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Botulinum toxin  [cached]
Nigam P,Nigam Anjana
Indian Journal of Dermatology , 2010,
Abstract: Botulinum toxin, one of the most poisonous biological substances known, is a neurotoxin produced by the bacterium Clostridium botulinum. C. botulinum elaborates eight antigenically distinguishable exotoxins (A, B, C 1 , C 2 , D, E, F and G). All serotypes interfere with neural transmission by blocking the release of acetylcholine, the principal neurotransmitter at the neuromuscular junction, causing muscle paralysis. The weakness induced by injection with botulinum toxin A usually lasts about three months. Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, and various spastic movement disorders, headaches, hypersalivation, hyperhidrosis, and some chronic conditions that respond only partially to medical treatment. The list of possible new indications is rapidly expanding. The cosmetological applications include correction of lines, creases and wrinkling all over the face, chin, neck, and chest to dermatological applications such as hyperhidrosis. Injections with botulinum toxin are generally well tolerated and side effects are few. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice.
Hypersecretory Disorders and Botulinum Toxin
Ha?met A. HANA?ASI
N?ropsikiyatri Ar?ivi , 2010,
Abstract: An increase in the popularity of botulinum toxin for treatment of salivary gland disorders has been observed in recent years. Hyperhidrosis is characterized by excessive sweat production, beyond the required quantity to return increased body temperature to normal. Sialorrhoea is a common symptom in many neurodegenerative disorders. Hyperhidrosis and sialorrhea can cause both physical and psychosocial disability. Many reports on the use of botulinum toxin in hypersecretory disorders have shown favourable results with minimal side effects. (Archives of Neuropsychiatry 2010; 47 Supplement: 48-51)
Effectiveness and Safety of Botulinum Toxin Type A in Children with Musculoskeletal Conditions: What Is the Current State of Evidence?  [PDF]
Noémi Dahan-Oliel,Bahar Kasaai,Kathleen Montpetit,Reggie Hamdy
International Journal of Pediatrics , 2012, DOI: 10.1155/2012/898924
Abstract: Children with musculoskeletal conditions experience muscle weakness, difficulty walking and limitations in physical activities. Standard treatment includes physiotherapy, casting, and surgery. The use of botulinum toxins appears as a promising treatment on its own, but usually as an adjunct to other treatment modalities and as an alternative to surgery. The objectives were to establish the evidence on the effectiveness, safety and functional outcome of BTX-A in children with musculoskeletal conditions. A literature search using five electronic databases identified 24 studies that met our inclusion criteria. Two randomized clinical trials were included; most studies were case studies with small sample sizes and no control group. Improvements in gait pattern, function, range of motion, reduction of co-contractions, and avoidance of surgical procedures were found following BTX-A injections. Adverse events were not reported in 10 studies, minor adverse events were reported in 13 children and there were no severe adverse events. Additional doses appear safe. BTX-A is a promising treatment adjunct in improving functional outcomes in children with musculoskeletal conditions. Future studies including larger samples, longer follow-up periods and a comparison group are required to provide evidence on the effectiveness and safety of this drug in children with musculoskeletal conditions.
Effectiveness and Safety of Botulinum Toxin Type A in Children with Musculoskeletal Conditions: What Is the Current State of Evidence?  [PDF]
Noémi Dahan-Oliel,Bahar Kasaai,Kathleen Montpetit,Reggie Hamdy
International Journal of Pediatrics , 2012, DOI: 10.1155/2012/898924
Abstract: Children with musculoskeletal conditions experience muscle weakness, difficulty walking and limitations in physical activities. Standard treatment includes physiotherapy, casting, and surgery. The use of botulinum toxins appears as a promising treatment on its own, but usually as an adjunct to other treatment modalities and as an alternative to surgery. The objectives were to establish the evidence on the effectiveness, safety and functional outcome of BTX-A in children with musculoskeletal conditions. A literature search using five electronic databases identified 24 studies that met our inclusion criteria. Two randomized clinical trials were included; most studies were case studies with small sample sizes and no control group. Improvements in gait pattern, function, range of motion, reduction of co-contractions, and avoidance of surgical procedures were found following BTX-A injections. Adverse events were not reported in 10 studies, minor adverse events were reported in 13 children and there were no severe adverse events. Additional doses appear safe. BTX-A is a promising treatment adjunct in improving functional outcomes in children with musculoskeletal conditions. Future studies including larger samples, longer follow-up periods and a comparison group are required to provide evidence on the effectiveness and safety of this drug in children with musculoskeletal conditions. 1. Introduction Thousands of children and adolescents across the United States suffer from musculoskeletal conditions each year [1, 2]. Common musculoskeletal conditions in children include cerebral palsy (CP), congenital muscular torticollis (CMT), Duchenne muscular dystrophy, idiopathic clubfoot, idiopathic toe walking (ITW), Legg-Calvé-Perthes disease (LCPD), limb length discrepancy, and neonatal brachial plexus palsy (NBPP). Musculoskeletal abnormalities and deformities can deprive children of physical activities, childhood experiences, and a healthy lifestyle. Besides the physical and psychosocial burden these conditions and injuries place on the child and family, these conditions also incur a financial burden for the patient and the healthcare system as multiple hospital visits are often required. Proper and timely treatment including standard approaches such as physiotherapy, casting, bracing, and surgery is essential to ensure the child optimal growth and development. Besides these traditional modalities, the use of botulinum toxins appears as a promising treatment on its own, as an adjunct to other treatment modalities and as an alternative to surgery. Several authors have
Botulinum Toxin Physiology in Focal Hand and Cranial Dystonia  [PDF]
Barbara Illowsky Karp
Toxins , 2012, DOI: 10.3390/toxins4111404
Abstract: The safety and efficacy of botulinum toxin for the treatment of focal hand and cranial dystonias are well-established. Studies of these adult-onset focal dystonias reveal both shared features, such as the dystonic phenotype of muscle hyperactivity and overflow muscle contraction and divergent features, such as task specificity in focal hand dystonia which is not a common feature of cranial dystonia. The physiologic effects of botulinum toxin in these 2 disorders also show both similarities and differences. This paper compares and contrasts the physiology of focal hand and cranial dystonias and of botulinum toxin in the management of these disorders.
Botulinum Toxin Treatment of Blepharospasm and Hemifacial Spasm
Raif ?AKMUR
N?ropsikiyatri Ar?ivi , 2010,
Abstract: Blepharospasm and hemifacial spasm are the two most common movement disorders that affect the facial muscles. Despite having different pathophysiological mechanisms, both disorders produce involuntary eyelid closure due to contractions of the orbicularis oculi muscle. The treatment of blepharospasm and hemifacial spasm most often involves the use of botulinum toxin. Although only a few double-blind, placebo-controlled studies exist, botulinum toxin injections have been accepted as a safe and efficacious treatment modality for these disorders. Complications include ptosis, blurred vision, diplopia, facial weakness and other minor side effects that usually improve in days to weeks. A large body of evidence supports the use of botulinum toxin as a first-line treatment for blepharospasm and hemifacial spasm. This review aims to present an update on the treatment of blepharospasm and hemifacial spasm with botulinum toxin type A. (Archives of Neuropsychiatry 2010; 47 Supplement: 6-10)
Therapeutic and Cosmetic uses of Botulinum Toxin  [cached]
Vinay Kant,Rita Koshal,Pawan Kumar Verma,Nrip Kishore Pankaj
Vet Scan , 2009,
Abstract: From times unknown man has greatly been benefited from uncovering and utilizing the chemicals from the natural world. Living organisms, such as plants, animals, microorganisms, offer a huge source of pharmaceutically useful medicine and toxins. Depending upon their source, the toxins are categorized as phytotoxins, mycotoxins and, zootoxins including venoms and bacterial toxins. Botulinum toxin is neurotoxic protein produced by the gram-positive, rod shaped, spore forming, strictly anaerobic bacterium Clostridium botulinum. These bacteria are widely distributed in soil and water (Dowell, 1984). Botulinum toxin is one of the most acutely toxic naturally occurring substances in the world with a lethal dose of about 200-300 pg/kg (100g could kill every human on earth. Botulinum toxin is odorless and tasteless, and shares many properties with the other bacterial toxins such as tetanospasmin and diphtheria toxin (Davis, 1993). Thousands of people in the world each year continue to be poisoned with botulinum toxin food-borne, infantile, or wound botulism but the neurotoxin is now sufficiently understood to allow it to be used as medicinal agent to paralyze specific muscles, giving temporary symptomatic relief from variety of neurologic disorders and for certain cosmetic purposes in minute doses. (Davis, 1993). The clostridia produce more protein toxins than any other bacterial genus and are a rich reservoir of toxins for research and medicinal uses. Research is underway to use these clostridial exotoxins or their toxin domains for drug delivery, prevention of food poisoning, and the treatment of cancer and other diseases. The remarkable success of botulinum toxin as a therapeutic agent has created a new field of investigation in microbiology.
Treatment of Tremor with Botulinum Toxin
Ay?e BORA TOK?AER
N?ropsikiyatri Ar?ivi , 2010,
Abstract: Tremor is one of the most frequently encountered involuntary movement disorders in clinical practice. The causes of tremor are heterogeneous, therefore, a unique approach to the management of tremor is not available. Drug management of tremor is sometimes effective, however, there are subtypes of tremor such as dystonic tremor, primary writing tremor, voice tremor and essential head tremor, which are unresponsive to oral medication. The observation of marked amelioration of severity of tremor accompanying dystonia after botulinum toxin type A (BoNT) injection suggests that BoNT can be an alternative treatment option for tremor. In this review, our aim was to summarize the published literature on BoNT treatment for different subtypes of tremor. (Archives of Neuropsychiatry 2010; 47 Supplement: 35-9)
Botulinum toxin in the treatment of sialorrhea  [PDF]
Svetel Marina,Vasi? Milan,Draga?evi? Nata?a,Pekmezovi? Tatjana
Vojnosanitetski Pregled , 2009, DOI: 10.2298/vsp0901009s
Abstract: Background/Aim. Botulinum toxin-A (BTX-A) is known to block the release of acetylcholine from motor and autonomic nerve terminals and may significantly decrease saliva production when injected intraglandulary. The aim of this study was to evaluate effects of BTX-A injections in the treatment of disabling sialorrhea in various neurological disorders. Methods. This study included 19 consecutive patients with significant sialorrhea associated with various neurological disorders. Out of them 13 patients were with Parkinson's disease, two with pantothenate kinase-associated neurodegeneration, two with multiple system atrophy, one with Wilson's disease, and one patient with postoperative sialorrhea. Botulinum toxin-A (Dysport , Ipsen Pharma) was injected into the parotid glands with (n = 7 patients) or without (n = 12 patients) ultrasound guidance. All the patients were scored before and after the treatment and in weekly intervals thereafter using the salivation item of the part II (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Results. Thirteen patients (68%) reported beneficial effect of BTX-A injection, while 6 of them (32%) had no response at all. The sialorrhea scores before and after the treatment were 3.1 ± 0.1 (range 2-4) and 1.8 ± 0.1 (range 0- 3), respectively (t = 5.636; p < 0.001). There was no difference in the magnitude of response between the groups with (t = 4.500; p = 0.004) and without (t = 3.674; p = 0.005) ultrasound control of injection sites. Adverse effects were registered in 5 patients (26%). Conclusions. Botulinum toxin-A injections to easily accessible parotid glands, without necessity for ultrasound guidance, are safe and efficaceous treatment for sialorrhea in different neurological disorders.
Botulinum toxin in the treatment of paralytic strabismus and essential blepharospasm  [cached]
Thomas Ravi,Mathai Annie,Rajeev B,Sen Subir
Indian Journal of Ophthalmology , 1993,
Abstract: As an alternative to conventional medical and surgical modalities that have met little success in the treatment of paralytic strabismus and essential blepharospasm, we explored the use of botulinum toxin as a treatment of choice in these two disorders. We used botulinum toxin in three patients with paralytic strabismus and in nine patients with essential blepharospasm. In three patients with paralytic strabismus, the botulinum toxin was injected into the ipsilateral antagonist of the paralysed muscle. The preinjection deviations ranged from 18 to 60 prism diopters. Two of these three patients achieved orthotropia around the thirtieth day and thereafter maintained it. The third patient became orthotropic on the eighteenth day, but deviation recurred and therefore required another injection of toxin. In nine patients with essential blepharospasm, botulinum toxin was injected into the orbicularis oculi muscles. Both objective and subjective improvement occurred in all nine patients within seven days and the effect lasted 12 to 15 weeks. Further injection of the toxin produced extremely beneficial results. However, the only significant complication that we encountered in both groups of strabismus and blepharospasm was ptosis, which was usually partial and temporary. From our experience, we advocate the use of botulinum toxin in the treatment of essential blepharospasm.
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