Role Of Botulinum Toxin Research Articles

The role of botulinum toxin in whiplash injuries

Cervical whiplash injuries are common and yet poorly understood. Several of these cases become chronic for unknown reasons and defy most forms of musculoskeletal therapy. Botulinum toxin has shown promise in selected cases in which soft tissue injury predominates. In conjunction with a good biomechanical assessment and appropriate physical rehabilitation techniques, this new approach to treatment may offer a way of treating the central and peripheral dysfunction that characterizes this condition.

Botulinum Toxin in Headache Treatment: The End of the Road?

In this issue of Cephalalgia, Silberstein et al. report a trial on the efficacy of botulinum toxin A in chronic tension-type headache (1). This is another important contribution to the growing evidence of the advantages and limitations of botulinum toxin A in headache treatment. There are now several studies either published or presented at conferences on the efficacy of botulinum toxin A in different primary headache disorders. A number of reports have appeared over the past 10 years on the role of botulinum toxin A for the prophylactic treatment of headache. This started with several positive open trials (for review see (2)). On this basis, placebo-controlled, double-blind trials have been performed for different headache disorders and for different types, doses and injection sites of botulinum toxin A. Coming now to a preliminary conclusion, it is obvious that in almost all double-blind, placebocontrolled trials on tension-type headache and migraine, the primary end-point was negative from a statistical point of view. In Table 1, all placebocontrolled and double-blind trials that give enough data to conclude on the efficacy of botulinum toxin A are listed. In prophylaxis trials, the comparison between verum and placebo within 3 months should be the basis of the primary efficacy parameter (3, 4). Considering this suggestion, only one trial on migraine in one (the low dose) subgroup fulfilled the criteria of a randomized, double-blind, placebocontrolled trial with a positive primary efficacy parameter for migraine diagnosed according to the International Headache Society criteria. The current study by Silberstein et al. (1) adds to these findings.

Botulinum toxin changes intrafusal feedback in dystonia: A study with the tonic vibration reflex

To investigate the possible role of botulinum toxin (BT-A) injection in reducing muscle afferent feedback, we evaluated electrophysiologically 10 right-handed patients with writer's cramp before and 3 weeks after treatment. The ratio between pre- and postinjection values of maximal M-wave (M-max), maximal voluntary contraction (MVC), and tonic vibration reflex (TVR) were measured in the injected muscles (wrist flexors or extensors). In all the subjects, BT-A injection reduced the TVR more than the M-max and MVC (mean ratio +/- SD: TVR, 0.24 +/- 0.22; MVC, 0.59 +/- 0.32; M-max, 0.68 +/- 0.24; P = 0.003). Long-term evaluation of 2 patients disclosed that, after 7 months, when some clinical benefits persisted, M-max and MVC had fully recovered, whereas the TVR was still depressed. This special sensitivity of the TVR to suppression by BT-A injection could be mediated by the chemodenervation of intrafusal muscle fibers, leading to a reduction in spindle inflow to the central nervous system during vibration. The action on intrafusal fibers could alter sensorimotor integration, thus contributing to the clinical benefits of BT-A injection.

The role of botulinum toxin in postparotidectomy fistula treatment. A technical note

Purpose Parotid fistula is a well-known complication of parotidectomy or penetrating injury of the parotid gland. The management of parotid fistula has been controversial, and numerous conservative and surgical treatment methods have been described. Methods We report 3 cases of parotid fistula after partial parotidectomy, which were treated by botulinum toxin injection under electromyographic control into the residual substance of parotid gland. Results Complete healing of the fistula was achieved with a single botulinum toxin treatment in all patients. No side effects were observed after the treatment. The patients are disease-free after 21, 18, and 14 months, respectively. Conclusions In the considered cases, the localized injection of botulinum toxin into the parotid gland resulted to an effective and long-lasting treatment of postparotidectomy fistula.

Tension-type headache

Tension-type headache, the most common type of primary headache disorder, is reclassified in the second International Headache Society classification with clear diagnostic criteria. Chronic tension-type headache (CTTH) differs from episodic form in frequency, lack of response to most treatment strategies, more medication overuse, and more loss of quality of life. New concepts in the pathophysiology of CTTH emphasize the possible role of central nociceptive pathway sensitization in addition to peripheral myogenic factors. Mechanisms of central sensitization, even though poorly understood, may involve nitric oxide system and N-methyl-D-aspartate receptors. Future treatment modalities are likely to be based on such mechanisms. Using MRI and voxel-based morphometry, structural abnormalities have been found in patients with CTTH for the first time. Pain processing areas such as dorsal rostral and ventral pons, anterior cingulate cortex, anterior and posterior insular cortex, right posterior temporal lobe, orbitofrontal cortex, para hippocampus bilaterally, and the right cerebellum were found to have decreased gray matter in patients with CTTH compared with control subjects and patients with medication overuse headache. Amitriptyline remains the most effective preventive treatment so far. The role of botulinum toxin is not fully defined.

The Role of Botulinum Toxin A in Augmentation of the Effect of Recession and/or Resection Surgery

The aim of this study is to assess the effectiveness of intraoperative botulinum toxin A (BTA) injection as an adjunct to the surgical treatment of large-angle esotropia or exotropia. Ten patients were included in the study. Mean age of the patients was 27+/-20 years. Of these 10 patients, 7 were esotropic and 3 exotropic. The average preoperative esodeviation was 73.6+/-16.5 prism diopters and exodeviation was 76.7+/-5.8 PD. Five units of BTA were injected intraoperatively into one of the recessed horizontal rectus muscles in all of the patients. The average follow-up was 14+/-10 months (range, 8 to 40 months). The average final deviation in the esotropia group was 13+/-9.6 PD of esotropia. The average final deviation in the exotropia group was 4.7+/-5 PD of exotropia. The final deviation of the 70% patients was within 10 PD of esotropia or exotropia. The results of this study suggest that the combination of BTA injection with recession may increase the expected correction of a conventional horizontal rectus muscle surgery.

Botulinum toxin – an update on its use in facial rejuvenation

The role of botulinum toxin in facial rejuvenation has been greatly expanded in the last several years. In this article, we first review the traditional approach to botulinum toxin therapy in the forehead and glabella. For the advanced reader, we then discuss both the literature and our personal approaches to treatments of the periocular region, mid face, lower face, and neck. Throughout the discussion, attempts are made to include a description of relevant anatomy, the physiologic result of specific muscle activity and denervation, and perhaps most importantly, precise directions for patient treatment.

The role of botulinum toxin in neurourology

Botulinum toxin is a presynaptic neuromuscular blocking agent that induces a selective and reversible muscle weakness of up to several months when injected intramuscularly in minute quantities. Different medical disciplines have applied the toxin to treat mainly muscular hypercontraction. For neurourologically impaired patients, the reported successful treatment of neurogenic detrusor overactivity and detrusor sphincter dyssynergia with botulinum-A toxin is a promising alternative option to conservative medication or surgery. This review of the literature presents current indications, techniques for and results of the use of botulinum toxin in neurourologically impaired patients and aims to give an insight into this new therapeutic option.

Role for botulinum toxin in back pain treatment in adults with cerebral palsy: report of a case

Objective. – To report a case illustrating the usefulness of botulinum toxin A in the treatment of spinal dystonia responsible for low back pain and postural disorders. Methods. – Critical appraisal of a case report. Case report. – A young woman with cerebral palsy had lumbar paraspinal muscle dystonia responsible for pain and hyperlordosis unresponsive to oral medications for muscle spasm. Botulinum toxin A (Botox®, 200 U) was injected into the paraspinal muscles at six sites, to good effect. Discussion. – The few reported cases consistently show a favorable effect of local botulinum toxin A injections in patients with painful paraspinal muscle dystonia related to neurological disease or chronic low back pain. Conclusion. – Botulinum toxin A may be a useful treatment for incapacitating painful dystonia of the paraspinal muscles. This treatment improves posture in the sitting position and facilitates the fitting of orthotic devices. Furthermore, botulinum toxin A treatment may help to determine whether an intrathecal baclofen test is in order.

Use of botulinum toxin the the treatment of muscle pain

The analgesic effects of botulinum toxin (BTX) have been discussed controversially due to substantial placebo effects and flaws in the study designs used. Additionally, pathophysiological concepts of pain and the specific analgesic mechanisms of BTX remain largely unclear. Apart from pain reduction through the well-documented effects of BTX at the neuromuscular endplate, additional analgesic mechanisms, including other synaptic and local effects, have been suggested. Currently, BTX can be recommended for pain treatment in dystonia and spasticity. In myofascial pain syndromes, pain relief by BTX injections has been reported, but definite proof according to evidence-based medicinal criteria is still lacking. In fibromyalgia, there seems to be no analgesic effect. The role of BTX in pain therapy is likely to increase in the future.

Harnessing a Poison to Manage Pain: The Role of Botulinum Toxin

Harnessing a Poison to Manage Pain: The Role of Botulinum Toxin

Is there a role for botulinum toxin in the treatment of migraine?

In this review, the studies and case reports that are available from reference systems and published congress contributions on the treatment of migraine with botulinum toxin are evaluated. The studies and reports were analyzed with respect to the study design, the efficacy parameters, and the significance of results. One double-blind, placebo-controlled, randomized study with negative (for a 75 U dose of botulinum toxin) and positive (for a 25 U dose of botulinum toxin) evidence of efficacy, one that was a partly positive controlled study (pain intensity, but not attack-frequency improved), and four positive open studies were available. For the acute treatment of migraine with botulinum toxin, only positive case reports were published. As a result of this analysis, there is no sufficient scientific evidence for a treatment recommendation of migraine with botulinum toxin. Further studies are needed for a definite evaluation of subgroups with probable benefit from such a treatment and for the comparison of botulinum toxin with other migraine prophylactic drugs.

The role of botulinum toxin in treating Cerebral Palsy hands

Botulinum toxin A (BTA) has been used beneficially for the treatment of a large number of spastic conditions. Its use in the management of the hand in children with Cerebral Palsy has not been widely reported. Five recent articles are reviewed and compared with our early and later work in this regard. It is difficult to standardize results due to the great individual variation found in these patients. Although methods of assessment varied in the studies, conclusions were that its use in selected muscles could greatly benefit children with Cerebral Palsy from both functional and cosmetic point of view.

A3. The role of botulinum toxin and alphahydroxy acids as agents to prolong the effects of skin rejuvenation procedures

The desire of ‘baby‐boomers’ to remain forever young can prove to be a tenuous goal that often eludes most of us. However, with the current popularity and availability of minimally invasive techniques of facial rejuvenation, many people with facial wrinkles and photodamage may be closer to the ideal of at least appearing youthful.Injections of Botulinum toxin (BTX) will remove many of the dynamic wrinkles of the face that denote a negative emotion and give the appearance of being old and tired or even angry and disgusted. These types of wrinkles are produced by hyperactive mimetic muscles of the face, which can be weakened by injections of BTX.The addition of superficial chemical peelings with the alphahydroxy acids (AHAs) can be used to rejuvenate the superficial surface of the face by diminishing the appearance of the fine, static wrinkles of the face, many of which are caused by photodamage and chronological ageing. Daily application of the AHAs in cream form can be used to maintain a supple, healthy glow on the surface of the skin, keeping the telltale wrinkles of the ageing process at bay.

Physiotherapy and botulinumtoxin in spasticity management

This article outlines the role of botulinum toxin as an adjunct to physiotherapy in spasticity management. It stresses the need for a multi-disciplinary approach in order to maximize the potential for a successful outcome. Criteria for effective use of botulinum toxin are discussed, and the importance of constant evaluation through outcome measures is emphasized.

The role of botulinum toxin in the management of cerebral palsy

Botulinum is a powerful biological toxin which has been misused for biological warfare in the past; the relatively recent discovery that it can reduce spasticity, including in cerebral palsy (CP), offers a promising variety of treatments for the future. It is safe and effective when used according to recommended protocols by individuals with appropriate training. In each case, effects should be monitored to determine if recurrent treatment is indicated. A lot of questions about this therapy remain to be answered by research, including optimal dosage and long-term efficacy.Botulinum toxin A therapy (BoNT A) is increasingly being offered as part of a package of services for CP at district as well as tertiary level. This article summarizes current understanding of the practical aspects, and can be used as a basis for formal instruction in the techniques involved.

Botulinum toxin: basic science and clinical uses in otolaryngology.

The role of botulinum toxin as a therapeutic agent is expanding rapidly in otolaryngology. Botulinum toxin is a protease that blocks the release of acetylcholine from nerve terminals. Its effects are transient and nondestructive, and largely limited to the area in which it is administered. These effects are also graded according to dose, allowing for individualized treatment of patients and disorders. Botulinum toxin has been used primarily to treat disorders of excessive or inappropriate muscle contraction. In the field of otolaryngology, these include spasmodic dysphonia, oromandibular dystonia, and blepharospasm; vocal tics and stuttering; cricopharyngeal achalasia; various tremors and tics; hemifacial spasm; temporomandibular joint disorders; and a number of cosmetic applications. Botulinum toxin treatment has recently begun to show some benefit in the control of pain from migraine and tension headache. It may also prove useful in the control of autonomic dysfunction, as in Frey syndrome, sialorrhea, and rhinorrhea. In over 20 years of use in humans, botulinum toxin has accumulated a considerable safety record, and in many cases represents relief for thousands of patients unaided by other therapy.

The role of botulinum toxin in the neuro-rehabilitation of young patients with brachial plexus birth palsy.

To favour the active movements of the shoulder abductor/external rotator, elbow extensor and supinator muscles, through the partial inhibition of the uninvolved antagonistic muscles, in the Brachial Plexus birth Palsy (BPP). The type A Botulinum Neuro Toxin (BNT-Dysport, Ipsen) was injected in 50 outpatients (mean age: 4.7 +/- 3.4 years) with BPP according to the criteria: early and current neuro-rehabilitation (Reflex Locomotion-RL), age <14 years, no cognitive impairment. Repeat injections (1.9 +/- 0.8) were performed in 30 patients. The range of active movements increased at the maximal benefit phase, compared to the baseline values (p < 0.05-0.01). The gain of shoulder's abduction was directly related to the youngest age (r = 0.6). An expanded compliance of the injected muscles and a faster response to the RL, in respect to that experienced in the pre-BNT sessions, was detected. The Global Clinical Rating Scale disclosed the temporal profile of the clinical outcome, with step-like increases of the function in 70% of the patients, and a 'plateau' trait in the remaining ones (+29.8 +/- 10.5%). The video-taped recordings showed an improvement in the global movements. The employment of BNT in the management of young patients with BPP has beneficial effects in the integration of the bodily scheme.

The role of drug treatment in children with strabismus and amblyopia.

Strabismus, or misalignment of the eyes, is a common ophthalmic problem in childhood, affecting 2 to 5% of the preschool population. Amblyopia is an important cause of visual morbidity frequently associated with strabismus, and both conditions should be treated simultaneously. Pharmacological means for treating strabismus and amblyopia can be divided into 3 categories: paralytic agents (botulinum toxin) used directly on the extraocular muscles to affect eye movements; autonomic agents (atropine, miotics) used topically to manipulate the refractive status of the eye and thereby affect alignment, focus and amblyopia; and centrally acting agents, including levodopa and citicoline, which affect the central visual system abnormalities in amblyopia. Botulinum toxin, the paralytic agent that causes the clinical symptoms of botulism poisoning, can be injected in minute quantities to achieve controlled paralysis of the extraocular muscles. Although the role of botulinum toxin is established in adults with paralytic strabismus, its usefulness in the treatment of comitant childhood strabismus (primary esotropia and exotropia) is not universally accepted. Botulinum injections tend to be more effective with smaller degrees of strabismus, in patients with good binocular fusion, and in managing overcorrections or undercorrections after traditional muscle surgery. Inadvertent ptosis and paralysis of adjacent muscles, unpredictable responses and technical constraints of the injections limit its use in children. Miotic therapy, by altering the refractive state of the treated eye, offers an alternative to optical correction with bifocals in treating esotropia due to excessive accommodative convergence. It is also effective in treating residual esotropia following surgery. The ease of use of glasses restricts the wide application of miotics in these common strabismus syndromes. Atropine, an anticholinergic agent, paralyses the ability of the eye to focus or accommodate. In amblyopia therapy, atropine is used to blur vision in the non-amblyopic eye and offers a useful alternative to traditional occlusion therapy with patching, especially in older children who are not compliant with patching. The neurotransmitter precursor levodopa and the related compound citicoline have been demonstrated to improve vision in amblyopic eyes. The therapeutic role of these centrally acting agents in the clinical management of amblyopia remains unproven.

What is the role of botulinum toxin in the treatment of dysthyroid strabismus?

Background: Botulinum toxin A has been used in the treatment of dysthyroid strabismus primarily as a temporary measure during the active phase of the disease. We report on our experience with 65 patients. Method: We review the records of 65 patients with dysthyroid strabismus who were treated with botulinum toxin A at Moorfields Eye Hospital between 1984 and 1996. Conclusions: Patients with a short duration of relatively mild dysthyroid strabismus have a chance of long-term benefit with botulinum toxin A. There is little use for botulinum toxin A in cases of severe dysthyroid disease. (J AAPOS 1999;3:272-4)