pain Scores When Combined With Temporomandibular Joint Arthroscopy for the Treatment of Concomitant Temporomandibular Joint Arthralgia and Myofascial Pain?

Currently, there is no standard of care for the treatment of refractory myofascial pain and concomitant temporomandibular joint (TMJ) arthralgia. This comparative study was conducted to determine the effectiveness of botulinum toxin A (Btx), as an adjunct to TMJ arthroscopy, in this patient population. A retrospective cohort study was conducted of patients who underwent TMJarthroscopy with (Btx group) or without (control group) intramuscular Btx for TMJ arthritis and refractory myofascial pain at the University of Michigan (Ann Arbor) from 2011 through 2014. For patients in the Btx group, intramuscular injections of Btx were administered at sites of maximal tenderness within the masseter and temporalis muscles. The primary outcome variable was pain score on the visual analog scale (VAS; 0 to 10). The secondary outcome variables included maximal interincisal opening, total score for sites of tenderness, total number of tender sites, and diet consistency tolerated. Statistical analysis included means and standard deviations, Student t test, simple regression analysis, and multiple regression analysis. The study cohort included 52 patients (30 in Btx group, 22 in control group), of which 48 (92.3%) were women. The mean follow-up was 5.56±1.41months. Patients in the Btx group had a significantly greater decrease in mean pain score (P=.04) on the VAS compared with the control group (score, 3.24 for Btx group; score, 1.13 for control group). On multivariate regression analysis, treatment with Btx trended toward significance (P=.084) and the preoperative pain score (P=.0007) was significantly correlated with the change in pain observed. The use of Btx appears to correlate with a clinically superior decrease in pain score compared with the control group. The use of Btx could be useful as an adjunctive treatment modality in the management of refractory myofascial pain.

VAIKŲ, SERGANČIŲ CEREBRINIU PARALYŽIUMI, ILGALAIKIO GYDYMO BOTULINO TOKSINU POVEIKIS ČIURNOS SĄNARIO JUDESIO AMPLITUDEI IR VAIKŲ MOBILUMUI

Introduction. Spasticity – the basic and the most common clinical syndrome of cerebral palsy. Most of the time child’s functional and movement disorders depend on this. Botulinum toxin is a drug that relaxes muscles by blocking the release of acetylcholine (ACH) in neuro muscular connection and reduces level of spasticity. The short-term effect of BTX has been proven in scientific literature and it is well known. The effect of treatment with BTX –A in a long-term remains insufficiently studied. Purpose. To evaluate the effect on changes in child’s with cerebral palsy conditions of ankle and child’s mobility over the long time (over 1 year) in the treatment with BTX-A. Method. 98 children with cerebral palsy were treated. The main indication for the treatment of BTX- A was a dynamic ankle joint contracture, resulting in functional status or movement disorders. Condition of all children were evaluated 1 month before starting the treatment with BTX; prior to each injection; within 1 – 2 months after the beginning of treatment with Dysport and after 4 months while planning further treatment with botulinum toxin. The passive ROM of child’s ankle joint was assessed with goniometer measuring the ankle of dorsiflexion while stretching the child’s knee. The functional movement of the child was assessed using the GMFM -88 scale. Results. The average age of children after first BTX-A injection was 33.29 ± 16.235 months. The majority of children (n = 45) were mobile belonging to I - II level at the GMFCS and partly mobile belonging to level III (n = 35). The number of injections of BTX –A ranged from 2 to 8 times per child. The data suggest that despite long-term treatment with BTX –A and physical therapy with the increase of child’s age the contracture of the ankle joint forms. In all cases the only criteria which are statistically significant is time. It means that passive changes in ankle joint dorsiflexion depend on its treatment time. Assessment of child’s functional movement with GMFM -88 scale showed that with each injection of BTX –A the functional movement of a child is enhanced. The highest improvement in motion has been established after the sixth injection of botulinum toxin. Conclusion. Treatment with BTX-A doesn’t have an impact on increase of passive amplitude of ankle and it doesn‘t affect the formation of contractures. Functional movements of a child improvement depend on treatment time: the best result was reached after sixth injection of BTX.

MP38-20 THE EFFICACY OF BOTULINUM TOXIN A FOR CONTROL OF URINARY INCONTINENCE IN PATIENTS WITH A SUPRAPUBIC CATHETER

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy II1 Apr 2014MP38-20 THE EFFICACY OF BOTULINUM TOXIN A FOR CONTROL OF URINARY INCONTINENCE IN PATIENTS WITH A SUPRAPUBIC CATHETER Bashir Mukhtar, Shafiul Chowdhury, Mahreen Pakzad, Julian Shah, Jeremy Ockrim, Tamsin Greenwell, and Rizwan Hamid Bashir MukhtarBashir Mukhtar More articles by this author , Shafiul ChowdhuryShafiul Chowdhury More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Julian ShahJulian Shah More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Rizwan HamidRizwan Hamid More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1277AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are a variety of methods for bladder drainage in disease state including suprapubic catheterisation (SPC). A proportion of these patients continue to have urgency related urinary incontinence refractory to antimuscarinics. Intradetrusor Botulinum toxin A (BTX) is an accepted treatment for control of detrusor overactivity (DO). However, the efficacy of BTX in controlling incontinence in patients with SPC is not well documented. We present our experience with BTX in this setting. METHODS We compiled a retrospectively collated database of patients that between September 2012 and September 2013 had undergone intradetrusor injections of BTX into multiple sites of the bladder wall at our institution. 206 patients were identified, of which 16 had SPC as a method of bladder drainage. All but one had urodynamic proven DO with urinary incontinence. 12 had a pre-treatment diagnosis of neuropathic bladder dysfunction, with the majority of these being secondary to multiple sclerosis. 3 had idiopathic bladder dysfunction and 1 had a diagnosis of chronic pelvic pain syndrome. Data on urodynamics results, including evidence of DO, leakage, BTX dose and further treatment, was collected from the trust computer database. Associated complications, improvement in symptoms, duration of cessation of leakage and if subsequent BTX treatment was effective, was collected via clinic letters, repeat urodynamics and subjectively via a telephone interview. RESULTS The mean age of the cohort was 59 years (range; 34-77 years). Gender ratio was 12 females to 4 males (3:1). From our cohort of 16 patients, 10 reported significant improvement in symptoms with quality-of-life improving effects. 3 had no discernable improvement in symptoms. In 3 the result could not be established. 6/10 patients with improvements were cured of incontinence. Indeed, at the time of follow-up, only one had reported a relapse (at 7 months). The others were within 3,3,5,5 and 9 months of their treatment and still asymptomatic for leakage. In those that had repeat BTX within the study time, all (5/5) reported excellent efficacy. Only 1 patient experienced significant discomfort from the treatment, which resulted in cessation of the procedure. No others reported any peri-operative difficulties (15/16). CONCLUSIONS In patients with urodynamic diagnosed DO who have SPC as a means of bladder drainage, and who experience urinary incontinence that is refractory to antimuscuranics, BTX is an effective treatment option, with good tolerability and beneficial effects that appear to be sustained with repeated injections. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e410 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Bashir Mukhtar More articles by this author Shafiul Chowdhury More articles by this author Mahreen Pakzad More articles by this author Julian Shah More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Rizwan Hamid More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Botulinum toxin type A-induced changes in the chemical coding of dorsal root ganglion neurons supplying the porcine urinary bladder

Botulinum toxin type A (BTX) is a potent neurotoxin, which in recent years has been effectively applied in experimental treatments of many neurogenic disorders of the urinary bladder. BTX is a selective, presynaptically-acting blocking agent of acetylcholine release from nerve terminals what, in turn, leads to the cessation of somatic motor and/or parasympathetic transmission. However, application of this toxin in urological practice is still in the developmental stages and the full mechanism of its action remain elusive. Thus, the present study was aimed at investigating the neurochemical characterization of dorsal root ganglion (DRG) neurons supplying the porcine urinary bladder after BTX treatment. Retrograde tracer Fast Blue (FB) was injected into the urinary bladder wall in six juvenile female pigs and three weeks later, intramural bladder injections of BTX (100 IU per animal) were carried out in all the animals. After a week, DRG from L1 to Cql were harvested from the pigs and neurochemical characterization of FB+ neurons was performed using double- labeling immunofluorescence technique on 10-microm-thick cryostat sections. BTX injections led to a significant decrease in the number of FB+ neurons containing substance P (SP), calcitonin gene-related peptide (CGRP), calbindin (CB), somatostatin (SOM) and neuronal nitric oxide synthase (nNOS) when compared with that found in the healthy animals (19% vs. 45%, 18% vs. 36%, 0.6% vs. 3%, 0.4 vs. 4% and 0.1% vs. 6%, respectively) These data demonstrated that BTX changed the chemical coding of bladder sensory neurons, and therefore this drug should be taken into consideration when it planning experimental therapy of selected neurogenic bladder disorders.

The Effect of Mesobotox Together with Intense Pulsed Light on Facial Wrinkles and Erythema

Facial ageing is a gradual process which could be due to intrinsic and extrinsic causes, it ultimately results in the appearance of gravity-induced tissue ptosis, wrinkles, epidermal and dermal atrophy, dryness, senile lentigo, flushing, telangiectasia, and enlarged pores. Mesobotox treatment is a technique of microinjections of diluted Botulinum toxin type A (BTX) to preserve the facial mobility in order to preserve the natural beauty. BTX treatment enhances the aesthetic improvements attained with IPL. Ten patients of age ranging between 40 - 60 years old ( mean 45±10.3 years) with skin type ranging between (III - V) were treated using BTX and Intense Pulsed Light (IPL) using cutoff filter 550 nm with a fluence of 25 J/cm2 together as a combination therapy. All patients received standard IPL treatment and were assigned to receive eight 0.1 mL intradermal injections of BTX in each cheek (8 U total dose). Vertical lines within the forehead also received five 0.1 mL intradermal injections of BTX. Small wrinkles and fine lines, erythema, apparent pore size, skin texture, and overall appearance were evaluated after one week. A significantly higher proportion of patients showed improvement in small wrinkles and erythema with IPL plus BTX compared with the baseline demonstrated by computerized image analysis. In conclusion, A combined therapy of mesobotx and IPL is an effective and safe treatment for fine wrinkles, telangiectasia, flushing.

Cervical dystonia: A new phenomenological classification for botulinum toxin therapy

ABSTRACT Background Cervical dystonia (CD) is the most frequent form of focal dystonia. Over the last years botulinum toxin has been the treatment of choice, but a significant proportion of patients do not respond adequately to the preparation. It is this problem that has led to this analysis of the clinical forms of CD using additional CT and MRI examinations. Patients and Methods 78 patients were investigated whose primary CD was confirmed by the first diagnostic procedures. The position of the neck and head in lateral tilt, rotation and flexion backwards or forwards was clinically evaluated. All patients underwent CT of the soft tissues of the neck using slices at levels C1 to C7 and the bone window from the base of the skull to C7. The cervical spine and the soft tissues of the neck were examined in T1 and T2-weighted magnetic resonance imaging using a slice thickness of 2 mm, as well as in T1-weighting tilted towards the deep muscles of the neck. For comparison, the MRI data were subsequently analysed of 50 patients who did not have CD. The greatest diameter was measured and the form described of all the muscles able to be captured in the neck region, including the small neck muscles, and the positions of the cervical vertebra relative to each other were noted. Only the results of the clinical and CT bone window examinations are analysed here. Results It was found that, concerning lateral flexion and rotation, in 20% of the patients the disorder affected muscles that act on the atlanto-occipital joints (producing laterocaput and/or torticaput), and in a further 20%, only affected muscles that act on the cervical spine (producing laterocollis and/or torticollis). 60% exhibited both types of disorders, although with different degrees of head (-caput) and neck (-collis) involvement. This produced a ratio consequently for these forms of the disorder of 1:1:3. The position of C1, C2 and C3 to each other and to the base of the skull was captured in the CT bone window in angle degrees, and permitted torticollis (all 4 levels show the same angle of rotation) to be differentiated from torticaput (the base of skull and C1 levels show the same angle of rotation but at C2 and C3 this angle is different). Obviously the obliquus capitis inferior muscle has a particular role in torticaput: in 73% of the patients with CD it was clearly different on each side. Conclusions 1. It is necessary to distinguish between neck and head types (-collis and -caput) to establish the treatment strategy with Btx, since different groups of muscles are affected. 2. Visual analysis of the clinical picture is usually sufficient for differentiating dystonia involving muscles that have their origin or insertion on the cervical spine from the disorder involving muscles that have their origin or insertion on the skull. Imaging (CT bone window) is only useful in addition to clinical evaluation for assessing rotation of the head. 3. Lateral shift always occurs when there is laterocollis on one side and laterocaput on the other. A sagittal shift forwards, as a combination of anterocollis and retrocaput, is usually caused by bilateral dystonia of the sternocleidomastoid muscles. 4. Anterocollis can be differentiated from anterocaput by clinical lateral observation of the angle between the cervical spine and the thoracic spine and/or between the cervical spine and the base of the skull. The same applies to differentiating retrocollis from retrocaput. 5. The term ‘cervical dystonia’ should be understood as a generic term that encompasses both CD in the narrower meaning (where the muscles acting on the cervical spine are dystonic) and cranial dystonia (where it is the muscles acting on the skull that are dystonic). 6. If the classification of CD proposed here is taken into account, injections of Btx into muscles that are not involved in the dystonia can be avoided.

Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita

Painful foot blistering is a common problem in patients with epidermolysis bullosa simplex (EBS) and pachyonychia congenita (PC). Hyperhidrosis, a condition which can be effectively blocked by plantar injections of botulinum toxin (Btx), often exacerbates the blistering. A retrospective evaluation of the effects of Btx injections in 14 patients with EBS and PC with foot blisters and painful callosities. After informed consent, patients with EBS (n = 6) and PC (n = 8), aged 7-66 years, who had received Btx therapy at our centre since 2003, were included. The treatment consisted of multiple plantar injections of Btx A or Btx B after prior regional or general anaesthesia. Patients were interviewed about the treatment effect and were asked to score the improvement from 0 to 5, where 5 is 'excellent'. One patient with PC with painful callosities was studied by magnetic resonance (MR) spectroscopic microimaging before and after Btx injections to disclose any underlying blisters. In total, 76 treatments were evaluated (one to 19 sessions per patient). Thirteen patients (93%) reported reduced plantar blistering and pain; the improvement score was ≥ 4 in four of six patients with EBS and six of eight patients with PC. The mean effect duration was 3 months. No adverse events, apart from mild anticholinergic side-effects in two patients, were noted. MR spectroscopic microimaging showed disappearance of intraepidermal blistering after Btx therapy. Plantar injection of Btx is an efficient, long-lasting and safe treatment of painful blistering and callosities in EBS and PC that can be given repeatedly without loss of efficacy.

The Effects and Side-Effects of Endoscopic Application of Botulinum Toxin-A In Children with Neurogenic Bladder

Purpose To evaluate the effects and side-effects of endoscopic application of Botulinum-A toxin in the treatment of overactive neurogenic bladder in children. Material and Methods A prospective, non placebo controlled study, conducted with the approval of a Local Ethics Committee. 142 procedures of endoscopic, intradetrusor injections of BTX were performed on 49 girls, and 37 boys, with neurogenic bladder overactivity, aged 1-14 years (mean age 6,4 years). In all of children decreased bladder capacity and detrusor overactivity with urine incontinence were estimated in cystometries despite of oral oxybutynin treatment. In 29 children one injection was performed, in the rest one or more re-injections were performed. Two products were used in weight dependent dosage: Dysport, Ipsen up to 50 U/ kg, Botox, Allergan up to 10 U/ kg body weight. The dose was diluted in 10 ml 0.9% NaCl and injected in 20 sites of bladder dome. We compared pre and post-procedure: volumes of catheterized urine, volumes, pressures from cystometries. Statistical analyses were performed using nonparametric tests: the Wilcoxon signed rank sum test and the U Mann-Whitney test. A p-value of less than 0.05 was considered statistically significant. Results Values of neuro-urologic parameters (catheterized bladder volumes, cystometric bladder capacity, detrusor pressure) improved significantly in 76 to 81% of patients after therapy (p Conclusions Endoscopic administration of Botulinum-A toxin improves functional parameters of neurogenic bladder in children. It represents an alternative to surgical augmentation of bladder and reduction of intravesical pressures.

Predicting Migraine Responsiveness to Botulinum Toxin Type A Injections

Botulinum toxin type A (BTX) is used prophylactically to reduce the frequency of migraine headaches, with inconsistent responses reported in the literature. The purpose of our study was to determine whether BTX injections at doses used for upper-face cosmetic purposes, which differ from doses typically used by headache specialists, could prevent imploding and ocular but not exploding migraines. Study participants were recruited among patients who had received or were planning to receive BTX injections for upper-face cosmetic purposes but also reported having migraines. Among the 18 patients who completed the study, most with imploding and ocular migraines experienced a significant reduction in their headache frequency, whereas those with exploding migraines generally did not. Our study supports the hypothesis that patients with imploding and ocular migraines are more responsive to BTX than those with exploding migraines. Injections of BTX at doses appropriate for cosmetic purposes may be sufficient to prevent migraine attacks.

The Effect of Botulinum Toxin Type A on Full-Face Intense Pulsed Light Treatment: A Randomized, Double-Blind, Split-Face Study

Botulinum toxin type A (BTX) is commonly used in combination therapy, and it has been reported that periocular BTX treatment enhances the aesthetic improvements attained with intense pulsed light (IPL). The objective was to evaluate if intradermal BTX treatment of the cheeks also enhances the efficacy of IPL. Fifteen females enrolled in this prospective, randomized, double-blind, split-face study (14 completed, 1 lost to follow-up). All received standard IPL treatment and were randomly assigned to receive eight 0.1-mL intradermal injections of BTX (BOTOX Cosmetic, Allergan) in one cheek (8 U total dose) and eight injections of saline in the contralateral cheek. Small wrinkles and fine lines, erythema, hyperpigmentation, apparent pore size, skin texture, and overall appearance were evaluated for 8 weeks. A significantly higher proportion of patients showed improvement in small wrinkles and fine lines with IPL plus BTX than IPL plus saline--93% versus 29% at Week 4 (p=.003). Adjunctive BTX also achieved a greater degree of improvement in erythema (although statistical significance was not achieved). Other efficacy measures showed comparable improvements with both regimens. The adjunctive use of BTX enhances the improvement in small wrinkles and fine lines, and possibly erythema, achieved with IPL alone.

Treatment of cremaster synkinesias with botulinum toxin A: A video case report

Synkinesias secondary to nerve lesions and aberrant re-innervation are well-known phenomena especially after lesions of the facial nerve. Synkinesias can successfully be treated with botulinum toxin A (BTx A). Synkinesias of the cremaster muscle have not been described or treated to date. We present the case of a 62-year-old man who developed synkinesias of both cremaster muscles after extensive laparatomy for esophageal cancer. Treatment of synkinesias with various oral medications had been unsuccessful. Electromyography-guided injections of BTx A in both cremaster muscles (15 MU on the right and 10 on the left) led to significant symptom relief for an average of 8 weeks. We present the case including pre- and posttreatment video clips.

Dose-dependent response to intramuscular botulinum toxin type A for upper-limb spasticity in patients after a stroke

Childers MK, Brashear A, Jozefczyk P, Reding M, Alexander D, Good D, Walcott JM, Jenkins SW, Turkel C, Molloy PT. Dose-dependent response to intramuscular botulinum toxin type A for upper-limb spasticity in patients after a stroke. Arch Phys Med Rehabil 2004;85:1063–9. Objective To test the hypothesis that intramuscular (IM) botulinum toxin type A (BTX) reduces excessive muscle tone in a dose-dependent manner in the elbow, wrist, and fingers of patients who experience spasticity after a stroke. Design Randomized, double-blind, placebo-controlled, multicenter, 24-week trial. Setting Six academic and 13 private US outpatient medical centers. Participants Ninety-one patients with a mean age of 60 years (range, 30–79y). Mean time elapsed from ischemic or hemorrhagic stroke to study enrollment was 25.8 months (range, 0.9–226.9mo). Interventions Up to 2 treatments of placebo, or 90, 180, or 360U of BTX. Concurrent splinting and physical therapy protocols were permitted, but no changes were allowed during the study. Main outcome measures Wrist, elbow, and finger flexor tone assessed by the Modified Ashworth Scale, physician and patient global assessments, pain, FIM instrument, and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results Muscle tone decreased more with injections of BTX than with placebo in the wrist flexors at weeks 1, 2, 3, 6, and 9 ( P≤.026); in the elbow flexors at weeks 1, 2, 3, 4, 5, and 9 ( P≤.033); and in the finger flexors at weeks 1 and 3 ( P≤.031). A dose-dependent response was generally observed in tone reduction but not in pain, FIM, or SF-36 measures. Conclusions IM BTX reduced muscle tone in a dose-dependent manner in the elbow, wrist, and fingers of patients who experience spasticity after a stroke but did not appear to affect global quality of life or disability.

Poster 165: Control of oral secretions in bulbar amyotrophoic lateral sclerosis using botulinum toxin type A: a pilot study and safety trial.

Objectives: To determine the effectiveness of botulinum toxin type A (BTX) in reducing sialorrhea for patients with bulbar amyotrophoic lateral sclerosis (ALS), through ultrasound-guided, intrasalivary gland injections, and to titrate to the minimum dosage of BTX required to significantly reduce salivary flow clinically, while minimizing adverse effects. Design: Open-label, nonblinded safety trial. Setting: Outpatient neuromuscular clinic in a large tertiary care center in Ontario, Canada. Participants: Referred sample of 3 patients with advanced bulbar ALS, presenting with disabling sialorrhea unresponsive to previous conventional treatments. Intervention: BTX was injected directly into bilateral parotid and submandibular glands after gland visualization was made using ultrasound. 10, 20 and 30U were injected at baseline, 1 and 2 months postbaseline, respectively. Main Outcome Measures: Subjective evaluation was made using a questionnaire comprised of rating scales for items including severity and frequency of salivation, improvement from baseline, and overall effectiveness of treatment. Objective measurements of salivation was performed by calculating saliva output per minute using the weight of intraoral dental gauze retained in the mouth. Results: All 3 subjects reported moderate to marked improvement in the severity and frequency of their sialorrhea after the 10- and 20-U dose injections, with a reported 37.5% to 75% reduction in salivation from baseline. An apparent supratherapeutic effect was seen after the 30-U injection in 2 subjects. Objective reductions in saliva secretion of 23.9%, 34.0%, and 36.6% were seen after the 10-, 20-, and 30-U injections, respectively. No side effects (eg, worsening of dysarthria, dysphagia, facial nerve paralysis) were reported. Conclusions: Ultrasound-guided injections of BTX into the salivary glands is a minimally invasive, safe, and efficacious treatment alternative for patients with sialorrhea secondary to bulbar ALS. An upper-dose tolerance of 25U was found in our safety trial.