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Effect of a clown’s presence at botulinum toxin injections in children: a randomized, prospective study  [cached]
Hansen LK,Kibaek M,Martinussen T,Kragh L
Journal of Pain Research , 2011,
Abstract: Lars Kjaersgaard Hansen1, Maria Kibaek1, Torben Martinussen2, Lene Kragh3, Mogens Hejl11Department of Paediatrics, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense; 2Roskilde Hospital, Roskilde; 3Department of Statistics, University of Southern Denmark, Odense, DenmarkBackground: The effect of the presence of a hospital clown during pediatric procedures has rarely been evaluated. In a pediatric ward, botulinum toxin injection is a painful procedure and a stressful experience for the child. We undertook a study of the effect of the presence of a hospital clown on children treated with botulinum toxin in an outpatient setting.Methods: In total, 60 children, the majority of whom had spastic cerebral palsy, were subjected to a total of 121 botulinum toxin treatment sessions. Thirty-two children were being treated for the first time. During a 2-year period, we enrolled 121 treatment sessions prospectively, and the children were randomized to either the presence of a female clown during treatment or to no presence of a clown. The duration of the child's crying during the procedure was used as an indicator of the effect of the presence of a clown.Results: The effect of the clown was significantly related to patient gender. Girls were found to have a significantly shorter period of crying when the clown was present. For children younger than 8 years, the effect on boys was negative. Children treated for the first time did not appear to benefit from the presence of the clown, and showed no difference in effect between genders.Conclusion: No effect of the clown was documented for children being treated for the first time. At repeat treatments, we saw a positive effect of the female clown in relation to girls, and a negative effect on boys younger than 8 years of age.Keywords: clown, injections, pain, botulinum toxin
Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study
Tahwinder Upile, Behrad Elmiyeh, Waseem Jerjes, Vyas Prasad, Panagiotis Kafas, Jesuloba Abiola, Bryan Youl, Ruth Epstein, Colin Hopper, Holger Sudhoff, John Rubin
Head & Face Medicine , 2009, DOI: 10.1186/1746-160x-5-20
Abstract: Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven.Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections.Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia.Adductor spasmodic dysphonia (ADSD) is a focal dystonia of the laryngeal musculature, causing abrupt, intermittent and involuntary vocal folds spasms producing a strained and strangled speech pattern. It is idiopathic in nature and may reflect abnormalities in central motor processing [1].The cardinal signs of ADSD are effortful vocal straining and harshness, quaver and voice arrest due to laryngospasm in the midst of non-effortful phonatory periods. It is described as "speaking whilst being strangled". Examination of the larynx may reveal true and false vocal folds hyper-adduction with laryngeal elevation and its attendant effects on speech. ADSD, a disabling disorder of voice, is characterised by involuntary disruption of phonation with functional, social and emotional consequences [1].Botulinum toxin is the treatment of choice for ADSD and has been in use since the late 1980's [2-5]. It improves the patients' perception of dysphonia, mental health and their social function [6]. The American Academy of Otolaryngology-Head and Neck Surgery recognizes treatment with Botulinum toxin as t
Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial
Megan Thorley, Samantha Donaghey, Priya Edwards, Lisa Copeland, Megan Kentish, Kim McLennan, Jayne Lindsley, Laura Gascoigne-Pees, Leanne Sakzewski, Roslyn N Boyd
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-120
Abstract: This study is a double blind randomized controlled trial. Forty participants will be recruited. In cycle I, participants will be randomized to either a treatment group who will receive BoNT-A injections into selected upper and/or lower limb muscles, or a control group who will undergo sham injections. Both groups will receive occupational therapy and /or physiotherapy following injections. Groups will be assessed at baseline then compared at 4 and 16 weeks following injections or sham control. Parents, treating clinicians and assessors will be masked to group allocation. In cycle II, all participants will undergo intramuscular BoNT-A injections to selected upper and/or lower limb muscles, followed by therapy.The primary outcome measure will be change in parent ratings in identified areas of concern for their child’s care and comfort, using the Canadian Occupational Performance Measure (COPM). Secondary measures will include the Care and Comfort Hypertonicity Scale (ease of care), the Cerebral Palsy Quality of Life Questionnaire (CP QoL–Child) (quality of life), the Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire (CPCHILD?) (health status) and the Paediatric Pain Profile (PPP) (pain). Adverse events will be carefully monitored by a clinician masked to group allocation.This paper outlines the theoretical basis, study hypotheses and outcome measures for a trial of BoNT-A injections and therapy for children with non-ambulant CP.Australia New Zealand Clinical Trials Registry:N12609000360213Cerebral palsy (CP) is “a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”. [1] p.9 Classification systems have been developed to indicate the severity of functional limitations in CP. The Gross Motor Function Classification System (GMFCS), developed by Palisano and colleagues in 1997, has bec
Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders [ISRCTN68653575]
Francisco J Juan
BMC Musculoskeletal Disorders , 2004, DOI: 10.1186/1471-2474-5-5
Abstract: This is a prospective, randomized, controlled clinical trial and botulinum toxin-A (Botox?) injections will be compared with placebo injections. The primary objective is to determine the efficacy of Botox? in the management of musculoskeletal pain in whiplash associated disorders.Botulinum toxin type-A toxin has been studied in small trials on whiplash associated disorder patients and has generally been found to relieve pain and improve range of motion. Specifically, we seek to assess the efficacy of Botox? in reducing pain and to improve the cervical spine range of movement, during the 6-month trial period.The term "whiplash" has been used to describe a mechanism of injury, and the various clinical manifestations as a consequence of the injury. Moreover, signs and symptoms have been designated the 'whiplash syndrome'. In 1995, the Quebec Task Force (QTF) on Whiplash Associated Disorders (WAD) adopted the following definition of whiplash: "whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor vehicle collisions, but can also occur during diving or other mishaps. The impact may result in bony or soft-tissue injuries (whiplash-injury), which in turn may lead to a variety of clinical manifestations called Whiplash Associated Disorders"[1]. Whiplash patients can be classified according to severity of signs and symptoms. The QTF-WAD classification system consists of five levels: WAD 0 indicates no complaints or physical signs; WAD I indicates neck complaints but no physical signs; WAD II indicates neck complaints and musculoskeletal signs (such as a decreased range of motion or muscle tenderness); WAD III and IV indicate neck complaints and neurological signs (WAD III) or fracture/dislocation (WAD IV), respectively. Research [2-5] has revealed that the most common presenting symptoms following an acute motor vehicle collision were neck pain (88–100 percent) and headache (54–66 percent). Other s
Botulinum toxin injections for blepharospasm prior to ocular surgeries
Okumus S, Coskun E, Erbagci , Tatar MG, Comez A, Kaydu E, Yayuspayi R, Gurler B
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S30277
Abstract: otulinum toxin injections for blepharospasm prior to ocular surgeries Original Research (2387) Total Article Views Authors: Okumus S, Coskun E, Erbagci , Tatar MG, Comez A, Kaydu E, Yayuspayi R, Gurler B Published Date May 2012 Volume 2012:6 Pages 579 - 583 DOI: http://dx.doi.org/10.2147/OPTH.S30277 Received: 27 January 2012 Accepted: 12 March 2012 Published: 03 May 2012 Seydi Okumus1, Erol Coskun1, brahim Erbagci1, M Gürkan Tatar2, Aysegul Comez1, Erdal Kaydu1, Ramazan Yayuspayi1, Bulent Gurler1 1Department of Ophthalmology, University of Gaziantep, 2Ophthalmology Clinic, Nizip State Hospital, Nizip, Gaziantep, Turkey Purpose: The aim of this study was to show the efficiency of preoperative botulinum toxin A (Botox A) in patients with benign essential blepharospasm who were to undergo ocular surgery with local anesthesia. Materials and methods: Twenty-eight benign essential blepharospasm patients who were administered unilateral Botox A prior to ocular surgery between January 2004 and May 2011 were included in this study. Eleven cases had pterygiums, ten had cataracts, and four had glaucomas, while the remaining three had aphakia. All cases’ severity of spasm (stage 0–4) and eyelid closing forces (stage 1–4) were evaluated according to the Jankovic scale prior to the injection, at 3 days, 14 days, 1 month, and 3 months after Botox A injection. Results: Of the patients enrolled in the study, 16 were female and 12 were male, with an average age of 55.52 ± 1.53 years (52–65). Average onset of the Botox injection's effect was 2.8 ± 0.9 (2–5) days. Its effect lingered for about 11.5 ± 3.6 (8–22) weeks. The severity of spasm and eyelid closing forces of all the patients enrolled were compared prior to the injection at 3 and 14 days and the first and third months after the injection. There were statistically significant differences between prior to the injection and 3 days (P = 0.001), 14 days (P < 0.001) and 1 month after the injection (P <0.001). There was no statistically significant difference between prior to the injection and 3 months after the injection (P = 0.513). Fourteen days following the injection, the surgeries were successfully performed. Conclusion: Botox A administered prior to ocular surgery will control both blepharospasm and lower the risks that can be encountered before and during surgery, thus increasing the comfort of the patient and the surgeon.
Botulinum Toxin Injections for Simple Partial Motor Seizures Associated with Pain
Edward C. Mader Jr.,Bruce J. Fisch,Nicole R. Villemarette-Pittman,Piotr W. Olejniczak,Michael E. Carey
Case Reports in Medicine , 2012, DOI: 10.1155/2012/295251
Abstract: Intractable epilepsy with painful partial motor seizures is a relatively rare and difficult disorder to treat. We evaluated the usefulness of botulinum toxin to reduce ictal pain. Two patients received two or four botulinum toxin (BTX) injections at one-to-two-month intervals. Patient 1 had painful seizures of the right arm and hand. Patient 2 had painful seizures involving the left foot and leg. Injections were discontinued after improved seizure control following resective surgery. Both patients received significant pain relief from the injections with analgesia lasting at least two months. Seizure severity was reduced, but seizure frequency and duration were unaffected. For these patients, BTX was effective in temporarily relieving pain associated with muscle contraction in simple partial motor seizures. Our findings do not support the hypothesis that modulation of motor end-organ feedback affects focal seizure generation. BTX is a safe and reversible treatment that should be considered as part of adjunctive therapy after failure to achieve control of painful partial motor seizures.
Botulinum toxin injections for blepharospasm prior to ocular surgeries  [cached]
Okumus S,Coskun E,Erbagci ?,Tatar MG
Clinical Ophthalmology , 2012,
Abstract: Seydi Okumus1, Erol Coskun1, brahim Erbagci1, M Gürkan Tatar2, Aysegul Comez1, Erdal Kaydu1, Ramazan Yayuspayi1, Bulent Gurler11Department of Ophthalmology, University of Gaziantep, 2Ophthalmology Clinic, Nizip State Hospital, Nizip, Gaziantep, TurkeyPurpose: The aim of this study was to show the efficiency of preoperative botulinum toxin A (Botox A) in patients with benign essential blepharospasm who were to undergo ocular surgery with local anesthesia.Materials and methods: Twenty-eight benign essential blepharospasm patients who were administered unilateral Botox A prior to ocular surgery between January 2004 and May 2011 were included in this study. Eleven cases had pterygiums, ten had cataracts, and four had glaucomas, while the remaining three had aphakia. All cases’ severity of spasm (stage 0–4) and eyelid closing forces (stage 1–4) were evaluated according to the Jankovic scale prior to the injection, at 3 days, 14 days, 1 month, and 3 months after Botox A injection.Results: Of the patients enrolled in the study, 16 were female and 12 were male, with an average age of 55.52 ± 1.53 years (52–65). Average onset of the Botox injection's effect was 2.8 ± 0.9 (2–5) days. Its effect lingered for about 11.5 ± 3.6 (8–22) weeks. The severity of spasm and eyelid closing forces of all the patients enrolled were compared prior to the injection at 3 and 14 days and the first and third months after the injection. There were statistically significant differences between prior to the injection and 3 days (P = 0.001), 14 days (P < 0.001) and 1 month after the injection (P <0.001). There was no statistically significant difference between prior to the injection and 3 months after the injection (P = 0.513). Fourteen days following the injection, the surgeries were successfully performed.Conclusion: Botox A administered prior to ocular surgery will control both blepharospasm and lower the risks that can be encountered before and during surgery, thus increasing the comfort of the patient and the surgeon.Keywords: botulinum toxin A, blepharospasm, ocular surgery
Predictors of Response to Intradetrusor Botulinum Toxin-A Injections in Patients with Idiopathic Overactive Bladder  [PDF]
Brian L. Cohen,Daniel J. Caruso,Prashanth Kanagarajah,Angelo E. Gousse
Advances in Urology , 2009, DOI: 10.1155/2009/328364
Abstract: Objectives. To evaluate whether there are any demographic or urodynamic differences in patients with idiopathic overactive bladder (I-OAB) that respond and do not respond to intradetrusor injections of botulinum toxin-A (BTX-A). Methods. This represents a secondary analysis of data collected from an investigator initiated randomized trial designed to evaluate clinical differences in outcomes for 100 versus 150 U BTX-A in patients with I-OAB. Preinjection demographic and urodynamic data were collected. Patients were evaluated 12 weeks after injection and were determined to be responders or nonresponders as defined by our criteria. Statistical comparisons were made between groups. Results. In patients with overactive bladder without incontinence (OAB-Dry), there were no variables that could be used to predict response to BTX-A. On univariate analysis, younger patients with overactive bladder with incontinence (OAB-Wet) were more likely to respond to BTX-A than older patients. However, this relationship was no longer statistically significant on multivariate analysis. Conclusions. We were unable to identify any preinjection demographic or urodynamic parameters that could aid in predicting which patients will achieve clinical response to BTX-A. Future studies are necessary to further evaluate this question.
Long-Term Efficacy and Safety of Botulinum Toxin Injections in Dystonia  [PDF]
Juan Ramirez-Castaneda,Joseph Jankovic
Toxins , 2013, DOI: 10.3390/toxins5020249
Abstract: Local chemodenervation with botulinum toxin (BoNT) injections to relax abnormally contracting muscles has been shown to be an effective and well-tolerated treatment in a variety of movement disorders and other neurological and non-neurological disorders. Despite almost 30 years of therapeutic use, there are only few studies of patients treated with BoNT injections over long period of time. These published data clearly support the conclusion that BoNT not only provides safe and effective symptomatic relief of dystonia but also long-term benefit and possibly even favorably modifying the natural history of this disease. The adverse events associated with chronic, periodic exposure to BoNT injections are generally minor and self-limiting. With the chronic use of BoNT and an expanding list of therapeutic indications, there is a need to carefully examine the existing data on the long-term efficacy and safety of BoNT. In this review we will highlight some of the aspects of long-term effects of BoNT, including efficacy, safety, and immunogenicity.
The Efficacy of Botulinum Toxin Type a Injection in the Hamstring and Calf Muscles With and Without Serial Foot Casting in Gait Improvement in Children With Cerebral Palsy
Amirsalari S,Dalvand H,Dehghan L,Feizy A
Tehran University Medical Journal , 2011,
Abstract: Background: The goal of this study was to compare the efficacy of botulinum toxin type A (BTX-A) injection in the hamstring and calf muscles with and without ankle serial casting in the improvement of gait in children with cerebral palsy (CP).Methods : This double-blind prospective clinical trial was performed on 25, 2 to 8-year-old children with hemiplegic or diplegic CP in Tehran, Iran in 2010. The participants were chosen by simple randomized sampling and were matched for age, gross motor function classification system (GMFCS) and type of CP and were randomly divided into two groups: children in the first group (13) only received BTX-A injection, but the second group (12) received BTX-A and serial foot casting starting one week after the injection.Results : Comparison of the gross motor function, right and left knee spasticities and passive ROM of both knees between the two groups before and 1, 3, 6 and 12 months after the injections were not statistically significant (P>0.1). Furthermore, comparison of the right and left ankle spasticities and passive ROM before the injections and in1 and 3-month follow-ups did not show a statistically significant difference (P>0.1), but the differences were significant in 6 and 12-month follow-ups (P<0.05).Conclusion: BTX-A injection with serial foot casting vs. BTX-A alone was more effective in decreasing spasticity and improving passive ROM in the ankle of children with CP, but such injections in the hamstrings were not useful in these regards.
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