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Díaz-Aristizabal U, Valdés-Vilches M, Fernández-Ferreras TR, Calero-Muñoz E, Bienzobas-Allué E, Aguilera-Ballester L, Carnicer-Cáceres J. Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae. Neurologia 2023; 38:560-565. [PMID: 37437657 DOI: 10.1016/j.nrleng.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/10/2021] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox© or Xeomin©) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.
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Affiliation(s)
- U Díaz-Aristizabal
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain.
| | - M Valdés-Vilches
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - T R Fernández-Ferreras
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - E Calero-Muñoz
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - E Bienzobas-Allué
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - L Aguilera-Ballester
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - J Carnicer-Cáceres
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
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Maroto Rodríguez B, Stoica BTL, Toledano Fernández N, Genol Saavedra I. Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:549-557. [PMID: 35879178 DOI: 10.1016/j.oftale.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION To compare the efficacy of botulinum toxin A (BoNTA) injection into the lacrimal gland versus lateral tarsal strip (LTS) for functional epiphora. METHODS Randomized clinical trial. Sequential, parallel, non-blinded study design. Patients aged 18 years or older with functional epiphora and a minimum score of 3 in Munk Scale (MS) were randomized to BoNTA or LTS group. Changes in Munk scale, Schirmer test (ST) and quality of life (QoL) were assessed at week 6 and during follow-up until week 30. The mean time without epiphora and the adverse events (AE) were recorded. RESULTS The final analysis included 25 patients, 12 (21 eyes) assigned to BoNTA (5U/0.05 mL) and 13 (20 eyes) to LTS. At 6 weeks there was an improvement in the MS in BoNTA versus LTS group (-2.48 vs -1.55, P = .0152) and at 12 weeks (-2.68 vs -1.69, P = .0267). A significant decrease was noted in the ST at week 2, 12 and 30 with BoNTA. The QoL improved after both interventions without statistical significance. The mean duration of effectiveness in BoNTA group was 26.2 weeks (range 7.7-36.6) and in LTS group was 24.8 weeks (range 6.7-37.6), P = .937. The main AE were temporary eyelid ptosis in 25% (3/12) of the BoNTA group and surgical scar discomfort in 23% (3/13) of the LTS groups, P = .722. No AE were classified as severe. CONCLUSION BoNTA injection into the lacrimal gland is a safe and effective treatment for functional epiphora, with a greater decrease in MS at 6 and 12 weeks compared with LTS.
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Affiliation(s)
- B Maroto Rodríguez
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
| | - B T L Stoica
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - N Toledano Fernández
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - I Genol Saavedra
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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Díaz-Aristizabal U, Valdés-Vilches M, Fernández-Ferreras TR, Calero-Muñoz E, Bienzobas-Allué E, Aguilera-Ballester L, Carnicer-Cáceres J. Effect of botulinum toxin typeA in functionality, synkinesis and quality of life in peripheral facial palsy sequelae. Neurologia 2021; 38:S0213-4853(21)00032-3. [PMID: 33722453 DOI: 10.1016/j.nrl.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.
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Affiliation(s)
- U Díaz-Aristizabal
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España.
| | - M Valdés-Vilches
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - T R Fernández-Ferreras
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - E Calero-Muñoz
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - E Bienzobas-Allué
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - L Aguilera-Ballester
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - J Carnicer-Cáceres
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
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Morcillo Pérez C, Guerras Normand I, García Chinchetru MC. [Notalgia paresthetica: Treatment with botulinum toxin type A]. Rehabilitacion (Madr) 2020; 54:142-145. [PMID: 32370829 DOI: 10.1016/j.rh.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022]
Abstract
Notalgia paresthetica is a sensory mononeuropathy caused by compression localized in the dorsal region. The condition is clinically characterised by the presence of pruritus, paresthesias and hyperalgesia associated with a hyperpigmented patch in the correspondingt dermatoma, substantially impairing quality of life. We report the cases of two patients aged between 35 and 65years with chronic symptoms and treated in our service with botulinum toxin type A in the affected areas. We observed a decrease in the EVA pain scale and the intensity of the pruritus after infiltrations, as well as a reduction in the hyperpigmented patch at the first, third and sixth months after the intradermal injections that has been maintained after a year. We conclude that botulinum toxin typeA treatment could be a safe and useful alternative in these patients, as it has been shown to be effective over a longer term than available treatments to date, although further studies are required to confirm our findings.
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Affiliation(s)
- C Morcillo Pérez
- Servicio de Rehabilitación, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - I Guerras Normand
- Servicio de Rehabilitación, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M C García Chinchetru
- Servicio de Rehabilitación, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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de la Fuente Díez Y, Olvera Morales O, Chen López CY, Tovilla Canales JL, Nava Castañeda A. Treatment of symptomatic epiblepharon with Botulinum toxin type A in patients under 2years of age. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:9-14. [PMID: 31806264 DOI: 10.1016/j.oftal.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Epiblepharon is a congenital eyelid malposition due to a horizontal skin fold and a redundant orbicular muscle, resulting in the inward positioning of the eyelashes. OBJECTIVE Personal experience is presented of the non-surgical correction of symptomatic epiblepharon using a pretarsal injection of 5 IU of botulinum toxin type A (BoNT-A) into the orbicular muscle. MATERIAL AND METHODS Patients with epiblepharon younger than 2 year were included in the study. A review was made of their clinical charts and the symptoms and signs of epiblepharon were evaluated before and after treatment with BoNT-A. RESULTS A total of 40 patients were included (28 girls [70%]). The mean age at treatment was 11 months (range, 4-24 months). A total of 76 eyelids were treated with BoNT-A. A statistically significant improvement in symptoms, lash-corneal touch, and punctate corneal epitheliopathy were reported after the treatment with 5IU BoNT-A. The mean final follow-up was 25.5 weeks (range, 4-92 months). CONCLUSIONS The present study provides evidence that a pretarsal BoNT-A injection is an effective and safe treatment for the correction of symptomatic epiblepharon in patients younger than 2 years of age.
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Affiliation(s)
- Y de la Fuente Díez
- Departamento de Órbita y Oculoplástica, Instituto Oftalmológico Conde de Valenciana (I.A.P.), Ciudad de México, CDMX, México.
| | - O Olvera Morales
- Departamento de Órbita y Oculoplástica, Instituto Oftalmológico Conde de Valenciana (I.A.P.), Ciudad de México, CDMX, México
| | - C Y Chen López
- Departamento de Órbita y Oculoplástica, Instituto Oftalmológico Conde de Valenciana (I.A.P.), Ciudad de México, CDMX, México
| | - J L Tovilla Canales
- Departamento de Órbita y Oculoplástica, Instituto Oftalmológico Conde de Valenciana (I.A.P.), Ciudad de México, CDMX, México
| | - A Nava Castañeda
- Departamento de Órbita y Oculoplástica, Instituto Oftalmológico Conde de Valenciana (I.A.P.), Ciudad de México, CDMX, México
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Alcántara Montero A, Sánchez Carnerero CI, Goicoechea García C. Emerging therapies in clinical development and new contributions for neuropathic pain. ACTA ACUST UNITED AC 2019; 66:324-34. [PMID: 31010688 DOI: 10.1016/j.redar.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/11/2019] [Accepted: 02/17/2019] [Indexed: 12/19/2022]
Abstract
Neuropathic pain is very challenging to manage because of the heterogeneity of aetiologies, symptoms, and underlying mechanisms. Conventional oral therapies have been limited by negative factors such as systemic side effects, drug-drug interactions, slow onset of action, the need for titration, multiple daily dosing, as well as the potential risk of addiction, dependence, withdrawal symptoms and abuse. Therefore, new therapeutic perspectives are justified. New drugs that act on different therapeutic targets are currently in preclinical development or in their first phases of clinical development. In this review, focus will be directed specifically on new pharmacological treatments for neuropathic pain for which clinical data are already available, including older and known drugs with new data on their anti-neuropathic activity.
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Puentes Gutiérrez AB, García Bascones M, Puentes Gutiérrez R, Díaz Jiménez M. [Subcutaneous botulinum toxin in the treatment of peripheral neuropathic pain]. Rehabilitacion (Madr) 2019; 53:131-135. [PMID: 31186096 DOI: 10.1016/j.rh.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/24/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
Neuropathic pain impairs quality of life in affected individuals and poses a challenge to clinicians due to the complexity of its treatment and frequent therapeutic failures. We present 4clinical cases of chronic neuropathic pain (LANSS ≥ 19), refractory to conservative treatment (meralgia paraesthetica, post-surgical pain and 2surgical scars). Subcutaneous botulinum toxin type A was infiltrated periodically over the painful area. All patients experienced subjective improvement in pain and improvement measured by the visual analogic scale. Pain relief started at 5-21 days and continued up to 1.5-3 months, and up to 9 months in one patient. Pain that reappeared was of lower intensity in 3patients and was reduced in area in 2patients.
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Affiliation(s)
| | - M García Bascones
- Servicio de Rehabilitación, Hospital Virgen de la Salud, Toledo, España
| | | | - M Díaz Jiménez
- Servicio de Rehabilitación, Hospital Virgen de la Salud, Toledo, España
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8
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Saadi M, Yu D, Malik Z, Parkman HP, Schey R. Pyloric sphincter characteristics using EndoFLIP ® in gastroparesis. Rev Gastroenterol Mex (Engl Ed) 2018; 83:375-384. [PMID: 29709494 DOI: 10.1016/j.rgmx.2018.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND AIMS Pyloric sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether pyloric sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP®) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to pyloric sphincter BoNT/A injection. METHODS EndoFLIP® study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12. RESULTS Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater pyloric compliance at baseline correlated with greater improvement in early satiety and náusea at 8 weeks and greater pyloric distensibility correlated with improvement in upper abdominal pain. CONCLUSIONS EndoFLIP® characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus.
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Affiliation(s)
- M Saadi
- Área de Gastroenterología, Departamento de Medicina, Temple University School of Medicine, Filadelfia, PA, Estados Unidos
| | - D Yu
- Temple Clinical Research Institute, Departamento de Ciencias Clínicas, Temple University School of Medicine, Filadelfia, PA, Estados Unidos
| | - Z Malik
- Área de Gastroenterología, Departamento de Medicina, Temple University School of Medicine, Filadelfia, PA, Estados Unidos
| | - H P Parkman
- Área de Gastroenterología, Departamento de Medicina, Temple University School of Medicine, Filadelfia, PA, Estados Unidos
| | - R Schey
- Área de Gastroenterología, Departamento de Medicina, Temple University School of Medicine, Filadelfia, PA, Estados Unidos.
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