Therapeutic Use Of Botulinum Toxin Research Articles

BOTULINUM TOXIN INJECTIONS FOR FACIAL REJUVENATION: COMPLICATIONS AND THEIR AVOIDANCE

The therapeutic use of botulinum toxin for facial reju­venation is the most popular aesthetic procedure. The prevalence of complications is approximately 16 percent and they are usually mild, transient, and self-limited. Of them, the most common is bruising, followed by ot­her less prevalent local adverse effects such as ptosis of the eyelid or eyebrow, facial asymmetry, diplopia and lagophthalmos, or local injection location pain as well as allergy which can manifest systemically. Accurate knowledge of the anatomy of the facial muscles and ot­her structures, correct technique, proper dosing of botu­linum toxin, and injection location marking being used are the fundamental ways to avoid such complications. Post-procedural management depends on the manifested complications.

Statement of the Rehabilitation Medicine Society of Australia and New Zealand for the therapeutic use of botulinum toxin A in spasticity management.

The Rehabilitation Medicine Society of Australia and New Zealand advocates the safe, effective and evidence-based use of botulinum toxin type A for spasticity management. The process requires appropriate training, alongside considerable knowledge and skills, to maximise efficacy. The processes before and after injection contribute to effectiveness. The gold standard of managing spasticity is for assessment by a multidisciplinary specialist team, deriving patient-centric goals, and designing an injection protocol to match these goals. The patient and/or carers are considered part of the decision-making team. Postinjection therapy and measurement of goal achievement are highly recommended as part of the wider holistic approach to management. The Society believes treatment failures can be minimised by following clear clinical guidelines.

The therapeutic use of botulinum toxin in different oral and maxillofacial conditions

The therapeutic use of botulinum toxin in different oral and maxillofacial conditions

Avoiding Complications on the Upper Face Treatment With Botulinum Toxin: A Practical Guide.

Background Currently, botulinum toxin (BoNT) injections are the most commonly performed non-invasive procedure for rejuvenation on the upper face. The therapeutic use of botulinum toxin has generally been safe and well tolerated. Adverse effects are considered mild, transient, and self-limited. However, as with all other injectable procedures, this one is also susceptible to adverse events and complications. When the safety zones are respected, the chance of any of these complications is practically null.Thus, this review aims to describe the main complications of treatment with BoNT on the upper face and to present a practical guide based on current evidence on how to avoid them.Methods The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles.Results The main complications secondary to BoNT injections on the upper face are: ptosis of eyelid or eyebrow, eyebrow asymmetry, diplopia, Lakeophthalmos, Palpebral ectropion, and prominence of the palpebral bags. To avoid such complications, it is necessary to have knowledge of the anatomy of this region and adequate and individualized planning based on the existing patterns of the frontalis muscle, glabella, and crow's feet. This review presents the specificities of each of these regions and practical suggestions to obtain satisfactory results, avoiding complications.Conclusion Particularly on the upper face treatment with BoNT offers predictable results, has few adverse effects, and is associated with high patient satisfaction. However, it is suggested that the commented parameters and safety areas be incorporated into daily practice so that the possibilities of complications are minimized as much as possible.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury.

Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.

Updates on the cosmiatric and therapeutic use of botulinum toxin

Updates on the cosmiatric and therapeutic use of botulinum toxin

Botulinum toxin for the treatment of strabismus.

Botulinum toxin for the treatment of strabismus.

Botulism like syndrome about one case

The therapeutic use of botulinum toxin A in the treatment of spasticity is well known. It inhibits the release of acetylcholine at the neuromuscular junction and causing a chemical denervation and paralysis of the muscle [1] . Its effects are usually locoregional nevertheless rare systemic side effects are described in the literature. We report a case of botulism-like syndrome. Mr D. aged 39 suffers from a cerebral palsy. The indication of botulinum toxin injections is retained to a clinical associating bilateral equinovarus and spasticity of both triceps surae to 3 on the modified Ashworth scale. The first injection of botulinum toxin is done in September 2012, he received 200 IU of Botox in each surae triceps. Before a good result, three other botulinum toxin injections with the same injection schedule are done out January 10, 20 September and 24 December 2013. Mr D. is seen in consultation January 20, 2014 in a context of tiredness, muscle weakness, and deficit of shoulder and pelvic girdles. Electromyography, made February 18, 2014, found neurogenic traced in the deltoids. The whole of clinic and electrical symptoms is strongly suggestive of a botulism-like syndrome. On May 26, 2014 electromyogram is performed while the patient has recovered its previous clinical condition. This is normal. In the literature, few cases of botulism-like syndrome have been described. The pathophysiologic exact mechanism remains unclear [2] . Our patient developed the botulism-like syndrome in the fourth injection so that the dose, dilution and injection technique are the same. However, the interrogation conducted as a result of this event is the notion of significant tiredness after the third injection without that he made the link with the injection. This shows the importance of information and education of our patients as part of repeated injections of botulinum toxin.

Therapeutic use of botulinum toxin in migraine: mechanisms of action.

Migraine pain represents sensations arising from the activation of trigeminal afferents, which innervate the meningeal vasculature and project to the trigeminal nucleus caudalis (TNC). Pain secondary to meningeal input is referred to extracranial regions innervated by somatic afferents that project to homologous regions in the TNC. Such viscerosomatic convergence accounts for referral of migraine pain arising from meningeal afferents to particular extracranial dermatomes. Botulinum toxins (BoNTs) delivered into extracranial dermatomes are effective in and approved for treating chronic migraine pain. Aside from their well-described effect upon motor endplates, BoNTs are also taken up in local afferent nerve terminals where they cleave soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) proteins, and prevent local terminal release. However, a local extracranial effect of BoNT cannot account for allthe effects of BoNT upon migraine. We now know that peripherally delivered BoNTs are taken up in sensory afferents and transported to cleave SNARE proteins in the ganglion and TNC, prevent evoked afferent release and downstream activation. Such effects upon somatic input (as from the face) likewise would not alone account for block of input from converging meningeal afferents. This current work suggests that BoNTs may undergo transcytosis to cleave SNAREs in second-order neurons or in adjacent afferent terminals. Finally, while SNAREs mediate exocytotic release, they are also involved in transport of channels and receptors involved in facilitated pain states. The role of such post-synaptic effects of BoNT action in migraine remains to be determined.

Botulinum toxin in the treatment of vocal fold nodules

Promising new techniques in the management of vocal fold nodules have been developed in the past 2 years. Simultaneously, the therapeutic use of botulinum toxin has rapidly expanded. This review explores the use of botulinum toxin in treatment of vocal nodules and summarizes current therapeutic concepts. New microsurgical instruments and techniques, refinements in laser technology, radiosurgical excision and steroid intralesional injections are all promising new techniques in the management of vocal nodules. Botulinum toxin-induced 'voice rest' is a new technique we have employed in patients with recalcitrant nodules. Successful resolution of nodules is possible with this technique, without the risk of vocal fold scarring inherent in dissection/excision techniques. Botulinum toxin usage is exponentially increasing, and large-scale, long-term studies demonstrate its safety profile. Targeted vocal fold temporary paralysis induced by botulinum toxin injection is a new, well tolerated and efficacious treatment in patients with persistent vocal fold nodules.

Justinus Kerners wagemutige Experimente mit Botulinumtoxin

The 19th century German romantic poet and medical officer Justinus Kerner (1786-1862) provided the first detailed clinical description of botulism and its associations with faulty sausage production. He collected data on 230 cases of botulism and published 2 important monographs in 1820 and 1822. Kerner gave a remarkably complete and accurate description of clinical botulism: its symptoms, time course, and physical findings - 70 years before this was identified as being caused by anaerobic microbes. He drank an extract of the faulty sausage poison to study the symptoms in a very dangerous self-experiment. Thereby he could describe that it was sour and could produce early stages of the „sausage poisoning”. Treating this disease he described the use of a gastric tube, 50 years before such experiments were recorded officially. Beyond of that he applied an extracorporal „pacemaker” - 100 years before this was introduced into clinical medicine. Finally, Kerner suggested the potential therapeutic use of botulinum toxin to block abnormal motor movements, such as chorea, and speculated on its use in other disorders such as hypersecretion, for example. His first description of „botulismus” is a highlight and up to now an example of pure natural science and shows that he was an excellent clinician, too.

Botulinum Toxin: vom Medikament zum Toxin ...

For most of its time, the history of botulinum toxin (BT) has been the history of botulism, i. e. of an intoxication with BT. By the end of the 1960's a paradigm shift took place which in this radicalness had never occurred before in the history of mankind. At that time BT was first used therapeutically to treat strabismus. From ophthalmology BT rapidly spread into numerous medical specialties. For most of its indications BT is the therapy of choice, for some it has revolutionized their treatment altogether. The widespread therapeutic use of BT allowed detailed clinical and technical investigations of BT's action upon the human body. Applying this knowledge we diagnosed for the first time chronic botulism in adults living on a farm with chronic bovine botulism. This constitutes another radical paradigm shift. The history of BT is the history of a dual paradigm shift each time induced by a complete reversal of the viewing perspective. Knowledge gain can be a linear process. It can, however, also be a circular one. Changes of the viewing perspective are crucial. Changing the viewing perspective may facilitate knowledge gain. This might be used to develop an instrument to facilitate knowledge gain.

The therapeutic use of botulinum toxin in cervical and maxillofacial conditions

Medline, Cochrane Library and bibliographies of identified articles. Studies of high methodological quality (systematic reviews or randomised controlled trials; RCT) were selected if considered use of botulinum toxin (BTX) either prophylactically or therapeutically, as an adjunct to dental implant therapy for temporomandibular disorders or for other maxillofacial conditions such as bruxism, masseteric hypertrophy, oromandibular dystonia or cervical dystonia. Only studies with high levels of evidence were evaluated. Four RCT met the search criteria in the area of cervical dystonia and chronic facial pain. No RCT were identified that evaluated dental implant therapy along with use of BTX. Four RCT did meet the search criteria in the area of cervical dystonia and chronic facial pain. People who had cervical dystonia exhibited significant improvements in baseline functional, pain and global assessments compared with placebo, whereas individuals with chronic facial pain improved significantly compared with placebo in terms of pain. During the period of study, no references were found evaluating use of BTX in dental implantology. Nevertheless, it appears relatively safe and effective in treating cervical dystonia and chronic facial pain associated with masticatory hyperactivity.

The therapeutic use of botulinum toxin in cervical and maxillofacial conditions: an evidence-based review

The role of botulinum toxin as a therapeutic agent for several conditions is expanding. We sought to determine if botulinum toxin is safe and effective in treating patients with cervical dystonia and maxillofacial conditions. Our purpose was to establish a safety and efficacy profile to determine whether or not this treatment may be used prophylactically in patients undergoing dental implant therapy. We performed a systematic search of the literature to identify randomized clinical trials evaluating patients treated with botulinum toxin as an adjunct to dental implant therapy, maxillofacial conditions including temporomandibular disorders (TMD), and cervical dystonia. Four randomized controlled trials (RCTs) met our search criteria in the area of cervical dystonia and chronic facial pain. No RCTs were identified evaluating dental implant therapy. Patients with cervical dystonia exhibited significant improvements in baseline functional, pain, and global assessments compared to placebo. Adverse events were mild and transient with numbers needed to harm (NNH) ranging from 12 to 17. Patients with chronic facial pain improved significantly from baseline in terms of pain compared to placebo. Rates of adverse events were less than 1%. Botulinum toxin appears relatively safe and effective in treating cervical dystonia and chronic facial pain associated with masticatory hyperactivity. No literature exists evaluating its use in dental implantology. Randomized clinical trials are warranted to determine its safety and efficacy in dental implantology and other maxillofacial conditions such as bruxism.

Treatment with botulinum toxin in a patient with myasthenia gravis and cervical dystonia

The therapeutic use of botulinum toxin (BTX) is contraindicated in patients with disorders of neuromuscular transmission (such as myasthenia gravis [MG]). In addition to the desired effect on muscles injected with BTX, instrument investigations reveal a remote cholinergic denervation distant from the injection site, consisting of an increase in jitter, evaluated by EMG-single fiber, and mild abnormalities of autonomic fibers evaluated by cardiovascular reflexes.1,2 We report the results of repeated treatments with BTX type A (BTX-A) in a patient with an association of MG and cervical dystonia (CD). A 23-year-old woman presented in May 2002. Her medical history was unremarkable (except for right esotropia present at birth) until 1998, when she had fluctuating ptosis and diplopia, later associated with generalized weakness involving limbs and neck extensor muscles. A good response to an anti-cholinesterase injection, CMAP decrement on low-rate RNS, and increased serum anti-acetylcholine receptor antibodies led to the diagnosis of MG. The patient was treated chronically …

Pearls and pitfalls in the therapeutic use of botulinum toxin.

Botulinum toxin is a potent toxin and powerful therapeutic tool. Botulinum toxin has therapeutic application in the treatment of a host of neurological, ophthalmologic, gastroenterological, urologic, and dermatologic conditions. Although there are issues specific to each disorder for which botulinum toxin therapy is employed, there are several common principles. This article reviews several of these general principles by addressing common questions that arise in the therapeutic use of botulinum toxin. Areas of focus include patient selection, drug preparation and delivery, use of electromyography to guide injections, drug resistance, and organization of a therapeutic botulinum toxin clinic.

Botulinum toxin in migraine prophylaxis

Migraine is a chronic headache disorder manifesting in attacks lasting 4-72 hours. Characteristics of headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity, and association with nausea, photophobia and phonophobia. The migraine aura is a complex of neurological symptoms, which occurs just before or at the onset of migraine headache. Botulinum toxin A represents a completely new option for patients with chronic pain conditions. Numerous retrospective open-label chart reviews and 4 double-blind, placebo-controlled studies have demonstrated that botulinum toxin type A is significantly effective in migraine prophylaxis and reduces the frequency, severity, and disability associated with migraine headaches. Studies have generally reported a good and consistent efficacy. The differential therapeutic use of botulinum toxin appears to be worth attempting in migraine patients with the following characteristic features: (1) Muscular stress as migraine trigger, e. g., in craniocervical dystonia, pericranial painful muscular trigger points or tender points, oromandibular dysfunction, (2) concurrent chronic tension-type headache with the aggravating factors of muscular stress or oromandibular dysfunction, (3) chronic migraine with frequent migraine attacks on more than 15 days per month for longer than 3 months and if other therapeutic options have been either ineffective or have not been tolerated. The use of the agent does not cause CNS side effects. Migraine patients in particular, often suffer greatly, as a result of the adverse effects of the drugs used, from fatigue, dizziness, reduced concentration, loss of appetite, weight gain, hair loss and changes in libido. These side effects are not known in association with botulinum toxin A. To date, neither organic damage nor allergic complications have been reported. Thus, both the tolerability and the safety of this therapeutic measure are high. The mode of action by which botulinum toxin is effective in migraine prophylaxis is not fully understood and is under investigation. Currently, a number of other randomized, placebo-controlled, clinical trials are being conducted to evaluate the efficacy, optimal dosing, and side-effect profile of botulinum toxin type A in the prophylaxis of migraine and other headache entities.

Nerve injection injury with botulinum toxin.

The therapeutic use of botulinum toxin (Botox) is increasing in popularity. Previous studies have shown that various drugs, especially when injected intrafascicularly, can cause major nerve damage. This study evaluates the potential for neurotoxicity of botulinum toxin in a rat sciatic nerve model. Lewis rats were randomly assigned to one of six groups (n = 10/group). Group 1, 2, and 3 rats received, respectively, an intrafascicular, extrafascicular, and extraneural injection of 50 microl of botulinum toxin (50 UI/ml). Group 4, 5, and 6 rats received 50 microl of 10% phenol as a positive control. Five animals received saline as a negative control. Animals were sacrificed at 2 and 7 weeks. Nerves were harvested and processed for histology and morphometry. Nerves in all botulinum toxin groups retained a normal architecture without cellular infiltration or demyelination. The number and diameter of fibers, the thickness of myelin, and the percentage of neural tissue were comparable with normal controls. Nerves injected intraneurally with phenol presented with severe damage, demyelination, and inflammation at 2 weeks and showed signs of early regeneration at 7 weeks. This study demonstrates that in a rat model, even direct intraneural injection of botulinum toxin caused no damage. This information should encourage the reconstructive surgeon to consider broader applications of this drug.

Therapeutic use of botulinum toxin in otorhinolaryngology. 1: Treatment of movement disorders of mimetic muscles

Therapeutic use of botulinum toxin in otorhinolaryngology. 1: Treatment of movement disorders of mimetic muscles

Historical note on the therapeutic use of botulinum toxin in neurological disorders.

Historical note on the therapeutic use of botulinum toxin in neurological disorders.