Toxin Treatment Research Articles

Botulinum Toxin Treatment in a Case of Dystonia Associated with Complex Regional Pain Syndrome

Botulinum Toxin Treatment in a Case of Dystonia Associated with Complex Regional Pain Syndrome

Positive Effects of Botulinum Toxin On Patients Suffering From Depression

Due to number of patients with depression constantly growing, new methods of treating and improving their well-being are being looked for. Depression has remained among the top diseases in terms of prevalence worldwide for years, and part of the patient group is resistant to drug treatment. Research in the area of improving the well-being of patients struggling with depression and facilitating their treatment process, such as through lifestyle changes, continues to expand. In 2006, the first publication suggesting a positive effect of botulinum toxin type A in patients suffering from depression appeared, and consistently in the following years more and more scientific papers appeared. Botulinum toxin treatments for the face are very popular; it is a drug registered for many medical indications. So what information do we have on this subject at this point? Could depression potentially become one of the indications for botulinum toxin use in the future?

Proximity of Percutaneous Tibial Nerve Stimulation Needle Insertion to Surrounding Anatomic Structures: A Cadaveric Study

(Abstracted from Am J Obstet Gynecol 2023;229:430.e1–430.e6) Each year, spending on treatment of overactive bladder and urinary urgency sans incontinence uses at least $65.9 billion. Although many treatments for such conditions exist, the third line of medication is percutaneous tibial nerve stimulation (PTNS) for patients who wish to avoid onabotulinum toxin treatment and decline implanted devices.

Experience of using incobotulinumtoxin A in the treatment of patients with chronic hemicrania

Introduction. More than a billion people suffer from migraines worldwide. One of the most severe forms of this disease is chronic migraine, in which headache attacks occur 15 or more days a month (at least 8 of them are typical migraine attacks). According to the current clinical guidelines for the treatment of chronic hemicrania botulinum toxin A is used. Randomized multicenter placebo-controlled clinical trials have been conducted to date only for onabotulotoxin A. However, data on possible use of incobotulinumtoxin А for this purpose has appeared. It has a number of advantages. For example, it has lower risk of antibody formation, is stored at room temperature and more economical. So, the opportunity of its use for the treatment of chronic hemicrania has undoubted research and clinical interest.
 Materials and methods. We conducted a retrospective study of outpatient records of twenty seven 23–25 years patients with chronic hemicrania who received 4 courses of injections of incobotulinumtoxin A (Xeomin, «Merz», Germany) with 145 units subcutaneously at 31 point every 12 weeks. The results of treatment were evaluated after the 1st and 4th courses of injections of the drug. 
 Results. After the 1st course of injections of incobotulinumtoxin A the days number with hemicrania decreased by more than 50% in 74.07% of patients, after the 4th course the effect remained in 73.07%. After the 1st and the 4th course of injections a number of days with headache decreased by more than 50% in 48.14% and 50% of patients, respectively. Intensity of pain on the visual-analog scale (VAS) decreased by 41.3% in the remaining days. There was also a quantitative decrease of drugs intake on average by 67.2 ± 2.1%. There was a decline in the anxiety and depression level according to the Hospital Anxiety and Depression Scale (HADS) in patients with a positive treatment effect. All patients responded to therapy maintained a stable effect during botulinum therapy. The treatment was characterized by good tolerability, low frequency and insignificant severity of undesirable effects.
 Limitations. This study has some limitations. The characteristics (age, hemicranias) in some patients appared to be inhomogeneous, and the sample is limited. It was also a retrospective analysis on the basis of one outpatient center, which may limit the applicability and generalization of the results obtained. In addition, this study was carried out in a conditions of real clinical practice, therefore, the study does not include a control group.
 Conclusion. Thus, injections of incobotulinumtoxin A have shown a high level of efficacy and safety in the treatment of patients with chronic hemicrania.

Quality of Life in Female Patients with Overactive Bladder after Botulinum Toxin Treatment.

Manifestations of OAB can considerably diminish the quality of life. Botulinum toxin has emerged as a valuable treatment option in diseases whose symptoms cannot be controlled adequately with other available therapies. The aim of the present study was to compare the subjective quality of life of patients with OAB before the injection of botulinum toxin and three and six months after the intervention. This study was based on a diagnostic survey with three validated questionnaires, ICIQ-OAB, ICIQ-OABqol, and ICIQ-LUTSqol, and an additional questionnaire developed by the authors to collect sociodemographic characteristics and selected medical data. This study demonstrated significant differences between pre-treatment scores and those at three and six months post injection. At three and six months after the intervention, mean scores for all three instruments (ICIQ-OAB, ICIQ-OABqol, ICIQ-LUTSqol) were significantly lower than the respective pre-treatment values, implying a significant attenuation of OAB symptoms and their lower impact on the quality of life. However, the severity of OAB symptoms and their impact on the quality of life at six months post intervention were significantly higher than at three months, except for the social interaction domain. Botulinum toxin is an effective treatment for OAB.

Blepharospasm Secondary to Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson Disease: Clinical Characteristics and Management Outcomes.

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for patients with motor symptoms of Parkinson disease but can be complicated by disabling blepharospasm and apraxia of eyelid opening (ALO). Currently, there is no clear consensus on optimal management, and addressing these issues is further hindered by systemic morbidity and resistance to treatments. We aim to describe the different phenotypes of these eyelid movement disorders, to report our management approach and patient responses to treatment. A retrospective case series of all patients with blepharospasm/ALO secondary to STN-DBS that were treated at a tertiary center between 2011 and 2020. Data collected included date of Parkinson diagnosis, date of DBS surgery, date of development of blepharospasm/ALO symptoms, STN-DBS stimulation settings, and treatment given. Patients' symptoms before and after treatment were measured using the blepharospasm disability index and Jankovic Rating Scale. Five patients were identified with eyelid movement disorders secondary to STN-DBS. All patients had moderate-to-severe symptoms at presentation. Four patients received periocular botulinum toxin injections. Three patients underwent surgery in the form of frontalis suspension or direct brow lift with or without upper lid blepharoplasty. All reported an improvement in symptoms following treatment. A multimodality, patient-specific approach is required in the treatment of blepharospasm/ALO secondary to STN-DBS. Botulinum toxin injections can be effective, but patients may require surgery if toxin treatment alone becomes ineffective. Tailoring treatment to individual needs can result in a measurable improvement in symptoms.

Botulinum Toxin Treatment for Calf Contouring Based on the Study of Combined Injection of Gastrocnemius and Soleus.

Botulinum toxin is administered to paralyze the gastrocnemius muscle and reduce its size, thereby improving the calf contour and reducing the leg circumference of the calf. In pursuit of better efficacy, we designed a new injection protocol that targeted both the gastrocnemius and soleus. An algorithm of botulinum toxin injection for calf contouring was proposed based on the results of the study and ultrasonographic data. A prospective, self-controlled, double-blind study was conducted. The gastronemius muscle (GM) group (n = 17) included the patients whose gastrocnemius muscles were treated, and the GM + soleus muscle (SM) group (n = 17) included the patients who had both the gastrocnemius and soleus treated. Parameters including the maximum leg circumference and the subcutaneous fat, gastrocnemius muscle, and soleus muscle thicknesses were collected before and after injection. Both GM and GM + SM injection helped improve calf contour. Although the thickness of the gastrocnemius muscle was reduced, reducing the leg circumference, the subcutaneous fat and soleus muscle had compensatory thickening after injection, especially over the long term, which may affect the efficacy. Compared with the GM group, the GM + SM group effectively reduced the tendency of the soleus muscle to thicken. Calf muscle thickness could be roughly estimated by constructing a fitting equation and measuring height, weight, and leg circumference. Two injection methods achieved the effect of improving calf contour and reducing the leg circumference with equivalent patient satisfaction. The GM + SM injection group did not show any obvious extra clinical benefit when compared with the GM injection group.

Influence of unilateral eyelid spasms and botulinum toxin treatment on intraocular pressure measured by transpalpebral tonometer.

Eyelid spasms might be associated with elevated intraocular pressure (IOP) in hemifacial spasm (HFS) patients. IOP assessment using a Goldmann applanation tonometer (GAT) is often compromised by eyelid spasms. This study aimed to assess the effect of HFS on IOP measurements using the transpalpebral tonometer Diaton® before and after treatment with botulinum toxin type A (BTX-A) and compared Diaton® and GAT measurements after treatment with BTX-A. IOP measurements were obtained with Diaton® in 27 patients with moderate-to-severe HFS before and after treatment with BTX-A. After treatment, the IOP was also measured using GAT and the results were compared with the ones measured with a Diaton®. The patients underwent automated perimetry, OCT, and pachymetry for screening to glaucoma. Mean IOP with Diaton® was 11 ± 3.42mmHg before treatment in the affected eye and 9 ± 2.98mmHg in the contralateral eye. This difference was statistically significant (P = 0.012). However, after treatment with BTX-A, no interocular difference was found in IOP obtained with Diaton® (P = 0.204) or GAT (P = 0.971). Comparison between GAT and Diaton® measurements showed no significant differences after BTX-A treatment between the affected (P = 0.212) and contralateral eye (P = 0.971). A significant reduction in IOP measurements on the affected side of HFS patients was observed after treatment with BTX-A, demonstrating that eyelid spasms may increase the IOP. No significant difference was observed between Diaton® and GAT measurements after the application of BTX-A. No differences were found in automated perimetry, OCT, and CCT when comparing affected eyes with contralateral eyes.

Botulinum toxin and conservative treatment strategies in people with cervical dystonia: an online survey

Isolated cervical dystonia is a focal, idiopathic dystonia affecting the neck muscles. Treatment usually consists of botulinum neurotoxin (BoNT) injections into the dystonic muscles. Our aim is to investigate the use of BoNT treatment and conservative treatments by people living with cervical dystonia. An online survey in English was conducted between June and August 2022. Participants were eligible to participate if they were living with cervical dystonia, were over 18 years old and could read and understand English. The survey consisted of demographic questions, characteristics of dystonia, questions relating to BoNT use and the perceived utility of conservative treatments. The data were analysed descriptively, and open-ended questions were grouped into similar topics represented by direct quotes. We received 128 responses from people with cervical dystonia, with an average age of 59 years and 77% women. Most participants (52%) described their cervical dystonia as mild to moderate with an average pain score of 5/10. Eighty-two (64%) participants were having regular BoNT injections, with overall positive perceived effects. Common activities reported to improve the symptoms were the use of heat packs, massage, relaxation, physiotherapy and participation in general exercise. Common coping strategies reported were getting sufficient rest, having the support of friends and family, and remaining engaged in enjoyable hobbies. We found that most participants received regular BoNT injections and that heat packs, exercise, massage, physiotherapy and relaxation were mostly perceived as effective in reducing the symptoms of cervical dystonia.

A Screening Models of (In Vivo And In Vitro) Used for the Study of Hepatoprotective Agents

In order to evaluate hepatoprotective function, both in vitro and in vivo liver or hepatoprotective models have been constructed in the past. These methods examine a drug's potential to prevent or minimize liver damage in test animals. To express their effectiveness and safety in humans, new drugs must first travel through a number of developmental phases, beginning with the identification of their pharmacological characteristics in cellular and animal models. In the medical literature, there are many methods for measuring hepatoprotective efficacy in vivo and in vitro. Fresh hepatocytes are exposed to hepatotoxin treatment in in vitro models, and the effects of the test chemical on those cells are examined. To elicit liver damage in test animals, dangerous dosages of an identified hepatotoxin are administered in in vivo models. The test material is provided before, after, and simultaneously with the toxin treatment. Hepatitis in Long Evans and other chemical agents are commonly exploited to generate hepatotoxicity in experimental animals for the evaluation of hepatoprotective medications. Cinnamon rats, liver cirrhosis and necrosis, hepatic fibrosis brought on by carbon tetrachloride in rats, liver cirrhosis brought on by galactosamine, inhibition of proline hydroxylation, trans-heptic investigations model in dogs, etc. The many forms of in vivo and in vitro hepatoprotective screening models are explained in this article.

Botulinum Toxin Treatment in Blepharospasm: Single-center Experience

Botulinum Toxin Treatment in Blepharospasm: Single-center Experience

Use of immersive virtual reality for stress reduction during botulinum toxin injection for spasticity (RVTOX): a study protocol of a randomised control trial

IntroductionBotulinum toxin injection is a common way to help reduce spasticity in the body caused by central neurological damage such as cerebral stroke, multiple sclerosis or traumatic brain injury. The...

Longitudinal Assessment of Botulinum Toxin Treatment for Lateral Trunk Flexion and Pisa Syndrome in Parkinson's Disease: Real-life, Long-Term Study.

Lateral trunk flexion (LTF) and its severe form, called Pisa syndrome (PS), are highly invalidating axial postural abnormalities associated with Parkinson's disease (PD). Management strategies for LTF lack strong scientific evidence. We present a real-life, longitudinal study evaluating long-term efficacy of botulinum toxin (BoNT) injections in axial muscles to reduce LTF and PS in PD. A total of 13 PD patients with LTF > 5° received ultrasound- and electromyography-guided BoNT injections every 4 months. Seven untreated matched PD patients with LTF served as controls and their changes in posture after 18 months were compared with those of seven patients continuing BoNT over 12 months. 53.8% of patients continued the BoNT injections for at least 12 months. Various individual LTF responses were observed. Overall, BoNT-treated patients obtained a not statistically significant improvement of LTF of 17 ± 41% (p = 0.237). In comparison, the seven untreated PD patients suffered a deterioration in LTF over 12 months by 36 ± 45% (p = 0.116), showing a significantly different trajectory of posture change (p = 0.026). In conclusion, repeated BoNT injections in axial muscles showed varying effects in managing PD-associated LTF, suggesting that: (a) a relevant number of patients with LTF can benefit from BoNT; (b) long-term treatment could prevent LTF worsening; (c) an instrumented, personalized approach is important; and (d) there is a need for prospective, long-term studies.

Kronik anal fissür için anal Botulinium toksin enjeksiyonu: 224 hastadan oluşan retrospektif bir kohortta etkinlik ve güvenlik analizi

Backgorund and Aims: The aim of this retrospective study is to evaluate the relationship between the number of injection sites and healing outcomes in 224 patients with chronic anal fissure who underwent anal Botulinum toxin treatment. Materials and Methods: The medical records of 224 patients who received anal Botulinum toxin treatment for chronic anal fissure were retrospectively analyzed. Patients were categorized into three groups based on the number of injection sites: Group A (two injection sites, n = 34), Group B (three injection sites, n = 109), and Group C (four injection sites, n = 81). Each injection contains 20 IU of Botulinum toxin. Healing outcomes, pain reduction, wound healing, and symptom resolution were evaluated. A comprehensive analysis of patient records and clinical data was performed. Demographic information, treatment details, healing outcomes, and adverse events were assessed. Results: Cox regression analysis revealed a significant association between the number of injection sites and healing outcomes. At all three post-operative time points, patients treated at multiple sites (Group C) reported higher recovery levels compared to patients treated at two sites (Group A). Conclusion: This study demonstrated a significant relationship between the number of injection sites treated with anal Botulinum toxin and healing outcomes in patients with chronic anal fissures. These findings highlight the importance of considering the number of injection sites. The study contributes to the understanding of anal Botulinum toxin treatment for chronic anal fissure, emphasizing its potential to improve patient care and overall quality of life.

Trajectory of health care resources among adults stopping or reducing treatment frequency of botulinum toxin for chronic migraine treatment in Alberta, Canada.

Understand health resource, medication use, and cost of adults with chronic migraine who received guideline-recommended onabotulinumtoxinA (botulinum toxin) treatment frequency and then continued or reduced/stopped. Botulinum toxin may be a beneficial treatment for chronic migraine; the trajectory of health resources utilization among those with continued or reduced/stopped use is unclear. A retrospective population-based cohort study utilizing administrative data from Alberta, Canada (2012-2020), was performed. A cohort of adults who received ≥5 botulinum toxin treatment cycles for chronic migraine over 18 months (6-month run-in; 1-year pre-index period) were grouped into those who (1) continued use (≥3 treatments/year), or (2) stopped or reduced use (stopped for 6 months then received 0 or 1-2 treatments/year, respectively) over a 1-year post-index period. Health resources and medication use were described, and pre-post costs were assessed. A second cohort that received ≥3 treatments/year immediately followed by 1 year of stopped or reduced use was considered in sensitivity analysis. Pre-post health resource, medication use, and costs were similar among those with continued use (n = 3336). Among those who stopped or reduced use (n = 1099; 756 stopped, 343 reduced), health resource, medication use, and costs were lower in the post- (total median per-person cost [IQR]: all-cause $4851 [$8090]; migraine-related $835 [$1915]) versus pre- (all-cause $6096 [$7207]; migraine-related $2995 [$1950]) index period (estimated cost ratios [95% CI]: total all-cause 0.86 [0.79, 0.95]; total migraine-related 0.44 [0.40, 0.48]). In the second cohort (n = 3763), return to continued use (≥3 treatments/year) occurred in up to 70.4% in those with reduced use. Of adults treated with botulinum toxin for chronic migraine, 75.2% had continued use, stable health resource and medication use, and costs over a 2 year period. In those that stopped/reduced use, the observed lower health resource and migraine medication use may indicate improved symptom control, but the resumption of guideline-recommended treatment intervals after reduced use was common.

Clinical Application of Botulinum Toxin for Hemifacial Spasm.

Hemifacial spasm is typically caused by contact between the facial nerve and blood vessels. Microvascular decompression, a treatment that directly addresses this pathogenesis, is often considered the most effective treatment method. However, surgery is not immediately performed for patients at risk from the surgical treatment, or for those with an unclear diagnosis. In these instances, Botulinum toxin injection can help manage the patient's symptoms. Numerous studies corroborate the effectiveness and safety of Botulinum toxin treatment, with large-scale studies indicating symptom control lasts, on average, around 15 weeks.

Botulinum Toxin Treatment of Adult Muscle Stem Cells from Children with Cerebral Palsy and hiPSC-Derived Neuromuscular Junctions.

Botulinum neurotoxin type-A (BoNT) injections are commonly used as spasticity treatment in cerebral palsy (CP). Despite improved clinical outcomes, concerns regarding harmful effects on muscle morphology have been raised, and the BoNT effect on muscle stem cells remains not well defined. This study aims at clarifying the impact of BoNT on growing muscles (1) by analyzing the in vitro effect of BoNT on satellite cell (SC)-derived myoblasts and fibroblasts obtained from medial gastrocnemius microbiopsies collected in young BoNT-naïve children (t0) compared to age ranged typically developing children; (2) by following the effect of in vivo BoNT administration on these cells obtained from the same children with CP at 3 (t1) and 6 (t2) months post BoNT; (3) by determining the direct effect of a single and repeated in vitro BoNT treatment on neuromuscular junctions (NMJs) differentiated from hiPSCs. In vitro BoNT did not affect myogenic differentiation or collagen production. The fusion index significantly decreased in CP at t2 compared to t0. In NMJ cocultures, BoNT treatment caused axonal swelling and fragmentation. Repeated treatments impaired the autophagic-lysosomal system. Further studies are warranted to understand the long-term and collateral effects of BoNT in the muscles of children with CP.

Guided Superficial Enhanced Fluid Fat Injection (SEFFI) Procedures for Facial Rejuvenation: An Italian Multicenter Retrospective Case Report.

The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles, and the loss of skin structure and quality. Recently, several studies have demonstrated the efficacy of therapies based on autologous adipose tissue grafting, which leverages the properties of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aims to verify the ability of guided superficial enhanced fluid fat injection (SEFFI) in the facial area to correct volume loss and skin aging, proving that this standardized procedure has a very low rate of complications. We retrospectively collected data from 2365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, synthetic calcium hydroxylapatite, botulin toxin, and microneedling. guided SEFFI was used alone in more than 60% of the patients and in all facial areas. In about one-tenth of the patients, guided SEFFI was combined with a botulin toxin treatment or hyaluronic acid filling. Other procedures were used more rarely. Ecchymosis in the donor or injection sites was the most frequent adverse event but was only observed in 14.2% and 38.6% of the patients, respectively. The guided SEFFI technique is standardized and minimally invasive, leading to very few complications. It constitutes a promising antiaging medical treatment that combines effectiveness, safety, and simplicity.

Environmental light-activated nanozymes for efficient inactivation of harmful algae and associated hemolytic toxin

Harmful algal blooms (HABs) pose a significant threat to aquatic ecosystems. Conventional anti-algal methods are associated with low anti-algal efficiency, and absence of treatment of toxins released by algae. Therefore, it is essential to establish effective HAB prevention strategies. Artificial nanozymes have a great potential in combating HABs due to their unique catalytic properties. An ultra-small carbon dots nanozyme (VCN) with oxidase-like activity was synthesized in this study. VCN exerts its catalytic effect by catalyzing the production of reactive oxygen species (ROS) from oxygen. VCN was utilized to inactivate hazardous marine algae based on its catalytic properties. It was found that VCN could rapidly remove more than 90% of harmful algae (Skeletonema costatum and Phaeocystis globosa) in just 4 h under environmental visible light. To the best of our knowledge, the algae removal efficacy is greater than that of previous reports. Additionally, VCN could attenuate the toxicity of toxins released by algae to counteract secondary pollution caused by algal fragmentation, which is important for practical applications in water pollution caused by algae. Collectively, under applicable and mild conditions, the VCN-presented enzyme activity can efficiently reduce HABs caused harmful pollution.

Changes in pelvic floor electrical activity and vulvar pain after botulinum toxin treatment of vestibulodynia: are clinical and electrophysiological outcomes related?

Vestibulodynia is a gynecological condition with different treatment options available, including botulinum neurotoxin type A (BoNT/A) injections into the vulvar vestibule. Unlike other treatments, no studies have assessed changes in the myoelectrical activity of the pelvic floor muscles (PFM) after BoNT/A treatment. The aim of this study was thus to evaluate these changes and to correlate them with changes in vulvar pain sensitivity. To do this, 35 patients with vestibulodynia were recruited, the myoelectrical activity of their left and right PFM was recorded with surface electromyography (sEMG), and their vulvar pain sensitivity was monitored according to Visual Analogue Scale (VAS) and an algometer, both before and after BoNT/A treatment. According to our results, patients' signals during PFM relaxation showed a significantly higher power than those of healthy women at baseline, as shown by their root mean square values (RMS), but became similar at follow-up. Patients' mean vulvar pain VAS scores significantly decreased after treatment. Furthermore, baseline-to-follow-up differences of RMS at PFM rest vs. mean VAS were significantly correlated (CC=0.48, p<0.01) so that higher reductions in the PFM activity power were associated with higher decreases in vulvar pain.Clinical Relevance- Altered PFM electrophysiological condition of patients with vestibulodynia becomes similar to healthy women's after BoNT/A treatment. This study also points to a relationship between the evolution of clinical and PFM electrophysiological conditions.