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The Botulinum Toxin II,
Update.
La Toxina Botulínica II, Actualización
*********************************
****** DATA-MÉDICOS *********
*********************************
LA TOXINA BOTULÍNICA II,
ACTUALIZACIÓN.
THE BOTULINUM TOXIN II,
UPDATE.
**************************************
***** DERMAGIC-EXPRESS No
(2)-79 *******
** 10 NOVIEMBRE 1.999 / 10 NOVEMBER 1999**
*********************************
EDITORIAL ESPAÑOL:
=====================
Hola Amigos de la red, el día 4 Diciembre 1.998 DERMAGIC/EXPRESS
hizo una revisión de la TOXINA BOTULÍNICA, 41 referencias fueron
lanzadas a la red esa fecha.
La semana pasada el DR. Armando Mocci (Panama)
me sugirió el tema para una actualización. Me fui al Cyber y
complete los artículos, con 39 referencias mas.
Entre los Usos de la TOXINA BOTULÍNICA
figuran: DERMATOLÓGICOS Y NO DERMATOLÓGICOS:
De modo
que la TOXINA BOTULÍNICA ES ÚTIL EN:
A..) FISURA ANAL,
LÍNEAS FACIALES, DISFONÍA, ESPASMOS FACIALES, ARRUGAS, TORTICOLIS,
BLEFAROESPASMO, ESTRABISMO, HIPERHIDROSIS AXILAR Y PALMAR, LÍNEAS
FACIALES, DISFONÍA, ESPASTICIDAD MUSCULAR, DISTROFIAS MUSCULARES,
PARÁLISIS CEREBRAL, DESORDENES TEMPORO-MANDIBULARES, ACALASIA, SÍNDROME
DE FREY, DOLOR DE CABEZA, DISTONÍAS, CALAMBRES, y otros.
PERO no es una moneda de plata,,,
también tiene sus EFECTOS
ADVERSOS:
B.) ERUPCIÓN PSORIASIFORME,
DIPLOPIA, DESPIGMENTACIÓN PERI-OCULAR, ATROFIA y PARÁLISIS MUSCULAR,
ANSIEDAD, DEPRESIÓN, SANGRAMIENTO INCONTROLABLE en heridas traumáticas en
sitios inyectados (cara), y otros.
NOTA: En Este link puedes encontrar la previa publicación de
LA TOXINA BOTULINICA I, con las primeras 41 REFERENCIAS
BIBLIOGRÁFICAS.
En esta publicación otras 39
referencias,,,
Saludos a todos !!!
Bienvenido a DERMAGIC Dr. S.
José Fishman (USA)
PRÓXIMA EDICIÓN: EL ERBIUM...y EL CO2....(DERMA
K)
Dr. José Lapenta R.,,,
EDITORIAL ENGLISH:
=====================
Hello Internet Friends, On December 4, 1998, DERMAGIC/EXPRESS published
a review of BOTULINUM TOXIN. 41 references were posted online that date.
Last week, Dr. Armando Mocci (Panama) suggested the topic to me for
an update. I went online and completed the articles, adding 39 more references. Among the uses of BOTULINUM TOXIN are: DERMATOLOGICAL AND
NON-DERMATOLOGICAL:
So BOTULINUM TOXIN IS USEFUL IN:
A.) ANAL FISSURE, FACIAL LINES, DYSPHONIA, FACIAL SPASMS, WRINKLES,
TORTICOLLIS, BLEPHAROSPASM, STRABISMUS, AXILLARY AND PALMAR HYPERHIDROSIS,
FACIAL LINES, DYSPHONIA, MUSCLE SPASTICITY, MUSCULAR DYSTROPHIES,
CEREBRAL PALSY, TEMPOROMANDBULAR DISORDERS, ACHALASIA, FREY'S SYNDROME,
HEADACHE, DYSTONIAS, CRAMPS, and others.
BUT it's not a
silver coin... it also has its SIDE EFFECTS:
B.) PSORIASIFORM RASH,
DIPLOPIA, PERIOCULAR DEPIGMENTATION, MUSCLE ATROPHY AND PARALYSIS,
ANXIETY, DEPRESSION, UNCONTROLLED BLEEDING in traumatic wounds at
injection sites (face), and others.
NOTE: In this link you can
find the previous publication of BOTULINUM TOXIN I, with the first 40
BIBLIOGRAPHIC REFERENCES.
NOTE: In this link you can find the previous publication of
THE BOTULINUM TOXIN I, with the first 41 BIBLIGRAPHICAL REFERENCES.
Another 39 references in this
publication...
Greetings to all!!!
Welcome to
DERMAGIC Dr. S. José Fishman (USA)
NEXT EDITION: ERBIUM...and
CO2....(DERMA K)
Dr. José Lapenta R.
================================================================
DERMAGIC/EXPRESS(79)
================================================================
REFERENCIAS BIBLIOGRÁFICAS /
BIBLIOGRAFICAL REFERENCES
================================================================
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.
===========================================================
===========================================================
===========================================================
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
===================================================================
DATA-MÉDICOS/DERMAGIC-EXPRESS No 2-(79) 10/11/99 DR. JOSÉ LAPENTA R.
===================================================================
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Produced by Dr. José Lapenta R.
Dermatologist
Maracay Estado Aragua Venezuela 1999-2026
Telf.:
04142976087 - 04127766810
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