Use Of Botulinum Neurotoxin Type Research Articles

Impact of botulinum toxin type A on tooth movement and bone remodeling in male Wistar rats

ObjectiveWe evaluated whether the use of botulinum neurotoxin type A (BTX-A) in masticatory muscles influences tooth movement and bone remodeling. DesignSeventy-seven male Wistar rats were allocated to the groups: S - Saline (n=20); SM - Saline with movement (n=20); BT - Botulinum toxin (n=18); BTM - Botulinum toxin with movement (n=19). On day 1, 0.02mL of sterile 0.9% saline was administered to groups S and SM and BTX-A (1U in 0.02mL of saline) to groups BT and BTM, in the masseter and temporal muscles laterally. On day 30, a nickel titanium spring was installed to move the first maxillary molar and euthanasia was performed on days 32 and 51. Tooth displacement, maxillary and mandibular bone volumes, collagen neoformation, bone and root resorptions, and masseter morphometry were assessed. Statistical analysis was conducted (p < 0.05). ResultsA higher percentage of type I collagen was observed in the BT than in the S group on day 51 and lower mass, length, and diameter of the masseter fibers in BT and BTM (p < 0.05). Tooth displacement, bone volume, bone and root resorptions, hyaline area, and masseter height showed no difference among groups with and without BTX-A, regardless of tooth movement (p > 0.05). ConclusionsBTX-A did not interfere with tooth displacement, bone volume, and dental and periodontal tissues related to tooth movement in rats; it increased mature collagen in animals without tooth movement; and it caused a decrease in the mass, length, and diameter of the masseter fibers.

The mechanisms of action and use of botulinum neurotoxin type A in aesthetics: Key Clinical Postulates II.

BackgroundThe literature on botulinum neurotoxin type A (BoNT‐A) is extensive, often contradictory, and confounded by a competitive market of products and research attempting to distinguish brand individuality.MethodsA comprehensive review of literature on the principles of BoNT‐A in aesthetics as well as clinical examples.ResultsIn 2017, the Eight Key Clinical Postulates were formulated as a guide for the aesthetic practitioner in understanding BoNT‐A pharmacodynamics and to compare different toxins. These are now updated to include (a) All type A toxins act identically; (b) The mathematical relationship between toxin and receptor is the basis of efficacy, and clinical efficacy is influenced by molecular potency and patient attributes including muscle mass, gender, age, and ethnicity; (c) Efficacy, onset, and duration are functions of “molecular potency” defined as the number of active 150 kDa molecules available for binding; (d) “Molecular potency” is difficult to objectively quantify for commercially available toxins; (e) Up to a point, increased molecular potency decreases time to onset and increases duration of effect, and the “Molecular Potency Quotient” is a construct for comparing molecular potency commercial cost; (f) The area of effect of a toxin injection is dependent upon molecular potency, diffusion (passive), and spread (active); (g) Differing reconstitution volumes; and (h) Increased number of injection sites can affect spread, onset, and duration of effect.ConclusionsThe principles of BoNT‐A use in aesthetics are complex yet understandable as outlined in the framework of the updated Eight Key Clinical Postulates and serves as a useful tool for providing the most effective treatment and interpreting research on present and future toxin formulations.

A Moving Residual Limb: Botulinum Toxin to the Rescue.

Movement disorders post-amputation are a rare complication and can manifest as the jumping stump phenomenon, a form of peripheral myoclonus. The pathophysiology remains unknown and there is currently no standardized treatment. We describe the case of a 57-year-old male with unremitting stump myoclonus, starting one month after transtibial amputation, in his residual limb without associated phantom or neurological pain. The consequence of the myoclonus was a reduction in prosthetic wearing time. Failure to respond to oral medication led us to attempt the use of botulinum neurotoxin Type A injections in the involved muscles of the residual limb. Injection trials, over a two-year period, resulted in an improvement of movement disorder, an increased prosthetic wearing time and a higher satisfaction level of the patient. Injection of botulinum toxin type A should be considered as an alternative treatment for stump myoclonus to improve prosthetic wearing time and comfort.

The Use of Botulinum Neurotoxin Type A in Aesthetics: Key Clinical Postulates.

The most common aesthetic procedure performed worldwide is the injection of botulinum neurotoxin Type A (BoNT-A). Aesthetic providers must fully comprehend the objective scientific data, theoretical mechanisms of action, and differences between brands of BoNT-A. To determine and review the relevant clinical postulates for the use of botulinum toxin in aesthetics. The BoNT-A clinical postulates presented here discuss how each brand of BoNT-A acts identically, how the molecular potency may vary between the different products, how patient age, gender, genetics, and muscle mass cause variation in toxin receptor number and density, and how both practitioner and patient can affect toxin distribution. A total of 8 clinical postulates have been identified that are key to understanding the use of botulinum toxin in aesthetics and to obtaining the best clinical results. All of these factors affect the potential efficacy of the injected toxin and hence the aesthetic results obtained.

Botulinum toxin on muscle-based and non-muscle-based injections for pain: A meta-analytic study

Background: Aside from the popular use of botulinum neurotoxin type A (BoNT/A) for cosmetic purposes, its analgesic potential has been a highlight in various studies. Albeit the effectiveness of BoNT/A on both muscle-based (nociceptive) and non-muscle-based (neuropathic) pain, there is paucity of literature explicating with which pain disorder it is more effective.

Botulinum Toxin Injection for Pain in Muscle Spasm and Visceromotor Disorders: A Meta-Analytic Study

Apart from the popular use of botulinum neurotoxin type A (BoNT/A) for neuro-rehabilitation and cosmetic purposes, its analgesic potential has been highlighted in various studies. Although BoNT/A is effective, there is a paucity of literature explicating its effectiveness on muscle-based and visceromotor pain. This meta-analysis determined the effectiveness of botulinum type A (BoNT-A) in treating muscle-based (nociceptive) and visceromotor pain.

IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations.

BackgroundAlthough there are various international consensus recommendations on the use of botulinum neurotoxin type A (BoNT/A) in facial aesthetics, there are no global or Russian guidelines on the optimal dose of incobotulinumtoxinA, free from complexing proteins, within specific aesthetic indications. This article reports the outcomes of two expert consensus meetings, conducted to review and analyze efficacy and tolerability data for incobotulinumtoxinA in various facial aesthetic indications and to give expert consensus recommendations to ensure best clinical practice among Russian clinicians.MethodsThirteen dermatology and/or plastic surgery experts attended meetings held in Paris, France (November 2013), and Moscow, Russia (March 2014). The expert group reviewed and analyzed the existing evidence, consensus recommendations, and Russian experts’ extensive practical experience of incobotulinumtoxinA in aesthetics to reach consensus on optimal doses, potential dose adjustments, and injection sites of incobotulinumtoxinA for facial aesthetics.ResultsAll experts developed guidance on the optimal doses for incobotulinumtoxinA treatment of different regions of the upper and lower face. The expert panel agreed that there are no differences in the efficacy and duration of the effect between the four BoNT/As that are commercially available for facial aesthetic indications in Russia and that, when administered correctly, all BoNT/As can achieve optimal results. Experts also agreed that nonresponse to BoNT/A can be caused by neutralizing antibodies.ConclusionOn the basis of the scientific and clinical evidence available for incobotulinumtoxinA, coupled with the extensive clinical experience of the consensus group, experts recommended the optimal doses of incobotulinumtoxinA effective for treatment of wrinkles of the upper and lower face to achieve the expected aesthetic outcome. These first Russian guidelines on the optimal use of incobotulinumtoxinA for augmentation of glabellar lines, periorbital wrinkles, forehead lines, bunny lines, perioral wrinkles, depressor anguli oris, mentalis, masseters and platysmal bands, and performing the Nefertiti lift, are presented here.

18. Use of botulinum neurotoxin type A (Xeomin) injections to the perineal muscles in cases of perineal pain and dysfunction associated with pelvic floor muscle overcontraction and myalgia

18. Use of botulinum neurotoxin type A (Xeomin) injections to the perineal muscles in cases of perineal pain and dysfunction associated with pelvic floor muscle overcontraction and myalgia

Use of Botulinum Toxin Type A in the Management of Neonatal Brachial Plexus Palsy

To evaluate functional outcomes and the impact on surgical interventions after the use of botulinum neurotoxin type A (BoNT-A) for muscle imbalance, cocontractions, or contractures with neonatal brachial plexus palsy. A retrospective cohort study. A brachial plexus center in a tertiary children's hospital. Fifty-nine patients with neonatal brachial plexus palsy (75 injection procedures, 91 muscles and/or muscle groups) received BoNT-A injections (mean age at injection, 36.2 months; range, 6-123 months; 31 boys; 30 right-sided injuries, 28 left-sided injuries, 1 bilateral injury). Data collected retrospectively from medical records, from procedure notes andclinic visits before BoNT-A use, at≤6 months follow-up (BoNT-A active [BA]) andat≥7 months follow-up (BoNT-A not active [BNA]) included demographics, injection indication, side, and site(s), previous surgical history, occupational therapy and/or physical therapy plan, and outcome measurements. Outcomes assessed before and after injections included active and passive range of motion, Mallet and Toronto scores, parent comments about arm function, preinjection surgical considerations, and postinjection surgical history. Injection procedures included 51 to shoulder internal rotators, 15 triceps, 15 pronator teres, 9 biceps, and 1 flexor carpi ulnaris. Active and passive shoulder external rotation (SER) range of motion improved after shoulder internal rotator injections (P=.0003 and P= .002, respectively), as did Mallet scores with BA; the latter were sustained with BNA. Surgical intervention was averted, modified, or deferred after BoNT-A in 45% (n= 20) under surgical consideration before BoNT-A. Active elbow flexion improved in 67% (P= .005), sustained BNA (P= .004) after triceps injections; 2 of 7 patients averted surgery. Active supination improved with BA (P= .002), with gains sustained BNA (P=.016). Passive elbow extension improved after biceps injections by an average 17° (P= .004) BA, although not sustained BNA. BoNT-A is an effective adjunct to therapy and surgery in managing muscle imbalance, cocontractions, and contractures in neonatal brachial plexus palsy. Use of BoNT-A can result in averting, modifying, or deferring surgical interventions in a number of affected children.

Botulinum toxin A increases analgesic effects of morphine, counters development of morphine tolerance and modulates glia activation and μ opioid receptor expression in neuropathic mice

The use of botulinum neurotoxin type A (BoNT/A) against pain, with emphasis for its possible use in alleviating chronic pain, still represents an outstanding challenge for experimental research. In this study, we examined the effects of BoNT/A on morphine-induced tolerance during chronic morphine treatment in neuropathic CD1 mice subjected to sciatic nerve lesion according to the Chronic Constriction Injury (CCI) model of neuropathic pain. We measured the effects of BoNT/A on CCI-induced allodynia and hyperalgesia and on the expression of glial fibrillary acidic protein (GFAP, marker of astrocytes), complement receptor 3/cluster of differentiation 11b (CD11b, marker of microglia), and neuronal nuclei (NeuN) at the spinal cord level. We also analyzed the colocalized expression of GFAP, CD11b and NeuN with phosphorylated p-38 mitogen-activated protein kinase and with μ-opioid receptor (MOR). A single intraplantar injection of BoNT/A (15 pg/paw) into the injured hindpaw, the day before the beginning of chronic morphine treatment (9 days of twice daily injections of 40 mg/kg morphine), was able to counteract allodynia and enhancement of astrocytes expression/activation induced by CCI. In addition, BoNT/A increased the analgesic effect of morphine and countered morphine-induced tolerance during chronic morphine treatment. These effects were accompanied, in neurons, by re-expression of MORs that had been reduced by repeated morphine administration. The combinatory effects of BoNT/A and morphine could have relevant therapeutic implications for sufferers of chronic pain who could benefit of pain relief reducing tolerance due to repeated treatment with opiates.

Current Aesthetic Use of AbobotulinumtoxinA in Clinical Practice: An Evidence-Based Consensus Review

The amount and complexity of scientific and clinical evidence for aesthetic use of botulinum neurotoxin type A (BoNT-A) has expanded rapidly in recent years, especially for abobotulinumtoxinA, necessitating reassessment of current knowledge about aesthetic use of abobotulinumtoxinA and other BoNT-A preparations. A committee of 13 plastic surgeons, facial plastic surgeons, and dermatologists engaged in a live discussion of information from a systematic literature review and an Internet-based survey of their beliefs and practices. The committee achieved consensus on most issues. It was concluded that doses of different BoNT-A preparations cannot be interconverted with a fixed ratio. The size of the "field of effect" is difficult to measure, and comparisons between preparations have yielded equivocal results. Nonresponse due to neutralizing antibodies appears exceedingly rare with currently available BoNT-A preparations and of little concern clinically. BoNT-A dose, injection depth, and injection technique should be adjusted according to the anatomic area being treated and each patient's individual characteristics and goals. Aesthetic use of BoNT-A has a good safety profile. Most adverse events are minor and related to the trauma of injection, although special care is needed in certain anatomic areas. Detailed recommendations for treatment of different anatomic areas are presented. BoNT-A products are often used in conjunction with other treatment modalities (eg, fillers and resurfacing), but little agreement was reached on best practices. The findings reported in this consensus document may serve as a practical guide for aesthetic practitioners as they apply the latest knowledge about BoNT-A in providing their patients with optimal care.

The use of botulinum toxin type A in the management of adult‐onset focal spasticity: A survey of Australian allied health professionals

Recently, the European Journal of Neurology published international consensus statements for the assessment, treatment and aftercare associated with the use of botulinum neurotoxin type A. This survey examined current allied health practice in relation to botulinum neurotoxin type A use in Australia in the light of these guidelines. An electronic questionnaire was distributed to members of neurology groups of the Australian Physiotherapy Association and Occupational Therapy Australia. The questionnaire explored assessment processes used, familiarity with pharmaceutical benefits scheme indications for botulinum neurotoxin type A use, goal setting and outcome measurement, follow-up therapy and access to spasticity management services. The 123 survey respondents (81 from the Australian Physiotherapy Association - response rate 16.2%, 42 from Occupational Therapy Australia - response rate 6.4%) reported that focal spasticity was a major problem for which botulinum neurotoxin type A was a primary intervention. The Tardieu scale was more frequently used than the modified Ashworth scale (82% vs. 48%). Most therapists (76.3%) reported being confident diagnosing spasticity and its functional implications (84.2%), but fewer were confident discussing referral for botulinum neurotoxin type A with doctors (56.1%). Goals were set in conjunction with the client (93.6%). Barriers to injection and adjunctive therapy (motor training etc.) included waiting times for botulinum neurotoxin type A injection, access to specialist adjunctive therapists and referral for treatment. Allied health practitioners in Australia report clinical practice to be closely aligned with international guidelines for the use of botulinum neurotoxin type A in adult spasticity. Therapist confidence in advocating for botulinum neurotoxin type A injection, consistent use of objective measures of spasticity and treatment outcomes and barriers to providing adjunctive therapy need to be addressed.

Current status of the use of Botulinum neurotoxin type A

European Journal of NeurologyVolume 16, Issue s2 p. 1-1 Current status of the use of Botulinum neurotoxin type A R. Benecke, R. Benecke Rostock, GermanySearch for more papers by this author R. Benecke, R. Benecke Rostock, GermanySearch for more papers by this author First published: 07 December 2009 https://doi.org/10.1111/j.1468-1331.2009.02876.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume16, Issues2Special Issue: XeominDecember 2009Pages 1-1 RelatedInformation

Treatment and Management of Migraine—The Road Ahead

The road ahead for migraine treatment depends on targeting pharmacological therapies to known pathophysiological mechananisms. Acute medications of the future may include calcitonin gene-related peptide antagonists, various glutamate antagonists, and serotonin 1F receptor agonists. New formulations of older medications include effervescent diclofenac, an orally inhaled dihydroergotamine, and sumatriptan iontophoretic patch and needless injection, all either approved in the US or in phase III trials. Preventive future treatments may include the use of botulinum neurotoxin type A for chronic daily headache and gabapentin enacarbil for episodic migraine, in addition to hormonal treatments and a potential for neuromodulators, but the preventive pipeline is far less developed. In the US, the United Council for Neurologic Subspecialty Board certification for headache medicine should raise quality of care and research in the future.

Interventional-neuropaediatric spectrum of treatments with botulinum neurotoxin type A, free of complexing proteins: Effective and safe application – Three exemplary cases

Introduction: Use of botulinum neurotoxin type A (BoNT/A), preparation Xeomin®, free of complexing proteins in (1) bilateral spastic cerebral palsy (BS-CP), (2) lower limb dystonia and (3) sialorrhea: efficacy and safety of the application in three patients in complex neuropaediatric supply.

Treatment of cerebral palsy: Use of botulinum neurotoxin type A free of complexing proteins (Xeomin®) in childhood

Objectives: Botulinum neurotoxin type A (BoNT A) is widely used in treatment of cerebral palsy (CP)1. Recently a preparation free of complexing proteins (Xeomin®) has been issued, but is not yet usable on-label in childhood. Methods: Case-report. We show preliminary data of 6 children aged 4 to 17 years, suffering uni- or bilateral cerebral palsy (GMFCS level 1–5°). Patients got intramuscular injections of BoNT A in other formula before. Because of secondary decrease of effect preparation was changed to off-label-used BoNT A Xeomin®. Results: Dosage applied was 10–76 MU/kg (max. 1.020 MU total), using multi-muscle-option. Injection was always performed while patients were in deep analgosedation using s-ketamin and midazolam (i.v. or rectal). All patients showed good painrelief and decrease of spasticity after injection. No relevant sideeffects occurred. Conclusions: In several conditions while treating children with spastic syndromes like CP we are in need for treatment-alternatives for conventional BoNT A (Botox®). BoNT free of complexing proteins (Xeomin®) is a possible alternative in cases when off-label-use is not a conditio-sine-qua-non, because Xeomin® seemed to bee as safe, dosage seemed to be equivalent to Botox®. 1 Heinen, F. eta al.: Botulinumtoxin fur Kinder mit Zerebralparesen: 10-Punkte-Tabelle, 2007. Ein interdisziplinarer deutscher Konsensus. Monatsschr Kinderheilkd 2007; 155: 537–543.

The use of botulinum neurotoxin type A (BoNTA) in urology

The use of Botulinum neurotoxin type A (BoNT/A) in the lower urinary tract was pioneered as early as 20 years ago with injections into the urethral sphincter reducing bladder voiding pressures, urethral pressures, and post-void residual urine. Over the past 9 years, the use of BoNT/A has revolutionised the treatment of intractable symptoms associated with the neurogenic or idiopathic overactive bladder, both in adults and children. The duration of clinical improvement is 6-11 months, is accompanied by significant amelioration of patients' quality of life and repeat bladder treatments appear to have sustained effects. Despite evidence for an effect on the afferent pathways, its mode of action in the human bladder remains largely unknown. The use of BoNT/A has also expanded into the painful bladder syndrome and in benign prostatic diseases, with promising preliminary results. This review aims to provide an insight of the use of BoNT/A in the lower urinary tract, addressing issues such as treatment outcomes and safety, mechanisms of action and potential for future research.

Botulinum neurotoxin type A injections reduce spasticity in mild to moderate hereditary spastic paraplegia— Report of 19 cases

Hereditary spastic paraplegia (HSP) is characterized by lower extremity spasticity. Symptomatic therapy generally includes physical therapy and oral antispastic agents, in selected cases intrathecal baclofen. Because of the positive results in other treatments of spasticity, the use of botulinum neurotoxin type A (BoNT-A) might also be considered for patients with HSP. We report the effect of BoNT-A injections in 19 unselected patients with HSP treated by the members of the German Spasticity Education Group. In 17 patients, the modified Ashworth scale had improved by one point. In one patient, it improved by three points. Most of the patients reported reduction of spasticity. BoNT-A injections were continued in 11 of 19 patients (57.9%). All of the patients with continued injections had a good or very good global subjective improvement. Patients with less pronounced spasticity and patients with accompanying physical therapy tended to exhibit a better effect. Only four patients reported adverse effects which were increased weakness in three patients and pain in one patient. BoNT-A injections appear to reduce spasticity effectively and safely, especially in patients with mild to moderate spasticity. The preliminary results of our case series should encourage larger studies of BoNT-A injections in HSP.

Understanding the Role of Botulinum Toxin A in the Treatment of the Overactive Bladder—More than Just Muscle Relaxation

The established use of botulinum neurotoxin type A (BoNT/A) therapy has been based on its reversible inhibition of acetylcholine (ACh) and associated muscle relaxation. Greater understanding of the pathophysiology of detrusor overactivity (DO), as well as macromolecular analysis and analysis of the duration of the effects of BoNT/A treatment and of data generated in pain models, has suggested that, in DO, a mechanism of action based solely on the inhibition of ACh-mediated muscular contraction is too simplistic. Evidence suggests that the sensory pathways involving the urothelium and suburothelium have a significant role in the coordination of bladder activity. BoNT/A treatment has been shown to reduce raised levels of sensory receptors in suburothelial nerve fibres, but not in the urothelium, without causing a degeneration of the fibres themselves. No signs of significant histologic changes in muscle-fibre density, muscle atrophy, or other degenerative changes have been noted following BoNT/A treatment. In contrast to the effects seen with skeletal muscle, limited evidence of axonal sprouting following BoNT/A treatment has been seen in the detrusor muscle, further supporting differences in the BoNT/A mechanism of action between skeletal and smooth muscles.

A Pilot Study to Investigate the Combined Use of Botulinum Neurotoxin Type A and Functional Electrical Stimulation, with Physiotherapy, in the Treatment of Spastic Dropped Foot in Subacute Stroke

The objective was to inform sample size calculations for a full randomized controlled trial (RCT). The design included an RCT pilot trial with a 16 week study period, including a 4 week baseline phase. The subjects were adults within 1 year of first stroke, ambulant with a spastic dropped foot. Twenty-one participants were recruited from the stroke services of 4 centers. For intervention all participants received physiotherapy; the treatment group also received botulinum neurotoxin Type A (BoNTA) intramuscular injections to triceps surae (800 U Dysport) and functional electrical stimulation (FES) of the common peroneal nerve to assist walking. The main outcome measure was walking speed. The result was a significant upward trend in median walking speed for both the control (p = 0.02) and treatment groups (nonstimulated p = 0.004, stimulated p = 0.042). Trend lines were different in location (p = 0.04 and p = 0.009, respectively). In conclusion, there is evidence of an additional, beneficial effect of BoNTA and FES. Sufficient information has been gained on the variability of the primary outcome measure to inform sample size calculations for a full RCT to quantify the treatment effect with precision.