| The Botulinum
Toxin II, Update./ La toxina Botulinica II, Acualizacion. Data-Medicos
Dermagic/Express No. 2-(82)
10 Noviembre / 10 November 1.999
~ La Toxina Botulinica II, actualización ~
~ The Botulinum Toxin II, Update ~
EDITORIAL ESPANOL
=================
Hola Amigos de la red, el dia 4 Diciembre 1.998 DERMAGIC/EXPRESS hizo una
revision de la TOXINA BOTULINICA, 41 referencias fueron lanzadas a la red.
La
semana pasada el DR. Armando Mocci (Panama) me sugirio el tema para una
revision.
Me fui al Cyber y complete los articulos con 40 mas. Entre los Usos de la
TOXINA
BOTULINICA figuran: DERMATOLOGICOS Y NO DERMATOLOGICOS:
Fisura anal, lineas faciales, disfonia, espasmos faciales, arrugas,
torticolis,
blefaroespasmo, estrabismo, hiperhidrosis axilar y palmar, espasticidad
muscular, distrofias musculares, paralisis cerebral, desordenes
temporomandibulares, acalasia, sindrome de Frey, dolor de cabeza, distonias,
calambres, y otros.
PERO no es una moneda de plata,,, tambien tiene sus EFECTOS ADVERSOS:
Erupcion psoriasiforme, diplopia, depigmentacion periocular, atrofia y
paralisis
muscular, ansiedad, depresion, sangramiento incontrolable en heridas
traumaticas en sitios inyectados (cara), y otros.
En estas 80 referencias,,, los hechos
Saludos a todos !!!
Bievenido a DERMAGIC Dr. S. Jose Fishman (USA)
PROXIMA EDICION: EL ERBIUM...y EL CO2....(DERMA K)
Dr. Jose Lapenta R.,,,
EDITORIAL ENGLISH
=================
Hello Friends of the net, the day 4 December 1.998 DERMAGIC/EXPRESS made a
revision of the BOTULINUM TOXIN, 41 references were thrown to the net in
that day.
Last week the DR. Armando Mocci (Panama) he suggested me the topic for a
revision. I
left to the Cyber and complete the articles with 40 but. Among the uses
of the
BOTULINUM TOXIN they figure: DERMATOLOGIC AND NON
DERMATOLOGIC:
Anal fissure, hyperkinetic facial lines, dysphonia, hemifacial spasm, frown
lines,
spasmodic torticollis, blepharospasm, strabismus, axillary hyperhidrosis,
limb
spasticity, Sweaty Palms, nerve palsy, esotropia, Duchenne muscular
dystrophy,
cerebral palsy, temporomandibular disorders, Achalasia, Frey's syndrome,
Writer's cramp, refractory headaches, dystonia, gustatory sweating, and
others.
BUT it is not a "silver coin", she also has their ADVERSE EFFECTS:
Psoriasiform eruption, Diplopia, periocular depigmentation, Muscle fiber
atrophy, muscle paralysis, uncontrollable hemorrhages in traumatic wound in
injected places (face), acute anxiety, depression and others.
In these 80 references,,, the facts...
Welcome to DERMAGIC Dr. S. Jose Fishman (USA)
NEXT EDITION: THE ERBIUM... and THE CO2... (DERMA K)
Greetings to ALL, !!
Dr. Jose Lapenta R.,,,
===================================================================
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
===================================================================
======================================================================
1.) Botulinum toxin for chronic anal fissure [see comments]
2.) Botulinum toxin A for hyperkinetic facial lines: results of a
double-blind,
placebo-controlled study.
3.) Botulinum toxin for the treatment of hyperfunctional lines of the face
[see comments]
4.) Spasmodic dysphonia. Emotional status and botulinum toxin treatment.
5.) Botulinum A toxin for treatment of aberrant facial nerve regeneration.
6.) Crystalline preparation of botulinum toxin type A (Botox): degradation
in potency with
storage [see comments]
7.) Botulinum toxin. From poison to medicine.
8.) Botulinum B toxin as an alternative to botulinum A toxin: a
9.) Psoriasiform eruption from intramuscular botulinum A toxin.
10.) Contralateral injections of botulinum A toxin for the treatment of
hemifacial spasm to
achieve increased facial symmetry [see comments]
11.) Clinical and laboratory comparison of botulism from toxin types A, B,
and E in the
United States, 1975-1988.
12.) Treatment of glabellar frown lines with C. botulinum-A exotoxin.
13.) Botulinum A toxin for (expressionistic) ptosis overcorrection after
frontalis sling.
14.) Botulinum A toxin for the treatment of adult-onset spasmodic
torticollis.
15.) Treatment of idiopathic spasmodic torticollis with botulinum-A toxin:
a pilot study of
19 patients.
16.) Botulinum A toxin injection. Failures in clinical practice and a
biomechanical system for the study of toxin-induced paralysis.
17.) Treatment of blepharospasm with botulinum toxin.
18.) Botulinum toxin: a treatment for facial asymmetry caused by facial
nerve paralysis.
19.) Management of facial spasm with Clostridium botulinum toxin, type A
(Oculinum)
[see comments]
20.) Treatment of anismus in intractable constipation with botulinum A toxin.
21.) Botulinum toxin chemodenervation in infants and children: an
alternative to incisional strabismus surgery.
22.) Oculinum injection-resistant blepharospasm in young patients.
23.) Botulinum A chemodenervation: a new modality in cerebral palsied hands.
24.) Botulinum toxin--a possible new treatment for axillary hyperhidrosis.
25.) Local injection into mimetic muscles of botulinum toxin A for the
treatment of facial
lines.
26.) Long term results of botulinum toxin type A (Dysport) in the treatment
of hemifacial
spasm: a report of 175 cases.
27.) Contemporary management of the aging brow and forehead.
28.) Botulinum A toxin therapy: neutralizing and nonneutralizing
antibodies--therapeutic
consequences.
29.) One hundred cases of anal fissure treated with botulin toxin: early
and long-term
results.
30.) Botulinum A toxins: units versus units.
31.) Reconstituted botulinum toxin type A does not lose potency in humans
if it is refrozen
or refrigerated for 2 weeks before use.
32.) [Mechanism of action, clinical indication and results of treatment of
botulinum toxin]
33.) Use of botulinum toxin in stroke patients with severe upper limb
spasticity.
34.) Nerve injection injury with botulinum toxin.
35.) DYSBOT: a single-blind, randomized parallel study to determine whether
any
differences can be detected in the efficacy and tolerability of two
formulations of
botulinum toxin type A--Dysport and Botox--assuming a ratio of 4:1.
36.) Patient selection in the treatment of glabellar wrinkles with
botulinum toxin type A
injection.
37.) Botulinum A neurotoxin for axillary hyperhidrosis. No sweat Botox.
38.) Botox-induced prostatic involution.
39.) Use of botulinum A toxin in patients at risk of wound complications
following eyelid
reconstruction.
40.) Cosmetic upper-facial rejuvenation with botulinum.
41.) New Treatment For Sweaty Palms Works for Up To A Year
42.) A review of 5 years' experience in the use of botulinium toxin A in
the treatment of
sixth cranial nerve palsy at the Singapore National Eye Centre.
43.) The role of botulinum toxin A in acute-onset esotropia.
44.) Long-term botulinum toxin treatment of cervical dystonia--EMG changes
in injected
and noninjected muscles.
45.) Botulinum toxin for amelioration of knee contracture in Duchenne
muscular
dystrophy.
46.) Double-blind study of botulinum A toxin injections into the
gastrocnemius muscle in
patients with cerebral palsy.
47.) Pure botulinum neurotoxin is absorbed from the stomach and small
intestine and
produces peripheral neuromuscular blockade.
48.) Botox for hyperadduction of the false vocal folds: a case report.
49.) The use of botulinum toxin for the treatment of temporomandibular
disorders:
preliminary findings.
50.) Achalasia: diagnosis and management.
51.) Cosmetic indications for botulinum A toxin.
52.) [Botulinum toxin type A treatment of cosmetically disturbing masseteric
hypertrophy].
53.) Botulinum toxin type A for Frey's syndrome: a preliminary prospective
study.
54.) Complications of botulinum A exotoxin for hyperfunctional lines.
55.) The adjunctive usage of botulinum toxin.
56.) [Writer's cramp treated with botulinum injections].
57.) Clinical indications and injection technique for the cosmetic use of
botulinum A
exotoxin.
59.) Botulinum toxin for the correction of hyperkinetic facial lines.
60.) Cosmetic use of botulinum A exotoxin for the aging neck.
61.) Axillary hyperhidrosis: treatment with botulinum toxin A.
62.) Treatment of hyperfunctional lines of the face with botulinum toxin A.
63.) Treatment of cerebral palsy with botulinum toxin A: functional benefit
and reduction
of disability. Three case reports.
64.) Understanding botulinum toxin. Surgical anatomy of the frown,
forehead, and
periocular region.
65.) Efficacy of repeated botulinum toxin injections as a function of timing.
66.) Counterparalysis for treatment of paralytic scoliosis with botulinum
toxin type A.
67.)Has botulinum toxin type A a place in the treatment of spasticity in
spinal cord injury
patients?
68.) Use of botulinum A toxin in patients at risk of wound complications
following eyelid
reconstruction.
69.) Botox for the treatment of dynamic and hyperkinetic facial lines and
furrows:
adjunctive use in facial aesthetic surgery.
70.) Botulinum toxin A, adjunctive therapy for refractory headaches
associated with
pericranial muscle tension.
71.) The role of botulinus toxin type A in treatment--with special
reference to children.
72.) Botulinum toxin type A injection for the treatment of frown lines.
73.) Dilution and storage of botulinum toxin.
74.) Botulinum toxin A improves muscle spasms and rigidity in stiff-person
syndrome.
75.) [Oromandibular dystonia and botulinum toxins].
76.) Treatment of gustatory sweating with botulinum toxin.
77.) Diplopia following subcutaneous injections of botulinum A toxin for
facial spasms.
78.) Prevalence of periocular depigmentation after repeated botulinum toxin
A injections
in African American patients.
79.) Muscle fiber atrophy in leg muscles after botulinum toxin type A
treatment of cervical
dystonia.
80.) Acute anxiety and depression induced by loss of sensation and muscle
control after
botulinum toxin A injection.
======================================================================
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
======================================================================
1.) Botulinum toxin for chronic anal fissure [see comments]
======================================================================
CM - Comment in: Lancet 1995 Jan 21; 345(8943):188-9
SO - Lancet 1994 Oct 22;344(8930):1127-8
AU - Gui D; Cassetta E; Anastasio G; Bentivoglio AR; Maria G; Albanese A
AD - Istituto di Clinica Chirurgica, Universita Cattolica del Sacro Cuore,
Roma, Italy.
PT - CLINICAL TRIAL; JOURNAL ARTICLE
AB - Botulinum toxin can chemically denervate striated muscle. Botulinum
toxin A (15
U) was used to treat ten patients with chronic anal fissure by injection in
the internal
sphincter. In seven patients, the lesion healed at 2 months after
treatment; one relapsed at
3 months. In one patient the lesion healed at 1 month, but partly relapsed
a month later.
Mild faecal incontinence lasting for 1 day was observed in one patient. We
propose that
botulinum toxin injections in the internal anal sphincter be considered an
alternative
approach to surgical therapy of anal fissure.
======================================================================
2.) Botulinum toxin A for hyperkinetic facial lines: results of a
double-blind,
placebo-controlled study.
======================================================================
SO - Plast Reconstr Surg 1994 Jul;94(1):94-9
AU - Keen M; Blitzer A; Aviv J; Binder W; Prystowsky J; Smith H; Brin M
AD - Department of Otolaryngology, Columbia University College of
Physicians and
Surgeons, New York, N.Y.
PT - CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED
TRIAL
AB - Previous work on patients with muscular dystonia has shown that small
intramuscular doses of botulinum toxin A eliminated hyperkinetic facial
lines for
approximately 6 months. The purpose of this study was to determine the
efficacy of
botulinum toxin A injections in eliminating facial wrinkles in aesthetic
surgery patients who
do not have muscular dystonia. Eleven healthy subjects were studied in a
double-blind
fashion. On both sides of the face, 0.2 cc of either normal saline or
botulinum toxin A was
injected into the forehead or into the periorbital wrinkles (crow's feet).
Documentation of
results was made by photographs taken of the patients during repose and
during facial
animation before and after injection. Assessment of facial wrinkles was
done from a
grading system in which the patient and the facial plastic surgeon were
asked to judge the
severity of the wrinkles on a scale from 0 to 3, with 0 reflecting no
facial wrinkles and 3
reflecting severe facial wrinkling. Nine of 11 subjects injected with
botulinum toxin A
noted a significant improvement in the severity of their facial wrinkles in
comparison with
the side of the face injected with saline, with a rating improvement of 2
points. Two of 11
subjects noted a moderate improvement, with a rating improvement of 1
point. No patient
injected with saline reported an improvement in the severity of the facial
wrinkles on the
control side. There were no serious complications. Botulinum toxin A is an
efficacious
method of nonsurgically eliminating facial wrinkles and may play a role in
the cosmetic
enhancement of the aging face.
======================================================================
3.) Botulinum toxin for the treatment of hyperfunctional lines of the face
[see comments]
======================================================================
CM - Comment in: Arch Otolaryngol Head Neck Surg 1995 Jun; 121(6):704
SO - Arch Otolaryngol Head Neck Surg 1993 Sep;119(9):1018-22
AU - Blitzer A; Brin MF; Keen MS; Aviv JE
AD - Department of Otolaryngology, Columbia-Presbyterian Medical Center, New
York, NY.
PT - JOURNAL ARTICLE
AB - OBJECTIVE: To determine the effectiveness of botulinum toxin
injections for the
management of hyperfunctional facial lines in patients with dystonia.
DESIGN: Twenty-six
patients were included in the study: 24 patients had dystonic movement of
the face as
either a primary or secondary component, and two patients were treated for
purely
hyperfunctional lines. Botulinum toxin type A was injected via a monopolar
hollow-bore
Teflon-coated electromyography needle into the facial muscles associated
with the
hyperfunctional lines. Doses were divided into 1.25- to 10-U aliquots.
Qualitative
assessments by the patient and physician were made before injection and 2
to 3 weeks
after injection. PATIENTS: Twenty-six patients (two male and 24 female) with
hyperfunctional lines were included. The ages were from 32 to 84 years with
an average
age of 59 years. Twenty had dystonia, four had hemifacial spasm, and two
had pure
hyperfunction without neuromuscular disease. RESULTS: All of the patients
had an effect
of toxin within the first 24 to 72 hours. All of the patients experienced
benefit from the
toxin injections with partial or total resolution of painful contractions
or unsightly
hyperfunctional lines and spasms. The effects of the injection lasted 3 to
6 months. No
systemic side effects were noted. Adverse effects included mild, temporary
eyelid or lip
weakness. CONCLUSION: Based on this initial pilot study, botulinum toxin
may be an
important new option for the treatment of patients with hyperfunctional
facial lines.
======================================================================
4.) Spasmodic dysphonia. Emotional status and botulinum toxin treatment.
======================================================================
SO - Arch Otolaryngol Head Neck Surg 1994 Mar;120(3):310-6
AU - Murry T; Cannito MP; Woodson GE
AD - Department of Otolaryngology-Head and Neck Surgery, University of
Tennessee
College of Medicine, Memphis.
PT - JOURNAL ARTICLE
AB - The objectives of this study were to determine the effects of
botulinum toxin
injection on measures of depression, anxiety, and somatic complaints in
patients
diagnosed as having spasmodic dysphonia. Patients were asked to complete
preinjection
questionnaires with self-ratings of depression, state and trait anxiety,
and somatic
complaints. Approximately 1 week and 2 months following injection, patients
were again
asked to complete the questionnaires. The spasmodic dysphonic subjects
exhibited
significantly elevated mean levels of depression and anxiety. These levels
were significantly
reduced approximately 1 week after injection. Two months later, depression
and anxiety
measures did not change significantly from their 1-week postinjection
values. The results
suggest that patients with spasmodic dysphonia who demonstrate
significantly elevated
measures of depression and anxiety show a reduction in those measures
following
treatment with botulinum toxin.
======================================================================
5.) Botulinum A toxin for treatment of aberrant facial nerve regeneration.
======================================================================
SO - Plast Reconstr Surg 1993 May;91(6):1042-5
AU - Borodic GE; Pearce LB; Cheney M; Metson R; Brownstone D; Townsend D;
McKenna M
AD - Department of Ophthalmology and Otolaryngology, Massachusetts Eye and
Ear
Infirmary, Boston.
PT - JOURNAL ARTICLE
AB - Twelve patients with involuntary synkinetic eyelid closure were given
40 injections
of botulinum A toxin. Temporary improvement in involuntary eyelid closure
was observed
in all 12 patients. Eleven of the 12 patients desired repeated injections.
Dose requirements
for this indication were compared with doses used in 697 injections in 112
patients with
essential blepharospasm and Meige syndrome. Additionally, dose comparisons
were
made with 269 injections in 71 patients with hemifacial spasm. Dose
requirements needed
to treat aberrant regeneration of the facial nerve were substantially less
than needed to
treat blepharospasm and Meige syndrome. The dose requirement was similar to
that in
hemifacial spasm treatment. The reason for the differences probably relates
to existing
muscular denervation associated with hemifacial spasm and aberrant facial
nerve
regeneration.
======================================================================
6.) Crystalline preparation of botulinum toxin type A (Botox): degradation
in potency with
storage [see comments]
======================================================================
CM - Comment in: Otolaryngol Head Neck Surg 1993 Nov; 109(5):968-9
SO - Otolaryngol Head Neck Surg 1993 Feb;108(2):135-40
AU - Gartlan MG; Hoffman HT
AD - Department of Otolaryngology-Head and Neck Surgery, University of Iowa
Hospitals and Clinics, Iowa City 52242.
MJ - Botulinum Toxins
MN - Biological Assay; Drug Storage [methods]; Freeze Drying; Mice, Inbred
Strains;
Mice; Time Factors
MT - Animal; Female
PT - JOURNAL ARTICLE
AB - Laryngeal injection of botulinum toxin type A is currently the most
effective method
of treating spasmodic dysphonia. Botox, a crystalline preparation of
botulinum toxin type
A, is the only toxin approved for clinical use in the United States and is
packaged in vials
of 100 mouse units (MU). One MU corresponds to the calculated median lethal
intraperitoneal dose (LD50) injected in mice. The logistic problems arising
from the need
for repeated injections of small amounts of Botox have been addressed by
several
investigators by refreezing unused Botox for use at a later time. Although
FDA labeling
recommends that Botox not used within 4 hours of reconstitution be
discarded, data
regarding degradation in potency after reconstitution and refreezing are
not currently
available. Using the LD50 Swiss-Webster mouse bioassay and statistical
analysis by the
Probit procedure, a 69.8% loss in potency was found when Botox was
reconstituted,
immediately frozen, and then assayed 2 weeks later (p 0.0001).
Statistically significant
degradation in potency was seen after refrigerator storage for 12 hours (p
= 0.007), but
not for 6 hours (p = 0.16). Clinical implications regarding the dilution,
use, and storage of
Botox are discussed.
======================================================================
7.) Botulinum toxin. From poison to medicine.
======================================================================
SO - West J Med 1993 Jan;158(1):25-9
AU - Davis LE
AD - Neurology Service, Veterans Affairs Medical Center, Albuquerque, NM
87108.
PT - JOURNAL ARTICLE; REVIEW (56 references); REVIEW, TUTORIAL
AB - Although thousands of people in the world each year continue to be
poisoned with
botulinum toxin-food-borne, infantile, or wound botulism-the neurotoxin is
now sufficiently
understood to allow it to be used as a medicinal agent to paralyze specific
muscles, giving
temporary symptomatic relief from a variety of dystonic neurologic
disorders. I review
some of the epidemiologic, clinical, and pathophysiologic aspects of
botulinum toxin and
how the neurotoxin may act as a poison or a medicine.
======================================================================
8.) Botulinum B toxin as an alternative to botulinum A toxin: a
======================================================================
histologic study.
SO - Ophthal Plast Reconstr Surg 1993;9(3):182-90
AU - Borodic GE; Pearce LB; Smith KL; Phelan M; Ferrante R
AD - Boston University School of Medicine, University Hospital,
Massachusetts.
PT - JOURNAL ARTICLE
AB - Histochemical effects of botulinum B toxin were studied on fibers
from longissimus
dorsi muscle in Albino rabbits and compared to effects produced by
botulinum A toxin.
Acetylcholinesterase staining, muscle fiber size analysis, and ATPase
staining indicated
botulinum B toxin produced a denervation gradient and field similar to that
produced by
botulinum A toxin. At 5 weeks postinjection with botulinum B toxin,
analysis showed
muscle fiber size variability, and diffuse acetylcholinesterase fiber
staining comparable to
botulinum A toxin at the injection site. Muscle sections taken at 4.0 cm
for analysis
showed statistically significant decreased fiber size variability and
contraction of
acetylcholinesterase staining pattern for both immunotypes. In addition,
the denervation
reflected by histochemical staining and fiber size analysis appeared
transient and lasted for
approximately 3 months for both immunotypes. These findings suggest
botulinum B toxin
produces pharmacologic effects on innervation of striated muscle similar to
botulinum A
toxin. Because immunologic tolerance has been demonstrated after
therapeutic botulinum
A toxin injections, further clinical studies need to be conducted with
other immunotypes of
toxin with no cross-reactivity to type A.
======================================================================
9.) Psoriasiform eruption from intramuscular botulinum A toxin.
======================================================================
SO - Cutis 1992 Dec;50(6):415-6
AU - Bowden JB; Rapini RP
AD - Department of Dermatology, University of Texas Medical School, Houston
77030.
PT - JOURNAL ARTICLE
AB - Botulinum A toxin is used intramuscularly in the treatment of spastic
neuromuscular
disorders, strabismus, and laryngeal dystonia. The toxin has recently been
reported as
being useful for the cosmetic removal of glabellar furrows. The clinical
effect of the toxin
lasts four months or longer. Systemic side effects are rare and usually
transient. We report
the case of a psoriasiform eruption temporally related to the injection of
botulinum A toxin
into the medial rectus muscle to treat an ocular motility disorder. To our
knowledge, this is
the first case of a psoriasiform dermatitis caused by this agent.
======================================================================
10.) Contralateral injections of botulinum A toxin for the treatment of
hemifacial spasm to
achieve increased facial symmetry [see comments]
======================================================================
CM - Comment in: Plast Reconstr Surg 1993 Dec; 92(7):1409
SO - Plast Reconstr Surg 1992 Dec;90(6):972-7; discussion 978-9
AU - Borodic GE; Cheney M; McKenna M
AD - Massachusetts Eye and Ear Infirmary, Boston.
PT - JOURNAL ARTICLE
AB - Six patients noted facial asymmetry after botulinum toxin injection
for hemifacial
spasm. Each patient was injected on the side contralateral to the spasms
with 10 to 15 IU
over the zygomatic major and minor muscles. Each patient noted improvement
in facial
symmetry in the resting position and dynamic facial movements. Five of the
six patients
desired this approach with subsequent injections. This injection method
variation proved
helpful in the managing of hemifacial weakness created by botulinum A toxin
for this
condition.
======================================================================
11.) Clinical and laboratory comparison of botulism from toxin types A, B,
and E in the
United States, 1975-1988.
======================================================================
SO - J Infect Dis 1992 Dec;166(6):1281-6
AU - Woodruff BA; Griffin PM; McCroskey LM; Smart JF; Wainwright RB; Bryant
RG; Hutwagner LC; Hatheway CL
AD - Enteric Diseases Branch, Centers for Disease Control, Atlanta,
Georgia 30333.
PT - JOURNAL ARTICLE
AB - Cases of adult botulism (n = 309) were studied to identify clinical
differences
between toxin types and to evaluate the sensitivity of diagnostic
laboratory testing.
Patients with illness from type E toxin had the shortest incubation
periods. Sporadic
case-patients were more severely ill: 85% required intubation compared with
only 42% in
multiperson outbreaks. Of patients with type A botulism, 67% required
intubation
compared with 52% with type B and 39% with type E. Toxin testing was
positive for
40%-44% of serum and stool specimens obtained within 3 days of toxin
ingestion and for
15%-23% of specimens obtained thereafter, while 37% of stool specimens
obtained 3
days after toxin ingestion were positive by culture. Patients with type A
botulism have
more severe illness. In general, specimens obtained early are more likely
to be positive by
toxin assay, and stool cultures are more sensitive than toxin detection for
specimens
obtained later in the illness.
======================================================================
12.) Treatment of glabellar frown lines with C. botulinum-A exotoxin.
======================================================================
SO - J Dermatol Surg Oncol 1992 Jan;18(1):17-21
AU - Carruthers JD; Carruthers JA
AD - Department of Opthalmology, University of British Columbia, Vancouver,
Canada.
PT - JOURNAL ARTICLE
AB - Eighteen patients with glabellar frown lines were treated with C.
botulinum-A
exotoxin. Sixteen of the 17 patients followed showed improvement for
periods ranging
from 3 months to 11 months. Side-effects were minimal and transient.
Because C.
botulinum-A exotoxin therapy of glabellar frown lines treats the underlying
cause of these
lines, it is more effective than soft tissue augmentation although this
improvement is
temporary. Treatment with C. botulinum-A exotoxin is a simple, safe
procedure.
======================================================================
13.) Botulinum A toxin for (expressionistic) ptosis overcorrection after
frontalis sling.
======================================================================
SO - Ophthal Plast Reconstr Surg 1992;8(2):137-42
AU - Borodic GE
AD - Gunderson Eye Clinic, Boston University, Massachusetts Eye and Ear
Infirmary,
Boston 02114.
PT - JOURNAL ARTICLE
AB - Botulinum A toxin was injected into the frontalis muscle in two
patients with
complete third nerve palsies to limit intermittent upper lid retraction
after a frontalis sling
procedure. This form of lid retraction is noted during periods of active
facial movement
with occipitofrontalis muscle contraction. Although upper lid position may
be symmetric
when the facial muscles are adynamic, the upper lid may retract during
periods of active
facial expression. This type of lid retraction was corrected using
Botulinum A toxin
injections into the frontalis muscles, without affecting the lid position
when the facial
muscles are adynamic. Both improvement in appearance and intermittent
exposure were
noted in both cases. Additionally, a blunting of the transverse forehead
creases occurred
over a defined area after this injection, representing a clinical example
of a denervation
field produced by a point injection of botulinum toxin.
======================================================================
14.) Botulinum A toxin for the treatment of adult-onset spasmodic
torticollis.
======================================================================
SO - Plast Reconstr Surg 1991 Feb;87(2):285-9
AU - Borodic GE; Mills L; Joseph M
AD - Massachusetts Eye and Ear Infirmary, Boston.
PT - JOURNAL ARTICLE
AB - Thirty-five patients with adult-onset idiopathic torticollis were
treated by local
injections of botulinum A toxin into dystonic cervical muscles. Substantial
improvement
with respect to reduction and elimination of pain was found in 81 percent,
improvement in
posture deformity and involuntary spasms in 70 percent, increased range of
motion of the
neck in 78 percent, reduction in visible sternocleidomastoid hypertrophy in
86 percent,
and improvement in tremor in 65 percent. The syndrome was divided into four
subtypes
based on pattern of dystonic muscle groups involved in the dystonia, head
and shoulder
posture, and sternocleidomastoid muscle hypertrophy. Injection strategy
based on this
subdivision is described.
=====================================================================
15.) Treatment of idiopathic spasmodic torticollis with botulinum-A toxin:
a pilot study of
19 patients.
======================================================================
SO - Med J Aust 1990 May 21;152(10):528-30
AU - Lorentz IT; Subramaniam SS; Yiannikas C
AD - Westmead Hospital, NSW.
PT - JOURNAL ARTICLE
AB - Nineteen patients with spasmodic torticollis, unresponsive to
standard therapy,
were administered local injections of botulinum-A toxin into the affected
muscles. During
an average follow-up period of 11.5 months, a more than 25% improvement was
noted in
14 of 19 patients. All those with purely focal dystonia and 9 of 10
patients with a disease
history of less than three years benefited from treatment. Side effects
were insignificant
and transient. Botulinum toxin is a very effective and safe method of
treatment for
spasmodic torticollis.
======================================================================
16.) Botulinum A toxin injection. Failures in clinical practice and a
biomechanical system for the study of toxin-induced paralysis.
======================================================================
SO - Ophthal Plast Reconstr Surg 1990;6(4):252-9
AU - Holds JB; Fogg SG; Anderson RL
AD - Department of Ophthalmology, Bethesda Eye Institute, St. Louis
University
School, Missouri 63110.
PT - JOURNAL ARTICLE
AB - Botulinum A toxin injection has great utility in the treatment of
essential
blepharospasm and other facial spasm disorders. Several investigators have
noted the
failure of botulinum toxin injections to relieve lid spasm in occasional
patients and a
decrease in effectiveness or duration of effect following multiple
injections in other
patients. We reviewed the charts of 30 consecutive patients presenting for
the evaluation
or treatment of facial dystonia. Of 20 patients who had received multiple
injections of
botulinum toxin, 10 patients were felt to be treatment failures. A new
biomechanical
system was developed to investigate the duration and degree of paralysis
induced in the
gastrocnemius muscle of the rat. Animals were treated with four sequential
injections at
6-week intervals to the same muscle, resulting in muscle atrophy and an
increase in the
duration and degree of muscle paralysis, contrary to clinical findings in
humans. The
review of patient data confirms that, for many patients, repeated injection
of botulinum
toxin results in a decrease in duration and degree of effect despite an
increased toxin
dose. An opposite effect was noted in our experimental model because of
progressive
muscle atrophy.
======================================================================
17.) Treatment of blepharospasm with botulinum toxin.
======================================================================
SO - Mayo Clin Proc 1989 Sep;64(9):1085-90
AU - Kennedy RH; Bartley GB; Flanagan JC; Waller RR
AD - Oculoplastic Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
PT - JOURNAL ARTICLE
AB - Many therapeutic modalities, including medications, excision of the
muscles used in
closure of the eyelids (myectomy), and selective extirpation of branches of
the facial nerve
(neurectomy), have been used for the management of blepharospasm. Because
of limited
effectiveness and undesirable side effects, none of these treatments has
been completely
satisfactory. Recent reports about injection of botulinum toxin indicate
that it is safe and
effective for most patients. Relief from blepharospasm, however, is usually
transient, and
repeated injections are usually necessary. The current availability of
effective therapy for
blepharospasm emphasizes the importance of prompt diagnosis and referral of
affected
patients to physicians knowledgeable in the use of botulinum toxin and
other therapeutic
approaches.
======================================================================
18.) Botulinum toxin: a treatment for facial asymmetry caused by facial
nerve paralysis.
======================================================================
SO - Plast Reconstr Surg 1989 Aug;84(2):353-5
AU - Clark RP; Berris CE
AD - Section of Plastic and Reconstructive Surgery, Mercy General Hospital,
Sacramento, Calif.
PT - JOURNAL ARTICLE
AB - Injury to the frontal or other facial nerve branches can result in an
asymmetry that
can be very distressful to both patient and surgeon. This is especially
true following
cosmetic procedures such as rhytidectomy. We propose a means to create
temporary
symmetry while awaiting the possible return of nerve function. Botulinum
neurotoxin
causes a muscle paralysis lasting for approximately 3 months, and it is
well established as
the preferred treatment for blepharospasm. A case is presented in which
botulinum toxin
type A was injected into the opposite functioning frontalis muscle of a
patient with
unilateral frontal nerve paralysis. The patient experienced satisfactory
relief of the
asymmetry caused by onesided forehead wrinkling and brow elevation.
Botulinum toxin
therapy should be considered for both temporary and permanent facial
asymmetries due
to facial nerve paralysis as well as spasm.
======================================================================
19.) Management of facial spasm with Clostridium botulinum toxin, type A
(Oculinum)
[see comments]
======================================================================
CM - Comment in: Arch Otolaryngol Head Neck Surg 1989 Jul; 115(7):882
SO - Arch Otolaryngol Head Neck Surg 1988 Dec;114(12):1407-12
AU - Biglan AW; May M; Bowers RA
AD - Department of Ophthalmology, University of Pittsburgh School of
Medicine, PA.
PT - JOURNAL ARTICLE; REVIEW (39 references); REVIEW OF REPORTED
CASES
AB - One hundred five patients received 391 graded injections of
Clostridium botulinum
type A toxin (Oculinum) to treat uncontrollable facial muscle spasm.
Patients had essential
blepharospasm (n = 61), hemifacial spasm (n = 24), or aberrant regeneration
of the
seventh cranial nerve (n = 20). Muscle spasms were reduced within two days
of the first
injection of toxin and, in most cases, the drug effect lasted three to four
months. Control
of facial muscle spasm was achieved in all patients. Complications related
to treatment
included transient blepharoptosis (n = 7), diplopia (n = 2), and altered
facial expression (n
= 11). Systemic side effects were not observed. Select chemodenervation of
facial
muscles with graded injections of botulinum toxin is a useful adjunct to
control
blepharospasm, hemifacial spasm, and facial spasm due to aberrant
regeneration of the
facial nerve.
======================================================================
20.) Treatment of anismus in intractable constipation with botulinum A toxin.
======================================================================
SO - Lancet 1988 Sep 24;2(8613):714-7
AU - Hallan RI; Williams NS; Melling J; Waldron DJ; Womack NR; Morrison JF
AD - Surgical Unit, London Hospital, Whitechapel.
PT - JOURNAL ARTICLE
AB - In seven patients with anismus the striated sphincter muscle complex
was
selectively weakened by local injection of Clostridium botulinum type A
toxin. Symptom
scores improved significantly and correlated with a significant reduction
in the maximum
voluntary and canal squeeze pressure and a significant increase in the
anorectal angle on
straining. Botulinum A toxin seems to be promising treatment for some
patients with
anismus.
EM - 8812
======================================================================
21.) Botulinum toxin chemodenervation in infants and children: an
alternative to incisional strabismus surgery.
======================================================================
SO - J Pediatr 1987 May;110(5):719-22
AU - Magoon E; Scott AB
MJ - Botulinum Toxins; Oculomotor Muscles [innervation]; Strabismus
[therapy]
MN - Child, Preschool; Child; Denervation [methods]; Electromyography;
Infant;
Ketamine
MT - Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.
PT - JOURNAL ARTICLE
AB - Eighty-two children aged 13 years or younger were given injections of
botulinum
toxin for horizontal strabismus. Improvement was achieved in all but one
patient. Children
younger than 1 year or older than 6 years of age received only topical drop
anesthesia
and no sedation. Young children generally required low-dose ketamine
sedation. The
technique typically undercorrects, so reinjection was necessary in 85% of
the patients.
There were no systemic complications. Side effects, lasting up to a few
weeks, included
transient ptosis and hypertropia caused by involvement of other extraocular
muscles.
======================================================================
22.) Oculinum injection-resistant blepharospasm in young patients.
======================================================================
SO - Ophthal Plast Reconstr Surg 1994 Sep;10(3):193-4
AU - Gausas RE; Lemke BN; Sherman DD; Dortzbach RK
AD - Department of Ophthalmology, University of Wisconsin-Madison
53792-3220.
PT - JOURNAL ARTICLE
AB - Botulinum toxin has recently been used as a nonsurgical treatment for
blepharospasm and other facial dyskinesias. This report describes four
patients between
the ages of 32 and 37 years who failed to respond to botulinum injections
for severe
blepharospasm. Other than age, no other features could be identified in
these patients that
would differentiate this group. Particularly early age of onset for
essential blepharospasm
might be an indicator of failure to respond to the injections.
======================================================================
23.) Botulinum A chemodenervation: a new modality in cerebral palsied hands.
======================================================================
SO - Br J Plast Surg 1993 Dec;46(8):703-6
AU - Wall SA; Chait LA; Temlett JA; Perkins B; Hillen G; Becker P
AD - Division of Plastic and Reconstructive Surgery, University of the
Witwatersrand,
South Africa.
PT - JOURNAL ARTICLE
AB - Botulinum A chemodenervation of the Adductor Pollicis muscle for the
treatment of
the thumb-in-palm deformity in cerebral palsied hands is presented as a new
therapeutic
option. Early results of a clinical trial in five hemiparetic Cerebral
Palsied (C.P.) children
are assessed using a prospective nontrialist-biased study design based on
an independent
panel assessment of pre- and post-intervention photographic and videotaped
records of
hand function and appearance, in combination with grip dynamometry and
goniometry. All
cases are shown to improve in terms of both function and appearance with
results
approaching statistical significance (p = 0.06) when assessed by the
Wilcoxon's
matched-pairs signed rank test, despite the small study group. The modality
is shown to
be simple, safe and effective over the period reported (229 days). The
benefit is sustained
beyond the period of muscle paresis and ongoing long term follow-up will
document the
need for, and timing of, reinjection.
======================================================================
24.) Botulinum toxin--a possible new treatment for axillary hyperhidrosis.
======================================================================
Author
Bushara KO; Park DM; Jones JC; Schutta HS
Address
Department of Neurology, University of Wisconsin Hospital and Clinics,
Madison
53792-5132, USA.
Source
Clin Exp Dermatol, 21(4):276-8 1996 Jul
Abstract
The inhibitory action of botulinum toxin is not limited to the
neuromuscular junction.
The toxin
also blocks the autonomic cholinergic fibres, including the
sympathetic fibres to sweat
glands.
We have previously demonstrated that the toxin produces localized
anhidrosis. To
determine
the dosage, pattern and duration of the anhidrotic effect of botulinum
toxin and to test
the
efficacy of axillary injections, we further studied seven healthy
volunteers. Two
individuals
had subcutaneous injections of botulinum toxin (20 mouse units,
Dysport-Porton
Products) in
the dorsum of the hand. Five healthy volunteers had 15-50U of
botulinum toxin A
(Botox)
injected in one axilla. A circular area of complete anhidrosis on the
dorsum of the hand
was
evident on day 2 and persisted for 11 months. By day 3, two of the
axillae (injected
with 50
U each) were totally dry and in one (injected with 30 U) the sweating
was
substantially
reduced. The effect persisted for 6-8 months before wearing off. No
effect was
appreciated
in two axillae (injected with 15 and 20 U). No significant
side-effects were
encountered.
Subcutaneous injections of botulinum toxin causes chemodenervation of
the sweat
glands. In
normal individuals axillary sweating can be abolished by 50 U of
botulinum toxin A
(Botox).
The results offer a possible novel treatment for severe cases of
axillary hyperhidrosis.
Language
Eng
======================================================================
25.) Local injection into mimetic muscles of botulinum toxin A for the
treatment of facial
lines.
======================================================================
Author
Guerrissi J; Sarkissian P
Address
Service of Plastic Surgery, Argerich Hospital, Buenos Aires, Argentina.
Source
Ann Plast Surg, 39(5):447-53 1997 Nov
Abstract
The purpose of this clinical investigation is to confirm the efficacy
of eliminating facial
wrinkles
by injecting botulinum toxin A into mimetic muscles. Fifty-four
patients were injected
with
BOTOX A-14 in the corrugator superciliaris, 19 in the frontalis
muscles, and 13 in
the
orbicularis oculis. Dilution was obtained by adding 4 ml
preservative-free saline to 100
IU of
BOTOX A. The dose used varied according to the patient. The severity
of wrinkles
and the
intensity of muscle contraction (facial expression) were taken into
account. The
paralysis
obtained in the mimetic muscles was effective for 6 months in 39
patients, 8 months in
10
patients, and 9 months in 1 patient. The results were documented by
photographs,
videotape,
and electromyographies pre- and postinjection. To preserve the
results, 21 patients
(39%)
demanded a second infiltration to achieve satisfactory results.
Neither local nor
general
adverse effects were noted, except transitory eyebrow palsy in 2
patients, and edema
and
ecchymosis in 4 patients. The improvement obtained in facial mimetic
wrinkles was
satisfactory to the patient and to us.
======================================================================
26.) Long term results of botulinum toxin type A (Dysport) in the treatment
of hemifacial
spasm: a report of 175 cases.
======================================================================
Author
Jitpimolmard S; Tiamkao S; Laopaiboon M
Address
Department of Medicine, Faculty of Medicine, Khon Kaen University,
Thailand.
[email protected]
Source
J Neurol Neurosurg Psychiatry, 64(6):751-7 1998 Jun
Abstract
OBJECTIVE: To describe the long term efficacy and side effects of the
treatment of
hemifacial spasm with Dysport and to evaluate two different sites of
injection to
hopefully
reduce side effects. METHODS: This study was designed as a prospective
descriptive
study.
Injections were made subcutaneously around the eye. Peak improvement was
subjectively
assessed by using a visual analogue scale and reported in percentages
(0-100%).
Duration of
improvement was assessed subjectively and reported in months. RESULTS:
Of 175
cases,
17 were lost to follow up and were excluded. 855 treatments were
injected in the
remaining
158 patients with a median of 4 treatments. The response rate was 97%.
Of 855
treatments,
the adjusted mean peak and duration of improvement was 77.2 (95%
confidence
interval
(95%CI) 74.7-79.4)% and 3.4 (95%CI 3.2-3.6) months respectively. In 158
patients
(complete group), the long term results from the first to the 12th
treatment showed that
the
mean peak improvement ranged from 72.70 to 80.10% and the duration of
improvement
was 2.60 to 3.71 months. It remained constant throughout (p=0.40, p=0.87
respectively).
The most common side effect was ptosis. Of the 158 patients, 21
completed 12
treatments
(subgroup). A separate analysis of this group disclosed a mean peak
and duration of
improvement from the first to 12th treatments ranging from 70.00 to
78.10% and 2.65
to
4.31 months respectively. Analysis of variance with repeated measures
showed no
significant
variation of peak and duration of improvement over the first to the
12th treatments
(p=0.38,
p=0.38 respectively). Only 3% of the treatments were unsuccessful but
responded to
subsequent treatments. The incidence of ptosis was reduced from 27.17%
to 9.68%
by
moving the injection site to the lateral part of orbital orbicularis
oculi without any loss
of
efficacy. The yearly cost of Dysport is considerably less than Botox.
CONCLUSION:
This
study is the first to show, in detail, the long term results of
treatments of hemifacial
spasm with
Dysport. The efficacy is constant throughout orbicularis oculi. The
efficacy of Dysport
is
comparable with Botox in long term follow up.
======================================================================
27.) Contemporary management of the aging brow and forehead.
======================================================================
Author
Koch RJ; Troell RJ; Goode RL
Address
Division of Otolaryngology-Head and Neck Surgery, Stanford University,
California
94305-5328, U.S.A.
Source
Laryngoscope, 107(6):710-5 1997 Jun
Abstract
Management of the aging brow and forehead has recently evolved based
on available
innovative technologies. Likewise, procedure-specific indications have
changed based
on
collective surgical experiences. No longer is the approach based
solely on hair pattern
or
degree of brow ptosis. Patients require varying combinations of brow
elevation (prior
to
blepharoplasty), correction of brow asymmetries, and
hairline-preserving forehead
elevation.
Some may only require excisional or paralytic procedures of the
frontalis muscle
(horizontal
forehead creases), corrugator supercilii muscles (vertical glabellar
furrows), and
procerus
muscle (horizontal glabellar furrows). We present a 3-year experience
using a
problem-specific approach. This incorporates endoscopic technology,
botulinum toxin
type A
purified neurotoxin complex (Botox, Allergan, Irvine, CA)
intramuscular injection, and
traditional procedures such as the coronal, pretrichial, midforehead,
and direct
browlift.
Current indications, patient selection, and results are also discussed.
======================================================================
28.) Botulinum A toxin therapy: neutralizing and nonneutralizing
antibodies--therapeutic
consequences.
======================================================================
Author
G¨oschel H; Wohlfarth K; Frevert J; Dengler R; Bigalke H
Address
Institute of Toxicology, Medical School of Hannover, Germany.
Source
Exp Neurol, 147(1):96-102 1997 Sep
Abstract
Although muscle-relaxant doses of botulinum A toxin (BoNT/A) are
generally lower
than
doses stimulating the immune system, specific antibodies are raised in
a substantial
number of
patients. As a rule, this necessitates the termination of treatment.
Therefore, a reliable
determination of specific anti-BoNT/A antibodies is helpful and we
introduced, for
this
purpose, a novel in vitro toxin-neutralizing assay based on a
nerve-muscle preparation.
We
measured the antibody titers in four groups of subjects: Group 1
comprised 75
randomly
selected patients of a total of 295 who responded to treatment with
Dysport in our
local
clinic. Five patients, in group 2, were nonresponders. Group 3
consisted of 32
untreated
volunteers and group 4 of 8 subjects immunized with a toxoid more than
10 years ago.
Two
of the responders had marginal titers of neutralizing antibodies,
while they were present
in all
nonresponders. The sera of all responders were also tested for
nonneutralizing
antibodies by
ELISA. Their occurrence, however, was of no consequence to the
therapeutic
success. The
blood samples of volunteers were free from specific antibodies,
whereas antibodies
persisted
in the immunized subjects for longer than a decade. Patients from
various clinics who
had
been treated unsuccessfully with the toxin-14 patients had received
BOTOX, 7 had
been
treated with Dysport, and 7 with both products-all had neutralizing
antibodies.
Whether there
was an antibody response depended on the amount of toxin administered.
We
believe,
however, the effective toxin dose can be reduced by so much as to make
antibody
production highly improbable.
======================================================================
29.) One hundred cases of anal fissure treated with botulin toxin: early
and long-term
results.
======================================================================
Author
Jost WH
Address
Department of Neurology and Clinical Neurophysiology, Deutsche Klinik
f¨ur
Diagnostik,
Wiesbaden, Germany.
Source
Dis Colon Rectum, 40(9):1029-32 1997 Sep
Abstract
PURPOSE: Sphincterotomy still is considered the therapy of choice to
eliminate
sphincter
spasm in the treatment of uncomplicated chronic anal fissure. The
surgery is weighted
with the
possible surgical risk and the risk of subsequent fecal incontinence.
This study reports
the
effect of botulin toxin injections within the first six months.
PATIENTS AND
METHODS:
One hundred patients were treated (43 females; average age, 34.7
years). The
injection of
botulin toxin (2.5-5 units of Botox each) was done bilaterally to the
fissure, thereby
causing
paresis of the sphincters for approximately three months. Patients
were re-examined
after one
week and three and six months. RESULTS: Within the first week, 78
percent of
patients
were free of pain. In 82 percent of patients, complete healing of the
fissure occurred
within
the first three months. Eight patients experienced relapses within the
first six months of
therapy, three of whom needed surgical intervention. The healing rate
after six months
was 79
percent. No healing occurred in 21 patients, and they had to undergo
surgery.
Transitory
fecal incontinence resulted in seven cases. CONCLUSIONS: Injection of
botulin
toxin
enables us to treat chronic, uncomplicated anal fissures with
increased sphincter tone.
It is
well tolerated, can be administered on an outpatient basis, does not
cause any lesion
of the
continence organ, and subsequently, does not lead to any permanent
latent or
apparent fecal
incontinence.
======================================================================
30.) Botulinum A toxins: units versus units.
======================================================================
Author
Wohlfarth K; G¨oschel H; Frevert J; Dengler R; Bigalke H
Address
Department of Neurology, Medical School of Hannover, Germany.
Source
Naunyn Schmiedebergs Arch Pharmacol, 355(3):335-40 1997 Mar
Abstract
We investigated the efficacies and potencies of two commercial
preparations of
botulinum
neurotoxin type A (BoNt/A) reputed to differ in potency. Tests were
conducted in
vitro using
the mouse phrenic nerve-hemidiaphragm which is an approved tool for
measuring
clostridial
toxicity. In addition, in a double-blind trial on volunteers, varying
amounts of one
product
were injected into the Musculus extensor digitorum brevis of the left
foot, while equal
amounts, i.e. units, of the other preparation were injected into the
same muscle of the
right
foot. Compound muscle action potentials (CMAPs) were recorded before
and at
various
points in time after the injections. As opposed to wide-spread
anecdotal reports, no
difference in effectiveness was found. The dose-response curves
obtained from the
mouse
organ preparation with both commercial products equalled one another
in potency
(number
of units) and corresponded to previous toxicity tests in mice
conducted elsewhere.
Dose-response curves from volunteers were also identical for both
commercial
preparations.
The time course of paralysis and recovery of muscle function did not
differ either. At
lower
concentrations of toxin, however, restoration of muscle function was
more rapid than
at
higher concentrations. Since the results obtained from man and the
animal organ
preparation
are in excellent accord, we conclude that 1 unit of Botox corresponds
to 1 unit of
Dysport.
======================================================================
31.) Reconstituted botulinum toxin type A does not lose potency in humans
if it is refrozen
or refrigerated for 2 weeks before use.
======================================================================
Author
Sloop RR; Cole BA; Escutin RO
Address
Department of Neurology, Loma Linda University School of Medicine, CA,
USA.
Source
Neurology, 48(1):249-53 1997 Jan
Abstract
Botulinum toxin type A (BTX-A) (Botox, Allergan, Irvine, CA) labeling
recommends
its use
within 4 hours of reconstitution. Since BTX-A is available only in
100-unit vials, a
substantial
quantity is often discarded. Using eight volunteers, we measured the
percent decline in
extensor digitorum brevis (EDB) M-wave amplitude (percent paralysis)
following
injection of
freshly reconstituted BTX (right EDB) and compared this with the
decline following
injection
of BTX that was refrozen (-20 degrees C) or refrigerated (+4 degrees
C) for 2 weeks
(left
EDB) after reconstitution. When analyzed as paired data, there was
essentially no
difference
in the muscle paralysis resulting from fresh BTX compared with
refrozen or
refrigerated BTX,
and no statistical difference between groups was noted. Reconstituted
BTX-A that is
subsequently refrigerated or refrozen for 2 weeks does not lose
potency in humans.
======================================================================
32.) [Mechanism of action, clinical indication and results of treatment of
botulinum toxin]
======================================================================
Author
Lagueny A; Burbaud P
Address
Service de neurologie, h^opital Haut-L´ev´eque, CHRU Bordeaux, Pessoc.
Source
Neurophysiol Clin, 26(4):216-26 1996
Abstract
Botulinum toxin, the most potent of the neurotoxins, produces
paralysis by blocking
presynaptic release of the neurotransmitter (acetylcholine) at the
neuromuscular
junction, with
reversible chemical denervation of the muscle fibre, thereby inducing
partial paralysis
and
atrophy. Because chemical denervation is reversible, botulinum toxin
has temporary
effects,
the muscle being progressively reinnervated by nerve sproutings. Type
A botulinum
toxin
(Bix-A) is available under two dosage forms: Botox and Dysport.
Although the initial
clinical
indication was strabismus, subsequent studies have demonstrated the
efficacy of
Btx-A,
mainly in dystonia, hemifacial spasm and spasticity. However,
botulinum toxin has
been
successfully used in various other clinical indications. In regard to
spasticity associated
with
cerebral palsy, Btx-A is a promising treatment requiring a
multidisciplinary approach.
Btx-A
injections lead to effective reduction of muscle hyperactivity with
minor side-effects.
They are
painless, even though electromyographic guidance may be required for
the injection of
deep
muscles. However, the production of antibodies to Btx-A may compromise
the effect
of
long-term treatment.
======================================================================
33.) Use of botulinum toxin in stroke patients with severe upper limb
spasticity.
======================================================================
Author
Bhakta BB; Cozens JA; Bamford JM; Chamberlain MA
Address
Rheumatology and Rehabilitation Research Unit, University of Leeds, UK.
Source
J Neurol Neurosurg Psychiatry, 61(1):30-5 1996 Jul
Abstract
OBJECTIVES--Spasticity can contribute to poor recovery of upper limb
function
after
stroke. This is a preliminary evaluation of the impact of botulinum
toxin treatment on
disability
caused by upper limb spasticity after stroke. METHODS--Seventeen
patients with
severe
spasticity and a non-functioning arm were treated with intramuscular
botulinum A
neurotoxin
(median age at treatment 54.5 years; median time between onset of
stroke and
treatment 1.5
years). Baseline and assessments two weeks after treatment were
compared to
assess
efficacy. The duration of improvement in disability was documented.
Outcome
measures used
were; passive range of movement at the shoulder, elbow, wrist, and
fingers; modified
Ashworth scale to assess spasticity of biceps and forearm finger
flexors; an eight point
scale
to assess the degree of difficulty experienced by the patient or carer
for each
functional
problem defined before treatment; the presence of upper limb pain. The
biceps,
forearm
finger flexors, and flexor carpiulnaris were treated with
intramuscular botulinum toxin.
Up to a
total dose of 400-1000 mouse units (MU) of Dysport (Speywood) or
100-200 MU
of
BOTOX (Allergan) was used in each patient. RESULTS--Functional problems
reported by
the patients before treatment were difficulty with cleaning the palm,
cutting fingernails,
putting
the arm through a sleeve, standing and walking balance, putting on
gloves, and rolling
over in
bed. Hand hygiene improved in 14 of 17 patients; difficulty with
sleeves improved in
four of
16; standing and walking balance improved in one of four; shoulder
pain improved in
six of
nine; wrist pain improved in five of six. Passive range of movement at
shoulder, elbow,
and
wrist improved after treatment. Benefit was noted within two weeks and
lasted one to
11
months. No adverse effects occurred. CONCLUSION--This preliminary study
suggests that
intramuscular botulinum toxin is a safe and effective treatment for
reducing disability in
patients with severe upper limb spasticity.
Language
======================================================================
34.) Nerve injection injury with botulinum toxin.
======================================================================
Author
Lu L; Atchabahian A; Mackinnon SE; Hunter DA
Address
Department of Surgery, Washington University School of Medicine, St.
Louis, MO,
USA.
Source
Plast Reconstr Surg, 101(7):1875-80 1998 Jun
Abstract
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.
======================================================================
35.) DYSBOT: a single-blind, randomized parallel study to determine whether
any
differences can be detected in the efficacy and tolerability of two
formulations of
botulinum toxin type A--Dysport and Botox--assuming a ratio of 4:1.
======================================================================
Author
Sampaio C; Ferreira JJ; Sim~oes F; Rosas MJ; Magalh~aes M; Correia AP;
Bastos-Lima
A; Martins R; Castro-Caldas A
Address
Institute of Pharmacology and General Therapeutics, Faculty of
Medicine, University
of
Lisbon, Portugal.
Source
Mov Disord, 12(6):1013-8 1997 Nov
Abstract
BACKGROUND: Elston and Russell discovered a difference in the biological
potency of the
English formulation of botulinum toxin type A or BTX-A (Dysport) and
the American
formulation (Botox). Potency of both is expressed in LD50 mouse units,
but because
of
assay differences, these units are not equivalent. Since the first
warning by Quinn and
Hallet
on the clinical importance of this issue, it has been impossible to
reach a consensus on
the
conversion factor for the potency of these formulations. OBJECTIVE: To
test the
hypothesis
that the conversion factor for the clinical potency of Dysport to
Botox is approximately
4:1.
DYSBOT is an acronym that results from adding "DYS" from Dysport with
"BOT"
from
Botox. PATIENTS AND METHODS: Design: A single-blind, randomized,
parallel
comparison. A total of 91 patients with blepharospasm or hemifacial
spasm were
randomized
to treatment with Dysport or Botox using a fixed potency ratio of 4:1.
Clinical
evaluations:
The patients were evaluated at baseline (day of the treatment). 1
month after
treatment, and
whenever the effect was judged to be fading. Objective and functional
rating scales
were
used as quantitative measures of the change in clinical status.
Adverse reactions were
collected using a systematic questionnaire. RESULTS: Using this ratio
between
products,
both Dysport and Botox groups produced similar clinical efficacy and
tolerability. For
patients showing a positive response without the need of a booster,
the duration of
effect was
13.3 +/- 5.9 weeks for the Dysport group and 11.2 +/- 5.8 weeks for
the Botox
group. Of
48 patients, 11 (23%) needed booster treatment in the Dysport group
compared with
five
(12%) of 43 in Botox group. Adverse events were noted in 24 (50%) of
48 patients in
the
Dysport group and 20 (47%) of 43 of the Botox-treated group.
CONCLUSIONS:
Using a
4:1 conversion ratio for Dysport and Botox, similar results were
obtained for the two
treatments in an appropriately powered study, suggesting that this
conversion factor is
a good
estimate of their comparative clinical potencies.
======================================================================
36.) Patient selection in the treatment of glabellar wrinkles with
botulinum toxin type A
injection.
======================================================================
Author
Pribitkin EA; Greco TM; Goode RL; Keane WM
Address
Department of Otolaryngology-Head & Neck Surgery, Jefferson Medical
College,
Philadelphia, Pa, USA.
Source
Arch Otolaryngol Head Neck Surg, 123(3):321-6 1997 Mar
Abstract
OBJECTIVES: To determine the dose-response characteristics and
side-effects
profile of
Clostridium botulinum type A exotoxin (Botox) used to treat glabellar
wrinkles and
develop
guidelines for patient selection based on the nature and severity of
the treated
wrinkles.
DESIGN: Prospective, nonrandomized pilot and electromyogram (EMG)-guided
studies.
SETTING: Two ambulatory care clinics at university hospitals.
PARTICIPANTS: For
the
pilot study, volunteer samples of 23 patients with glabellar wrinkles;
for the
EMG-guided
study, volunteer samples of 57 patients with glabellar wrinkles.
INTERVENTIONS:
For the
pilot study, 23 patients were serially injected with up to 10.0 mouse
units (MU) of
Botox
into each corrugator muscle; for the EMG-guided study, 57 patients
were injected
under
EMG guidance with an initial dose of 10.0 MU of Botox into each
corrugator muscle.
Eleven
patients with persistent corrugator activity were reinjected with 10.0
MU of Botox.
MAIN
OUTCOME MEASURES: For the pilot study, slide photographs were obtained
before and
2 weeks after injection; for the EMG-guided study, slide photographs
were obtained
before
and at 2 weeks and at 2 months after injection. Patients were asked to
evaluate
results
numerically. RESULTS: For the pilot study, injection of up to 10.0 MU
of Botox into
each
corrugator muscle produced a satisfactory improvement in 12 patients;
for the
EMG-guided
study, 43 patients were satisfied with improvement after full
abolition of corrugator or
accessory lateral brow muscle activity. Women were more likely to
achieve
satisfactory
results than were men (80% [40/50] vs 43% [3/7]; P < or = .03).
Improvement was
not age
related. No significant side effects or complications were observed.
CONCLUSIONS:
Glabellar wrinkles may be satisfactorily treated with Botox injection
into the
corrugator
supercilii muscles. Improvement is temporary, dose dependent, and may
not be seen
in some
patients even with successful denervation of the treated muscles.
Clinicians may begin
treatment with a dose of 10.0 MU of Botox into each corrugator muscle,
and may
select
candidates for injection by determining the type of wrinkle to be
treated and its
spreadability
(glabellar spread test).
======================================================================
37.) Botulinum A neurotoxin for axillary hyperhidrosis. No sweat Botox.
======================================================================
Author
Glogau RG
Address
Department of Dermatology, University of California, San Francisco, USA.
Source
Dermatol Surg, 24(8):817-9 1998 Aug
Abstract
BACKGROUND: Axillary hyperhidrosis causes considerable emotional
stress and is
associated with extraordinary costs and limitations in clothing.
Existing topical and
surgical
therapies are either ineffective or associated with unacceptable
morbidity and
sequelae.
Botulinum A neurotoxin (Botox) has been shown to decrease sweating in
normal skin
and in
palmar hyperhidrosis. OBJECTIVE: The current study was undertaken to
demonstrate the
utility of using Botox in the treatment of axillary hyperhidrosis.
METHODS: Twelve
patient
with axillary hyperhidrosis underwent intradermal injection with 50
units of Botox in
the
axillary skin bilaterally. RESULTS: All patients enjoyed relatively
complete anhidrosis
of the
axillary skin in periods ranging from 4 to 7 months. Repeat injections
produced similar
results.
CONCLUSION: Botulinum A neurotoxin (Botox) is an elegant and simple
treatment
for
axillary hyperhidrosis.
Language
======================================================================
38.) Botox-induced prostatic involution.
======================================================================
Author
Doggweiler R; Zermann DH; Ishigooka M; Schmidt RA
Address
Division of Urology, University of Colorado Health Science Center,
Denver 80262,
USA.
[email protected]
Source
Prostate, 37(1):44-50 1998 Sep 15
Abstract
BACKGROUND: A simple approach to induced prostatic atrophy was explored.
Surgical
denervation is known to produce profound atrophy of the rat prostate.
Because
Botulinum
toxin type A (Botox) produces a long-term chemical denervation, the
potential to
induce
atrophy of the rat prostate was explored. METHODS: Thirty rat
prostates were
injected with
varying doses of Botox. Single and serial injections were used, and
rats were
subsequently
sacrificed after either 1 or 4 weeks, respectively. The prostate
glands were harvested,
weighed, and histologically studied for morphologic and apoptotic
changes.
RESULTS: The
total prostate volume and weight were found to be reduced in all
Botox-injected
animals.
Histologically, a generalized atrophy of the glands was observed with
the H&E stain.
There
was also diffuse glandular apoptosis evident with the Tunel stain.
There were no
significant
complications (e.g., urinary retention, weight loss, or hind/limb
weakness).
CONCLUSIONS: Botulinum toxin type A injection into the prostate gland
induces
selective
denervation and subsequent atrophy of the prostate. Apoptosis was seen
diffusely
throughout
the gland. It may be possible that in the future, this long-acting
neurotoxin could be
used for
the treatment of common pathologies of the human prostate.
Language
======================================================================
39.) Use of botulinum A toxin in patients at risk of wound complications
following eyelid
reconstruction.
======================================================================
Author
Choi JC; Lucarelli MJ; Shore JW
Address
Ophthalmic Consultants of Boston, Massachusetts, USA.
Source
Ophthal Plast Reconstr Surg, 13(4):259-64 1997 Dec
Abstract
Our purpose was to determine the efficacy of botulinum A toxin (BOTOX)
in
promoting
wound immobilization and preventing wound dehiscence in patients at
risk of
wound-healing
complications following eyelid reconstruction. In 11 patients at risk
of postoperative
wound
complications, we injected BOTOX into the periocular musculature in
addition to
standard
suture tarsorrhaphy. Each patient experienced excellent wound
immobilization and
wound
healing. There were no complications. Adjuvant use of BOTOX, in
conjunction with
suture
tarsorrhaphy, immobilizes the eyelids and promotes wound healing in
patients at risk
of
wound complications following eyelid reconstruction.
Language
Eng
======================================================================
40.) Cosmetic upper-facial rejuvenation with botulinum.
======================================================================
Author
Ellis DA; Tan AK
Address
Department of Otolaryngology, University of Toronto, Ontario.
Source
J Otolaryngol, 26(2):92-6 1997 Apr
Abstract
OBJECTIVE: This study was conducted to evaluate the cosmetic use of
botulinum
toxin type
A (Botox), which blocks the release of acetylcholine at the
presynaptic neuromuscular
junction leading to an irreversible, but temporary chemical
denervation muscular
paralysis and
weakness. This produces a significant cosmetic improvement of
wrinkling in the upper
face
due to hyperfunctional animation. METHOD: A prospective clinical study
representing
our
experience with this new technique is presented. Patient selection and
evaluation,
classification of animation lines, techniques, results and
complications are discussed. In
a
15-month period, 23 patients with seven anatomic sites were injected.
Twenty-three
patients
had the lateral aspect and the inferior aspect of their squint lines
injected, and 26
patients had
their glabellar frownlines injected. RESULTS: Significant improvement
occurred to
the
average depth and length of the glabellar frownlines. The subjective
improvement by
the
patients was also significant. Regarding the crow's feet, the lateral
canthal lines showed
more
improvement than the inferior lateral canthal lines because the latter
has a greater
component
of zygomaticus major and minor muscle, which contributes to the
inferior lateral squint
line.
CONCLUSION: Botox is a safe, easy-to-use, effective modality for the
temporary
elimination of hyperfunctioning upper-facial muscles.
==========================================================
41.) New Treatment For Sweaty Palms Works for Up To A Year
==========================================================
SCHAUMBURG, IL -- February 13, 1998 -- People who find no relief from
conventional drug treatment for the persistent problem of sweaty palms
may get
long-term improvement from injections of a potent bacterial toxin,
according to a study
reported in this month’s issue of the Journal of the American Academy of
Dermatology.
Botulinum toxin type A is a powerful chemical that in its diluted
prescription form (Botox)
has been used safely in treating eye muscle disorders, wrinkles and other
conditions. It
reduces sweating by blocking release of the chemical
acetylcholine, which stimulates secretion of the sweat glands.
"Botulinum toxin safely and effectively inhibits excessive sweat
production in the palms
for as long as 12 months," said Walter Shelley, MD, PhD, a study co-author
and
dermatologist at the Medical College of Ohio, Toledo.
Earlier studies of botulinum toxin therapy for sweaty palms showed it
reduced sweating
for up to only three months.
Four months was the shortest improvement seen in the study conducted by
Shelley, Nickolai Talanin, MD, PhD, and E. Dorinda Shelley, MD. All patients
experienced substantial improvement of their condition after receiving
multiple injections
of botulinum toxin. The drug was injected close to the sweat glands in the
patients' palms
after their skin was numbed with an anesthetic.
"These results offer good news to patients whose severe palm sweating is
resistant to other treatments and who want to avoid surgery," Shelley said.
Persistent sweating of the palms, called palmar hyperhidrosis, is caused by
an abnormal
sensitivity to acetylcholine.
"Palmar hyperhidrosis is not common," Shelley said. "However, individuals
with severe
cases often suffer social, psychological and occupational problems because
of their
disease."
Endoscopic surgery of the sympathetic nervous system, which controls
sweating, provides a permanent solution but requires general anesthesia
andcan cause
circulatory problems later.
===========================================================
42.) A review of 5 years' experience in the use of botulinium toxin A in
the treatment of
sixth cranial nerve palsy at the Singapore National Eye Centre.
===========================================================
Singapore Med J 1999 Jun;40(6):405-9
Quah BL, Ling YL, Cheong PY, Balakrishnan V
Singapore National Eye Centre, Singapore.
INTRODUCTION: This retrospective study reports our experience on the use of
botulinum toxin A (BTXA) in the treatment of sixth cranial nerve palsy at
the Singapore
National Eye Centre. BTXA is derived from clostridium botulinum; it causes
temporary
paralysis of the extraocular muscle (medial rectus) into which it is
injected, thus preventing
its contracture and allows the antagonist lateral rectus muscle to take up
the slack and
reduce or correct the ocular misalignment. METHODS: Nineteen patients had
BTXA
injection for estropia due to sixth cranial nerve palsy during the period
September 1992 to
August 1997. The sixth cranial nerve palsy was related to nasopharyngeal
carcinoma in
76.7% of cases. Follow-up after the last injection ranged from zero
(defaulted) to 21
months (mean 8, median 6 months). RESULTS: A total of 25 injections were
given to 19
patients. Seven patients (36.8%) had final ocular alignment within 10 prism
dioptres of
orthotropia of which six achieved fusion at primary gaze position. There
was no
correlation between the number of injections per patient and the size of
strabismus or
grade of lateral rectus muscle function. The incidence of ptosis was 48%,
subconjunctival
haemorrhage 16% and hypertropia 16%. DISCUSSION: Our results suggest that
those
patients with smaller strabismus and a shorter time interval between onset
of strabismus
and botulinum injection tend to achieve better outcome in terms of fusion
or ocular
alignment within 10 prism dioptres of orthotropia. The treatment of
strabismus with
BTXA is an acceptable approach in selected patients. The procedure is
simple, safe,
cheap, effective, and avoids the risks of general anaesthesia. It can
substitute for or
eliminate the need for strabismus surgery in some cases of sixth nerve palsy.
===========================================================
43.) The role of botulinum toxin A in acute-onset esotropia.
===========================================================
Ophthalmology 1999 Sep;106(9):1727-30
Dawson EL, Marshman WE, Adams GG
Department of Orthoptics, Moorfields Eye Hospital, London, England.
OBJECTIVE: To establish the effectiveness of botulinum toxin A (BTXA) in the
treatment of patients with acute acquired concomitant esotropia. DESIGN:
Retrospective,
interventional, noncomparative case series. PARTICIPANTS: Fourteen patients
presenting to the Strabismus and Pediatric Service at Moorfields Eye
Hospital with
acute-onset esotropia over a 6-year period (1991-1997). INTERVENTION: 2.5
units
of BTXA injected into the unilateral medial rectus muscle of the deviating
eye under
electromyographic control. MAIN OUTCOME MEASURES: Pre- and postinjection
angle of deviation, pre- and postinjection stereopsis, final level of
stereopsis achieved, and
whether corrective squint surgery was later required. RESULTS: Fourteen
patients were
identified, of whom eight were male and six female. The mean age at
presentation was 5.4
years, and the average time from onset to attending the clinic was 18
weeks. The mean
time from onset of acute esotropia to injection was 32.5 weeks. All
patients, except one,
showed considerable improvement in their manifest deviation after one
injection of
BTXA. Eight patients (57%) maintained high-grade stereopsis of 120 seconds
of arc or
better and long-term ocular alignment with toxin treatment alone. In total,
11 patients
(79%) gained improved stereopsis and maintained satisfactory ocular
alignment with toxin
therapy and did not require squint surgery. Two patients (14%) did not
maintain a stable
ocular position after toxin treatment and later required squint surgery,
gaining good ocular
alignment and high-grade stereopsis. The one patient who did not respond to
the initial
BTXA injection refused all further treatment. The mean follow-up time was
22 months.
CONCLUSIONS: Botulinum toxin therapy has a definite role in the treatment
of children
with acute-onset esotropia. It may well obviate the need for squint
surgery. The safety
and ease of administration of this treatment add to its merits.
===========================================================
44.) Long-term botulinum toxin treatment of cervical dystonia--EMG changes
in injected
and noninjected muscles.
===========================================================
Clin Neurophysiol 1999 Sep;110(9):1650-4
Erdal J, Ostergaard L, Fuglsang-Frederiksen A, Werdelin L, Dalager T, Sjo
O, Regeur
L
Department of Neurology, Copenhagen Hospital Corporation, University of
Copenhagen,
Denmark.
OBJECTIVE: To evaluate changes in quantitative EMG of injected and
noninjected
sternocleidomastoid muscles following long-term unilateral botulinum toxin
treatment of
cervical dystonia. METHODS: We investigated 27 patients with cervical
dystonia, who
received repeated unilateral botulinum toxin injections of the
sternocleidomastoid muscle,
with quantitative EMG at rest and at maximal voluntary contraction. The
patients had on
the average 7.1 botulinum toxin treatments and the follow-up period was on
the average
31 months (SD 16). RESULTS: After the first treatment, the injected
sternocleidomastoid
muscles showed a significant decrease in turns/s (mean 45%) and amplitude
(mean 52%)
at rest, and in amplitude at maximal flexion (mean 24%) and rotation (mean
39%). Except
for a reduction in turns/s at rotation (mean 19%) no further reductions in
EMG
parameters were seen after long-term treatment. The contralateral noninjected
sternocleidomastoid muscles showed no significant change in EMG activity
after the first
BT treatment, but after long-term treatment a significant reduction in
turns/s and amplitude
at both maximal flexion (turns: mean 28%; amplitude: mean 25%) and rotation
(turns/s:
mean 32%; amplitude: mean 25%) were seen as compared to pretreatment values.
CONCLUSION: The results indicate that there seems to be no cumulative
chemodenervation by repeated botulinum toxin injections of
sternocleidomastoid muscles
measured by quantitative EMG. Contralateral noninjected sternocleidomastoid
muscles
however, seem to be affected following long-term treatment. The mechanism
behind this
finding is unknown.
===========================================================
45.) Botulinum toxin for amelioration of knee contracture in Duchenne
muscular
dystrophy.
===========================================================
Europ J Paediatr Neurol 1999;3(4):175-6
von Wendt LO, Autti-Ramo IS
University of Helsinki, Hospital for Children and Adolescents, Neurology,
Finland.
An 11-year-old non-ambulant boy with Duchenne muscular dystrophy developed
tightness in his left knee flexors, which caused difficulties in standing
exercises. Botulinum
toxin A (BTX-A) was injected into the medial and lateral hamstring muscles
and the range
of motion increased by 20 degrees but after 5 months, when the
pharmacological effect of
BTX-A had vanished, an increase of only 5 degrees in range compared with
the initial
finding was left. It is concluded that there may be a role for BTX-A in
controlling
contractures in Duchenne muscular dystrophy.
===========================================================
46.) Double-blind study of botulinum A toxin injections into the
gastrocnemius muscle in
patients with cerebral palsy.
===========================================================
Gait Posture 1999 Sep;10(1):1-9
Sutherland DH, Kaufman KR, Wyatt MP, Chambers HG, Mubarak SJ
Motion Analysis Lab, Children's Hospital, 3020 Children's Way, 5054, San
Diego, CA
92123, USA. [email protected]
The purpose of this study was to quantify the gait of subjects receiving
two injections of
either botulinum A toxin or saline vehicle into the gastrocnemius
muscle(s). The study
group consisted of cerebral palsy patients who walked with an equinus gait
pattern. This
study was a randomized, double-blinded, parallel clinical trial of 20
subjects. All were
studied by gait analysis before and after the injections. There were no
adverse effects.
Peak ankle dorsiflexion in stance and swing significantly improved in
subjects who
received the drug and not in controls. Results of this double blind study
give support to
the short term efficacy of botulinum toxin A to improve gait in selected
patients with
cerebral palsy.
===========================================================
47.) Pure botulinum neurotoxin is absorbed from the stomach and small
intestine and
produces peripheral neuromuscular blockade.
===========================================================
Infect Immun 1999 Sep;67(9):4708-12
Maksymowych AB, Reinhard M, Malizio CJ, Goodnough MC, Johnson EA, Simpson
LL
Departments of Medicine and of Biochemistry and Molecular Pharmacology,
Jefferson
Medical College, Philadelphia, Pennsylvania 19107, USA.
Clostridium botulinum serotype A produces a neurotoxin composed of a
100-kDa heavy
chain and a 50-kDa light chain linked by a disulfide bond. This neurotoxin
is part of a ca.
900-kDa complex, formed by noncovalent association with a single nontoxin,
nonhemagglutinin subunit and a family of hemagglutinating proteins.
Previous work has
suggested, although never conclusively demonstrated, that neurotoxin alone
cannot survive
passage through the stomach and/or cannot be absorbed from the gut without
the
involvement of auxiliary proteins in the complex. Therefore, this study
compared the
relative absorption and toxicity of three preparations of neurotoxin in an
in vivo mouse
model. Equimolar amounts of serotype A complex with hemagglutinins, complex
without
hemagglutinins, and purified neurotoxin were surgically introduced into the
stomach or into
the small intestine. In some experiments, movement of neurotoxin from the
site of
administration was restricted by ligation of the pylorus. Comparison of
relative toxicities
demonstrated that at adequate doses, complex with hemagglutinins, complex
without
hemagglutinins, and pure neurotoxin can be absorbed from the stomach. The
potency of
neurotoxin in complex was greater than that of pure neurotoxin, but the
magnitude of this
difference diminished as the dosage of neurotoxin increased. Qualitatively
similar results
were obtained when complex with hemagglutinins, complex without
hemagglutinins, and
pure neurotoxin were placed directly into the intestine. This work
establishes that pure
botulinum neurotoxin serotype A is toxic when administered orally. This
means that pure
neurotoxin does not require hemagglutinins or other auxiliary proteins for
absorption from
the gastrointestinal system into the general circulation.
===========================================================
48.) Botox for hyperadduction of the false vocal folds: a case report.
===========================================================
J Voice 1999 Jun;13(2):234-9
Rosen CA, Murry T
Department of Otolaryngology, University of Pittsburgh, School of Medicine,
PA, USA.
We present a patient with severe hyperadduction of the false vocal folds
(FVF) treated
with Botulinum Toxin injections to each FVF. This patient presented with
severe
dysphonia and was found to demonstrate severe hyperadduction of the FVF's
with all
phonatory tasks. The patient was treated with extensive speech therapy
without
improvement in voice quality nor FVF motion pattern. He was then injected
with Botox A
bilaterally using a peroral approach to the FVFs. Shortly after treatment
the patient
experienced dramatic improvement in voice quality. Videolaryngoscopy
revealed no
adduction of the FVFs with phonation and essentially normal true vocal fold
motion. He
remained with normal voice quality one year after treatment without any
further treatment.
Possible mechanism of action of this type of treatment are discussed.
===========================================================
49.) The use of botulinum toxin for the treatment of temporomandibular
disorders:
preliminary findings.
===========================================================
J Oral Maxillofac Surg 1999 Aug;57(8):916-20; discussion 920-1
Freund B, Schwartz M, Symington JM
Faculty of Dentistry, University of Toronto, Ontario, Canada.
[email protected]
PURPOSE: The aim of this study was to evaluate the response of patients with
temporomandibular disorders to Botulinum toxin A (BTX-A) therapy. METHODS:
The
15 subjects enrolled in this uncontrolled study were diagnostically
categorized and treated
with 150 units of BTX-A. Both masseter muscles received 50 units each under
eletromyographic (EMG) guidance. Similarly, both temporalis muscles were
injected with
25 units each. Subjects were assessed at 2-week intervals for 8 weeks.
Outcome
measures included subjective pain by visual analog scale (VAS), measurement
of bite
force, interincisal opening, tenderness to palpation, and a functional
index based on
multiple VAS. RESULTS: All mean outcome measures, with the exception of
bite force,
showed a significant (P = .05) difference between the preinjection
assessment and the
four follow-up assessments. No side effects were reported. CONCLUSIONS: BTX-A
injections produced a statistically significant improvement in four of five
measured
outcomes, specifically pain, function, mouth opening, and tenderness. No
statistically
significant changes were found in mean maximum voluntary contraction or in
paired
correlation of factors such as age, sex, diagnosis, depression index, or
time of onset.
===========================================================
50.) Achalasia: diagnosis and management.
===========================================================
Semin Gastrointest Dis 1999 Jul;10(3):103-12
Vaezi MF
Center for Swallowing and Esophageal Disorders, Cleveland Clinic
Foundation, OH
44195, USA.
Achalasia is a primary esophageal motor disorder of unknown cause that
produces
complaints of dysphagia, regurgitation, and chest pain. The current
treatments for
achalasia involve the reduction of lower esophageal sphincter (LES)
pressure, resulting in
improved esophageal emptying. Calcium channel blockers and nitrates, once
used as an
initial treatment strategy for early achalasia, are now used only in
patients who are not
candidates for pneumatic dilation or surgery, and in patients who do not
respond to
botulinum toxin injections. Because of the more rigid balloons, the current
pneumatic
dilators are more effective than the older, more compliant balloons. The
graded approach
to pneumatic dilation, using the Rigiflex (Boston Scientific Corp, Boston,
MA) balloons
(3.0, 3.5, and 4.0 cm) is now the most commonly used nonsurgical means of
treating
patients with achalasia, resulting in symptom improvement in up to 90% of
patients.
Surgical myotomy, once plagued by high morbidity and long hospital stay,
can now be
performed laparoscopically, with similar efficacy to the open surgical
approach (94%
versus 84%, respectively), reduced morbidity, and reduced hospitalization
time. Because
of the advances in both balloon dilation and laparoscopic myotomy, most
patients with
achalasia can now choose between these two equally efficacious treatment
options.
Botulinum toxin injection of the LES should be reserved for patients who
can not undergo
balloon dilation and are not surgical candidates.
===========================================================
51.) Cosmetic indications for botulinum A toxin.
===========================================================
Semin Ophthalmol 1998 Sep;13(3):142-8
Foster JA, Wulc AE, Holck DE
The Cleveland Clinic Foundation, Cleveland, OH, USA.
This article describes the use of botulinum toxin type A in the cosmetic
treatment of facial
wrinkles. Injection techniques, volumes, and concentration of the botulinum
A toxin are
described for various types of facial wrinkles.
===========================================================
52.) [Botulinum toxin type A treatment of cosmetically disturbing masseteric
hypertrophy].
===========================================================
Ned Tijdschr Geneeskd 1998 Mar 7;142(10):529-32
Rijsdijk BA, van ES RJ, Zonneveld FW, Steenks MH, Koole R
Academisch Ziekenhuis, Utrecht.
Two patients, a woman aged 21 and a man aged 29, with asymmetrical
swellings of both
mandibular angles and a painful, heavy sensation in the masticatory muscles
(and in the
woman also round the maxillary joint), were diagnosed as having hypertrophy
of the
masseter muscles. Both had the habit of jaw clenching and tooth grinding.
Treatment
consisted not of the traditional surgical debulking which also allows
correction of
overdeveloped osseous mandibular angles, but of injections with botulinum
toxin type A.
Injection of 40-60 IU (product: Botox) per muscle was followed by some
atrophy;
cosmetically satisfactory results were achieved after repetition of the
treatment a few
months later. Reduction of muscle volume was confirmed by a quantitative
volumetric
assessment of MRI scans. In the female patient, the pain also abated.
===========================================================
53.) Botulinum toxin type A for Frey's syndrome: a preliminary prospective
study.
===========================================================
Ann Otol Rhinol Laryngol 1998 Jan;107(1):52-5
Laccourreye O, Muscatelo L, Naude C, Bonan B, Brasnu D
Department of Otorhinolaryngology-Head and Neck Surgery, Laennec Hospital,
Assistance Publique des Hopitaux de Paris, University Paris V, France.
Fourteen patients with severe Frey's syndrome (occurring after conservative
parotidectomy) managed with intracutaneous injection of botulinum toxin
type A were
prospectively evaluated. Results were analyzed for effectiveness,
complications, and
adverse effects. Complications were not encountered. The only adverse
effect noted was
a temporary and slight partial paresis of the upper lip of 3 months'
duration in 2 patients.
Permanent paresis was not encountered. Frey's syndrome was always
controlled within 2
days following the intracutaneous injection of botulinum toxin A. Frey's
syndrome
recurrence was not encountered with a follow-up duration that varied from 3
to 9 months
(mean follow-up 7 months). This preliminary report confirmed that in
patients who have
Frey's syndrome after conservative parotidectomy, the intracutaneous
injection of
botulinum toxin is a valuable treatment option that should be further
investigated.
===========================================================
54.) Complications of botulinum A exotoxin for hyperfunctional lines.
===========================================================
Dermatol Surg 1998 Nov;24(11):1249-54
Matarasso SL
Department of Dermatology, University of California School of Medicine, San
Francisco,
USA.
Clostridium botulinum type A exotoxin is one of the recent advances for
treatment of the
aging face. Due to the sudden and exponential surge in popularity, there is
little precise
consensus regarding its safety and efficacy. Many of the reported
complications
associated with its aesthetic use are few and anecdotal. As we gain more
experience and
long-term follow-up with this procedure, complications and their treatment
can be better
documented. As most of the salutary effects of Botulinum toxin are temporary,
fortunately, so too are the complications associated with this form of
therapy.
===========================================================
55.) The adjunctive usage of botulinum toxin.
===========================================================
Dermatol Surg 1998 Nov;24(11):1244-7
Carruthers J, Carruthers A
Department of Ophthalmology, University of British Columbia, Vancouver,
Canada.
BACKGROUND: Botulinum toxin is a safe, helpful adjunct to many other
treatments for
facial rejuvenation. Used together, the final result is more polished and
refined. In
addition, botulinum toxin can be used to maintain the surgical laser
results by preventing
dynamic facial muscular action re-establishing expressive wrinkles and folds.
OBJECTIVES: We describe the facial areas best treated with botulinum toxin
and our
adjunctive techniques so that the cosmetic physician can easily incorporate
these into their
practice. RESULTS: The aesthetic results are improved with the combination of
botulinum toxin and the surgical or laser procedure over either modality
alone.
CONCLUSIONS: We believe that there are many new treatment options for
combined
therapy with botulinum toxin, laser resurfacing, and surgical procedure in
periocular and
facial rejuvenation that the aesthetic physician can easily incorporate
into their practice.
===========================================================
56.) [Writer's cramp treated with botulinum injections].
===========================================================
Ned Tijdschr Geneeskd 1998 Aug 1;142(31):1768-71
Koelman JH, Struys MA, Ongerboer de Visser BW, Speelman JD
Academisch Medisch Centrum, Amsterdam.
OBJECTIVE: To evaluate the first clinical experience with local botulinum
toxin A (BTA)
injections in patients with writer's cramp. DESIGN: Descriptive. SETTING:
Academic
Medical Centre, Amsterdam, the Netherlands. METHOD: In May 1993-January 1996
ten patients with writer's cramp were treated with BTA (Dysport). Age of
the patients
varied from 28 to 68 years, the duration of complaints from 1 to 29 years.
Muscles for
injections were selected by observation, sometimes combined with
electromyography.
BTA was administered under electromyographic guidance. RESULTS: The amount of
BTA administered per treatment session ranged from 15 to 400 IU. In three
patients the
BTA-induced weakness necessary to reach a beneficial effect on writing was
unacceptable. In seven patients the response was satisfactory or good and
lasted 2 to 15
months (mean: 3.5 months). CONCLUSION: The results confirm the efficacy of
BTA in
writer's cramp.
===========================================================
57.) Clinical indications and injection technique for the cosmetic use of
botulinum A
exotoxin.
===========================================================
Dermatol Surg 1998 Nov;24(11):1189-94
Carruthers A, Carruthers J
Division of Dermatology, University of British Columbia, Vancouver, Canada.
BACKGROUND: Some wrinkles and unsightly facial expressions are due to
overactivity
of the underlying facial musculature. Botulinum A exotoxin reversably
paralyses selected
muscles. Botulinum toxin has been used to correct facial cosmetic concerns.
OBJECTIVES: This paper describes the authors' experience with the cosmetic
use of
botulinum toxin. The areas that can be treated, the appropriate technique
for each area
and special considerations such as dose, dilution, and relevant anatomy are
discussed.
RESULTS: Our results have been published previously and are referenced in
this paper.
CONCLUSIONS: Botulinum toxin is safe and effective in the management of
some facial
lines and wrinkles. Its use is associated with a high degree of patient and
physician
satisfaction.
===========================================================
59.) Botulinum toxin for the correction of hyperkinetic facial lines.
===========================================================
Australas J Dermatol 1998 Aug;39(3):158-63
Goodman G
[email protected]
The present article illustrates the effects of low dose botulinum toxin
(BTx) injections for
the improvement of hyperkinetic facial lines and presents a grading
treatment chart
designed to standardize the reporting of the improvement seen. A
questionnaire of patient
acceptance, the patients' impression of therapy and short-term results and
complications
are reported. Twelve patients with 26 injected-paired regions were charted
and the
response to injection was graded. Patients had hyperkinetic facial lines in
glabella,
periorbital regions or horizontal forehead lines. Diluted BTx type A (1
IU/0.1 mL) was
injected and patients were assessed at 10 days. A second follow up
injection was offered
to patients at this stage if required. Objectively, all patients'
hyperkinetic actions and lines
improved or diminished. The degree of improvement was similar in all areas
injected and
a symmetry of results was always observed. In a minority of cases, all
movement was lost
(7/26) and in others it was weakened but present (19/26). In some injected
areas the
actual expression line that was visible at rest disappeared entirely
(11/26): in the others it
was diminished (15/26). Complications were few. Two patients had temporary
brow
ptosis that spontaneously recovered within the first week. No eyelid ptosis
was noted.
Bruising and headaches were the most common reported complications. Low
dose BTx
is an effective and well-tolerated treatment for hyperkinetic facial lines
with few significant
complications in this small pilot study. The grading chart may allow easier
comparisons of
results between studies on the effects of BTx therapy.
===========================================================
60.) Cosmetic use of botulinum A exotoxin for the aging neck.
===========================================================
Dermatol Surg 1998 Nov;24(11):1232-4
Brandt FS, Bellman B
Department of Dermatology and Cutaneous Surgery, University of Miami School
of
Medicine, Florida, USA.
BACKGROUND: The use of botulinum toxin for facial rhytides has become more
popular. In the past, plastic surgery was the only choice for rejuvenation
of the aging
neck. We discuss the cosmetic use of botulinum toxin for the rejuvenation
of the neck and
review the anatomy. OBJECTIVES: We will review the four age-related neck
degeneration categories and discuss how to inject botulinum A exotoxin into
the platysmal
neck bands. RESULTS: We will discuss how botulinum can tighten neck jowls,
eliminate
horizontal neck rhytides, and improve skin laxity. CONCLUSION: Botulinum A
exotoxin
is a safe, effective, alternative treatment for rejuvenation of the aging
neck and lower face.
Patients are uniformly satisfied and complications are minimal.
===========================================================
61.) Axillary hyperhidrosis: treatment with botulinum toxin A.
===========================================================
Arch Phys Med Rehabil 1998 Mar;79(3):350-2
Odderson IR
Department of Rehabilitation Medicine, University of Washington, Seattle,
USA.
Hyperhidrosis can be emotionally challenging and socially and
professionally disruptive,
and there are few effective treatments. This condition was successfully
treated with
botulinum toxin in two men who, since their early teens, had had excessive
axillary
sweating, requiring frequent shirt changes. They received bilateral
axillary injections with
100 units of botulinum toxin type A, and within 5 days reported cessation
of excessive
sweating. Quantitative measurements before and 2 to 4 weeks after the
injections
demonstrated an average reduction of 71% and 76% (from 11.6 to 3.4 and from
2.5 to
0.6 mL/min m2) in axillary sweating during rest. A 96% reduction (from 42.9
to 1.7
mL/min m2) was seen in one patient during mental stress. No complications
developed.
This study quantitates the reduced axillary sweating achieved through
chemodenervation
with botulinum toxin A.
===========================================================
62.) Treatment of hyperfunctional lines of the face with botulinum toxin A.
===========================================================
Dermatol Surg 1998 Nov;24(11):1198-205
Binder WJ, Blitzer A, Brin MF
Department of Head and Neck Surgery, University of California at Los
Angeles, USA.
Since Botulinum toxin A became a mainstay therapy for blepharospasm, its
use in treating
other dystonic conditions, spasticity disorders, as well as hyperfunctional
lines of the face
has increased exponentially in recent years. The following article
summarizes our
experience in establishing a safe and reliable method of administration of
botulinum toxin
A for treating hyperfunctional lines of the face.
===========================================================
63.) Treatment of cerebral palsy with botulinum toxin A: functional benefit
and reduction
of disability. Three case reports.
===========================================================
Pediatr Rehabil 1997 Oct-Dec;1(4):235-7
Mall V, Heinen F, Linder M, Philipsen A, Korinthenberg R
Department of Neuropediatrics, Children's Hospital, University of Freiburg,
Germany.
Three patients with cerebral palsy are described suffering, respectively,
of pes equinus,
spasm of the m. teres major and flexion spasm of the hand, who were treated
with
botulinum toxin A. These patients demonstrate not only the local reduction
of the muscular
hyperactivity following treatment with botulinum toxin A but also the
potential functional
benefit resulting from such a treatment. Thus, local intramuscular
injection of botulinum
toxin A in children with cerebral palsy should be considered as part of a
multidisciplinary
treatment concept, since reduction of the disability and the functional
improvements could
have high impact on daily living activities.
===========================================================
64.) Understanding botulinum toxin. Surgical anatomy of the frown,
forehead, and
periocular region.
===========================================================
Dermatol Surg 1998 Nov;24(11):1172-4
Wieder JM, Moy RL
Division of Dermatology, UCLA School of Medicine, USA.
BACKGROUND: Cosmetic denervation of hyperfunctional facial lines using
botulinum
toxin (Botox, Allergan, Inc., Irvine, CA) has gained growing popularity
over recent years.
Understanding the clinical use and effects of botulinum toxin requires a
thorough
understanding of the muscular anatomy of the treatment areas. OBJECTIVE: The
purpose of this article is to review the anatomy of the frown, forehead,
and periocular
regions. Function of individual muscles is discussed to understand proper
injection
technique. CONCLUSIONS: The anatomy of the frown, forehead, and periocular
regions is complex. Individual muscles are tightly intertwined and
treatment of one
anatomic region may affect many different muscles. A complete understanding
of the
anatomy of the upper face is essential to ensure proper injection
technique, safe and
predictable results as well as anticipating complications.
===========================================================
65.) Efficacy of repeated botulinum toxin injections as a function of timing.
===========================================================
Ann Otol Rhinol Laryngol 1997 Dec;106(12):1012-9
Inagi K, Ford CN, Rodriquez AA, Schultz E, Bless DM, Heisey DM
Department of Surgery, University of Wisconsin Medical School, Madison, USA.
This pilot study was designed to determine if the interval between repeated
botulinum
toxin injections influenced physiologic and histologic effects on laryngeal
muscles in a rat
model. The physiologic measurements included digitized videomicroscopic
recording of
vocal fold movement and electromyography. The histologic measurements
included
muscle fiber size and digitized optical density of laryngeal muscles after
glycogen depletion
by electrical stimulation. The results demonstrated that the effect of
timing of the second
injection was strongly correlated to laryngeal changes. Most notable were
results in the
subjects that underwent injections 6 weeks apart. We hypothesize that these
findings
might be related to terminal axonal sprouting with reinnervation. The
results from this
study help confirm and expand the validity of using the rat laryngeal model
to understand
the effect of botulinum toxin. Moreover, we believe that the data might be
extrapolated to
prove useful in predicting human responses to botulinum toxin treatment for
functional
dystonias such as spasmodic dysphonia.
===========================================================
66.) Counterparalysis for treatment of paralytic scoliosis with botulinum
toxin type A.
===========================================================
Am J Orthop 1997 Mar;26(3):201-7
Nuzzo RM, Walsh S, Boucherit T, Massood S
Overlook Hospital, Summit, New Jersey, USA.
In this study, botulinum toxin was used to treat paralytic scoliosis.
Twelve children with
paralytic scoliosis and severe, complicating additional diseases required
surgical delay.
Although this use of botulinum toxin is experimental, alternative
treatments posed greater
risks. An institutional review board protocol for nonestablished dosage and
indication for
treatment was initiated to monitor safety and effect. Treatment was
intended to
supplement, not replace, other desirable treatment modalities. The effect
was to be
measured by the return of efficacy of conservative treatment in halting
curve progression.
Short-term results show that none of the children had worsened scoliosis;
all had some
reduction in curve measurement (up to >50 degrees).
===========================================================
67.)Has botulinum toxin type A a place in the treatment of spasticity in
spinal cord injury
patients?
===========================================================
Spinal Cord 1998 Dec;36(12):854-8
Al-Khodairy AT, Gobelet C, Rossier AB
Department of Physical Medicine and Rehabilitation, Hopital de Gravelone,
CH-1950
Sion, Switzerland.
OBJECTIVE: To present and discuss treatment of severe spasms related to
spinal cord
injury with botulinum toxin type A. DESIGN: A 2-year follow-up study of an
incomplete
T12 paraplegic patient, who was reluctant to undergo intrathecal baclofen
therapy,
presenting severe painful spasms in his lower limbs treated with
intramuscular injections of
botulinum toxin type A. SETTING: Department of Physical Medicine and
Rehabilitation,
Hopital de Gravelone, Sion, Switzerland. SUBJECT: Single patient case
report. MAIN
OUTCOME MEASURE: Spasticity, spasms and pain measured with the modified
Ashworth scale, spasm frequency score and visual analogue scale. RESULTS:
Treatment
of spasticity with selective intramuscular injections of botulinum toxin
type A resulted in
subjective and objective improvement. CONCLUSION: Botulinum toxin type A
has its
place in the treatment of spasticity in spinal cord injury patients. This
treatment is
expensive and its effect is reversible. It can complement intrathecal
baclofen in treating
upper limb spasticity in tetraplegic patients. Tolerance does occur to the
toxin. Although
high doses of the product are well tolerated, the quantity should be
tailored to the patient's
need. The minimal amount necessary to reach clinical effects should be
adhered to and
booster doses at short period intervals should be avoided.
===========================================================
68.) Use of botulinum A toxin in patients at risk of wound complications
following eyelid
reconstruction.
===========================================================
Ophthal Plast Reconstr Surg 1997 Dec;13(4):259-64
Choi JC, Lucarelli MJ, Shore JW
Ophthalmic Consultants of Boston, Massachusetts, USA.
Our purpose was to determine the efficacy of botulinum A toxin (BOTOX) in
promoting
wound immobilization and preventing wound dehiscence in patients at risk of
wound-healing complications following eyelid reconstruction. In 11 patients
at risk of
postoperative wound complications, we injected BOTOX into the periocular
musculature
in addition to standard suture tarsorrhaphy. Each patient experienced
excellent wound
immobilization and wound healing. There were no complications. Adjuvant use
of
BOTOX, in conjunction with suture tarsorrhaphy, immobilizes the eyelids and
promotes
wound healing in patients at risk of wound complications following eyelid
reconstruction.
===========================================================
69.) Botox for the treatment of dynamic and hyperkinetic facial lines and
furrows:
adjunctive use in facial aesthetic surgery.
===========================================================
Plast Reconstr Surg 1999 Feb;103(2):701-13
Fagien S
Boca Raton Center for Ophthalmic Plastic Surgery, Fla, USA.
Our improved understanding of the pathophysiology of facial lines,
wrinkles, and furrows
has broadened the treatment options for a variety of facial cosmetic
blemishes. The
persistence or recurrence of certain facial rhytids after surgery has
confirmed the lack of
full comprehension of their origin. Glabellar forehead furrows (frown
lines) and lateral
canthal rhytids (crow's feet) have been the most popular facial lines that
have been shown
to be mostly the result of regional hyperkinetic muscles, and their
eradication may be
more suitable, at times, to chemodenervation than to soft-tissue fillers,
skin resurfacing, or
surgical resection. Aesthetic surgical procedures that have yielded
suboptimal results may
also occur from failure to recognize other causative factors including
hyperkinetic or
dynamic musculature, which may contribute to etiology of the visible
soft-tissue changes
and lack of persistent effect after surgery. Chemodenervation with
botulinum toxin A
(Botox) has proven to be useful both as a primary treatment for certain
facial rhytids and
as an adjunctive agent for a variety of facial aesthetic procedures to
obtain optimal
results.
===========================================================
70.) Botulinum toxin A, adjunctive therapy for refractory headaches
associated with
pericranial muscle tension.
===========================================================
Headache 1998 Jun;38(6):468-71
Wheeler AH
Charlotte Spine Center, NC 28207, USA.
Pericranial muscle tension may contribute to the development of facial
discomfort, chronic
daily headache, and migraine-type headache. Elimination of pericranial
muscle tension
may reduce associated myalgia and counteract influences that can trigger
secondary
headaches which fall within the migraine continuum. Four patients with
chronic,
predominantly tension-type headaches and associated pericranial muscle
tension failed
prolonged conventional treatment and, therefore, symptomatic areas were
treated with
botulinum toxin A. This alleviated myalgia and reduced the severity and
frequency of
migraine-type headaches with a concomitant reduction in subsequent medical
and physical
therapy interventions. Judicious use of botulinum toxin A into defined
areas of pericranial
muscle tension may be useful for reducing primary myalgia and secondary
headache.
===========================================================
71.) The role of botulinus toxin type A in treatment--with special
reference to children.
===========================================================
Brain Dev 1999 Apr;21(3):147-51
Gordon N
Although botulinum toxin A was first introduced to treat strabismus and
blepherospasm it
is now used in an increasing number of conditions, many in the field of
pediatrics. Its
action results from a prevention of the release of acetylcholine from nerve
terminals. A
number of studies recording the effects of the toxin in the treatment of
spastic cerebral
palsy are reviewed, and although these can be criticized, there seems to be
no doubt that
it can be of benefit. It is few side effects, but it may reveal an
underlying weakness. Other
disadvantages are its cost and the need for repeated injections. It can be
used for the
relief of rigidity, although the effects in the extrapyramidal form of
cerebral palsy are not
so dramatic. Also it can be beneficial in some forms of dystonia, rarely if
this is
generalized, but certainly if it is focal, and especially if there is
accompanying pain. There
are several conditions seen in children, such as strabismus, blepherospasm
and tremors, in
which this form of treatment will rarely be indicated; but they will be
mentioned. An
exception may be spasmodic torticollis during adolescence if it does not
respond to other
therapy, as it is so disabling. Botulinum toxin can be used to block the
discharges from
cholinergic sympathetic and parasympathetic terminals. Focal hyperhidrosis
can be very
distressing among older children, and the use of the toxin should sometimes
be considered
in this and other autonomic disorders.
===========================================================
72.) Botulinum toxin type A injection for the treatment of frown lines.
===========================================================
Ann Pharmacother 1998 Dec;32(12):1365-7
Song KH
Professional Product Information, Roche Laboratories, Inc., Nutley, NJ
07110, USA.
Patients who have exaggerated frown lines frequently ask for treatment
because others
mistake them to be constantly angry or annoyed. Current treatment options
(surgery or
implants) do not address the underlying cause of these lines, namely the
excessive nerve
stimulation. The mechanism of action of BTX makes it an ideal agent to
target the major
cause of these lines. BTX inhibits calcium metabolism in the presynaptic
neuron, thereby
inhibiting neuromuscular transmission and producing muscle paralysis. The
current medical
literature indicates that BTX can be used safely and effectively for the
cosmetic treatment
of frown lines. The procedure can be performed in an ambulatory setting and
the use of
an EMG instrument may provide better direction for the placement of the
drug. However,
the benefits are transient and repeated injections are necessary. The
adverse effects
associated with BTX injections were mild and transient. Currently, there
are no safety
data on the long-term effects of continuous BTX injections for the
treatment of frown
lines. However, studies on the long-term use of BTX at doses to treat
blepharospasm and
Meige's disease have shown no serious adverse effects or production of
antibodies to
BTX. Muscle biopsies taken from patients who have received numerous doses
of BTX
for more than 7 years have not shown any signs of atrophy or permanent muscle
degeneration. The medical literature supports BTX therapy as an option for
the treatment
of cosmetic facial frown lines. However, there is not enough information on
what patient
characteristics are ideal in a candidate to achieve optimal response with
BTX. Also, no
data are available on the safety and efficacy of continuous injections in
the long-term use
of BTX for facial frown lines. Therefore, the use of BTX to treat frown
lines should be
examined carefully against other therapeutic options.
===========================================================
73.) Dilution and storage of botulinum toxin.
===========================================================
Dermatol Surg 1998 Nov;24(11):1179-80
Klein AW
Department of Dermatology, UCLA School of Medicine, USA.
BACKGROUND: There has been an ongoing controversy as to the best dilution for
botulinum toxin for use in cosmetic applications. Recommended dilutions
have ranged
from 1 ml per vial to 10 ml per vial. There has also been much discussion
on the diluent,
i.e., preserved versus unpreserved saline, to be used and on storage time
of the material
after dilution. OBJECTIVES: The objective of this paper is to examine the
literature and
experience of practitioners in the field to try to resolve some of the
questions concerning
dilution and storage of botulinum toxin. CONCLUSIONS: Although there is great
variation in the dilutions adopted by various physicians, much of this is a
matter of
personal preference. It does seem to appear that most clinicians use a
dilution near 2.5 to
3.0 ml per vial and three-quarters of them limit the storage of the diluted
product to 1
week or less.
===========================================================
74.) Botulinum toxin A improves muscle spasms and rigidity in stiff-person
syndrome.
===========================================================
Mov Disord 1997 Nov;12(6):1060-3
Liguori R, Cordivari C, Lugaresi E, Montagna P
Institute of Neurology, University of Bologna, Italy.
We studied the effect of botulinum toxin A (BTA) on painful muscular spasms
and rigidity
in two bedridden patients with clinical, electrophysiologic, and
immunologic evidence of
stiff-person syndrome. We injected BTA or saline solution into several limb
muscles with
both the rater and patient blinded to the order of the injections. A
physician, unaware of
the treatment order, used an objective rating scale for rigidity and spasm
frequency scale
and independently assessed the treatment results. BTA administration
significantly
reduced rigidity and stopped the spasms in all limbs. Following BTA
injection on one
side, the spasm frequency decreased bilaterally possibly because of the
spread of
hematogenous toxin.
===========================================================
75.) [Oromandibular dystonia and botulinum toxins].
===========================================================
Acta Stomatol Belg 1996 Mar;93(1):37-41
[Article in French]
Van Durme B, Loeb I, Van Reck J
Service de Stomatologie et Chirurgie Maxillo-Faciale, C.H.U. St. Pierre,
Bruxelles.
The authors describe the Meige's Syndrome also known as blepharospasm or
mandibulo-oral dystonia. This Syndrome rather known by Neurologists and
Ophthalmologists than by Stomatologists actually benefits by a specific
treatment based
on botulin toxins.
===========================================================
76.) Treatment of gustatory sweating with botulinum toxin.
===========================================================
Ann Neurol 1997 Dec;42(6):973-5
Naumann M, Zellner M, Toyka KV, Reiners K
Department of Neurology, Bayerische Julius-Maximilians-Universitat, Wurzburg,
Germany.
Gustatory sweating is an autonomic disorder that frequently occurs after
parotid gland
surgery. We investigated the action of intracutaneous injections of
botulinum toxin (BTX)
(1.0-2.0 mouse units/2.25-cm2 skin area) in 45 patients (mean age, 52
years) with
gustatory sweating. The area of hyperhidrosis was determined by Minor's
iodine test
before and up to 24 weeks after the injection. The effect of BTX was
assessed by
measuring the hyperhidrotic area. The maximum BTX-induced reduction of
gustatory
sweating was seen at 7.4 +/- 4.5 days after injection. The area of sweating
decreased
from 17.6 +/- 8.6 cm2 before BTX to 1.3 +/- 1.6 cm2 after BTX (p < 0.0001).
Half the
patients rated gustatory sweating subjectively as completely abolished, and
the remainder
felt pronounced improvement. No toxic effects were observed. In none of the
patients did
hyperhidrosis recur over a 6-month follow-up. We conclude that BTX is a
safe and
effective treatment that can be recommended as the therapy of choice in
gustatory
sweating.
===========================================================
77.) Diplopia following subcutaneous injections of botulinum A toxin for
facial spasms.
===========================================================
J Pediatr Ophthalmol Strabismus 1997 Jul-Aug;34(4):229-34
Wutthiphan S, Kowal L, O'Day J, Jones S, Price J
Ocular Motility Clinic, Royal Victorian Eye and Ear Hospital, Melbourne,
Australia.
PURPOSE: To study the incidence, cause, recovery time, and prevention of
diplopia
following subcutaneous injection of botulinum A toxin for the treatment of
facial spasms.
METHODS: Patients who experienced diplopia after botulinum A toxin
injections had
their deviations examined in detail. When the muscle that caused diplopia
was identifiable,
the injection closest to that muscle was omitted in the next treatment in
an attempt to
prevent diplopia. RESULTS: Of 250 patients receiving about 1500 sets of
injections, 25
(1.7%) incidents of diplopia occurred in 10 patients. Excluding two
patients who declined
further treatment after having diplopia on their first botulinum A toxin
treatment, seven of
the remaining eight patients had multiple incidents of diplopia. The most
common pattern
of diplopia was "uncertain diagnosis." The most common identifiable cause
of diplopia
was paresis of the inferior oblique muscle. Omission of the injection into
the central
portion of the lower eyelids in the next treatment prevented recurrence of
diplopia in only
one of the four patients. No significant correlation between botulinum A
toxin doses
injected and times to recovery was noted. CONCLUSIONS: Diplopia following
botulinum A toxin treatment is uncommon. Seven patients (3% of patients
studied) had 22
episodes of diplopia (88% of episodes). When diplopia occurs, it tends to
recur on
reinjection, sometimes with a prolonged recovery time. This response may
not be dose
dependent. The extraocular muscles of some patients may be more susceptible
to
chemodenervation than others, or botulinum A toxin may diffuse to
extraocular muscles
more easily in some patients than in others.
===========================================================
78.) Prevalence of periocular depigmentation after repeated botulinum toxin
A injections
in African American patients.
===========================================================
J Neuroophthalmol 1999 Mar;19(1):7-9
Roehm PC, Perry JD, Girkin CA, Miller NR
Neuro-Ophthalmology Unit, The Johns Hopkins Medical Institutions, Baltimore,
Maryland, USA.
Botulinum toxin A (Botox), administered by subcutaneous or intramuscular
injection, is
the most commonly used and most successful medication for many craniocervical
dystonias. Although some patients experience side effects related to the
neuroparalytic
action of the medication, these side effects are temporary. In 1996,
permanent periocular
cutaneous depigmentation was reported in three white patients after
repeated Botox
injections, suggesting that loss or alteration of melanin pigment might be
a permanent side
effect of long-term Botox injections. The authors examined and photographed
26 African
American patients who were receiving periocular Botox injections for
hemifacial spasm
and essential blepharospasm. The authors found no evidence of periocular
cutaneous
depigmentation in any of these patients.
===========================================================
79.) Muscle fiber atrophy in leg muscles after botulinum toxin type A
treatment of cervical
dystonia.
===========================================================
Neurology 1997 May;48(5):1440-2
Ansved T, Odergren T, Borg K
Department of Neurology, Karolinska Institute, Karolinska Hospital,
Stockholm,
Sweden.
Previous electrophysiologic studies on the effects of local injections of
botulinum toxin
type A (BTX-A) have indicated impaired neuromuscular transmission in
distant muscles.
To further study possible distant effects of repeated BTX-A injections, we
obtained
percutaneous muscle biopsies of the vastus lateralis muscle from 11
patients with cervical
dystonia. We examined the biopsies with histopathology and morphometry, and
compared them with age-matched healthy controls. There was an increased
frequency of
angular atrophic type IIB fibers in the patient group, and the mean size of
IIB fibers was
significantly smaller (p < 0.05). In addition, there was a negative
correlation between
accumulated dose of botulinum toxin and relative size of type IIA fibers (p
< 0.05). We
postulate that the observed atrophy is due to distant effects of botulinum
toxin causing
progressive denervation-like changes in non-treated muscle. This
observation calls for
further, prospective studies of the long-term effects of the treatment.
===========================================================
80.) Acute anxiety and depression induced by loss of sensation and muscle
control after
botulinum toxin A injection.
===========================================================
South Med J 1999 Jul;92(7):738
Brenner R, Madhusoodanan S, Korn Z, Spitzer M
Publication Types:
Letter
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DATA-MEDICOS/DERMAGIC-EXPRESS No 2-(82) 10/11/99 DR. JOSE
LAPENTA R.
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