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Theuriet J, Huchon L, Luaute J, Vallet AE, Bouhour F, Pegat A. Electrophysiological abnormalities of the neuromuscular transmission in two patients with botulism-like syndrome following Botulinum-A muscle injections. Neurophysiol Clin 2024; 54:102984. [PMID: 38759365 DOI: 10.1016/j.neucli.2024.102984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/19/2024] Open
Abstract
Botulinum neurotoxin serotype A (BoNT-A) has several therapeutic indications such as spasticity and dystonia. Although its use is generally considered safe, a systemic diffusion can lead to systemic complications, and a botulism-like syndrome can occur after intramuscular injections. Herein, two adult cases who developed general muscle weakness after a BoNT-A intramuscular injection are reported. Both presented with a progressive decrement on low-frequency (LF) repetitive nerve stimulation (RNS). It is suggested that a progressive decrement on LF-RNS in muscles distant from the injection site strongly supports the diagnosis of iatrogenic botulism.
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Affiliation(s)
- Julian Theuriet
- Service d'ENMG et de Pathologies Neuromusculaires, Centre de Référence des Maladies Neuromusculaires PACA-Réunion-Rhône-Alpes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Groupement Est, 69500, Bron, France; Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, Université Lyon 1, Faculté de Médecine Lyon Est, 69008, Lyon, France
| | - Laure Huchon
- Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Groupement Sud, Saint-Genis-Laval, 69230, France
| | - Jacques Luaute
- Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Groupement Sud, Saint-Genis-Laval, 69230, France
| | - Anne-Evelyne Vallet
- Service d'ENMG et de Pathologies Neuromusculaires, Centre de Référence des Maladies Neuromusculaires PACA-Réunion-Rhône-Alpes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Groupement Est, 69500, Bron, France
| | - Françoise Bouhour
- Service d'ENMG et de Pathologies Neuromusculaires, Centre de Référence des Maladies Neuromusculaires PACA-Réunion-Rhône-Alpes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Groupement Est, 69500, Bron, France; Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, Université Lyon 1, Faculté de Médecine Lyon Est, 69008, Lyon, France
| | - Antoine Pegat
- Service d'ENMG et de Pathologies Neuromusculaires, Centre de Référence des Maladies Neuromusculaires PACA-Réunion-Rhône-Alpes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Groupement Est, 69500, Bron, France; Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, Université Lyon 1, Faculté de Médecine Lyon Est, 69008, Lyon, France.
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Facciorusso S, Spina S, Picelli A, Baricich A, Francisco GE, Molteni F, Wissel J, Santamato A. The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis. Toxins (Basel) 2024; 16:184. [PMID: 38668609 PMCID: PMC11053519 DOI: 10.3390/toxins16040184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024] Open
Abstract
Botulinum toxin type-A (BoNT-A) has emerged as a key therapeutic agent for the management of spasticity. This paper presents a comprehensive bibliometric and visual analysis of research concerning BoNT-A treatment of spasticity to elucidate current trends and future directions in this research area. A search was conducted in the Web of Science database for articles focused on the use of BoNT-A in spasticity published between 2000 and 2022. We extracted various metrics, including counts of publications and contributions from different countries, institutions, authors, and journals. Analytical methods in CiteSpace were employed for the examination of co-citations, collaborations, and the co-occurrence of keywords. Our search yielded 1489 publications. Analysis revealed a consistent annual increase in research output. The United States, United Kingdom, and Italy were the leading contributors. The top institution in this research was Assistance Publique Hopitaux, Paris. The journal containing the highest number of relevant publications was Toxins. Key frequently occurring keywords were 'stroke', 'cerebral palsy', 'adult spasticity', and 'upper extremity'. This study identified 12 clusters of keywords and 15 clusters of co-cited references, indicating the main focus areas and emerging themes in this field. This study comprehensively analyzed and summarized trends in BoNT-A research in the field of spasticity over the past 22 years.
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Affiliation(s)
- Salvatore Facciorusso
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Stefania Spina
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy;
| | - Alessio Baricich
- Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Gerard E. Francisco
- Department of Physical Medicine & Rehabilitation, University of Texas Health McGovern Medical School, Houston, TX 77030, USA;
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital Como, 23845 Costa Masnaga, Italy;
| | - Jörg Wissel
- Department of Neurorehabilitation and Physical Therapy, Vivantes Hospital Spandau, 13585 Berlin, Germany;
| | - Andrea Santamato
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
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Nicoletti MM, Anatriello A, Liguori V, Cantone A, di Mauro G, Izzo I, Lettera N, Della Ragione JM, Campitiello MR, Cosenza V, Scavone C. Skin Toxicities Associated with Botulin Toxin Injection for Aesthetic Procedures: Data from the European Spontaneous Reporting System. Pharmaceuticals (Basel) 2023; 16:1611. [PMID: 38004476 PMCID: PMC10675122 DOI: 10.3390/ph16111611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Botulinum toxin is a protein deriving from the bacteria Clostridium botulinum and it is widely used for the treatment of a variety of muscle hyperactivity syndromes and for cosmetic indications. Having a long-lasting effect, Botulinum toxin type A (BTA) is one of the most botulin toxin products used. Even if BTA has shown benefits in reducing the vertical lines between the eyebrows, Adverse Drug Reactions (ADRs) have been experienced as well, of which the most common ones are headache and drooping eyelids. In addition, since other local and systemic risks have been identified, a non-interventional post-authorization safety study (PASS) has been started. The aim of the present study was to report cases of skin toxicity associated with this drug, considering Individual Case Safety Reports (ICSRs) existing on the Eudravigilance website. Among 1464 ICSRs sent to the EV database, 718 ICSRs, including 5154 PTs, reported BTA as a suspected drug associated with cutaneous toxicity. The majority of patients experiencing BTA-induced skin toxicity were female (92.1%) belonging mostly to the age group of 18-64 years. The most serious criteria, when reported, were "Other Medically Important Condition" and "Caused/prolonged hospitalization", although the outcome was mainly reported as "Unknown". The most reported PTs, related to skin disorders, were: "Erythema", "Rash", "Pruritus", "Urticaria", "Swelling face", "Brow ptosis", "Eyelid ptosis", "Injection site pain", and "Angioedema". Considering that in most ICSRs, ADRs related to skin disorders were symptoms of hypersensitivity reactions which in some conditions could be life-threatening, further studies are required to better define the safety profile of BTA used for aesthetic procedures.
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Affiliation(s)
| | - Antonietta Anatriello
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.A.); (V.L.); (A.C.)
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Valerio Liguori
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.A.); (V.L.); (A.C.)
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Andrea Cantone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.A.); (V.L.); (A.C.)
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Gabriella di Mauro
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
- UOC Pharmacy, AORN Santobono Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - Imma Izzo
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Nicoletta Lettera
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Joao Marcos Della Ragione
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Maria Rosaria Campitiello
- Department of Obstetrics and Gynaecology and Physiopathology of Human Reproduction, ASL Salerno, 84124 Salerno, Italy;
| | - Vincenzo Cosenza
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DiSTABiF), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.A.); (V.L.); (A.C.)
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
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Awadeen A, Fareed M, Elameen AM. The Impact of Botulinum Toxin Injection on the Outcomes of Breast Surgeries: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2023; 47:1771-1784. [PMID: 37464214 PMCID: PMC10582146 DOI: 10.1007/s00266-023-03466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/11/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Breast surgeries aim to restore the natural appearance of the breasts with acceptable functional and cosmetic outcomes. However, these surgical procedures may be associated with considerable adverse events. The present systematic review and meta-analysis was designed to reveal the functional and aesthetic outcomes of botulinum toxins (BTX) injection in patients subjected to breast surgeries. METHODS A literature review was performed up to 21 September 2022. All clinical studies included patients older than 18 years old and treated with BTX injection for breast surgeries were included. RESULTS The present study included 12 articles, encompassing 496 patients. The average dosage of BTX injection ranged from 20 to 100 units. Injecting BTX significantly reduced the mean post-operative opioid analgesics usage (SMD -1.577; 95% -2.087, -1.067; P < 0.001) and the risk of severe animation deformity (RR 12.37; 95% 1.76, 86.66; P = 0.01). There was a statistically significant higher mean expansion volume per visit in the BTX injection group (SMD 1.166; 95% 0.313, 2.018; P = 0.007). There was no statistically significant impact of BTX injection on the risk of surgical site infection (RR 0.59; 95% 0.15, 2.34; P = 0.45) and seroma (RR 0.51; 95% 0.03, 10.15; P = 0.66). CONCLUSIONS The present study revealed the potential benefits of BTX injection in breast surgeries. This included reduced post-operative analgesics, as well as the risk of severe animation deformity. This was accomplished with increased expansion volume per visit and a similar risk of BTX injection-related complications. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Abdelrahman Awadeen
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (Boys), Al-Azhar University, Al Mokhaym Al Daem, Gameat Al Azhar, Nasr City, Cairo, Egypt.
| | - Mohamed Fareed
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (Boys), Al-Azhar University, Al Mokhaym Al Daem, Gameat Al Azhar, Nasr City, Cairo, Egypt
| | - Ali Mohamed Elameen
- Department of Plastic and Reconstructive Surgery, El-Sahel Teaching Hospital, Cairo, Egypt
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Pini Prato A, Faticato MG, Mazzola C, Arrigo S, Mattioli G, Arnoldi R, Mosconi M. Intrasphincteric Botox injections in Hirschsprung's disease: indications and outcome in 64 procedures over a ten-year period. Minerva Pediatr (Torino) 2023; 75:482-489. [PMID: 30419742 DOI: 10.23736/s2724-5276.18.05238-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Intrasphincteric botulinum toxin (Botox) injection for symptomatic postoperative anal achalasia in Hirschsprung's disease (HSCR) has found wide application in the last twenty years. The aim of this study was to describe effectiveness and functional outcome of a series of patients treated over a 10-year period. METHODS All consecutive HSCR patients who received intrasphincteric Botox injections between January 2007 and December 2016 were included. Demographic data and clinical features were collected. A detailed questionnaire focusing on outcome in the medium and long-term was administered to all families. RESULTS In the study period 64 intrasphincteric Botox injections were performed in 31 patients. Completed questionnaires were returned by 27 out of 28 eligible patients (96%) reporting improvement or symptoms resolution in 16 (59%). The highest success rates were experienced by patients younger than 4, with long HSCR forms and with recurrent enterocolitis (75%, 100% and 100% of success rates, respectively). No major complications occurred. Minor complications were described by 7 patients (26%). CONCLUSIONS Intrasphincteric Botox injection proved to be feasible, safe and reasonably effective in children with HSCR and postoperative anal achalasia. Infants and toddlers with long HSCR forms and recurrent bouts of enterocolitis are those who would benefit most from this treatment.
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Affiliation(s)
- Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy -
| | - Maria G Faticato
- Department of Pediatric Surgery, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
- Department of Neuroscience, Ophthalmology, Rehabilitation, Genetics and Maternal-Infant Science - DINOGMI, University of Genoa, Genoa, Italy
| | - Cinzia Mazzola
- Department of Pediatric Surgery, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Serena Arrigo
- Unit of Pediatric Gastroenterology, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Girolamo Mattioli
- Department of Pediatric Surgery, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
- Department of Neuroscience, Ophthalmology, Rehabilitation, Genetics and Maternal-Infant Science - DINOGMI, University of Genoa, Genoa, Italy
| | - Rossella Arnoldi
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Manuela Mosconi
- Department of Pediatric Surgery, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
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Jost WH, Kaňovský P, Hast MA, Hanschmann A, Althaus M, Patel AT. Pooled Safety Analysis of IncobotulinumtoxinA in the Treatment of Neurological Disorders in Adults. Toxins (Basel) 2023; 15:353. [PMID: 37368654 DOI: 10.3390/toxins15060353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/27/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
The pooled incidences of treatment-emergent adverse events (TEAEs) were examined by indication using the integrated clinical database of Merz-sponsored, placebo-controlled, or repeat-dose studies of incobotulinumtoxinA in adults with cervical dystonia, blepharospasm, limb spasticity, sialorrhea, or essential tremor of the upper limb. Overall incidences of TEAEs, serious TEAEs, TEAEs leading to discontinuation, fatal TEAEs, TEAEs of special interest (TEAESIs; indicating possible toxin spread), and treatment-related (TR) events were determined for incobotulinumtoxinA and placebo after a single injection and for repeated dose cycles of incobotulinumtoxinA. The most frequent events after a single dose of incobotulinumtoxinA are summarized. After a single cycle, incidences of overall TEAEs were similar between incobotulinumtoxinA and the placebo in most indications, although between-indication differences were observed. Few TEAEs led to incobotulinumtoxinA discontinuation; there were no fatal TEAEs with incobotulinumtoxinA. In general, repeated cycles did not increase the incidence of any event. The most frequent TR-TEAEs were indication-dependent, including dysphagia for indications affecting the head or neck. The TR-TEAESIs across all indications were most commonly muscular weakness, dysphagia and dry mouth. Overall, the results of this pooled analysis support and extend the favorable safety and tolerability profile of incobotulinumtoxinA for the treatment of adult neurological disorders established by individual clinical studies.
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Affiliation(s)
| | - Petr Kaňovský
- Faculty of Medicine and Dentistry and University Hospital, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
| | | | | | | | - Atul T Patel
- Kansas City Bone and Joint Clinic, Overland Park, KS 66211, USA
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Shear Wave Velocity to Evaluate the Effect of Botulinum Toxin on Post-Stroke Spasticity of the Lower Limb. Toxins (Basel) 2022; 15:toxins15010014. [PMID: 36668834 PMCID: PMC9865964 DOI: 10.3390/toxins15010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: The evaluation of muscles with spasticity using ultrasound elastography has attracted attention recently, and the shear wave velocity (SWV) technique can measure the mechanical properties of tissues objectively and quantitatively. The purpose of this study was to evaluate the effect of using SWV to assess the effect of Botulinum toxin type A (BoNT-A) treatment in adult patients with post-stroke lower limb spasticity. (2) Methods: We assessed the modified Ashworth Scale, the modified Tardieu Scale, and SWV at rest and after stretching before and at 1 month after BoNT-A treatment in 10 adult participants with post-stroke lower limb spasticity. (3) Results: Significant changes in SWV of the ankle joint in maximum dorsiflexion to the extent possible (SWV stretched) were observed after BoNT-A treatment. SWV stretched was positively correlated with joint range of motion. Participants whose joint range of motion did not improve (i.e., gastrocnemius medialis muscle (GCM) extension distance did not change) had significantly more reductions in SWV stretched after BoNT-A treatment. (4) Conclusions: Our results suggest that the SWV measurements may serve as a quantitative assessment to determine the effect of the BoNT-A treatment in adult stroke patients. SWV measurements to assess GCM spasticity should consider the effects of tension, material properties and activation level of muscles. The challenge is to measure SWV with matching limb positions in patients without contractures.
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Hara T, Niimi M, Yamada N, Shimamoto Y, Masuda G, Hara H, Abo M. Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis. Disabil Rehabil 2022; 44:6815-6823. [PMID: 34547217 DOI: 10.1080/09638288.2021.1977394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE We analysed the effect of botulinum neurotoxin A therapy (BoNT-A) with intensive rehabilitation on the upper limb (UL) spasticity in post-stroke patients by classifying function by UL movement and examining differences in functional improvement. MATERIALS AND METHODS In this non-randomized, controlled study. The patient function was classified into groups from the score of the sub-categories of the Fugl-Meyer Assessment (FMA-UE) before treatment in the Intervention group by hierarchical cluster analysis. RESULTS A total of 139 patients in the Intervention group were classified into six groups. All groups showed a significant improvement in FMA-UE after the intervention. In the group scoring 19-31 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, and finger, a significant improvement was observed compared to the Control group. Further, in the group scoring 26-47 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, wrist, and finger, a significant improvement was observed compared to the Control group. CONCLUSIONS In this study, BoNT-A and intensive rehabilitation showed improvement in spasticity and UL function. A high therapeutic effect is expected in patients with moderate impairment levels who have voluntary movement in whole UL or in UL except for the wrist.IMPLICATIONS FOR REHABILITATIONHierarchical cluster analysis focusing on the Fugl-Meyer Assessment of the Upper Extremity sub-categories may be useful for studies aimed to improve the upper arm function.Botulinum Neurotoxin A therapy (BoNT-A) and intensive rehabilitation in post-stroke patients showed improvement in spasticity and upper arm function.The degree of the upper arm function before the intervention may affect the improvement effect of BoNT-A and intensive rehabilitation.In the motor function, the post-stroke patients with a moderate impairment level who have voluntary movement of the whole upper limb or upper limb except for the wrist are most likely to receive these therapeutic effects.
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Affiliation(s)
- Takatoshi Hara
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Masachika Niimi
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Naoki Yamada
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Yusuke Shimamoto
- Department of Rehabilitaion Medicine, Kikyougahara Hospital, Nagano, Japan
| | - Go Masuda
- Department of Rehabilitaion Medicine, Kyoto Ohara Memorial Hospital, Kyoto, Japan
| | - Hiroyoshi Hara
- Department of Rehabilitaion Medicine, Isawa Kyoritsu Hospital, Yamanashi, Japan
| | - Masahiro Abo
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
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Byun J, Kwak S, Kwon JH, Shin M, Lee DK, Rhee CH, Kang WH, Oh JW, Cruz DJM. Comparative Pharmacodynamics of Three Different Botulinum Toxin Type A Preparations following Repeated Intramuscular Administration in Mice. Toxins (Basel) 2022; 14:toxins14060365. [PMID: 35737026 PMCID: PMC9227525 DOI: 10.3390/toxins14060365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022] Open
Abstract
Botulinum neurotoxin type A (BoNT/A) causes muscle paralysis by blocking cholinergic signaling at neuromuscular junctions and is widely used to temporarily correct spasticity-related disorders and deformities. The paralytic effects of BoNT/A are time-limited and require repeated injections at regular intervals to achieve long-term therapeutic benefits. Differences in the level and duration of effectivity among various BoNT/A products can be attributed to their unique manufacturing processes, formulation, and noninterchangeable potency units. Herein, we compared the pharmacodynamics of three BoNT/A formulations, i.e., Botox® (onabotulinumtoxinA), Xeomin® (incobotulinumtoxinA), and Coretox®, following repeated intramuscular (IM) injections in mice. Three IM injections of BoNT/A formulations (12 U/kg per dose), 12-weeks apart, were administered at the right gastrocnemius. Local paresis and chemodenervation efficacy were evaluated over 36 weeks using the digit abduction score (DAS) and compound muscle action potential (CMAP), respectively. One week after administration, all three BoNT/A formulations induced peak DAS and maximal reduction of CMAP amplitudes. Among the three BoNT/A formulations, only Coretox® afforded a significant increase in paretic effects and chemodenervation with a prolonged duration of action after repeated injections. These findings suggest that Coretox® may offer a better overall therapeutic performance in clinical settings.
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Affiliation(s)
- Jaeyoon Byun
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea
| | - Seongsung Kwak
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Jin-Hee Kwon
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Minhee Shin
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Dong-Kyu Lee
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Chang-Hoon Rhee
- Medytox Osong R&D Center, 102 Osongsaengmyeong 4-ro, Osong-eup, Heungdeok-gu, Cheongju-si 28161, Korea;
| | - Won-ho Kang
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Jae-Wook Oh
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea
- Correspondence: (J.-W.O.); (D.J.M.C.); Tel.: +82-2-2049-6271 (J.-W.O.); +82-31-8065-8254 (D.J.M.C.)
| | - Deu John M. Cruz
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
- Correspondence: (J.-W.O.); (D.J.M.C.); Tel.: +82-2-2049-6271 (J.-W.O.); +82-31-8065-8254 (D.J.M.C.)
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Toxin-associated infectious diseases: tetanus, botulism and diphtheria. Curr Opin Neurol 2021; 34:432-438. [PMID: 33840775 DOI: 10.1097/wco.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the implementation of immunization programs also in low-and-middle-income countries (LAMICs) and by improving hygiene conditions. But still, single cases occur, and they need fastest possible recognition and management. RECENT FINDINGS Over the past 20 years, the incidence of neonatal tetanus has declined by more than 90%. This success was achieved by immunizing women in reproductive age in areas of high risk as sub-Saharan Africa and parts of Asia. Larger regional outbreaks of diphtheria have been reported from the former Soviet Union in the 1990s and from India in 2017. Botulism is still rare, mainly seen in infants and, in recent years, in intravenous drug abusers. SUMMARY Tetanus, diphtheria and botulism are rarities in high-income countries (HICs) with unlimited access to immunization programs and standard hygiene procedures. The diagnosis of all three diseases is still, even in the 21st century, based upon patient's history and clinical signs and symptoms. Neither biochemical bedside tests nor neuroradiological investigations help to confirm the diagnosis in an emergency situation.
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Danchenko N, Johnston KM, Haeussler K, Whalen J. Comparative efficacy, safety, and cost-effectiveness of abobotulinumtoxinA and onabotulinumtoxinA in children with upper limb spasticity: a systematic literature review, indirect treatment comparison, and economic evaluation. J Med Econ 2021; 24:949-961. [PMID: 34340647 DOI: 10.1080/13696998.2021.1957582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The objective of this study was to compare clinical- and cost-effectiveness of type A botulinum toxin (BoNT-A) therapies for management of pediatric upper limb spasticity, including AbobotulinumtoxinA (aboBoNT-A) and Onabotulinumtoxin A (onaBoNT-A). METHODS Systematic literature review and indirect treatment comparisons were conducted of randomized controlled trials reporting efficacy and safety outcomes. Efficacy was characterized by Modified Ashworth Scale (MAS) and Ashworth Scale (AS) up to 16-weeks post-injection. Results were used to inform a cost-effectiveness model with a 1-year time horizon, linking response rates with health-related quality-of-life (HRQoL) outcomes and costs from a UK perspective. Other data sources included in the cost-effectiveness model were drug unit costs, health care resource utilization based on UK physician survey, and HRQoL impacts of adverse events associated with oral anti-spasticity therapies. Results were characterized as cost per quality-adjusted life year and cost per responder. RESULTS Six studies were included in evidence syntheses. There was a trend towards greater response rate for aboBoNT-A which resulted in improved HRQoL and lower annual costs compared with onaBoNT-A. Safety outcomes were similar across BoNT-A therapies. In cost-effectiveness analysis, aboBoNT-A was an economically dominant therapy with respect to cost per quality-adjusted life year. The cost per responder at 1 year was estimated to be £39,056 for aboBoNT-A vs. £54,831 for onaBoNT-A. LIMITATIONS AND CONCLUSIONS Based on observed safety and efficacy data, aboBoNT-A is estimated to result in higher treatment response and consequently increased quality-of-life and reduced costs, vs. onaBoNT-A in children with upper limb spasticity. Limitations to the study include study heterogeneity limited details available for onaBoNT-A studies (e.g. use of physical therapy), and limited availability of responder data. Where assumptions were required, they were made to be conservative towards aboBoN-A.
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Affiliation(s)
- N Danchenko
- IPSEN 65 Quai Georges Gorse Boulogne-Billancourt, Île-de-France, France
| | - K M Johnston
- Broadstreet Health Economics & Outcomes Research, Vancouver, Canada
| | | | - J Whalen
- IPSEN 1234 Madeup street Slough, London, UK
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12
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Halakoo S, Ehsani F, Masoudian N, Zoghi M, Jaberzadeh S. Does anodal trans-cranial direct current stimulation of the damaged primary motor cortex affects wrist flexor muscle spasticity and also activity of the wrist flexor and extensor muscles in patients with stroke?: a Randomized Clinical Trial. Neurol Sci 2020; 42:2763-2773. [PMID: 33150514 DOI: 10.1007/s10072-020-04858-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/24/2020] [Indexed: 11/27/2022]
Abstract
Spasticity is a common symptom in stroke survivors. This study is double-blinded, sham-controlled randomized, clinical trial with three parallel arms. The aim of the study was to investigate the effects of anodal trans-cranial direct current stimulation (a-tDCS) over the damaged primary motor cortex (M1) on spasticity of the wrist flexor and also the activity of wrist flexor and extensor muscles in sub-acute stroke patients. This study was performed on 32 stroke patients. The patients are assigned to three groups (intervention, sham, and control). All participants in the first two groups received 20-min concurrent M1 a-tDCS or sham tDCS and functional electrical stimulation (FES) for 10 sessions (5 sessions per week), while participants in control group were given only 20-min FES for 10 sessions. Modified Ashworth scale of wrist flexors and also electromyography (EMG) activity of flexor carpi radialis (FCR) and extensor carpi radialis (ECR) were recorded before, immediately, and 1 month after the interventions. A significant reduction was shown in the MAS and EMG activity of FCR muscle at passive rest position of the wrist, immediately and 1 month after the intervention in M1 a-tDCS compared to sham and control groups (p < 0.001). Also, the EMG activity of FCR and ECR muscles during active wrist flexion and extension increased immediately and 1 month after intervention in M1 a-tDCS compared to the other groups, respectively (p < 0.001). M1 a-tDCS can significantly decrease the spasticity of wrist flexor muscle and also increase the wrist flexor and extensor muscles activity in stroke patients during active flexion and extension.
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Affiliation(s)
- Sara Halakoo
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Nooshin Masoudian
- Neurology Ward, Department of Internal Medicine, School of Medicine, Kosar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Zoghi
- Discipline of Physiotherapy, Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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13
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Fairmont I, Winkler A. Novel Cosmetic Uses of Botulinum Toxin in the Head and Neck. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Kandasamy M. Perspectives for the use of therapeutic Botulinum toxin as a multifaceted candidate drug to attenuate COVID-19. MEDICINE IN DRUG DISCOVERY 2020; 6:100042. [PMID: 32352081 PMCID: PMC7189194 DOI: 10.1016/j.medidd.2020.100042] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/29/2022] Open
Abstract
The recent outbreak of coronavirus disease (COVID-19) resulting from a distinctive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues to evolve in many countries and pose life-threatening clinical issues to global public health. While the lungs are the primary target for the SARS-CoV-2-mediated pathological consequence, the virus appears to invade the brain and cause unpredicted neurological deficits. In the later stage, COVID-19 can progress to pneumonia, acute respiratory failure, neurodegeneration and multi-organ dysfunctions leading to death. Though a significant portion of individuals with COVID-19 has been recovering from clinical symptoms, the pathological impact of the SARS-CoV-2 infection on the structural and functional properties of the lungs, heart, brain and other organs at the post-recovery state remains unknown. Presently, there is an urgent need for a remedial measure to combat this devastating COVID-19. Botulinum toxins (BoNTs) are potent neurotoxins that can induce paralysis of muscle and acute respiratory arrest in humans. However, a mild dose of the purified form of BoNT has been known to attenuate chronic cough, dyspnoea, pneumonia, acute respiratory failure, abnormal circulation, cardiac defects and various neurological deficits that have been recognised as the prominent clinical symptoms of COVID-19. Considering the fact, this review article provides 1) an overview of the SARS-CoV-2 mediated pathological impact on the lungs, heart and brain, 2) signifies the therapeutic uses of BoNTs against pulmonary failure, cardiac arrest and neurological deficits, and 3) emphasize the rationality for the possible use of BoNT to prevent SARS-CoV-2 infection and manage COVID-19.
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Affiliation(s)
- Mahesh Kandasamy
- Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli – 620024, Tamilnadu, India.
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Lee KC, Pascal AB, Halepas S, Koch A. What Are the Most Commonly Reported Complications With Cosmetic Botulinum Toxin Type A Treatments? J Oral Maxillofac Surg 2020; 78:1190.e1-1190.e9. [PMID: 32192924 DOI: 10.1016/j.joms.2020.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the present study was to determine the most commonly reported complications with cosmetic botulinum toxin type A (BTX-A) treatments. MATERIALS AND METHODS The present study was a cross-sectional review of the US Food and Drug Administration (FDA) Adverse Event Reporting System. From January 2014 through September 2019, records were included in the study sample if they implicated Botox (onabotulinumtoxinA), Dysport (abobotulinumtoxinA), Xeomin (incobotulinumtoxinA), or Jeuveau (prabotulinumtoxinA-xvfs), and if the indication for use had been to perform a cosmetic skin procedure. The study predictors included patient (ie, age, weight, gender) and treatment (ie, product, country of treatment, 10 most common reactions) characteristics. The study outcome was the frequency of serious events as defined by the standard FDA definition for biologic products. A multivariate logistical regression model was created for the study outcome using all significant univariate predictors. RESULTS The final sample included 10,577 reports detailing 29,471 adverse events and covering 1,473 reactions. The mean patient age was 48.4 ± 11.2 years, and nearly all patients were women (95.0%). The most commonly reported events were pain (9.3%), swelling (6.4%), and eyelid/brow ptosis (6.1%). Serious outcomes occurred in 13.5% of patients. In the multivariate model, serious outcomes were independently associated with older age, heavier weight, headache, allergy, vision changes, fatigue, facial paresis, and dizziness but notably were not associated with pain, swelling, or ptosis. CONCLUSIONS A wide range of alleged complications have been reported to the FDA, many of which were likely not mediated through injection or direct toxin effects. Patients may have inaccurately attributed some of their symptoms to BTX-A, and providers should be prepared to dispel any misinformation. Local complications such as pain, swelling, and ptosis were the most common reactions but were not associated with serious patient outcomes. However, constitutional symptoms should be approached more carefully.
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Affiliation(s)
- Kevin C Lee
- Resident, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY.
| | - Alexander B Pascal
- Dental Student, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Steven Halepas
- Resident, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Alia Koch
- Program Director, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
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Hara T, Momosaki R, Niimi M, Yamada N, Hara H, Abo M. Botulinum Toxin Therapy Combined with Rehabilitation for Stroke: A Systematic Review of Effect on Motor Function. Toxins (Basel) 2019; 11:toxins11120707. [PMID: 31817426 PMCID: PMC6950173 DOI: 10.3390/toxins11120707] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/16/2022] Open
Abstract
Aim: The purpose of this study was to examine the effectiveness of botulinum toxin A (BoNT-A) therapy combined with rehabilitation on motor function in post-stroke patients. Methods: The following sources up to December 31, 2018, were searched from inception for articles in English: Pubmed, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL. Trials using injections of BoNT-A for upper and lower limb rehabilitation were examined. We excluded studies that were not performed for rehabilitation or were not evaluated for motor function. Results: Twenty-six studies were included. In addition to rehabilitation, nine studies used adjuvant treatment to improve spasticity or improve motor function. In the upper limbs, two of 14 articles indicated that significant improvement in upper limb motor function was observed compared to the control group. In the lower limbs, seven of 14 articles indicated that significant improvement in lower limb motor function was observed compared to the control group. Conclusions: The effect of combined with rehabilitation is limited after stroke, and there is not sufficient evidence, but results suggest that BoNT-A may help to improve motor function. In future studies, the establishment of optimal rehabilitation and evaluation times of BoNT-A treatment will be necessary for improving motor function and spasticity.
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Affiliation(s)
- Takatoshi Hara
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
- Correspondence: ; Tel.: +81-3-3433-1111; Fax: +81-3-3431-1206
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa 213-8507, Japan
| | - Masachika Niimi
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Hiroyoshi Hara
- Rehabilitation Center, Ainomiyako Neurosurgery Hospital, Osaka 538-0044, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
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Thomas AJ, Larson MO, Braden S, Cannon RB, Ward PD. Effect of 3 Commercially Available Botulinum Toxin Neuromodulators on Facial Synkinesis: A Randomized Clinical Trial. JAMA FACIAL PLAST SU 2019; 20:141-147. [PMID: 28973094 DOI: 10.1001/jamafacial.2017.1393] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Botulinum toxin neuromodulators are an important treatment for facial synkinesis. Whether a difference in efficacy exists among the 3 different botulinum neuromodulators used in treating this condition remains unknown. Objective To evaluate the effectiveness of 3 commercially available botulinum toxin neuromodulators in the treatment of facial synkinesis. Design, Setting, and Participants In this single-blind, 3-arm comparison randomized clinical trial, 28 patients at the Facial Nerve Center, University of Utah, Salt Lake City, were randomized to onabotulinumtoxinA, abobotulinumtoxinA, or incobotulinumtoxinA treatment. Each patient was given the Synkinesis Assessment Questionnaire (SAQ) to assess severity of synkinesis before treatment and 1, 2, and 4 weeks after treatment, and improvements were compared among the groups. Data were collected from July 3, 2012, to March 31, 2015. Interventions Botulinum toxin type A neuromodulator (onabotulinumtoxinA, abobotulinumtoxinA, or incobotulinumtoxinA) injected into synkinetic areas of the face. Main Outcomes and Measures Synkinesis assessed using the SAQ (score range, 20-100; lower scores indicate less severe synkinesis) before treatment and 1, 2, and 4 weeks after treatment. Results A total of 28 patients (mean [SD] age, 49.1 [18.5] years; 8 [28.6%] male and 20 [71.4%] female), with 6 patients enrolled multiple times, received 38 treatments (15 onabotulinumtoxinA, 13 abobotulinumtoxinA, and 10 incobotulinumtoxinA). No significant difference existed in baseline pretreatment SAQ scores among the 3 groups. Mean (SD) SAQ score improvement at 4 weeks was 41% (31%) for the onabotulinumtoxinA, 42% (20%) for the abobotulinumtoxinA, and 17% (18%) for the incobotulinumtoxinA groups. No significant differences were noted in SAQ score improvements among the 3 groups at weeks 1 and 2 after treatment (week 1 mean improvements of 42% in the onabotulinumtoxinA, 45% in the abobotulinumtoxinA, and 26% in the incobotulinumtoxinA groups; P = .19; week 2 mean improvements of 43% in the onabotulinumtoxinA, 46% in the abobotulinumtoxinA, and 28% in the incobotulinumtoxinA groups; P = .20). The difference in mean SAQ score improvement for abobotulinumtoxinA vs incobotulinumtoxinA from pretreatment to 4 weeks after treatment was not significant (30 vs 12 points; P = .11) despite a significant difference in mean total SAQ score for abobotulinumtoxinA vs incobotulinumtoxinA (40.34 vs 58.00; P = .02). Conclusions and Relevance AbobotulinumtoxinA had similar efficacy to onabotulinumtoxinA and incobotulinumtoxinA for the management of facial synkinesis up to 4 weeks after treatment. IncobotulinumtoxinA had significantly less effect on SAQ score improvement than onabotulinumtoxinA at 4 weeks, perhaps because of the shorter duration of action. Shorter intervals between treatments or larger doses may be required when using incobotulinumtoxinA treatment for facial synkinesis. Trial Registration clinicaltrials.gov Identifier: NCT03048383. Level of Evidence 1.
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Affiliation(s)
- Andrew J Thomas
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Michael O Larson
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Samuel Braden
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Richard B Cannon
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - P Daniel Ward
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
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Sandrini G, Baricich A, Cisari C, Paolucci S, Smania N, Picelli A. Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey. FUNCTIONAL NEUROLOGY 2019; 33:37-43. [PMID: 29633695 DOI: 10.11138/fneur/2018.33.1.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present paper provides practical guidance on the management of adult spasticity with OnabotulinumtoxinA. Advisory Board members reviewed the available evidence and discussed their personal experiences in order to address the unmet needs in the management of spasticity with botulinum toxin type A identified by the recent Italian Real-Life Post-Stroke Spasticity Survey. Stroke patients should be referred to spasticity services that have adequate facilities and multidisciplinary teams with the necessary training, competence and expertise. The current literature shows a strong correlation between the development of post-stroke spasticity and the degree of central sensorimotor system destruction/disorganization. Use of tools such as the Poststroke Checklist may help clinicians in the long-term follow-up of stroke patients. The maximum dose of onabotulinumtoxinA - according to the current literature this ranges from 300U to 400U for upper limb and from 500U to 600U for lower limb aggregate postures - should be re-considered. In addition, there is a need for future consensus (also based on pharmacoeconomic considerations) on consistent clinical care models for the management of patients with post-stroke spasticity.
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Hara T, Abo M, Hara H, Sasaki N, Yamada N, Niimi M, Shimamoto Y. The Effect of Repeated Botulinum Toxin A Therapy Combined with Intensive Rehabilitation on Lower Limb Spasticity in Post-Stroke Patients. Toxins (Basel) 2018; 10:toxins10090349. [PMID: 30200281 PMCID: PMC6162421 DOI: 10.3390/toxins10090349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study is a retrospective investigation of the effects of repetitive botulinum toxin A therapy (BoNT-A) and intensive rehabilitation (IR) on lower limb spasticity in post-stroke patients. Methods: Thirty-five post-stroke patients was included in this study and received BoNT-A for the first time. A 12-day inpatient protocol was with 4 cycles of the treatment protocol. The severity of spasticity, motor function and brace status were evaluated. Results: The modified Ashworth Scale (MAS) score of ankle dorsiflexors, range of motion, walking speed and balancing ability were significantly improved after cycle 1. The improvement of spasticity and motor function was persistent through cycles 2–4. One-third of brace users were able to discontinue the use of a brace. All of these brace users showed a forward gait pattern prior to therapy. Conclusions: Repeated BoNT-A combined with IR improved lower limb spasticity in post-stroke patients. Our results suggest that patients who show the forward gait pattern prior to therapy may be able to discontinue the use of their brace after therapy.
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Affiliation(s)
- Takatoshi Hara
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
- Department of Rehabilitaion Medicine, Kikyogahara Hospital 1295, 3996461 Nagano, Japan.
| | - Masahiro Abo
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
| | - Hiroyoshi Hara
- Department of Rehabilitaion Medicine, Kikyogahara Hospital 1295, 3996461 Nagano, Japan.
| | - Nobuyuki Sasaki
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
| | - Naoki Yamada
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
| | - Masachika Niimi
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
| | - Yusuke Shimamoto
- Department of Rehabilitaion Medicine, Kikyogahara Hospital 1295, 3996461 Nagano, Japan.
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Moga MA, Dimienescu OG, Bălan A, Scârneciu I, Barabaș B, Pleș L. Therapeutic Approaches of Botulinum Toxin in Gynecology. Toxins (Basel) 2018; 10:toxins10040169. [PMID: 29690530 PMCID: PMC5923335 DOI: 10.3390/toxins10040169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 12/15/2022] Open
Abstract
Botulinum toxins (BoNTs) are produced by several anaerobic species of the genus Clostridium and, although they were originally considered lethal toxins, today they find their usefulness in the treatment of a wide range of pathologies in various medical specialties. Botulinum neurotoxin has been identified in seven different isoforms (BoNT-A, BoNT-B, BoNT-C, BoNT-D, BoNT-E, BoNT-F, and BoNT-G). Neurotoxigenic Clostridia can produce more than 40 different BoNT subtypes and, recently, a new BoNT serotype (BoNT-X) has been reported in some studies. BoNT-X has not been shown to actually be an active neurotoxin despite its catalytically active LC, so it should be described as a putative eighth serotype. The mechanism of action of the serotypes is similar: they inhibit the release of acetylcholine from the nerve endings but their therapeutically potency varies. Botulinum toxin type A (BoNT-A) is the most studied serotype for therapeutic purposes. Regarding the gynecological pathology, a series of studies based on the efficiency of its use in the treatment of refractory myofascial pelvic pain, vaginism, dyspareunia, vulvodynia and overactive bladder or urinary incontinence have been reported. The current study is a review of the literature regarding the efficiency of BoNT-A in the gynecological pathology and on the long and short-term effects of its administration.
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Affiliation(s)
- Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Oana Gabriela Dimienescu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Andreea Bălan
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Ioan Scârneciu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Barna Barabaș
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Liana Pleș
- Clinical Department of Obstetrics and Gynecology, The Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania.
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Picelli A, Baricich A, Cisari C, Paolucci S, Smania N, Sandrini G. The Italian real-life post-stroke spasticity survey: unmet needs in the management of spasticity with botulinum toxin type A. FUNCTIONAL NEUROLOGY 2018; 32:89-96. [PMID: 28676142 DOI: 10.11138/fneur/2017.32.2.089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The present national survey seeking to identify unmet needs in the management of spasticity with botulinum toxin type A focused on the use of OnabotulinumoxinA, since this is the brand with the widest range of licensed indications in Italy. Physicians from twenty-four Italian neurorehabilitation units compiled a questionnaire about "real-life" post-stroke spasticity management. OnabotulinumtoxinA was reported to be used in the following average doses: upper limb 316.7 ± 79.1 units; lower limb 327.8 ± 152.3; upper and lower limb 543.7 ± 123.7 units. Of the physicians surveyed, 37.5% felt that increasing the frequency of OnabotulinumtoxinA injection would improve its efficacy; 70.8% use electrical stimulation/electromyography guidance (one fourth of injections with no instrumental guidance). Instrumental evaluation was used by 41.7% of the physicians. The participants expressed the view that early identification of post-stroke spasticity would be facilitated by the availability of a post-stroke checklist, and that this should be used by physiotherapists (91.7%), physiatrists (58.3%), family doctors (50%), stroke unit physicians (25%), patients and caregivers (79.2%). According to our findings, the management of poststroke spasticity has several unmet needs that, were they addressed, might improve these patients' clinical outcomes and quality of life. These needs concern patient follow-up, where a clearly defined pathway is lacking; furthermore, there is a need to use maximum doses per treatment and to ensure early intervention on post-stroke spasticity.
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Lee S, Park S, Lew H. Long-term Efficacy of Botulinum Neurotoxin-A Treatment for Essential Blepharospasm. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:1-7. [PMID: 29376224 PMCID: PMC5801084 DOI: 10.3341/kjo.2017.0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose In the present study, we investigated the treatment efficacy and clinical outcomes of botulinum neurotoxin-A (BoNT-A) administered for longer than 5 years to patients with essential blepharospasm. Methods We retrospectively reviewed 19 patients (male : female = 8 : 11) diagnosed with essential blepharospasm between March 2006 and July 2016 who underwent BoNT-A injections for over 5 years and were followed. Efficacy of 297 injections of Botox (n = 162), Meditoxin (n = 75), Hugel-tox (n = 40), or Dysport (n = 20) was based on the symptom improvement score at the final injection (−1, worse; 0, same; 1, better). Injection dose (botox unit), duration of efficacy (months), and adverse events were also investigated. Results Based on product type, significant differences in patient age (59.3 ± 9.8 years), disease period (5.0 ± 5.4 years), number of botulinum neurotoxin injections before visiting our clinic (1.6 ± 2.6), and follow-up period (7.2 ± 1.6 years) were not observed. Treatment efficacy score and injection dose of repetitive injections were 0.1 ± 0.5 and 39.1 ± 4.0 units, respectively, and did not show significant differences with repeated injections. Duration of response was 5.9 ± 5.4 months, but this significantly decreased as the injections were repeated (p < 0.01). Among the 297 injections, adverse events occurred 12 times (4.0%) with no severe sequelae. Conclusions In this study, we showed that repetitive, long-term BoNT-A injections are considered a stable and effective treatment for essential blepharospasm in terms of consistent injection dose and maintenance of treatment efficacy. However, the duration of long-term efficacy could be decreased in patients injected repetitively.
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Affiliation(s)
- Seunghyun Lee
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sangrye Park
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Zakin E, Simpson D. Botulinum Toxin in Management of Limb Tremor. Toxins (Basel) 2017; 9:E365. [PMID: 29125566 PMCID: PMC5705980 DOI: 10.3390/toxins9110365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
Essential tremor is characterized by persistent, usually bilateral and symmetric, postural or kinetic activation of agonist and antagonist muscles involving either the distal or proximal upper extremity. Quality of life is often affected and one's ability to perform daily tasks becomes impaired. Oral therapies, including propranolol and primidone, can be effective in the management of essential tremor, although adverse effects can limit their use and about 50% of individuals lack response to oral pharmacotherapy. Locally administered botulinum toxin injection has become increasingly useful in the management of essential tremor. Targeting of select muscles with botulinum toxin is an area of active research, and muscle selection has important implications for toxin dosing and functional outcomes. The use of anatomical landmarks with palpation, EMG guidance, electrical stimulation, and ultrasound has been studied as a technique for muscle localization in toxin injection. Earlier studies implemented a standard protocol for the injection of (predominantly) wrist flexors and extensors using palpation and EMG guidance. Targeting of muscles by selection of specific activators of tremor (tailored to each patient) using kinematic analysis might allow for improvement in efficacy, including functional outcomes. It is this individualized muscle selection and toxin dosing (requiring injection within various sites of a single muscle) that has allowed for success in the management of tremors.
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Affiliation(s)
- Elina Zakin
- Department of Neuromuscular Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA.
| | - David Simpson
- Department of Neuromuscular Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA.
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Blumenfeld A, Evans RW. OnabotulinumtoxinA for Chronic Migraine. Headache 2017; 57:E10-E16. [DOI: 10.1111/j.1526-4610.2011.02071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Park KS, Lee CH, Lee JW. Use of a botulinum toxin A in dentistry and oral and maxillofacial surgery. J Dent Anesth Pain Med 2017; 16:151-157. [PMID: 28884147 PMCID: PMC5586551 DOI: 10.17245/jdapm.2016.16.3.151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/23/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022] Open
Abstract
Botulinum toxin (BT) was the first toxin to be used in the history of human medicine. Among the eight known serotypes of this toxin, those currently used in medicine are types A and B. This review article mainly discusses BT type A (BTA) because it is usually used in dentistry including dental anesthesiology and oral and maxillofacial surgery. BTA has been used mainly in the treatment of temporomandibular joint disorder (TMD) and hypertrophy and hyperactivity of the masticatory muscles, along with being a therapeutic option to relieve pain and help in functional recovery from dental and oral and maxillofacial surgery. However, it is currently used broadly for cosmetic purposes such as reducing facial wrinkles and asymmetry. Although the therapeutic effect of BTA is temporary and relatively safe, it is essential to have knowledge about related anatomy, as well as the systemic and local adverse effects of medications that are applied to the face.
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Affiliation(s)
- Kyung-Soo Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Chi-Heun Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
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Pirazzini M, Rossetto O, Eleopra R, Montecucco C. Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology. Pharmacol Rev 2017; 69:200-235. [PMID: 28356439 PMCID: PMC5394922 DOI: 10.1124/pr.116.012658] [Citation(s) in RCA: 410] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The study of botulinum neurotoxins (BoNT) is rapidly progressing in many aspects.
Novel BoNTs are being discovered owing to next generation sequencing, but their
biologic and pharmacological properties remain largely unknown. The molecular
structure of the large protein complexes that the toxin forms with accessory
proteins, which are included in some BoNT type A1 and B1 pharmacological
preparations, have been determined. By far the largest effort has been dedicated to
the testing and validation of BoNTs as therapeutic agents in an ever increasing
number of applications, including pain therapy. BoNT type A1 has been also exploited
in a variety of cosmetic treatments, alone or in combination with other agents, and
this specific market has reached the size of the one dedicated to the treatment of
medical syndromes. The pharmacological properties and mode of action of BoNTs have
shed light on general principles of neuronal transport and protein-protein
interactions and are stimulating basic science studies. Moreover, the wide array of
BoNTs discovered and to be discovered and the production of recombinant BoNTs endowed
with specific properties suggest novel uses in therapeutics with increasing
disease/symptom specifity. These recent developments are reviewed here to provide an
updated picture of the biologic mechanism of action of BoNTs, of their increasing use
in pharmacology and in cosmetics, and of their toxicology.
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Affiliation(s)
- Marco Pirazzini
- Department of Biomedical Sciences, University of Padova, Italy (M.P., O.R., C.M.); Neurologic Department, University-Hospital S. Maria della Misericordia, Udine, Italy (R.E.); and Consiglio Nazionale delle Ricerche, Institute of Neuroscience, University of Padova, Italy (C.M.)
| | - Ornella Rossetto
- Department of Biomedical Sciences, University of Padova, Italy (M.P., O.R., C.M.); Neurologic Department, University-Hospital S. Maria della Misericordia, Udine, Italy (R.E.); and Consiglio Nazionale delle Ricerche, Institute of Neuroscience, University of Padova, Italy (C.M.)
| | - Roberto Eleopra
- Department of Biomedical Sciences, University of Padova, Italy (M.P., O.R., C.M.); Neurologic Department, University-Hospital S. Maria della Misericordia, Udine, Italy (R.E.); and Consiglio Nazionale delle Ricerche, Institute of Neuroscience, University of Padova, Italy (C.M.)
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Italy (M.P., O.R., C.M.); Neurologic Department, University-Hospital S. Maria della Misericordia, Udine, Italy (R.E.); and Consiglio Nazionale delle Ricerche, Institute of Neuroscience, University of Padova, Italy (C.M.)
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Montastruc J, Marque P, Moulis F, Bourg V, Lambert V, Durrieu G, Montastruc JL, Montastruc F. Adverse drug reactions of botulinum neurotoxin type A in children with cerebral palsy: a pharmaco-epidemiological study in VigiBase. Dev Med Child Neurol 2017; 59:329-334. [PMID: 27682175 DOI: 10.1111/dmcn.13286] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 01/28/2023]
Abstract
AIM The aim of this study was to assess the risk of adverse drug reactions (ADRs) with botulinum neurotoxin type A (BoNT-A) in children with cerebral palsy (CP) using the World Health Organization global individual case safety report (ICSR) database, VigiBase. METHOD We extracted all children ICSRs for ADRs with BoNT-A used as anti-spastic drug in CP recorded between 1995 and 2015 in VigiBase. We also performed a case/non-case method (disproportionality analysis) to assess the link between exposure to BoNT-A and each ADR of interest in children and adults, calculating reporting odds ratios (RORs). RESULTS In VigiBase, 162 ICSRs were registered. They involved mainly males (n=95, 59%) and mean (SD) age was 7 years 11 months (4y 4mo). The most frequent ADR was dysphagia (27 ICSRs, 17%) followed by asthenia and muscular weakness (25 ICSRs each, 16%). Nineteen ICSRs (12%) were lethal. There was a significant association between BoNT-A and death in children (ROR=11.1 95%, confidence interval [CI] 7.0-17.7) but not in adults. INTERPRETATION In children with CP, most ADRs seem to be linked to a systemic spread of BoNT-A. Our study suggests a higher risk of ADRs with BoNT-A in children than in adults.
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Affiliation(s)
- Jeanne Montastruc
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Toulouse, France
| | - Philippe Marque
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Toulouse, France
| | - Florence Moulis
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'informations sur le Médicament, CIC INSERM 1436, INSERM U 1027, Faculté de Médecine et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Véronique Bourg
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Toulouse, France
| | - Valérie Lambert
- Centre Paul Dottin ASEI, Soins de suite et de réadaptation pédiatriques spécialisés, Toulouse, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'informations sur le Médicament, CIC INSERM 1436, INSERM U 1027, Faculté de Médecine et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'informations sur le Médicament, CIC INSERM 1436, INSERM U 1027, Faculté de Médecine et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'informations sur le Médicament, CIC INSERM 1436, INSERM U 1027, Faculté de Médecine et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Eek MN, Himmelmann K. No Decrease in Muscle Strength after Botulinum Neurotoxin-A Injection in Children with Cerebral Palsy. Front Hum Neurosci 2016; 10:506. [PMID: 27766077 PMCID: PMC5052872 DOI: 10.3389/fnhum.2016.00506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Spasticity and muscle weakness is common in children with cerebral palsy (CP). Spasticity can be treated with botulinum neurotoxin-A (BoNT-A), but this drug has also been reported to induce muscle weakness. Our purpose was to describe the effect on muscle strength in the lower extremities after BoNT-A injections in children with CP. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion. Twenty children with spastic CP were included in the study, 8 girls and 12 boys (mean age 7.7 years). All were able to walk without support, but with increased muscle tone interfering with motor function and gait pattern. Sixteen children had unilateral spastic CP and four bilateral spastic CP. Twenty-four legs received injections with BoNT-A in the plantar flexor muscles. The children were tested before treatment, around 6 weeks after at the peak effect of BoNT-A, and at 6 months after treatment, with measurement of muscle strength, gait analysis, and range of motion. There were no differences in muscle strength in plantar flexors of treated legs at peak effect compared to baseline. Six months after treatment, there was still no change in untreated plantar flexor muscles, but an increasing trend in plantar flexor strength in legs treated with BoNT-A. Parents reported positive effects in all children, graded as: small in three children, moderate in eight, and large in nine children. The gait analysis showed a small improvement in knee extension at initial contact, and there was a small increase in passive range of motion for ankle dorsiflexion. Two children had a period with transient weakness and pain. We found that voluntary force production in plantar flexor muscles did not decrease after BoNT-A, instead there was a trend to increased muscle strength at follow-up. The increase may be explained as an effect of the blocking of involuntary nerve impulses, leading to an opportunity to using and training the muscles with voluntary control. Adequate muscle strength is important for maintaining the ability to walk and knowledge of how a treatment affects muscle strength is useful when selecting interventions.
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Affiliation(s)
- Meta N Eek
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg Gothenburg, Sweden
| | - Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg Gothenburg, Sweden
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Carraro E, Trevisi E, Martinuzzi A. Safety profile of incobotulinum toxin A [Xeomin(®)] in gastrocnemious muscles injections in children with cerebral palsy: Randomized double-blind clinical trial. Eur J Paediatr Neurol 2016; 20:532-7. [PMID: 27177451 DOI: 10.1016/j.ejpn.2016.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 10/25/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The only two preparations of botulinum toxin A for which there are published evidences of efficacy in children with cerebral palsy are onabotulinum toxin A (Botox(®)) and abobotulinum toxin A (Dyport(®)); these toxins should be considered generally safe and appropriate in the treatment for localized upper and lower limb spasticity. AIMS To establish the safety profile of incobotulinum toxin A (Xeomin(®)) in children with cerebral palsy and muscle spasticity. METHODS Randomized double-blind controlled trial that involved the recruitment of children of both sexes with spastic hemiplegia or diplegia in cerebral palsy, aged between 3 and 18 years. Children were randomized to either the study group (SG, incobotulinum toxin A) or the control group (CG, onabotulinum toxin A) both to be injected with 5units/kg on gastrocnemius (medialis and lateralis) muscles. The occurrence of adverse events at baseline, after 48 h, 10 days and 3 months was recorded by the caregivers in a checklist that listed both common and uncommon side effects. RESULTS 35 patients were treated (CG = 18; SG = 17); the 2 groups were well balanced regarding demographics and anthropometry characteristics. At least 1 adverse event occurred in 49% of patients within first 2 days, 46% between 2 and 10 days, and 12% between 10 and 90 days. All the reported events were minor; no serious adverse event was recorded. Fatigue was the most frequent complaint. There was no significant difference in frequency and type of events between the 2 groups. CONCLUSION Incobotulinum toxin A and onabotulinum toxin A share similar profile of safety in the treatment of lower limb spasticity in CP children.
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Affiliation(s)
- Elena Carraro
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy.
| | - Enrico Trevisi
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
| | - Andrea Martinuzzi
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
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Ward R, Reynolds JE, Bear N, Elliott C, Valentine J. What is the evidence for managing tone in young children with, or at risk of developing, cerebral palsy: a systematic review. Disabil Rehabil 2016; 39:619-630. [DOI: 10.3109/09638288.2016.1153162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Roslyn Ward
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Jess E. Reynolds
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- School of Sport, Science, Exercise and Health, the University of Western Australia, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Physiotherapy, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Department of Clinical Research, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Catherine Elliott
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- School of Occupational Therapy and Social Work, Curtin University, Western Australia, Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
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Gilotra M, Nguyen T, Christian M, Davis D, Henn RF, Hasan SA. Botulinum toxin is detrimental to repair of a chronic rotator cuff tear in a rabbit model. J Orthop Res 2015; 33:1152-7. [PMID: 25626677 DOI: 10.1002/jor.22836] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 01/19/2015] [Indexed: 02/04/2023]
Abstract
Re-tear continues to be a problem after rotator cuff repair. Intramuscular botulinum toxin (Botox) injection can help optimize tension at the repair site to promote healing but could have an adverse effect on the degenerated muscle in a chronic tear. We hypothesized that Botox injection would improve repair characteristics without adverse effect on the muscle in a chronic rotator cuff tear model. The supraspinatus tendon of both shoulders in 14 rabbits underwent delayed repair 12 weeks after transection. One shoulder was treated with intramuscular Botox injection and the other with a saline control injection. Six weeks after repair, outcomes were based on biomechanics, histology, and magnetic resonance imaging. Botox-treated repairs were significantly weaker (2.64 N) than control repairs (5.51 N, p = 0.03). Eighty percent of Botox-treated repairs and 40% of control repairs healed with some partial defect. Fatty infiltration of the supraspinatus was present in all shoulders (Goutallier Grade 3 or 4) but was increased in the setting of Botox. This study provides additional support for the rabbit supraspinatus model of chronic cuff tear, showing consistent fatty infiltration. Contrary to our hypothesis, Botox had a negative effect on repair strength and might increase fatty infiltration.
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Affiliation(s)
- Mohit Gilotra
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - Thao Nguyen
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - Matthew Christian
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - Derik Davis
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - Syed Ashfaq Hasan
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
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Moawad EMI, Abdallah EAA. Botulinum Toxin in Pediatric Neurology: Switching Lanes From Death to Life. Glob Pediatr Health 2015; 2:2333794X15590149. [PMID: 27335961 PMCID: PMC4784590 DOI: 10.1177/2333794x15590149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Botulinum neurotoxins are natural molecules produced by anaerobic spore-forming bacteria called Clostradium boltulinum. The toxin has a peculiar mechanism of action by preventing the release of acetylcholine from the presynaptic membrane. Consequently, it has been used in the treatment of various neurological conditions related to muscle hyperactivity and/or spasticity. Also, it has an impact on the autonomic nervous system by acting on smooth muscle, leading to its use in the management of pain syndromes. The use of botulinum toxin in children separate from adults has received very little attention in the literature. This review presents the current data on the use of botulinum neurotoxin to treat various neurological disorders in children.
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Strobl W, Theologis T, Brunner R, Kocer S, Viehweger E, Pascual-Pascual I, Placzek R. Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel) 2015; 7:1629-48. [PMID: 25969944 PMCID: PMC4448165 DOI: 10.3390/toxins7051629] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxin A (BoNT-A) is considered a safe and effective therapy for children with cerebral palsy (CP), especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS) of IV and the risks are substantial for level V. Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age.
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Affiliation(s)
- Walter Strobl
- Department of Paediatric- and Neuro-Orthopaedics, Orthopaedic Hospital Rummelsberg, 90592 Schwarzenbruck, Germany and MOTIO, 1080 Vienna, Austria.
| | - Tim Theologis
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road Headington, Oxford OX3 7LD, Oxfordshire, UK.
| | - Reinald Brunner
- Department of Paediatric- and Neuro-Orthopaedics, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland.
| | - Serdar Kocer
- Centre de Réadaptation de COUBERT (Ugecam) 77170, France and ROMATEM, Etiler Istanbul 34337, Turkey.
| | - Elke Viehweger
- Pediatric Orthopaedics and Institue of Motion Sciences Department, Aix-Marseille Université, Boulevard Jean Moulin, Marseille 13885, France.
| | - Ignacio Pascual-Pascual
- Department of Paediatrics, Hospital Infantil La Paz, Universidad Autonóma de Madrid, Madrid, Spain.
| | - Richard Placzek
- Orthopedic Department, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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Baricich A, Grana E, Carda S, Santamato A, Cisari C, Invernizzi M. High doses of onabotulinumtoxinA in post-stroke spasticity: a retrospective analysis. J Neural Transm (Vienna) 2015; 122:1283-7. [PMID: 25724294 DOI: 10.1007/s00702-015-1384-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/19/2015] [Indexed: 11/27/2022]
Abstract
We retrospectively evaluated the efficacy and safety of high doses of onabotulinumtoxinA (from 600 to 800 units) in 26 patients affected by upper and/or lower limb post-stroke spasticity. They were assessed before, 30 and 90 days after treatment. We observed a significant muscle tone reduction and a significant functional improvement (assessed with the Disability Assessment Scale). No adverse events were reported. In our retrospective analysis the treatment with high doses of onabotulinumtoxinA showed to be effective and safe.
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Affiliation(s)
- Alessio Baricich
- Physical and Rehabilitative Medicine - University Hospital "Maggiore della Carità", Novara, Italy,
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Abstract
BACKGROUND Treatment options for essential (ET) and Parkinson disease (PD) tremor are suboptimal, with significant side effects. Botulinum toxin type A (BoNT A) is successfully used in management of various focal movement disorders but is not widely used for tremor. METHOD This study examines complexity of wrist tremor in terms of involvement of its three anatomical degrees of freedom (DOF) in two common situations of rest and posture. The study examines tremor in 11 ET and 17 PD participants by kinematic decomposition of motion in 3-DOF. RESULTS Tremor decomposition showed the motion involved more than one DOF (<70% contribution in one DOF) in most ET (rest: 100%, posture: 64%) and PD (rest: 77%, posture: 77%) patients. Task variation resulted in change in both amplitude and composition in ET, but not in PD. Amplitude significantly increased from rest to posture in ET. Directional bias was observed at the wrist for ET (pronation), and PD (extension, ulnar deviation, pronation). Average agreement between clinical visual and kinematic selection of muscles was 55% across all subjects. CONCLUSION This study shows the complexity of tremor and the difficulty in visual judgment of tremor, which may be key to the success of targeted focal treatments such as BoNT A.
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Ruet A, Durand MC, Denys P, Lofaso F, Genet F, Schnitzler A. Single-fiber electromyography analysis of botulinum toxin diffusion in patients with fatigue and pseudobotulism. Arch Phys Med Rehabil 2015; 96:1103-9. [PMID: 25620718 DOI: 10.1016/j.apmr.2015.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/17/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To characterize electromyographic abnormalities according to symptoms (asymptomatic, fatigue, pseudobotulism) reported 1 month after botulinum toxin injection. DESIGN Retrospective, single-center study comparing single-fiber electromyography (SFEMG) in the extensor digitorum communis (EDC) or orbicularis oculi (OO) muscles. SETTING Hospital. PARTICIPANTS Four groups of adults treated for spasticity or neurologic bladder hyperactivity (N=55): control group (asymptomatic patients: n=17), fatigue group (unusual fatigue with no weakness: n=15), pseudobotulism group (muscle weakness and/or visual disturbance: n=20), and botulism group (from intensive care unit of the same hospital: n=3). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mean jitter, percentage of pathologic fibers, and percentage of blocked fibers were compared between groups. RESULTS SFEMG was abnormal for 17.6% of control patients and 75% of patients in the pseudobotulism group. There were no differences between the control and fatigue groups. Mean jitter, percentage of pathologic fibers, and percentage of blocked fibers of the EDC muscle were significantly higher in the pseudobotulism group than in the fatigue and control groups. There were no differences between groups for the OO muscle. The SFEMG results in the botulism group were qualitatively similar to those of the pseudobotulism group. CONCLUSIONS SFEMG of the EDC muscle confirmed diffusion of the toxin into muscles distant from the injection site in the pseudobotulism group. SFEMG in the OO muscle is not useful for the diagnosis of diffusion. No major signs of diffusion of botulinum toxin type A were found away from the injection site in patients with fatigue but no motor weakness. Such fatigue may be related to other mechanisms.
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Affiliation(s)
- Alexis Ruet
- Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France.
| | - Marie Christine Durand
- Department of Physiology, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin (EA 4497), Garches, France
| | - Pierre Denys
- Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France
| | - Frederic Lofaso
- Department of Physiology, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin (EA 4497), Garches, France
| | - François Genet
- Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France
| | - Alexis Schnitzler
- Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France
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Lee JH, Jung SK, Baik JS, Yang SW. Comparative Study of Hugel-tox® versus Botox® for the Treatment of Essential Blepharospasm. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.6.811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jee Hye Lee
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Kyung Jung
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Sun Baik
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Woo Yang
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Chung E. Botulinum toxin in urology: a review of clinical potential in the treatment of urologic and sexual conditions. Expert Opin Biol Ther 2014; 15:95-102. [DOI: 10.1517/14712598.2015.974543] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gajendran VK, Hentz V, Kenney D, Curtin CM. Multiple collagenase injections are safe for treatment of Dupuytren's contractures. Orthopedics 2014; 37:e657-60. [PMID: 24992063 DOI: 10.3928/01477447-20140626-64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 12/27/2013] [Indexed: 02/03/2023]
Abstract
The authors report the case of a 65-year-old, right-hand-dominant man who had severe Dupuytren's disease with multiple cords and flexion contractures of the metacarpophalangeal and proximal interphalangeal joints of both hands and underwent repeated collagenase injections for treatment. Collagenase has been shown to be safe and effective in the treatment of Dupuytren's contractures when administered as a single dose, but the results of multiple injections over a prolonged period are unknown. Antibodies to collagenase develop in all patients after several treatments, raising concerns about safety and efficacy as a result of sensitization from repeated exposures. The antibodies generated as a result of repeated exposure to collagenase could theoretically render it less effective with time and could also lead to immune reactions as severe as anaphylaxis. The authors present the case of a single patient who experienced continued correction of his contractures with only minor and self-limited adverse reactions after administration of 12 collagenase doses through 15 injections during a 4-year period. Over time, the injections continued to be effective at correcting metacarpophalangeal joint contractures, but less effective at correcting proximal interphalangeal joint contractures. The patient did eventually require a fasciectomy, but the safety and modest success of the repeated collagenase injections shows promise for a less invasive treatment with a better risk profile than open fasciectomy. Although further studies are needed, repeated administration of collagenase appears to be safe and modestly effective for severe Dupuytren's contractures, although a fasciectomy may ultimately be required in the most severe cases.
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Iozzo I, Tengattini V, Antonucci VA. Multipoint and multilevel injection technique of botulinum toxin A in facial aesthetics. J Cosmet Dermatol 2014; 13:135-42. [DOI: 10.1111/jocd.12090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Vera Tengattini
- Division of Dermatology; Department of Specialized, Diagnostic and Experimental Medicine; University of Bologna; Bologna Italy
| | - Valentina A Antonucci
- Division of Dermatology; Department of Specialized, Diagnostic and Experimental Medicine; University of Bologna; Bologna Italy
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Batten RL, Ng WF. Facial nerve compression by the posterior inferior cerebellar artery causing facial pain and swelling: a case report. J Med Case Rep 2014; 8:105. [PMID: 24661509 PMCID: PMC4018959 DOI: 10.1186/1752-1947-8-105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/27/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction We report an unusual case of facial pain and swelling caused by compression of the facial and vestibulocochlear cranial nerves due to the tortuous course of a branch of the posterior inferior cerebellar artery. Although anterior inferior cerebellar artery compression has been well documented in the literature, compression caused by the posterior inferior cerebellar artery is rare. This case provided a diagnostic dilemma, requiring expertise from a number of specialties, and proved to be a learning point to clinicians from a variety of backgrounds. We describe the case in detail and discuss the differential diagnoses. Case presentation A 57-year-old Caucasian woman with a background of mild connective tissue disease presented to our rheumatologist with intermittent left-sided facial pain and swelling, accompanied by hearing loss in her left ear. An autoimmune screen was negative and a Schirmer’s test was normal. Her erythrocyte sedimentation rate was 6mm/h (normal range: 1 to 20mm/h) and her immunoglobulin G and A levels were mildly elevated. A vascular loop protocol magnetic resonance imaging scan showed a loop of her posterior inferior cerebellar artery taking a long course around the seventh and eighth cranial nerves into the meatus and back, resulting in compression of her seventh and eighth cranial nerves. Our patient underwent microvascular decompression, after which her symptoms completely resolved. Conclusion Hemifacial spasm is characterized by unilateral clonic twitching, although our patient presented with more unusual symptoms of pain and swelling. Onset of symptoms is mostly in middle age and women are more commonly affected. Differential diagnoses include trigeminal neuralgia, temporomandibular joint dysfunction, salivary gland pathology and migrainous headache. Botulinum toxin injection is recognized as an effective treatment option for primary hemifacial spasm. Microvascular decompression is a relatively safe procedure with a high success rate. Although a rare pathology, posterior inferior cerebellar artery compression causing facial pain, swelling and hearing loss should be considered as a differential diagnosis in similar cases.
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Affiliation(s)
- Rebecca L Batten
- Clinical Research Facility, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4PE, UK.
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Diener HC, Dodick DW, Turkel CC, Demos G, Degryse RE, Earl NL, Brin MF. Pooled analysis of the safety and tolerability of onabotulinumtoxinA in the treatment of chronic migraine. Eur J Neurol 2014; 21:851-9. [PMID: 24628923 PMCID: PMC4233954 DOI: 10.1111/ene.12393] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/28/2014] [Indexed: 11/26/2022]
Abstract
Background and purpose OnabotulinumtoxinA was effective and well tolerated for prophylaxis of headache in patients with chronic migraine (CM) in two randomized, double-blind, placebo-controlled, phase 3 trials. To further assess the safety and tolerability of onabotulinumtoxinA in CM prophylaxis in adults, the pooled safety data from four double-blind, placebo-controlled trials were analyzed. Methods The pooled analysis included two phase 2 and two phase 3 double-blind, placebo-controlled trials. The safety population was 2436 patients, 1997 of whom received ≥1 dose of onabotulinumtoxinA. The studies shared similar dosing intervals (approximately 12 weeks) with doses between 75 and 260 U. Safety assessments included adverse events (AEs), physical examination and clinical laboratory tests. Results OnabotulinumtoxinA was safe and well tolerated, with a low discontinuation rate (3.4%) due to AEs. The majority of patients in this pooled analysis received doses between 150 and 200 U, with an average of 163 U per treatment cycle. Of the 1997 patients who received any onabotulinumtoxinA injections, 1455 patients (72.9%) reported at least one AE. Neck pain (12.6%) was the most common onabotulinumtoxinA-associated AE, followed by muscle weakness (8.0%), musculoskeletal stiffness (6.1%) and eyelid ptosis (4.6%). Serious AEs were infrequent, occurring in 5.4% of patients who received any onabotulinumtoxinA treatment and 3.0% of patients receiving placebo. AEs were consistent with the known tolerability profile of onabotulinumtoxinA. Conclusions Multiple treatments with onabotulinumtoxinA at doses of 75–260 U administered every 12 weeks, and up to five treatment cycles, were well tolerated for the prophylaxis of headache in adults with CM.
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Affiliation(s)
- H-C Diener
- Department of Neurology, University of Essen, Germany
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Efficacy and safety of serial injections of botulinum toxin A in children with spastic cerebral palsy. World J Pediatr 2013; 9:342-5. [PMID: 24235067 DOI: 10.1007/s12519-013-0442-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 10/17/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND Botulinum toxin A (BTX-A) has been successfully used as a treatment for children with spastic cerebral palsy; however, the effect of BTX-A on reducing spasticity only lasts a few months, thus serial injections are required. The present study was to evaluate the efficacy and safety of serial injections of BTX-A in children with spastic cerebral palsy. METHODS Fifty-two pediatric patients with spastic cerebral palsy, 2-12 years of age (mean age, 4.79 ± 2.70), were retrospectively analyzed. Muscle tone was assessed with the Modified Ashworth Scale, and gait was assessed with the Physician Rating Scale. Assessments were undertaken at baseline, 3 months, and 6 months after serial injections of BTX-A. RESULTS The beneficial effects of BTX-A occurred 1 week after the injection, whereas the adverse side-effects appeared within 1 week and lasted <2 weeks. BTX-A significantly improved muscle tone and gait 3 and 6 months after its serial injections compared to baseline (P <0.05). CONCLUSIONS Serial injections of BTX-A are effective and safe for children with spastic cerebral palsy. The sideeffects of serial injections of BTX-A are mild and selflimited.
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Peña E. Treatment with botulinum toxin: An update. World J Neurol 2013; 3:29-41. [DOI: 10.5316/wjn.v3.i3.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/10/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Botulinum neurotoxin (BoNT) is a potent toxin produced by the anaerobic bacterium clostridium botulinum. It causes flaccid, long-lasting, local and reversible paralysis. In addition, BoNT inhibits the secretion of the exocrine glands and could have properties in the control of pain. Thus, BoNT is useful in the treatment of many neuromuscular conditions where an increase of muscle tone is associated with the pathogenic mechanism. Furthermore, BoNT is recommended in the treatment of some hypersecretion disorders of the exocrine gland and could play a role in the treatment of migraine and other chronic pain conditions. In the BoNT therapy adverse effects are usually mild and reversible. However, repeated injections of BoNT can lead to the development of neutralizing antibodies that can subsequently inhibit the biological activity of the toxin. In this sense, many factors can influence the immunogenicity of the BoNT, such as product-related factors, the dose of BoNT used, the frequency of injection and the previous exposure to the toxin. In this review, we are going to discuss the current clinical applications of BoNT with a special focus on evidence, doses, injection technique and adverse effects for those applications more frequently used in neurology, namely spasticity, blepharospasm, hemifacial spasm, cervical dystonia and other focal dystonias, as well as chronic migraine, tremor, sialorrhea, facial palsy, neurogenic bladder and many other neurological condition.
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Al-Qattan MM, Al-Shanawani BN, Alshomer F. Botulinum toxin type A: implications in wound healing, facial cutaneous scarring, and cleft lip repair. Ann Saudi Med 2013; 33:482-8. [PMID: 24188943 PMCID: PMC6074896 DOI: 10.5144/0256-4947.2013.482] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Botulinum toxin is a neurotoxin that has been utilized to induce chemo-denervation of muscles. Cutaneous wounds represent a special situation in which the tensile forces applied by these muscles on wound edges might have deleterious effects on the healing process. The aim of this review was to investigate such an effect and to review other mechanisms this toxin might have on the healing process. We also reviewed the role of botulinum toxin in the management of hypertrophic scars and cleft lip repair.
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Affiliation(s)
- Mohammad M Al-Qattan
- Prof. Mohammad Al-Qattan, Department of Surgery,, Plastic and Recontructive Surgery Unit,, King Saud University,, King Khalid University Hospital, PO Box 18097, Riyadh 11415,, Saudi Arabia,
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Williams SA, Reid S, Elliott C, Shipman P, Valentine J. Muscle volume alterations in spastic muscles immediately following botulinum toxin type-A treatment in children with cerebral palsy. Dev Med Child Neurol 2013; 55:813-20. [PMID: 23789782 DOI: 10.1111/dmcn.12200] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 11/27/2022]
Abstract
AIM With evidence for an atrophic effect of botulinum toxin type A (BoNT-A) documented in typically developing muscles, this study investigated the immediate morphological alterations of muscles in children with cerebral palsy (CP) after BoNT-A treatment. METHOD Fifteen children (10 males, five females; age range 5-11y, mean age 8y 5mo, SD 1y 10mo) with spastic diplegic CP [Gross Motor Function Classification System Levels I (n=9) and II (n=6)] receiving BoNT-A injections for spasticity management were included. None of the children was a first-time receiver of BoNT-A. Magnetic resonance imaging and Mimics software assessed muscle volume, timed 2 weeks before and 5 weeks after injection. All participants received BoNT-A bilaterally to the gastrocnemius muscle, and five participants also received BoNT-A bilaterally to the medial hamstring muscles. Functional assessment measures used were the 6-Minute Walk Test (6-MWT), the Timed Up and Go (TUG) test, and hand-held dynamometry. RESULTS Whilst total muscle group volume of the injected muscle group remained unchanged, a 4.47% decrease in the injected gastrocnemius muscle volume (p=0.01) and a 3.96% increase in soleus muscle volume (p=0.02) was evident following BoNT-A. There were no statistically significant changes in function after BoNT-A as assessed by the TUG. There was also no statistically significant change in distance covered in the 6-MWT. Muscle strength, as assessed using hand-held dynamometry was also not statistically different after BoNT-A treatment. INTERPRETATION Muscle volume decreases were observed in the injected muscle (gastrocnemius), with synergistic muscle hypertrophy that appeared to compensate for this decrement. The 4% to 5% decrease in the volume of BoNT-A injected muscles are not dramatic in comparison to reports in recent animal studies, and are a positive indication for BoNT-A, particularly as it also did not negatively alter function.
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Affiliation(s)
- Sîan A Williams
- School of Sport Science, Exercise & Health, The University of Western Australia, Perth, WA, Australia.
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Ababneh OH, Cetinkaya A, Kulwin DR. Long-term efficacy and safety of botulinum toxin A injections to treat blepharospasm and hemifacial spasm. Clin Exp Ophthalmol 2013; 42:254-61. [PMID: 23844601 DOI: 10.1111/ceo.12165] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate efficacy and safety of botulinum toxin A injections after more than 10 consecutive years of treatment for benign essential blepharospasm and hemifacial spasm. DESIGN Retrospective chart review at university-affiliated hospital. PARTICIPANTS Study consisted of 64 patients treated with botulinum toxin A injections between October 2005 and May 2006. METHODS Inclusion criteria included patients treated with at least one annual botulinum toxin-A injection for more than 10 consecutive years. Data collected included diagnoses and patient characteristics, injection dates, doses administered at each visit, response scores, duration of effect, and adverse events. MAIN OUTCOME MEASURES Included changes in doses, response scores, duration of effects, and adverse events between the first and last botulinum toxin A injections. RESULTS Thirty-two of 64 patients (mean age at first injection, 57.2 ± 12.4 years; 25 women) met the inclusion criteria. The mean duration of follow up was 14.1 ± 3.1 years (range 10-20 years; mean total visits 44.4 ± 19). A higher mean injection dose per visit was administered during the last year compared with the first year (26.8 ± 10.3 vs. 22.5 ± 7.5 units, respectively) (P = 0.003). The mean durations of effect during the first and last years were 12.4 ± 7.1 and 14.6 ± 7.0 weeks, respectively (P = 0.076). There were no significant differences between genders or between benign essential blepharospasm and hemifacial spasm subgroups. The most common adverse events were ptosis, lagophthalmos and dry eye. CONCLUSIONS Botulinum toxin A is an effective, safe, long-term treatment for patients with benign essential blepharospasm and hemifacial spasm. Sustained treatment efficacy required higher doses; however, fewer adverse reactions developed.
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Affiliation(s)
- Osama H Ababneh
- Department of Ophthalmology, The University of Jordan, and Jordan University Hospital, Amman, Jordan
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Bittencourt MKW, de Vasconcellos JPC, Bittencourt MD, Malagó R, Bacellar M. Evaluation of the Efficacy and Safety of Botulinum Toxin Type A to Induce Temporary Ptosis in Dogs. J Ocul Pharmacol Ther 2013; 29:431-6. [DOI: 10.1089/jop.2012.0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Rodolfo Malagó
- Department of Veterinary Clinical Medicine, Itajubá Veterinary College (FEPI), Itajubá, Minas Gerais, Brazil
| | - Marianna Bacellar
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
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Kim BW, Park GH, Yun WJ, Rho NK, Jang KA, Won CH, Chang SE, Chung SJ, Lee MW. Adverse events associated with botulinum toxin injection: A multidepartment, retrospective study of 5310 treatments administered to 1819 patients. J DERMATOL TREAT 2013; 25:331-6. [DOI: 10.3109/09546634.2013.789473] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Byung Wook Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea
| | - Gyeong-Hun Park
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea
| | - Woo Jin Yun
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea
| | | | | | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea
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Lungu C, Considine E, Zahir S, Ponsati B, Arrastia S, Hallett M. Pilot study of topical acetyl hexapeptide-8 in the treatment for blepharospasm in patients receiving botulinum toxin therapy. Eur J Neurol 2013; 20:515-518. [PMID: 23146065 PMCID: PMC4747634 DOI: 10.1111/ene.12009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 09/10/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Injectable botulinum neurotoxin (BoNT) is the principal effective treatment for blepharospasm (BSP). This trial explores the safety and efficacy of topical acetyl hexapeptide-8 (AH8), a competitive SNAP25 inhibitor, as a potential new therapy in BSP. METHODS Double-blind, placebo-controlled, randomized trial of daily topical application of AH8 in 24 patients with BSP. The primary outcome was time to return to baseline Jankovic Blepharospasm Rating Scale (JBRS) after a BoNT injection simultaneously with the initiation of AH8. Patients displaying a strictly regular pattern of response to 3-monthly injections of BoNT were included. RESULTS There were no significant adverse events. There was a trend for longer time until return to baseline JBRS after injection in the active group compared to placebo (3.7 months vs. 3.0 months), and for better scores in the active group. One-third (4/12) of the patients in the active group had a considerable extension of symptom control after BoNT (range: 3.3-7.1 months). CONCLUSIONS Topical AH8 is safe and promising for extending the duration of action of BoNT therapy for BSP.
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Affiliation(s)
- Codrin Lungu
- Office of the Clinical Director, NINDS, NIH, Bethesda, MD
| | - Elaine Considine
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD
| | - Sana Zahir
- Office of the Clinical Director, NINDS, NIH, Bethesda, MD
| | | | | | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD
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