Use Of Botulinum Toxin Type Research Articles

Clinical Aspects of the Use of Botulinum Toxin Type A in the Treatment of Dysfunction of the Masticatory System.

The purpose of this work is to present a new, still experimental method of treating temporomandibular disorders (TMD) by injecting botulinum toxin Type A (TBX-A), using its effects not as a toxin but as a medication. The mechanism of TBX-A, indications and contraindications for its use, as well as possible side effects, are discussed. Temporomandibular disorders are of concern to approximately 70-80% of the population. The effect of botulinum toxin depends on blocking the release of acetylcholine from a presynaptic neuromuscular synapse and, in the autonomous system, blocking its release from post-ganglionic cholinergic neurons. In cases of long-term TMJ disorders, muscle activity increases and spastic contractions may even appear. TBX-A offers an opportunity for a normal social and family life for many patients suffering from masticatory system disorders (MSD), who have been isolated from the environment by pain. The study is based on a review of the literature and the authors' own experiences during several attempts to treat patients by this method. TBX-A is a safe medicine when the injection is performed by a well-trained physician.

Botulinum Toxin A Therapy In Early Post-Stroke Spasticity: Providing A Wider Treatment Avenue

The use of Botulinum toxin type A (BoNT) to address spasticity has been established over the years, and recently considered first line treatment in chronic post stroke patients. With its promising results, BoNT is now being combined with early neurorehabilitation to treat post-stroke spasticity in order to address the various neuromuscular and biomechanical impairments, contracture prevention, dystonia, associated reactions and pain. The beneficial effects of BoNT as an adjunct to early stroke rehabilitation, in contrast to customary physical therapy alone, is the case in point of this review, so as to suggest another complementary treatment avenue in rehabilitation care.

Botulinum toxin application in the secondary intention healing

Use of botulinum toxin type A in first intention healing wounds has been widely adopted in order to inhibit the formation of hypertrophic scars. In this report we demonstrate the use of the toxin in a surgical wound left to heal by secondary intention, after the removal of a squamous cell carcinoma in situ by Mohs micrographic surgery in supralabial region, with good cosmetic result. Botulinum toxin acts by inhibiting the proliferation of fibroblasts, by differentiating fibroblasts and by producing type I collagen, which are the main factors responsible for the good quality of the healing process.

Unilateral blepharoptosis secondary to the intramuscular injection of botulinum toxin

Botulinum toxin type A is widely used to reduce the dynamic rhytides associated with repetitive use of the underlying muscles in the upper third of the face. However, as its use has grown, appreciation of the risk of complications and their management may be underestimated. This case report of a 33-year-old female patient presenting with eyelid ptosis, or unilateral myogenic blepharoptosis, revisits the management of a complication associated with the use of botulinum toxin type A for facial rejuvenation. The patient reported difficulty in attaining maximal aperture of the left eye 3 days post treatment. This was successfully managed using 0.5% apraclonidine instilled three times daily for 6 weeks.

TREATMENT OF RECURRENT TEMPOROMANDIBULAR JOINT DISLOCATION WITH BOTULINUM TOXIN

Introduction: The use of botulinum toxin type A (BTX-A) injection as it is a more recently reported treatment to alter the musculature with the intended effect to weaken the lateral pterygoid muscle (LPM) sufficiently to prevent temporomandibular joint (TMJ) dislocation. This caused a new imbalance between the muscles used for opening and closing the jaws, and mouth opening was slightly limited because of the weakness of the LPM. Objectives: To evaluate the efficacy of injection of BTX-A as the first choice of treatment for patients with chronic TMJ dislocation not responding to conservative line of treatment. Materials and methods: A prospective study was conducted on a total of 20 patients complaining of recurrent episodes of chronic TMJ dislocation. Group A: (The study group) patients were injected with BTX-A in the LPM through an intraoral approach, Group B: (The control group) patients suffering from chronic TMJ dislocation and treated by inter maxillary fixation (IMF). Results: The study revealed that injecting BTX-A in the LPM prevents the TMJ dislocation and reduced pain caused by the movement of the LPM by 90 % through temporary paralysis of the muscle, thus allowing the muscle to move more naturally. Conclusions: This is a relatively conservative option, injection into the muscle is straightforward and can be done in outpatients with few complications. Key words: Temporomandibular joint; Dislocation; Botulinum toxin type A; Lateral pterygoid muscle.

Botulinum Toxin Type A Reconstituited with Lidocaine: A Report of 356 Consecutive Cases

Background: The purpose of this paper is to evaluate the predictability of the off-label aesthetic use of botulinum toxin type A (BoNTA) reconstituted with lidocaine. Material and Methods: Three-hundred and fifty-six (356) BoNTA treatments were performed on 118 patients, between the January 2010 and the January 2013; BoNTA was reconstituited with lidocaine. Results: A few minute after the BoNTA injection the effect of muscle paralysis was seen in all the cases, this allowed the Author to provide an optimal symmetric result with no need of a touch up procedure at the control after a week. Maior complication were not registered. Conclusion: The results of this study shows how the reconstitution of BoNTA with lidocaine may avoid imperfect results after the injections; all components retain their function and immediate feedback on the extent of paralysis to be expected from the chemodenervation action of BoNTA let the physician to have an immediate control of the final result. Keywords: Botulinum toxin, Facial aesthetic, Minimally-invasive, Lidocaine.

Botulinum toxin type A chemodenervation treatment in spastic forms of cerebral palsy

Cerebral palsy (CP) is one of the most serious outcomes of the perinatal lesion of central nervous system and the most common reason for neurological disability in children. Being the key cause of pathological dynamic stereotypes that frequently result in pathological posture and contractures, spasticity is critically important for CP. The use of botulinum toxin type A (BTA) in complex treatment 2-6 years old CP patients allows significantly to improve motor abilities, help to change the surgical procedure, delay or even avoid some types of surgery. For elder children the use of BTA allows to improve local motor impairment. The treatment of spasticity in CP with BTA is safe (evidence level A) and highly effective (evidence level A). It leads to the positive change of pathological dynamic stereotype, significantly improves gait, decreases muscle tone with Ashworth and Tardeu scales and rises the gross motor function score. Our own experience of onabotulinumtoxinA treatment as a part of complex therapy in 68 patients with spastic forms of CP demonstrates the significant improvement of motor function, most noticeable in younger patients (early pre-school age) with GMFS I-III.

上下肢痙縮を有する脳卒中後の片麻痺患者を対象としたA型ボツリヌス毒素製剤投与状況の調査

日本人の上下肢痙縮に対してA型ボツリヌス毒素製剤（BoNT／A）を投与する際の指針となるデータを収集すべく，脳卒中に罹患した片麻痺患者を対象として診療録に基づく多施設共同・後方視的研究を実施し，日常診療で痙縮の治療に携わっている医師の診療状況を調査した．調査対象期間（2012年1月1日～2013年11月30日）にBoNT／Aを投与された307例のデータを集計した結果，1回あたりの合計投与量や1筋あたりの投与量・注射部位数，筋同定法，薬液濃度など，BoNT／A投与の結果に影響する多様な因子について情報が得られた．1筋あたりのBoNT／A投与量を左右する因子としては，患者の体格よりも痙縮の重症度が重視されている可能性が示唆された．経験豊富な医師によるノウハウの一端を明らかにした本研究の集計結果は，実地臨床においてBoNT／Aを投与する際の目安となることが期待される．

Effect of intravesical botulinum neurotoxin-A injection on detrusor hyperreflexia in spinal cord injured patients.

To evaluate the effects of Botulinum Toxin A injection into the detrusor muscle on various voiding parameters in spinal cord injured patients with neurogenic detrusor hyperreflexia Materials and methods: 24 patients with spinal cord injuries who had detrusor overactivity and urinary incontinence and were refractory to oral medications, were injected 300 IU of BTX-A into the detrusor muscle. The pre-and post-treatment evaluations included determination of bladder urinary continence status, frequency/volume chart of CIC, Incontinence Quality of Life questionnaire (I-QOL) and patient satisfaction. The urodynamic parameters measured included maximum cystometric capacity (MCC), reflex detrusor volume (RDV) and maximum detrusor pressure during bladder contraction (MDP) were analyzed at the outset and during the follow-up (2, 6, and 24 weeks) examinations. The evaluation of urodynamic parameters during follow-up examinations (2, 6 and 24 weeks) revealed significant increase in mean reflex volume (p<0.05) and cystometric capacity (p<0.05), on the other detrusor pressure decreased significantly (p<0.05). In majority of patients there was considerable reduction in incontinence episodes and no complications or side effects were reported. Most of the patents were satisfied with the treatment. The use of Botulinum toxin type A for treatment of neurogenic detrusor overactivity in spinal cord injured patients is safe and efficacious. In our 24-week study period, there was significant improvement in most urodynamic parameters with consistence and subjective satisfaction indicated by the treated patients.

Botulinum Toxin Type A in the treatment of myofascial pain related to masticatory muscles

Objective: To systematize the scientific evidence on the efficacy of botulinum toxin type A in the treatment of myofascial pain related to masticatory muscles. Method: A bibliographical search was made in the PubMed Central Journal and Allergan Product Literature databases - botulinum toxin (APL) encompassing the past 12 years, with the descriptors: “myofascial pain,” “botulinum toxin,” “treatment,” “masticatory muscles”. The methodological quality of the studies was evaluated through the Jadad scale. Four randomized, double-blind, clinical trial studies were selected. Results: It was found that the research on the use of botulinum toxin type A for myofascial pain contributed to improving the treatments that existed until that time for this clinical condition. Conclusion: The need for more studies and forms of evaluating precisely and quantitatively is essential in order to find a definitive answer on the efficacy and safety of this treatment.

Cost analysis of the use of botulinum toxin type A in Spain

To estimate treatment costs of blepharospasm, cervical dystonia(CD), upper limb spasticity (ULS) and spasticity in children with cerebral palsy (SCCP) with botulinum neurotoxin type A (BoNT-A) in Spain. Annual BoNT-A treatment costs were calculated (2013 ex-factory price () applying RDL 8/2010 and RDL 9/2011 deductions), based on initial dose (id), average dose (ad) and maximum dose (md) according to Summary of Product Characteristics of Botox® (100U/50U), Dysport®(500U) and Xeomin® (100U) and considering the use of complete vials.In addition, annual treatment costs were calculated considering the useof vials in more than one patient and also patient population annual treatment costs based on diseases' prevalence. Annual BoNT-A treatment costs per patient were estimated at between 265 and 2,120 with savings from 10% to 55% accordingto the selected BoNT-A. CD and ULS treatment provided the greatest cost per patient. Botox® provided greater savings in ULS (id/ad), CD(id), and in blepharospasm and SCCP (id/ad/md). Dysport® treatment was less costly in CD (md) and ULS (md), while Xeomin® was in CD(ad). Based on the estimated treated population in Spain, the annual treatment costs ranged from 368,392 to 13,958,836 depending on indication, dose and BoNT-A considered. The appropriate BoNT-A choice would lead to considerable savings for the National Health System. Botox® would generate lower costs per patient than other BoNT-A products in 9 out of 12 scenarios considered.

Efficacy of botulinum toxin type B for the treatment of primary palmar hyperhidrosis: a prospective, open, single-blind, multi-centre study

Primary palmar hyperhidrosis is a distressing and disabling condition that can produce social, psychological and occupational problems. Although the use of botulinum toxin type A (BoNT-A) has been reported as an efficacious and safe intervention to improve palmar hyperhidrosis, only one study concerned botulinum toxin type B (BoNT-B) in this disorder. The aim of study was to evaluate the efficacy and safety of BoNT-B in treating primary palmar hyperhidrosis. Participants were injected with 5,000 IU of BoNT-B in each palm. Visual analogue test (VAS) to evaluate the intensity of decrease in sweat production, Minor's iodine starch test and measurement of paper towels' weight were used to ascertain palmar sweating at baseline, 4, 12 and 24 weeks after BoNT-B injections by a blind examiner. Thirty-two subjects (12 males, 20 females, mean age 31 ± 11) were enrolled. Significant reduction of palmar sweating was detected after BoNT-B injection: 2.9 ± 1.4, 0.3 ± 0.4, 0.9 ± 0.8, and 2.1 ± 1.5 g (p < 0.001) of paper towels' weight for the right palm at baseline, 4, 12 and 24 weeks; and 2.8 ± 1.7, 0.5 ± 0.6, 0.8 ± 0.7, and 1.8 ± 1.25 g (p < 0.001) at same time, respectively for the left palm. Significant reduction of mean VAS values were also detected after BoNT-B injections: 8.6 ± 1.1, 0.6 ± 0.8, 3.5 ± 2.5, and 7.1 ± 2.4 (p < 0.0001) at baseline, 4, 12 and 24 weeks, respectively. Mild side effects consisting in local pain and hand weakness were observed in 4 (12.5%) subjects. The findings indicated that the use of 5,000 IU BoNT-B injection in each palm was safe and significantly improved the severity of palmar hyperhidrosis.

Non-surgical aesthetic nasal enhancement: indications, contraindications and anatomy

The non-surgical facial aesthetics arena is rapidly evolving and there has been a high demand over recent years for the correction of mild-to-moderate external nasal deformities. The minimally invasive rhinoplasty combines the adjuvant use of botulinum toxin type A and dermal fillers to rectify or improve a range of perceived or actual nasal defects (e.g. drooping tip, depressed areas). The procedure takes place in an outpatient setting and involves virtually no discomfort, little associated downtime, and is considered very safe and efficient, yielding high patient satisfaction rates. This article will explore the history of the procedure, describe the ideal nasal proportions, outline the anatomy of the external nose and cover the indications and contraindications for the procedure. A second article will look at the products used and provide readers with a treatment protocol. Both articles are reflective of the author's experience.

The use of botulinum toxin type a in the acute phase of facial nerve injury after neurosurgical surgery

To evaluate the role of botulinum toxin type A in the acute phase of facial nerve injury after neurosurgical surgery. The study involved 55 patients with acute facial muscle paresis caused by facial nerve injury during surgery on the posterior cranial fossa and cerebello-pontine angle (CPA). The first group consisted of 35 patients (mean age, 48.14±1.26 years) who were administered botulinum toxin type A (xeomin) at a dose of 2-3 U per point in muscles of the intact side of the face. The control group included 20 patients (mean age, 49.85±1.4 years) who underwent standard rehabilitation treatment of this pathology. The treatment efficacy was evaluated using the House-Brackmann Scale, the Yanagihara facial grading system, the Facial Disability Index (FDI), and the Sunnybrook Facial Grading (SFG) Scale. Before treatment, patients of both groups experienced severe dysfunction according to the House-Brackmann Scale. A month after the botulinium toxin type A therapy had been started, a significant improvement in the group of patients who received botulinum toxin was observed at all scales (p<0.05), whereas improvement in the facial nerve function in the second group was observed only by the 3rd month of rehabilitation treatment (p<0.05). The number of synkineses in the patients who did not receive botulinum toxin was 46% higher than that in the first group (p=0.019) one year after the surgery, and it was higher by 91% after 2 years (p<0.001). The use of botulinum toxin type A is reasonable in acute facial nerve injury and should be mandatory in combined therapy of these patients.

Correlation of Botulinum Toxin Dose with Neurophysiological Parameters of Efficacy and Safety in the Glabellar Muscles: A Double-blind, Placebo-controlled, Randomized Study

Despite the extensive use of botulinum toxin type A (BoNT-A) in treatments for glabellar frown lines, the dose-response effect in the glabellar muscles remains unknown. The aim of this randomized, double-blind, placebo-controlled prospective study was to characterize the neurophysiological parameters that correlate with the effect of BoNT-A in the glabellar muscles and its diffusion to surrounding ocular muscles. Sixteen healthy women were recruited and randomized to 3 different dose-groups of onabotulinumtoxin A (Vistabel®) or placebo and followed 24 weeks by neuro-physiological examinations. Efficacy of treatment on corrugator supercilii muscles was measured by compound motor action potential (CMAP) and electromyography (EMG). Photographs were used to score glabellar frown lines. Diffusion of the drug to surrounding muscles was assessed by CMAP of the nasalis muscle, EMG and concentric needle electrode jitter analysis (CNE) of the orbicularis oculi muscle. CMAP reduction correlated well with intramuscular BoNT-A dose. Muscle paralysis, measured by EMG, began from 2 weeks and was not entirely reversed at 24 weeks in individuals who received high dose of onabotulinumtoxin. Limited diffusion of orbicularis oculi was detected with CNE. In conclusion, we developed a novel neurophysiological strategy for effect evaluation of BoNT-A in glabellar muscles. CMAP and EMG correlated with given BoNT-A dose and are more defined effect measures than clinical glabellar photo scales.

Botulinum Toxin Type A in the treatment of myofascial pain related to masticatory muscles

Objective: To systematize the scientific evidence on the efficacy of botulinum toxin type A in the treatment of myofascial pain related to masticatory muscles. Method: A bibliographical search was made in the PubMed Central Journal and Allergan Product Literature databases - botulinum toxin (APL) encompassing the past 12 years, with the descriptors: “myofascial pain,” “botulinum toxin,” “treatment,” “masticatory muscles”. The methodological quality of the studies was evaluated through the Jadad scale. Four randomized, double-blind, clinical trial studies were selected. Results: It was found that the research on the use of botulinum toxin type A for myofascial pain contributed to improving the treatments that existed until that time for this clinical condition. Conclusion: The need for more studies and forms of evaluating precisely and quantitatively is essential in order to find a definitive answer on the efficacy and safety of this treatment.

Use of botulinum toxin type A in the management of patients with neurological disorders: a national survey.

The aim of this survey was to provide an overview of important issues relating to therapeutic strategies based on botulinum toxin type A injection for the treatment of patients with neurological disorders. Two hundred and ten physicians from neurology and neurorehabilitation units in Italian hospitals answered a questionnaire exploring some clinical aspects of the use of botulinum toxin type A in patients with spasticity/dystonia. 66% of the physicians treated patients with dystonia, 80% treated adults with spasticity, and 35% treated children with cerebral palsy. Palpation with no instrumental guidance was the injection technique most commonly used for treating patients with dystonia, spasticity and cerebral palsy; 57% of the physicians evaluated patients instrumentally before toxin injection, while 45% assessed postinjection improvements by instrumental means; 78% of the physicians prescribed (when appropriate) rehabilitation procedures after toxin injection. Our results seem to show that the routine use of botulinum toxin in clinics is far from standardized.

A systematic review of the use of Botulinum toxin type A with subpectoral breast implants

To determine the efficacy of Botulinum toxin A (BTX-A) injections for pain relief following placement of subpectoral tissue expanders and breast implants. MEDLINE and EMBASE were searched from their inception to December 2012 to identify studies reporting the efficacy of perioperative BTX-A injections following breast surgery with subpectoral prostheses. Study designs included controlled and uncontrolled studies. Seven studies met the inclusion criteria (2 prospective controlled cohort, 3 retrospective cohort and 2 case series). Five studies assessed the efficacy of BTX-A and three measured pain improvement as a primary outcome. The studies enrolled 427 women: 91.8% received intraoperative BTX-A injection at the time of tissue expander breast reconstruction and 4.7% following augmentation mammaplasty. Only 3.5% of women received BTX-A injections in the postoperative setting. Overall, all the studies demonstrated improvement in pain and favorable side effect profile without any major adverse effects. However, the quality of this evidence was low. The results of this systematic review suggest that BTX-A may alleviate postoperative pain associated with the placement of subpectoral tissue expanders and implants. The available data on outcome assessment of this practice are inconsistent and lack methodological rigor. With paucity of high-level evidence to support this practice in implant-based breast surgery, further studies are needed.

Botulinum toxin type A: implications in wound healing, facial cutaneous scarring, and cleft lip repair

Botulinum toxin is a neurotoxin that has been utilized to induce chemo-denervation of muscles. Cutaneous wounds represent a special situation in which the tensile forces applied by these muscles on wound edges might have deleterious effects on the healing process. The aim of this review was to investigate such an effect and to review other mechanisms this toxin might have on the healing process. We also reviewed the role of botulinum toxin in the management of hypertrophic scars and cleft lip repair.

Reviews of botulinum toxin products in aesthetic use must be accurate, clear and avoid speculation

Reviews of botulinum toxin products in aesthetic use must be accurate, clear and avoid speculation Andy Pickett1,2 1Toxin Science Limited, Wrexham, UK; 2Botulinum Research Center, University of Massachusetts (UMASS), North Dartmouth, MA, USAOne of the most surprising and, at the same time, most frustrating aspects of the continual rise in the use of botulinum toxin type A (BoNT-A), particularly in aesthetic applications, is the sheer number of reviews currently being published. So far in 2013, there have been seven single or joint reviews of BoNT products focusing on facial aesthetics. The frustrating aspects of these reviews cover two areas: Firstly, they inevitably speculate about why there are &quot;apparent differences&quot; between the products. They attempt to use the science of BoNT-A to explain these differences. This speculation is both inappropriate and weak. In fact, the majority of differences between the products seen clinically are, by far, due to simple dose differences used in studies, especially when two or more products are being compared.View original paper by Prager.