Role Of Botulinum Toxin Research Articles

Role of botulinum toxin A in cyclic esotropia—a long-term follow-up

Cyclic strabismus is a rare entity with unknown etiology. The few case reports with the use of Botulinum toxin A (BTXA) did not include the long term outcome. We herein report two cases of childhood cyclic esotropia who underwent BTXA treatment with a follow up at least 8 years in an attempt to demonstrate the long term outcome of BTXA treatment.

The role of botulinum toxin on pain and gait impairment in cervical dystonia

The role of botulinum toxin on pain and gait impairment in cervical dystonia

Role of botulinum toxin A in treatment of intractable diplopia

To evaluate the effect of botulinum toxin A (BTXA) in patients with intractable diplopia related to intracranial problems or long-term interruption of fusion due to cataract or uncorrected aphakia and to identify the group of resistant cases who have no potential to fuse the two images. The medical records of patients seen by the senior author (SBÖ) over a period of 20years were reviewed retrospectively to identify those who underwent BTXA treatment for intractable diplopia. All cases had horizontal and/or vertical deviations. The diagnostic criterion was persistence of diplopia in free space despite neutralization of the deviation by prisms or synoptophore. BTXA was injected into the appropriate extraocular muscle to control the deviation in the identified patients. A total of 22 patients were identified: 13 developed intractable diplopia following head trauma, intracranial surgery, or stroke; 9 had a history of binocular sensory deprivation due to traumatic cataract or uncorrected aphakia. The duration of sensory deprivation ranged from 2 to 41years. BTXA was injected into the appropriate extraocular muscle(s). Diplopia resolved completely in 14 patients, resolved incompletely with short-term single vision in 3 cases, and persisted in 5 patients despite correction of the deviation by BTXA. Our results suggest that BTXA offers the advantage of a temporary decrease of the deviation without altering image quality that allows the visual system to recover fusion under real-life conditions. Permanent treatment with surgical correction of the deviation should be reserved for those who achieve fusion during the orthotropic period provided by BTXA.

THE EMERGING ROLE OF BOTULINUM TOXIN IN THE TREATMENT OF OROFACIAL DISORDERS: LITERATURE UPDATE

Botulinum toxin (BTX) is a lethal neurotoxin produced by Gram-positive anaerobic bacterium called Clostridium botulinum. It is the first toxin used fortherapeutic purposes since 1989. BTX treatment is relatively safe and efficacious, less invasive, conservative, and the effects are faster and reversible.The purpose of this article is to review the literature regarding the applications of BTX in the treatment of various orofacial disorders, their mechanismof action, contraindications, and complications. From the recently published literature, it is clear that the role of BTX as a therapeutic agent for severalconditions is expanding. With the training of BTX-A injection techniques and adequate knowledge about treatment protocols, general dentists cansafely administer BTX injections. The ability to use Botox as an adjuvant and primary mode of the treatment for various maxillofacial disorders offersexciting treatment options for dentists and patients in the future.

Poster 78: Examining the Role of Botulinum Toxin on Functional Outcomes in an Inpatient Setting (Preliminary Results)

Poster 78: Examining the Role of Botulinum Toxin on Functional Outcomes in an Inpatient Setting (Preliminary Results)

Role of Botulinum Toxin in Post-Stroke Spasticity Related Shoulder Pain

Shoulder pain is a very common complication after stroke, with a reported prevalence varying from 23% to 64%. There are very few treatment options that have been shown to be more effective than placebo for relief of poststroke shoulder pain. One of the factors most frequently associated with shoulder pain is spasticity, especially when the muscles are stretched. Botulinum toxin A (BT-A) is one of the treatments available for the treatment of focal spasticity and its effectiveness in reducing upper limb spasticity in stroke is well documented. In this review, patients with shoulder pain and spasticity after hemiplegia, a single injection of BT-A was associated with a statistically significantly greater reduction in shoulder pain on a numerical rating scale (NRS) from 6/10 at initial assessment; to 1/10 two months post injection. Nine patients (56%) were pain free at 5 and 9 months postinjection. Median Modified Ashworth Scale (MAS) scores for shoulder spasticity in the affected upper limb improved from 3 at the initial assessment to 2, two months post injection and remained as 1+, five and nine months post injection. There was also a significant improvement in median passive shoulder abduction range of motion on the affected upper limb from 80 degrees at the initial assessment to 95 degrees, two months post injection and further improvement to 110 degrees in 9 patients, 5 months post injection. BT-A seems to be effective in managing post- stroke shoulder pain secondary to spasticity.

The role of botulinum toxin in depression and anxiety in patients with craniocervical dystonia

The role of botulinum toxin in depression and anxiety in patients with craniocervical dystonia

The Role of Botulinum Toxin A in the Treatment of Raynaud Phenomenon.

Raynaud phenomenon (RP) is a transient digital ischemia that occurs after exposure to cold temperature or emotional distress. It presents with a triphasic course: the initial white phase is followed by cyanotic discoloration and, subsequently, erythema. The attacks may be associated with pain, paresthesia, and complicate with nonhealing ulceration often leading to amputation. To date, there are no clear-cut therapeutic guidelines and many medications are used off-label. Encouraging results were reported with the use of botulinum neurotoxin-A (BoNT-A). However, there is still ongoing debate regarding indications, contraindications, best injection technique, and mechanism of action. The aim of this study was to address these issues by providing an up-to-date and detailed overview of the use of BoNT-A in RP.A PubMed database search was conducted. The available studies and techniques were evaluated and compared.The search yielded a total of 29 studies. Ten papers, published between 2004 and 2014, were considered relevant. A total of 128 patients underwent BoNT-A injections. Seventy-five percent to 100 % of the patients reported pain reduction after treatment. Healing of ulcers was reported in 75% to 100% of the affected patients. The most common complication was temporary hand weakness, with an average incidence of 14.1%. Injections targeting the neurovascular bundle at or slightly proximal to the A1 pulley were the most commonly performed.Botulinum neurotoxin-A injection proved to be a valid approach in both primary and secondary RP. The available evidence shows the achievement of both symptomatic and functional improvements in this debilitating condition. However, the patient should be adequately informed about the risk of transient hand weakness.

Role of Botulinum Toxin in Depression.

The goal of this review was to consolidate the evidence concerning the efficacy of botulinum toxin type A (onabotulinumtoxinA) in depression. We searched MEDLINE, EMBASE, Cochrane, and Scopus through May 5, 2014, for studies evaluating the efficacy of botulinum toxin A in depression. Only randomized controlled trials were included in the meta-analysis. A pooled mean difference in primary depression score, and pooled odds ratio for response and remission rate with 95% confidence interval (CI) were estimated using the random-effects model. Heterogeneity was assessed using Cochran Q test and χ statistic. Of the 639 articles that were initially retrieved, 5 studies enrolling 194 subjects (age 49±9.6 y) were included in the systematic review, and 3 randomized controlled trials enrolling 134 subjects were included in the meta-analysis. The meta-analysis showed a significant decrease in mean primary depression scores among patients who received botulinum toxin A compared with placebo (-9.80; 95% CI, -12.90 to -6.69) with modest heterogeneity between the studies (Cochran Q test, χ=70). Response and remission rates were 8.3 and 4.6 times higher, respectively, among patients receiving botulinum toxin A compared with placebo, with no heterogeneity between the studies. The 2 studies excluded from the meta-analysis also found a significant decrease in primary depression scores in patients after receiving botulinum toxin A. A few subjects had minor side effects, which were similar between the groups receiving botulinum toxin and those receiving placebo. This study suggests that botulinum toxin A can produce significant improvement in depressive symptoms and is a safe adjunctive treatment for patients receiving pharmacotherapy for depression. Future trials are needed to evaluate the antidepressant effect per se of botulinum toxin A and to further elucidate the underlying antidepressant mechanism of botulinum toxin A.

The role of botulinum toxin A in treating neurogenic bladder.

Neurogenic detrusor overactivity (NDO) can result in lower and upper urinary tract complications and eventually even in end-stage kidney failure. Since the driving force of this clinical cascade is high bladder pressure, controlling intravesical pressure in NDO patients improves both quality of life and life-expectancy in these patients. Botulinum toxin A (BTX-A) has proven its efficacy in reducing intravesical pressure and in reducing incontinence episodes. BTX-A also improves quality of life in patients with NDO. Both onabotulinumtoxinA (Botox®, Allergan, Irvine, USA) and abobotulinumtoxinA (Dysport®, Ipsen, Paris, France) have a level A recommendation for NDO-treatment. The recommended dose for intradetrusor injections in NDO patients is 200 U of onabotulinumtoxinA or 500 U of abobotulinumtoxinA. The drug is generally administered extratrigonal in the detrusor muscle, via cystoscopic guided injection at 20 sites in 1 mL injections. Intradetrusor BTX-A injections are safe, with mostly local complications such as urinary tract infection and high post-void residual or retention. The effect of the toxin lasts for approximately 9 months. Repeat injections can be performed without loss of efficacy. Different injection techniques, novel ways of BTX-A administration, eliminating the need for injection or new BTX-A types with better/longer response rates could change the field in the future.

English

OBJECTIVES AND AIM Chronic anal fissure is a common condition presenting to surgical OPD. The treatment for Anal Fissure is based on reducing the spasm of the internal anal sphincter, by use of local anesthetics, by muscle relaxation with the help of chemical sphincterot omy or surgical sphincterotomy. Analysis of the available literature shows that medical manipulation of the internal sphincter should be the first-line treatment in Anal Fissure. A surgical therapy is called for if the medical therapy fails or there is a recurrence. The treatment for Anal Fissure is based on reducing the spasm of the internal anal sphincter by dilating the anal canal and breaking this vicious cycle and this can be achieved by 2 methods. a) Surgical: Lateral Internal Sphincterotomy. It is a surgical technique to cure Anal Fissure. It has been favored by most of the surgeons, because it offers long-lasting relief in sphincter spasm. Lateral Internal Sphincterotomy is considered as the gold standard treatment for chronic fissures, but it permanently weakens the internal sphincter and may lead to anal deformity and incontinence in 8–30% of patients. Therefore, recently nonsurgical treatment modalities have come to the forefront. b) Non-Surgical: Smooth muscle relaxation is an effective non-surgical treatment for Chronic Anal Fissure and has advantages over surgical treatment in avoiding long-term complications. Additionally, it does not require hospitalization. Smooth muscle relaxation is also the first option in patients with a high risk of incontinence. Smooth muscle relaxation has been tried using a variety of agents, e.g., Glyceryl Trinitrate (GTN) and Botulinum Toxin (BTX). This study is to see the role of Botulinum Toxin (A smooth muscle relaxant) in non-surgical management of Chronic Anal Fissure. Materials and Methods:

The role of botulinum toxin a in the establishment of symmetry in pediatric paralysis of the lower lip.

Botulinum toxin A has been described as an effective adjunct treatment for achieving symmetry in adults with facial paralysis. Few investigators have described the use of botulinum toxin A in pediatric patients with facial paralysis. To present our preliminary experience with botulinum toxin A in pediatric patients presenting with asymmetry of the lower lip. We performed a retrospective medical record review of all pediatric patients (age range, 4-17 years; mean [SD] age, 11.2 [4.7] years) with facial paralysis who were treated with botulinum toxin A injections from January 1, 2004, through December 31, 2012. Patients presented for treatment at The Hospital for Sick Children, Toronto, Ontario, Canada, or the Massachusetts Eye and Ear Infirmary, Boston. Using facial analysis software, we measured lower lip asymmetry in the patients' photographs before and after treatment, at rest, and in a dynamic state. We performed analysis of variance to assess for improvement in symmetry. We identified 18 patients with the following 3 primary indications for treatment: focal lip asymmetry (n = 11), extensive hemifacial asymmetry (n = 5), and focal synkinesis (n = 2). We found no complications related to botulinum toxin A treatment. The mean (SD) dynamic deviation before the injection was 3.5 (1.7) mm, whereas the mean dynamic deviation after the injection was 1.5 (0.8) mm. The mean (SD) deviation correction was evaluated at 61% (6%) and was statistically significant (P = .04). Botulinum toxin A injection is a safe procedure for improving localized asymmetry in pediatric patients with facial paralysis. Preliminary results indicate that botulinum toxin A may be an effective treatment for lower lip asymmetry in children and adolescents. 4.

Pharmacotherapy for the management of achalasia: Current status, challenges and future directions.

This article reviews currently available pharmacological options available for the treatment of achalasia, with a special focus on the role of botulinum toxin (BT) injection due to its superior therapeutic effect and side effect profile. The discussion on BT includes the role of different BT serotypes, better pharmacological formulations, improved BT injection techniques, the use of sprouting inhibitors, designer recombinant BT formulations and alternative substances used in endoscopic injections. The large body of ongoing research into achalasia and BT may provide a stronger role for BT injection as a form of minimally invasive, cost effective and efficacious form of therapy for patients with achalasia. The article also explores current issues and future research avenues that may prove beneficial in improving the efficacy of pharmacological treatment approaches in patients with achalasia.

The role of botulinum toxin A in the management of neurogenic lower urinary tract symptoms

Urinary incontinence associated with neurogenic detrusor overactivity is a common and distressing disorder in patients with chronic neurological conditions. When conservative therapy and antimuscarinic agents fail to treat or improve symptoms, intra-detrusor injections of botulinum toxin A may be considered. This article outlines the history of botulinum toxin A and its use in the management of neurogenic detrusor overactivity. Clinical issues such as patient selection, risks and benefits, and how to appropriately counsel patients prior to considering this treatment are discussed.

Hidradenitis suppurativa: A practical review of possible medical treatments based on over 350 hidradenitis patients

Hidradenitis suppurativa (HS), a pathological follicular disease, impacts patients' lives profoundly. HS most commonly involves cutaneous intertriginous areas, such as the axilla, inner thighs, groin and buttocks, and pendulous breasts, but can appear on any follicular skin. Protean, HS manifests with variations of abscesses, folliculitis, pyogenic granulomas, scars (oval honeycombed), comedones, tracts, fistulas, and keloids. The pathophysiology might involve both defects of the innate follicular immunity and overreaction to coagulase negative Staphylococcus. Treatment depends on the morphology, extent, severity, and duration. Topical clindamycin and dapsone are often adequate for treating mild HS. For Stage 1 and 2 HS, first line treatment combines rifampin with either oral clindamycin or minocycline. Other HS treatments include: fluoroquinolones with metronidazole and rifampin, oral dapsone, zinc, acitretin, hormone blockers (oral contraceptive pills, spironolactone, finasteride, and dutasteride), and oral prednisone. For severe HS, cyclosporine, adalimumab, or infliximab (used at double psoriatic doses) and intravenous carbapenems or cephalosporins are often required. Isotretinoin, etanercept, isoniazid, lymecycline, sulfasalazine, methotrexate, metformin, colchicine, clarithromycin, IVIG, and thalidomide are less favored treatments. The role of botulinum toxin is uncertain. The most important life style modification is weight loss. De-roofing fluctuant nodules and injection of intralesional corticosteroids ameliorates the disease and perhaps, if done at regular intervals, improves HS more permanently. Surgical excision and CO2 laser ablation are more definitive treatments. The 1064 nm laser for hair removal aids in the treatment of HS. This article centers on medical therapies and will only passingly mention surgical and laser treatments. This article summarizes my treatment experience with over 350 HS patients.

Book Review: Botulinum Neurotoxin for Head and Neck Disorders

A Blitzer, BE Benson, J Guss . Botulinum Neurotoxin for Head and Neck Disorders. New York: Thieme, 2012. ISBN-10: 1604065850 Botulinum Neurotoxin for Head and Neck Disorders is a moderately sized text covering a very specific, clinically relevant, and contemporary topic that is applicable to physicians in many specialties, including plastic surgery, facial plastic surgery, otolaryngology/head and neck surgery (Oto-HNS), neurology, and dentistry. An initial review of the contents of the text reveal several appealing color illustrations and diagrams and a moderately large, easy-to-read font. The 19 chapters are subdivided into 4 distinct topic sections: dystonia, other motor disorders, pain syndromes, and autonomic disorders. Following the Table of Contents is a listing of 22 online videos that demonstrate the injection techniques described in the text. The foreword provides the reader with a brief history of the medical uses of botulinum toxin (BoNT) to be described in the text, including strabismus, focal dystonias such as spasmodic dysphonia and blepharospasm, migraine headache, hyperhidrosis, and wrinkle reduction. The preface describes the intended audience for the book, which includes clinicians familiar with treating a variety of disorders affecting the head and neck—plastic surgeons, otolaryngologists, neurologists, dentists, and pain specialists. After reading this book, we would agree with the intended audience and add medical students and novice practitioners to the list. This book provides a comprehensive review of the more common clinical applications of BoNT, including the treatment of focal dystonias, pain syndromes, and cosmetic applications. Included in each section are descriptions of the pathology under consideration, important differential diagnostic considerations, accepted medical and surgical therapies for each condition, the role of BoNT in ameliorating …

Botulinum toxin for meralgia paresthetica in type 2 diabetes

Botulinum toxin has been used for a variety of neuropathic conditions in diabetes mellitus. Meralgia paresthetica is a mononeuropathy of femoral nerve seen in diabetes and obesity with an unclear etiopathogenesis. We studied the role of botulinum toxin in resistant cases of meralgia paresthetica in type 2 diabetes.

A Review of Thoracic Outlet Syndrome and the Possible Role of Botulinum Toxin in the Treatment of This Syndrome

The objective of this paper is to discuss the classification, diagnosis, pathophysiology and management of Thoracic outlet syndrome (TOS). Thoracic outlet syndrome (TOS) is a complex entity that is characterized by different neurovascular signs and symptoms involving the upper limb. TOS is defined as upper extremity symptoms due to compression of the neurovascular bundle in the area of the neck just above the first rib. Compression is thought to occur at one or more of the three anatomical compartments: the interscalene triangle, the costoclavicular space and the retropectoralis minor spaces. The clinical presentation can include both neurogenic and vascular symptoms. TOS can be difficult to diagnose because there is no standardized objective test that can be used and the clinician must rely on history and several positive findings on physical exam. The medial antebrachial cutaneous nerve conduction may be a sensitive way to detect pathology in the lower trunks of the brachial plexus which is promising for future research. Treatment options continue to be conservative and surgical. However, for those who have failed physical therapy there is research to suggest that botulinum toxin may help with symptom relief. However, given that there has been conflicting evidence, further research is required using randomized controlled trials.

Can botulinum toxin improve mood in depressed patients?

Evaluation of: Wollmer MA, de Boer C, Kalak N et al. Facing depression with botulinum toxin: a randomized controlled trial. J. Psychiatr. Res. 46(5), 574–581 (2012).Depression has a number of significant symptoms such as depressed mood, lack of volition/energy, suicidal ideation, low concentration, sleep disturbance, anger, anxiety, psychomotor retardation, fear and sadness. In addition, various facial expressions such as frowning and sadness can also be easily recognized in depressed patients. In fact, major muscles involved in the development of such negative emotion have been reported in depressed patients, for instance, corrugators and procerus muscles in the glabellar regions of the face. Electromyography studies have also reported that depressed patients had overactivity of such grief muscles during different affective imagery paradigms. Furthermore, subjective emotion has also been found to be affected by differential facial expression via an image feedback system. Interestingly, anecdotal open-label studies have shown that botulinum toxin may have a role in treatment of depression and a recent randomized-placebo controlled study has also confirmed the effect of botulinum toxin in reduction of depressive symptoms for the first time. This article will discuss the putative role of botulinum toxin in a treatment of depression in the context of the clinical significance, limitations and future research directions.

The role of botulinum toxin A and abduction bracing in the management of hip development in children with cerebral palsy

The role of botulinum toxin A and abduction bracing in the management of hip development in children with cerebral palsy