Patients Receiving Botulinum Toxin Injections Research Articles

Botulinum Toxin Injection Technique for Reducing the Masseter Size and Enhancing the Jawline.

The injection of botulinum toxin into the masseter muscle is an important method for improving hypertrophy. However, some patients may experience adverse reactions, such as sagging of the lower jaw. Therefore, we proposed a method of injecting botulinum toxin into the masseter and platysma muscles that would reduce masseter size and enhance the jawline. The aim of this study was to reduce the masseter size while enhancing the jawline. Twenty patients received botulinum toxin injections into the masseter and platysma muscles. Pain levels were evaluated with the visual analog scale. All patients were photographed before and 6 months after treatment. Evaluations were performed based on standardized criteria. The lift index, reduction index, and symmetry index were performed to assess the degree of jawline elevation, masseter size reduction, and jawline symmetry before and after treatment. The mean visual analog scale score of the 20 patients was 2.80 (±1.24). The mean lift index score decreased from 4.93 (±0.34) to 4.53 (±0.37), P < .05. The mean reduction index score decreased from 3.13 (±0.27) to 2.74 (±0.27), P < .05. The mean symmetry index score changed from 0.0393 (±0.0296) to 0.0257 (±0.0246), P < .05. Botulinum toxin injections into the masseter and platysma muscles through nerve block reduced the masseter size, elevated the jawline, and improved symmetry.

The Patient Journey in Facial Aesthetics: Findings from a European Consensus Meeting on Improving the Quality of Life for Patients Receiving Botulinum Toxin Injections.

Successful treatment of facial lines with botulinum toxin is largely dependent on patient satisfaction; thus, a structured treatment journey that uses patient-reported outcomes (PROs) is helpful for maximizing botulinum toxin results. To develop a patient-centric approach for botulinum toxin injections in facial aesthetics, a group of clinicians met to provide opinions on an optimal treatment journey that uses PROs to quantify treatment benefits on patient quality of life. A multidisciplinary panel of 9 clinicians with expertise in facial aesthetic procedures convened for an advisory board that was preceded by and followed up with a structured, multistep consensus discussion. Based on current literature, the panel's expertise, structured questions, and group discussion, panelists assessed, reconciled, and agreed upon on a patient journey for botulinum toxin treatment in facial aesthetics. Panelists agreed that an optimal patient journey includes screening, assessment, treatment, posttreatment, and follow-up visits. A compact, easy-to-complete, and digital PRO questionnaire should be provided before the visit. During screening, thorough assessments are integral for a successful patient journey because they provide an opportunity to understand treatment goals, address patient concerns, discuss risks and benefits, obtain medication lists/medical history, and take pretreatment photographs. Treatment strategies should include discussing and educating on the approach/choice of botulinum toxin and ensuring patients are comfortable. Posttreatment, clinicians should request intense muscle movements to enhance product uptake and be available to address patient concerns. Finally, during follow-up, PRO questionnaires can be provided to gauge patient satisfaction with treatment, and pretreatment photographs can be provided to allow patients to track their progression. Follow-ups should be scheduled with new patients or those reporting low satisfaction. Establishing a relationship, being aware of the patient's goals, and developing an individualized care plan allows for a structured, patient-centered treatment journey that promotes positive aesthetic outcomes.

New-Onset Focal Task Specific Oromandibular Dystonia in Association with Quran Recitation: A Case Series.

Focal task-specific dystonia is a form of isolated focal dystonia that occurs during the performance of a specific skilled motor task. The occurrence of oromandibular dystonia (OMD) specifically in association with the recitation of Quranic verses have been rarely reported in the literature, in non-native Arabic-speaking patients. This case series describe a rare type of focal task-specific dystonia that occurs exclusively by reciting Quran in native Arabic-speaking patients, which has never been reported, to the best of our knowledge. In this case series, we identified five patients with new-onset OMD that was exclusively induced by reciting Quran. Cases were evaluated in our Movement Disorders outpatient clinic at Ibn Sina hospital; the main tertiary neurology center in Kuwait, between 2015 and 2023. Five cases (3 males, 2 females) were identified in this study. Mean age of onset of the symptoms was 52.3 ± 4.1 years, while the median duration of the symptoms prior to diagnosis was 3 years. All patients were native Arab-speaking, with no previous history of other types of dystonia. No identifiable risk factors could be obtained including exposure to dopamine blocking agents or antipsychotics, or history of oral or dental surgery. Patients underwent a full clinical, laboratory, and radiological evaluation. All patients had OMD dystonia in varying forms and severity, while two patients had additional spasmodic dysphonia/ blepharospasm on progressive recitation. Most patients had minimal improvement with combination of oral medications and speech therapy. Four patients received botulinum toxin injections with better results. The mental and physical stress in attempting to recite the Quranic verses could have contributed to the development of OMD. Moreover, the increased demand on the muscles of the jaw, lips, and tongue during recitation can trigger the dystonic symptoms. OMD exclusively during Quran recitation is a rare phenomenon, and expands the spectrum of task-specific focal dystonia described in the literature. It was found to be distressing to the patients and a challenge to treat. Prompt recognition could minimize unnecessary testing and procedures, and facilitate earlier treatment.

Virtual Reality for Decreasing Procedural Pain during Botulinum Toxin Injection Related to Spasticity Treatment in Adults: A Pilot Study.

Botulinum toxin injections are commonly used for the treatment of spasticity. However, injection procedures are associated with pain and procedural anxiety. While pharmacological approaches are commonly used to reduce these, innovative technology might be considered as a potential non-pharmacological alternative. Given this context, immersive virtual reality (VR) has shown effectiveness in the management of procedural pain. Our retrospective pilot study aimed to assess the potential added value of virtual reality in the management of pain and anxiety during intramuscular injections of botulinum toxin. Seventeen adult patients receiving botulinum toxin injections were included. A numerical rating scale was used to assess pain and anxiety during the injection procedure. The patients reported the pain experienced during previous injections without VR before injection and the pain experienced in the current procedure with VR after the end of the procedure. The level of satisfaction of VR experience, whether or not they agreed to reuse VR for the subsequent toxin botulinum injection, and whether or not they would recommend VR to other patients were assessed. The use of virtual reality led to a decrease of 1.8 pain-related points compared to the procedure without technology. No significant improvement in the level of anxiety was reported. Patients were very satisfied with their VR experiences (7.9 out of 10), and many would agree to reuse VR in their next injection procedure (88%) and to recommend the use of VR in other patients (100%). VR was useful for managing procedural pain related to botulinum toxin injection in adults, with a high level of satisfaction reported by the patients. VR should be considered as a valuable alternative to pharmacological approaches to manage procedural pain during botulinum toxin injection in adults.

Assessing change in functional outcomes and quality of life in myogenic temporomandibular disorders undergoing botulinum toxin injection: A before and after comparison

PurposeThis prospective study aimed to evaluate the changes in functional outcomes and quality of life after the injection of botulinum toxin (BTX) into the masticatory muscles for the management of myogenic temporomandibular disorders (TMDs). Materials and MethodsThis study was conducted with 45 individuals who presented with clinically myogenic TMDs according to the Diagnostic Criteria for Temporomandibular Disorders. All patients received BTX injections in the temporalis and masseter muscles. The Oral Health Impact Profile–Temporomandibular Dysfunction (OHIP–TMD) questionnaire was used to evaluate the effects of treatment on quality of life. The OHIP–TMD, visual analogue scale (VAS), and maximum mouth opening (MMO) scores before and 3 months after BTX injection were evaluated. ResultsThe preoperative and postoperative assessments revealed a statistically significant reduction (p ≤ 0.001) in the average overall OHIP–TMD scores. A significant increase in the MMO scores and a significant decrease in the VAS scores were observed (p < 0.001). ConclusionsThe injection of BTX into the masticatory muscles is beneficial for improving the clinical and quality of life parameters in the management of myogenic TMD.

Botulinum Toxin Use for Abdominal Wall Reconstruction

INTRODUCTION: Preoperative botulinum toxin (BTX) injection may assist in fascial closure of large incisional hernia repair. We examine outcomes of incisional hernia patients who receive BTX injections before abdominal wall reconstruction (AWR). METHODS: A retrospective cohort study of patients from 2019–2021 who underwent BTX abdominal wall injections and interval AWR was conducted. A matched cohort who underwent IH repair without BTX treatment was selected for comparable defect size and BMI. Clinical and demographic data were extracted from charts. RESULTS: Twenty patients received BTX injections, and 30 comparable patients did not. There was no difference in average age (58.6 and 61.4 years, p = 0.514), BMI (32.9kg/m2 and 32.4kg/m2, p = 0.813), or defect size (663.9 cm2 and 608.43 cm2, p = 0.513). Primary outcome of fascial closure was achieved in every patient in the BTX group (20 of 20) vs 86.7% (26 of 30) in the non-BTX group (p = 0.089). The BTX group had a lower rate of component separation (65.0% of the BTX group vs 93.3%, p = 0.01). The BTX group had higher rates of seroma (p = 0.03) and longer surgery time, 4:07 vs 3:58 (p < 0.01). The postoperative period had one dehiscence (non BTX group). There was no difference in incidence of surgical site infection, abscess, delayed healing, respiratory failure, pulmonary embolism, acute kidney injury, or length of stay. CONCLUSION: Patients receiving botulinum toxin injections into their abdominal wall musculature achieved greater rates of closure with good outcomes. We conclude that botulinum toxin injection for large incisional hernias is an effective method for relaxation of abdominal wall muscle and closure of large abdominal wall.

Current trends in the rehabilitation of patients with spastic paresis with focal brain damage

Spasticity is one of the most frequent movement disorders and its development is associated with such CNS lesions as stroke, multiple sclerosis, cerebral palsy, craniocerebral and spinal injuries, CNS tumors, neurodegenerative diseases. Post-stroke spasticity develops in about 40% of patients, and about 15% of patients have severe and disabling spasticity. According to statistics, after TBI, about 75% of patients develop spasticity, and half of them require treatment.Spasticity worsens walking, complicates hygiene, dressing, complicates rehabilitation measures, and reduces the quality of life of patients and his family members. In recent years, this movement disorder has been actively studied, new data have appeared on the pathophysiology of spastic paresis and encouraging data on improving function in patients receiving botulinum toxin injections as part of multidisciplinary rehabilitation.The article presents data from the latest systematic reviews on the effectiveness of various rehabilitation technologies for the treatment of spasticity.The use of botulinum neurotoxin for the treatment of spastic paresis of the upper and lower extremities is the preferred method of complex multidisciplinary rehabilitation of patients with spasticity and has the highest level of evidence.Currently, there is no doubt that botulinum toxin should be used as early as possible in patients with an emerging pathological movement pattern, which can contribute to pattern change and muscle length maintenance. But the question remains: which rehabilitation technology is most effective for enhancing and prolonging the action of botulinum neurotoxin. To date, there is no clear answer to this question.

Efficacy of Botulinum Toxin in the Treatment of Convergence Spasm

ABSTRACTBackground: Previous studies have shown that botulinum toxin can be an important adjunct to management of convergence spasm. However, we have not experienced the same level of success in our cohort of patients. Methods:Using retrospective review, we collected data on patients presenting to our department with convergence spasm. This included presenting symptoms, examination findings, response to atropine and plus lenses, number and dosage of botulinum toxin injections received, and the status at last follow-up/discharge. Results: We identified a total of 6 patients with a male: female ratio of 1:1 and mean age of 44.3 years. Commonest symptom was diplopia followed by headache and blurred vision. Depression was present in 4 out of 6 patients.Average pre-injection deviation for near was 32.5 PD ET (Prism Diopters esotropia) and for distance was 27.7 PD ET. All of the patients received botulinum toxin injections to the medial rectus muscle. The response to toxin was variable with an average near deviation at 2 weeks of 10 PD XT (exotropia), range 20 PD XT to 25 PD ET and at 3 months 12.5 PD ET (10 PD XT to 35 PD ET). At the last follow-up, after the toxin effect had worn off, all the patients returned to the pre-injection levels and the symptoms recurred. Conclusion: The response of patients with convergence spasm to botulinum toxin was variable with a recurrence of the deviation once the effect wore off. In our experience, botulinum toxin has a limited role in the management of convergence spasm.

Botulinum toxin for treatment of spasticity in patients with primary lateral sclerosis

Primary lateral sclerosis:(PLS) is a rare motoneuronal disease resulting in pyramidal and bulbar syndrome. The clinical pattern mimics amyotrophic lateral sclerosis (ALS). Nevertheless, PLS evolution resembles hereditary spastic paraplegia and most of the patients have a good life expectancy. Spasticity is a major symptom of the disease. Despite the rarity of the disease, many patients with PLS are referred to our department. This study describes spasticity management and outcome in patients with PLS using botulinum toxin injections. Between 2009 and 2015, 55 patients suffering from PLS with either paraparesis or tetraparesis were referred to the specialized consultation in physical rehabilitation medicine department in Hospital Pitié-Salpêtrière in Paris, in order to manage their spasticity. Their medical charts were retrospectively analyzed, to determine the effects of botulinum toxin therapy. Among the 55 patients, 44 patients received botulinum toxin injections, preceded by motor block for 16 patients. Injections were mostly performed in lowers limbs in order to ameliorate comfort, or ambulation. The treatment was uncomplicated. Among the 44 patients treated with botulinum toxin injections, 28 patients (63.6%) were satisfied by the treatment. Twenty-two patients (50%) underwent botulinum toxin therapy for at least a year, 6 patients (13.6%) for more than 3 years. This study confirms the interest of botulinum toxin for the treatment of spasticity in patients with PLS as it provided clinical improvement of spasticity in almost two thirds of our patients. PLS evolutes slowly, this treatment could be reiterated in a long-term approach.

Practical management of flu-like symptoms among patients receiving botulinum toxin injections

Practical management of flu-like symptoms among patients receiving botulinum toxin injections

Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients.

Objectives: This paper reviews a 12-year experience in more than 900 patients with spasmodic dysphonia who have been treated with botulinum toxin. Study Design: This is a retrospective analysis of patients with adductor spasmodic dysphonia (strainstrangled voice), abductor spasmodic dysphonia (whispering voice), and adductor breathing dystonia (paradoxical vocal fold motion), all of whom have been treated with botulinum toxin injections for relief of symptom. Methods: All of the patients were studied with a complete head and neck and neurologic examination; fiberoptic laryngostroboscopy; acoustic and aerodynamic measures; and a speech evaluation including the Universal spasmodic dysphonia rating scale. Some were given electromyography. All patients received botulinum toxin injections into the affected muscles under electromyographic guidance. Results: The adductor patients had an average benefit of 90% of normal function lasting an average of 15.1 weeks. The abductor patients had an average benefit of 66.7% of normal function lasting an average of 10.5 weeks. Adverse effects included mild breathiness and coughing on fluids in the adductor patients, and mild stridor in a few of the abductor patients. Conclusion: Botulinum toxin A injection of the laryngeal hyperfunctional muscles has been found over the past 12 years to be the treatment of choice to control the dystonic symptoms in most patients with spasmodic dysphonia. Laryngoscope, 108:1435–1441, 1998

Hemidystonia‐hemiatrophy syndrome

To define the clinical and radiological features of patients with the combination of hemidystonia (HD) and hemiatrophy (HA), the HD-HA syndrome. HD is a very disabling neurological condition that is rarely associated with HA of the affected body part, similar to the hemiparkinsonism-hemiatrophy syndrome. We reviewed the medical records of 26 patients with the HD-HA syndrome and the data was entered into a database and analyzed. Video recordings as well as imaging studies were also reviewed. Twenty six patients (14 female) with a mean age at onset of HD at 14.9 years (1-46 years) were followed for a mean of 3.4 years. Fourteen (53%) had HD and HA on the left side and 23 (88%) had hemiparesis preceding the onset of HD. The mean latency from the onset of hemiparesis to the onset of HD was 14.7 years (2 weeks-46 years). All patients with hemiparesis had marked improvement in their weakness prior to the onset of HD. Common causes leading to hemiparesis and subsequent HD were birth or perinatal complications (N = 13) and stroke (N = 10). Seven patients (26%) had associated seizures. Twenty two patients (85%) had abnormal brain MRI: eight had lesions directly involving the basal ganglia and nine had cerebral hemiatrophy or non specific diffuse atrophy. Sixteen patients received botulinum toxin injections and responded well to treatment. HD-HA is usually associated with static encephalopathy originating at very young age, but the syndrome may also represent delayed sequelae of a stroke or brain injury.

Quantitative EMG of facial muscles in myasthenia patients with MuSK antibodies

ObjectiveOur aim was to study the pathophysiological process leading to facial muscle atrophy in 13 patients with MuSK antibody positive myasthenia gravis (MuSK-MG), and to compare with findings from 12 acetylcholine receptor antibody positive myasthenia patients (AChR-MG), selected because they suffered from the same degree of disease severity and required similar treatment. MethodsMotor unit action potential (MUAP) and interference pattern analysis from orbicularis oculi (O oculi) and orbicularis oris (O oris) muscles were studied using a concentric needle electrode, and compared with findings in 20 normal subjects, 6 patients receiving botulinum toxin injections (representing a neurogenic model) and 6 patients with a muscle dystrophy (representing a myopathic model). The techniques and control data have been reported previously. ResultsThe mean MUAP durations for O oculi and O oris were significantly reduced (p<0.001) in both MG cohorts when compared with healthy subjects, and were similar to those in the myopathic control group. They were significantly different from those obtained from the neurogenic control group (p<0.001 for both O oculi and O oris). The MUAP findings in O oculi occurred independently from neuromuscular blocking on single fibre EMG (SFEMG) in the same muscle. On turns amplitude analysis (TAA), 50% of MuSK-MG patients and 42% of AChR-MG patients had a pattern in O oculi which was similar to that in the myopathic control group, and 62% of MuSK-MG patients and 50% of AChR-MG patients had a pattern in O oris that was also similar to that in the myopathic control group. The TAA findings for O oculi and O oris in both MG cohorts were different from those obtained from the neurogenic control group. ConclusionsFacial muscle atrophy in MuSK-MG patients is not neurogenic and the pathophysiological changes are akin to a myopathic process. The selected AChR-MG patients also show evidence of a similar pathophysiological process in the facial muscles albeit to a lesser degree. SignificanceWe propose that muscle atrophy in MuSK-MG is a myopathic process consisting of either muscle fibre shrinkage or loss of muscle fibres from motor units. The duration of disease and long-term steroid treatment may be further contributory factors.

Turns amplitude analysis of the orbicularis oculi and oris muscles

Objective The aim of the study was to determine whether ‘clouds’ from turns amplitude analysis obtained from the orbicularis oculi and oris muscles without force monitoring can be used to differentiate pathological processes affecting the face. Methods The interference pattern from orbicularis oculi and orbicularis oris was studied using a concentric needle electrode. Data-points from 20 normal subjects were plotted on a logarithmic scale of mean amplitude between turns versus turns/second, from which linear regression analysis defined the 95% confidence intervals. This enabled us to draw the boundaries of the normal cloud on a linear plot. Data-points from the interference pattern in two pathological cohorts, of 6 patients receiving botulinum toxin injections (representing a neurogenic model), and 6 patients with a muscle dystrophy (representing a myopathic model) were plotted against the normal cloud. These findings were compared and correlated with the mean durations obtained on motor unit action potential analysis from these same two facial muscles. Results The majority of patients receiving botulinum toxin injections into their facial muscles showed a pattern of high amplitude with low turns/s, or low amplitude with a low-to-normal range of turns/s in both facial muscles. These findings were associated with high-duration motor unit action potentials in most cases. In the myopathic group of patients 66% showed a pattern of low amplitude with low-to-normal range of turns/s in O oculi and O oris. This correlated with short-duration motor unit action potentials in both facial muscles. Conclusions We have demonstrated that turns amplitude analysis without force monitoring can be used to study the interference pattern from facial muscles and can be applied to differentiate primary neurogenic from myopathic pathological processes. Significance Turns amplitude analysis without force monitoring in the facial muscles can be used as an effective and practical method of interference pattern analysis to complement findings from conventional motor unit action potential analysis.

Severe, intractable headache after injection with botulinum a exotoxin: Report of 5 cases

Background: Botulinum A exotoxin is a safe agent in common use in dermatology. Occasionally, patients receiving botulinum toxin injections report postprocedure discomfort, including headaches. Objective: Our purpose was to estimate the rate of severe headaches occurring after injection with botulinum toxin for dermatologic indications. Methods: We used prospective monitoring of botulinum toxin injection outcomes in a single-site, 3-dermatologist practice. There was in-office and telephone follow-up of patients experiencing severe headaches. Results: Approximately 1% of patients (4/320) receiving botulinum A exotoxin injections may experience severe, debilitating headaches. These may persist at high intensity for 2 weeks to 1 month before gradually fading. Conclusion: Botulinum A exotoxin injection may be associated with the development of life-altering headaches. Patients should be informed of this possibility. (J Am Acad Dermatol 2002;46:62-5.)

Dysphagia and Chronic Mental Illness: Looking Beyond Hysteria and Broadening the Psychiatric Differential Diagnosis.

Dysphagia and Chronic Mental Illness: Looking Beyond Hysteria and Broadening the Psychiatric Differential Diagnosis.

Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients.

This paper reviews a 12-year experience in more than 900 patients with spasmodic dysphonia who have been treated with botulinum toxin. This is a retrospective analysis of patients with adductor spasmodic dysphonia (strain-strangled voice), abductor spasmodic dysphonia (whispering voice), and adductor breathing dystonia (paradoxical vocal fold motion), all of whom have been treated with botulinum toxin injections for relief of symptom. All of the patients were studied with a complete head and neck and neurologic examination; fiberoptic laryngostroboscopy; acoustic and aerodynamic measures; and a speech evaluation including the Universal spasmodic dysphonia rating scale. Some were given electromyography. All patients received botulinum toxin injections into the affected muscles under electromyographic guidance. The adductor patients had an average benefit of 90% of normal function lasting an average of 15.1 weeks. The abductor patients had an average benefit of 66.7% of normal function lasting an average of 10.5 weeks. Adverse effects included mild breathiness and coughing on fluids in the adductor patients, and mild stridor in a few of the abductor patients. Botulinum toxin A injection of the laryngeal hyperfunctional muscles has been found over the past 12 years to be the treatment of choice to control the dystonic symptoms in most patients with spasmodic dysphonia.

Physical and occupational therapy considerations in adult patients receiving botulinum toxin injections for spasticity

Physical and occupational therapists play important roles in the evaluation and management of patients receiving botulinum toxin injections for spasticity. Baseline evaluation includes areas beyond the muscles being injected, since local spasticity reduction may lead to more widespread functional changes. Because the evaluation itself influences tone, a consistent order of muscle evaluation is recommended. The range of preinjection assessments includes evaluation of tone, mobility, strength, balance, endurance, assistive devices, and others. After injection, therapeutic interventions have multiple aims, including strengthening and facilitation, increasing range of motion, retraining of ambulation and gait, improving the fit and tolerance of orthoses, and improved functioning in ADLs.

Physical and occupational therapy considerations in adult patients receiving botulinum toxin injections for spasticity

Physical and occupational therapy considerations in adult patients receiving botulinum toxin injections for spasticity