The Botulinum Toxin / La toxina botulinica

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****** DATA-MÉDICOS *********
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LA TOXINA BOTULÍNICA
THE BOTULINUM TOXIN
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***** DERMAGIC-EXPRESS No 21 *********
****** 04 DICIEMBRE 1.998 *******
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EDITORIAL ESPAÑOL:
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Hola amigos del Cyber, cuando me puse a indagar el tema sobre la , específicamente la A (BOTOX, DYSPOT), me encontré con la sorpresa que hay estudios que datan de 1.983, 1,987 y 1988, de modo que no es tan nueva su puesta en práctica.

La otra cosa que me sorprendió fue la gran versatilidad de usos de la misma: torticolis, estrabismo, en pacientes con infarto, líneas de expresión, disfonía, acalasia, fisuras anales, hiperhidrosis axilar y palmar, etc., el numero de referencias fue alto, pero me pareció tan interesante el tema que MONTE 41, a veces uno se va a buscar información y se encuentra que lo que es aparentemente nuevo, no es tan nuevo. !!!

saludos,,,

Próximas ediciones: * MELASMA

Dr. José Lapenta

EDITORIAL ENGLISH:
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Hello friends of the Cyber, when I began to investigate the topic on the botulinum toxin, specifically the A (BOTOX, DYSPOT), I met with the surprise that there are studies that date of 1.983, 1,987 and 1988, so that it is not so new their setting in practice.

The other thing that I was surprised it was the great versatility of uses of the same one: torticollis, strabismus, in patient with stroke, facial lines, disfonia, achalasia, anal fissures, axillary and palmar hiperhidrosis, etc, the one numbers of references it was high, but I found so interesting the topic that MOUNTS 41. Sometimes one will look for information and it is found that what is seemingly new, is not so new. !!!

Greetings

Next edition: * THE MELASMA

Dr. José Lapenta
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DERMAGIC/EXPRESS(21)
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LA TOXINA BOTULINICA / THE BOTULINUM TOXIN
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1.) Botulinum toxin for chronic anal fissure [see comments]
2.) Botulinum toxin A for hyperkinetic facial lines: results of a double-blind, placebo-controlled study.
3.) Botulinum toxin for the treatment of hyperfunctional lines of the face [see comments]
4.) Spasmodic dysphonia. Emotional status and botulinum toxin treatment.
5.) Botulinum A toxin for treatment of aberrant facial nerve regeneration.
6.) Crystalline preparation of botulinum toxin type A (Botox): degradation in potency with storage [see comments]
7.) Botulinum toxin. From poison to medicine.
8.) Botulinum B toxin as an alternative to botulinum A toxin: a
9.) Psoriasiform eruption from intramuscular botulinum A toxin.
10.) Contralateral injections of botulinum A toxin for the treatment of hemifacial spasm to achieve increased facial symmetry [see comments]
11.) Clinical and laboratory comparison of botulism from toxin types A, B, and E in the United States, 1975-1988.
12.) Treatment of glabellar frown lines with C. botulinum-A exotoxin.
13.) Botulinum A toxin for (expressionistic) ptosis overcorrection after frontalis sling.
14.) Botulinum A toxin for the treatment of adult-onset spasmodic torticollis.
15.) Treatment of idiopathic spasmodic torticollis with botulinum-A toxin: a pilot study of 19 patients.
16.) Botulinum A toxin injection. Failures in clinical practice and a
biomechanical system for the study of toxin-induced paralysis.
17.) Treatment of blepharospasm with botulinum toxin.
18.) Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis.
19.) Management of facial spasm with Clostridium botulinum toxin, type A (Oculinum) [see comments]
20.) Treatment of anismus in intractable constipation with botulinum A toxin.
21.) Botulinum toxin chemodenervation in infants and children: an
alternative to incisional strabismus surgery.
22.) Oculinum injection-resistant blepharospasm in young patients.
23.) Botulinum A chemodenervation: a new modality in cerebral palsied hands.
24.) Botulinum toxin--a possible new treatment for axillary hyperhidrosis.
25.) Local injection into mimetic muscles of botulinum toxin A for the treatment of facial lines.
26.) Long term results of botulinum toxin type A (Dysport) in the treatment of hemifacial spasm: a report of 175 cases.
27.) Contemporary management of the aging brow and forehead.
28.) Botulinum A toxin therapy: neutralizing and nonneutralizing antibodies--therapeutic consequences.
29.) One hundred cases of anal fissure treated with botulin toxin: early and long-term results.
30.) Botulinum A toxins: units versus units.
31.) Reconstituted botulinum toxin type A does not lose potency in humans if it is refrozen or refrigerated for 2 weeks before use.
32.) [Mechanism of action, clinical indication and results of treatment of botulinum toxin]
33.) Use of botulinum toxin in stroke patients with severe upper limb spasticity.
34.) Nerve injection injury with botulinum toxin.
35.) DYSBOT: a single-blind, randomized parallel study to determine whether any differences can be detected in the efficacy and tolerability of two formulations of botulinum toxin type A--Dysport and Botox--assuming a ratio of 4:1.
36.) Patient selection in the treatment of glabellar wrinkles with botulinum toxin type A injection.
37.) Botulinum A neurotoxin for axillary hyperhidrosis. No sweat Botox.
38.) Botox-induced prostatic involution.
39.) Use of botulinum A toxin in patients at risk of wound complications following eyelid reconstruction.
40.) Cosmetic upper-facial rejuvenation with botulinum.
41.) New Treatment For Sweaty Palms Works for Up To A Year
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1.) Botulinum toxin for chronic anal fissure [see comments]
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CM - Comment in: Lancet 1995 Jan 21; 345(8943):188-9
SO - Lancet 1994 Oct 22;344(8930):1127-8
AU - Gui D; Cassetta E; Anastasio G; Bentivoglio AR; Maria G; Albanese A
AD - Istituto di Clinica Chirurgica, Universita Cattolica del Sacro Cuore, Roma, Italy.
PT - CLINICAL TRIAL; JOURNAL ARTICLE

AB - Botulinum toxin can chemically denervate striated muscle. Botulinum toxin A (15 U) was used to treat ten patients with chronic anal fissure by injection in the internal sphincter. In seven patients, the lesion healed at 2 months after treatment; one relapsed at 3 months. In one patient the lesion healed at 1 month, but partly relapsed a month later. Mild faecal incontinence lasting for 1 day was observed in one patient.

We propose that botulinum toxin injections in the internal anal sphincter be considered an alternative approach to surgical therapy of anal fissure.

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2.) Botulinum toxin A for hyperkinetic facial lines: results of a double-blind, placebo-controlled study.
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SO - Plast Reconstr Surg 1994 Jul;94(1):94-9
AU - Keen M; Blitzer A; Aviv J; Binder W; Prystowsky J; Smith H; Brin M
AD - Department of Otolaryngology, Columbia University College of Physicians and Surgeons, New York, N.Y.
PT - CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL

AB - Previous work on patients with muscular dystonia has shown that small intramuscular doses of botulinum toxin A eliminated hyperkinetic facial lines for approximately 6 months.

The purpose of this study was to determine the efficacy of botulinum toxin A injections in eliminating facial wrinkles in aesthetic surgery patients who do not have muscular dystonia. Eleven healthy subjects were studied in a double-blind fashion. On both sides of the face, 0.2 cc of either normal saline or botulinum toxin A was injected into the forehead or into the periorbital wrinkles (crow's feet).

Documentation of results was made by photographs taken of the patients during repose and during facial animation before and after injection. Assessment of facial wrinkles was done from a grading system in which the patient and the facial plastic surgeon were asked to judge the severity of the wrinkles on a scale from 0 to 3, with 0 reflecting no facial wrinkles and 3 reflecting severe facial wrinkling. Nine of 11 subjects injected with botulinum toxin A noted a significant improvement in the severity of their facial wrinkles in comparison with the side of the face injected with saline, with a rating improvement of 2 points. Two of 11 subjects noted a moderate improvement, with a rating improvement of 1 point.

No patient injected with saline reported an improvement in the severity of the facial wrinkles on the control side. There were no serious complications. Botulinum toxin A is an efficacious method of nonsurgically eliminating facial wrinkles and may play a role in the cosmetic enhancement of the aging face.

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3.) Botulinum toxin for the treatment of hyperfunctional lines of the face [see comments]
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CM - Comment in: Arch Otolaryngol Head Neck Surg 1995 Jun; 121(6):704
SO - Arch Otolaryngol Head Neck Surg 1993 Sep;119(9):1018-22
AU - Blitzer A; Brin MF; Keen MS; Aviv JE
AD - Department of Otolaryngology, Columbia-Presbyterian Medical Center, New York, NY.
PT - JOURNAL ARTICLE

AB - OBJECTIVE: To determine the effectiveness of botulinum toxin injections for the management of hyperfunctional facial lines in patients with dystonia.

DESIGN: Twenty-six patients were included in the study: 24 patients had dystonic movement of the face as either a primary or secondary component, and two patients were treated for purely hyperfunctional lines. Botulinum toxin type A was injected via a monopolar hollow-bore Teflon-coated electromyography needle into the facial muscles associated with the hyperfunctional lines. Doses were divided into 1.25- to 10-U aliquots. Qualitative assessments by the patient and physician were made before injection and 2 to 3 weeks after injection.

PATIENTS: Twenty-six patients (two male and 24 female) with hyperfunctional lines were included. The ages were from 32 to 84 years with an average age of 59 years. Twenty had dystonia, four had hemifacial spasm, and two had pure hyperfunction without neuromuscular disease.

RESULTS: All of the patients had an effect of toxin within the first 24 to 72 hours. All of the patients experienced benefit from the toxin injections with partial or total resolution of painful contractions or unsightly hyperfunctional lines and spasms. The effects of the injection lasted 3 to 6 months. No systemic side effects were noted. Adverse effects included mild, temporary eyelid or lip weakness.

CONCLUSION: Based on this initial pilot study, botulinum toxin may be an important new option for the treatment of patients with hyperfunctional facial lines.

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4.) Spasmodic dysphonia. Emotional status and botulinum toxin treatment.
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SO - Arch Otolaryngol Head Neck Surg 1994 Mar;120(3):310-6
AU - Murry T; Cannito MP; Woodson GE
AD - Department of Otolaryngology-Head and Neck Surgery, University of Tennessee College of Medicine, Memphis.
PT - JOURNAL ARTICLE

AB - The objectives of this study were to determine the effects of botulinum toxin injection on measures of depression, anxiety, and somatic complaints in patients diagnosed as having spasmodic dysphonia. Patients were asked to complete preinjection questionnaires with self-ratings of depression, state and trait anxiety, and somatic complaints. Approximately 1 week and 2 months following injection, patients were again asked to complete the questionnaires. The spasmodic dysphonic subjects exhibited significantly elevated mean levels of depression and anxiety. These levels were significantly reduced approximately 1 week after injection.

Two months later, depression and anxiety measures did not change significantly from their 1-week postinjection values. The results suggest that patients with spasmodic dysphonia who demonstrate significantly elevated measures of depression and anxiety show a reduction in those measures following treatment with botulinum toxin.

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5.) Botulinum A toxin for treatment of aberrant facial nerve regeneration.
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SO - Plast Reconstr Surg 1993 May;91(6):1042-5
AU - Borodic GE; Pearce LB; Cheney M; Metson R; Brownstone D; Townsend D; McKenna M
AD - Department of Ophthalmology and Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
PT - JOURNAL ARTICLE

AB - Twelve patients with involuntary synkinetic eyelid closure were given 40 injections of botulinum A toxin. Temporary improvement in involuntary eyelid closure was observed in all 12 patients. Eleven of the 12 patients desired repeated injections.

Dose requirements for this indication were compared with doses used in 697 injections in 112 patients with essential blepharospasm and Meige syndrome. Additionally, dose comparisons were made with 269 injections in 71 patients with hemifacial spasm. Dose requirements needed to treat aberrant regeneration of the facial nerve were substantially less than needed to treat blepharospasm and Meige syndrome. The dose requirement was similar to that in hemifacial spasm treatment.

The reason for the differences probably relates to existing muscular denervation associated with hemifacial spasm and aberrant facial nerve regeneration.

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6.) Crystalline preparation of botulinum toxin type A (Botox): degradation in potency with storage [see comments]
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CM - Comment in: Otolaryngol Head Neck Surg 1993 Nov; 109(5):968-9
SO - Otolaryngol Head Neck Surg 1993 Feb;108(2):135-40
AU - Gartlan MG; Hoffman HT
AD - Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242.
MJ - Botulinum Toxins
MN - Biological Assay; Drug Storage [methods]; Freeze Drying; Mice, Inbred Strains; Mice; Time Factors
MT - Animal; Female
PT - JOURNAL ARTICLE

AB - Laryngeal injection of botulinum toxin type A is currently the most effective method of treating spasmodic dysphonia. Botox, a crystalline preparation of botulinum toxin type A, is the only toxin approved for clinical use in the United States and is packaged in vials of 100 mouse units (MU). One MU corresponds to the calculated median lethal intraperitoneal dose (LD50) injected in mice.

The logistic problems arising from the need for repeated injections of small amounts of Botox have been addressed by several investigators by refreezing unused Botox for use at a later time.

Although FDA labeling recommends that Botox not used within 4 hours of reconstitution be discarded, data regarding degradation in potency after reconstitution and refreezing are not currently available. Using the LD50 Swiss-Webster mouse bioassay and statistical analysis by the Probit procedure, a 69.8% loss in potency was found when Botox was reconstituted, immediately frozen, and then assayed 2 weeks later (p 0.0001).

Statistically significant degradation in potency was seen after refrigerator storage for 12 hours (p = 0.007), but not for 6 hours (p = 0.16). Clinical implications regarding the dilution, use, and storage of Botox are discussed.

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7.) Botulinum toxin. From poison to medicine.
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SO - West J Med 1993 Jan;158(1):25-9
AU - Davis LE
AD - Neurology Service, Veterans Affairs Medical Center, Albuquerque, NM 87108.
PT - JOURNAL ARTICLE; REVIEW (56 references); REVIEW, TUTORIAL

AB - Although thousands of people in the world each year continue to be poisoned with botulinum toxin-food-borne, infantile, or wound botulism-the neurotoxin is now sufficiently understood to allow it to be used as a medicinal agent to paralyze specific muscles, giving temporary symptomatic relief from a variety of dystonic neurologic disorders. I review some of the epidemiologic, clinical, and pathophysiologic aspects of botulinum toxin and how the neurotoxin may act as a poison or a medicine.

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8.) Botulinum B toxin as an alternative to botulinum A toxin: ahistologic study.
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SO - Ophthal Plast Reconstr Surg 1993;9(3):182-90
AU - Borodic GE; Pearce LB; Smith KL; Phelan M; Ferrante R
AD - Boston University School of Medicine, University Hospital, Massachusetts.
PT - JOURNAL ARTICLE

AB - Histochemical effects of botulinum B toxin were studied on fibers from longissimus dorsi muscle in Albino rabbits and compared to effects produced by botulinum A toxin. Acetylcholinesterase staining, muscle fiber size analysis, and ATPase staining indicated botulinum B toxin produced a denervation gradient and field similar to that produced by botulinum A toxin.

At 5 weeks postinjection with botulinum B toxin, analysis showed muscle fiber size variability, and diffuse acetylcholinesterase fiber staining comparable to botulinum A toxin at the injection site. Muscle sections taken at 4.0 cm for analysis showed statistically significant decreased fiber size variability and contraction of acetylcholinesterase staining pattern for both immunotypes. In addition, the denervation reflected by histochemical staining and fiber size analysis appeared transient and lasted for approximately 3 months for both immunotypes.

These findings suggest botulinum B toxin produces pharmacologic effects on innervation of striated muscle similar to botulinum A toxin. Because immunologic tolerance has been demonstrated after therapeutic botulinum A toxin injections, further clinical studies need to be conducted with other immunotypes of toxin with no cross-reactivity to type A.

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9.) Psoriasiform eruption from intramuscular botulinum A toxin.
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SO - Cutis 1992 Dec;50(6):415-6
AU - Bowden JB; Rapini RP
AD - Department of Dermatology, University of Texas Medical School, Houston 77030.
PT - JOURNAL ARTICLE

AB - Botulinum A toxin is used intramuscularly in the treatment of spastic neuromuscular disorders, strabismus, and laryngeal dystonia. The toxin has recently been reported as being useful for the cosmetic removal of glabellar furrows. The clinical effect of the toxin lasts four months or longer. Systemic side effects are rare and usually transient. We report the case of a psoriasiform eruption temporally related to the injection of botulinum A toxin into the medial rectus muscle to treat an ocular motility disorder. To our knowledge, this is the first case of a psoriasiform dermatitis caused by this agent.

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10.) Contralateral injections of botulinum A toxin for the treatment of hemifacial spasm to achieve increased facial symmetry [see comments]
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CM - Comment in: Plast Reconstr Surg 1993 Dec; 92(7):1409
SO - Plast Reconstr Surg 1992 Dec;90(6):972-7; discussion 978-9
AU - Borodic GE; Cheney M; McKenna M
AD - Massachusetts Eye and Ear Infirmary, Boston.
PT - JOURNAL ARTICLE

AB - Six patients noted facial asymmetry after botulinum toxin injection for hemifacial spasm. Each patient was injected on the side contralateral to the spasms with 10 to 15 IU over the zygomatic major and minor muscles. Each patient noted improvement in facial symmetry in the resting position and dynamic facial movements. Five of the six patients desired this approach with subsequent injections. This injection method variation proved helpful in the managing of hemifacial weakness created by botulinum A toxin for this condition.

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11.) Clinical and laboratory comparison of botulism from toxin types A, B, and E in the United States, 1975-1988.
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SO - J Infect Dis 1992 Dec;166(6):1281-6
AU - Woodruff BA; Griffin PM; McCroskey LM; Smart JF; Wainwright RB; Bryant RG; Hutwagner LC; Hatheway CL
AD - Enteric Diseases Branch, Centers for Disease Control, Atlanta, Georgia 30333.
PT - JOURNAL ARTICLE

AB - Cases of adult botulism (n = 309) were studied to identify clinical differences between toxin types and to evaluate the sensitivity of diagnostic laboratory testing. Patients with illness from type E toxin had the shortest incubation periods. Sporadic case-patients were more severely ill: 85% required intubation compared with only 42% in multiperson outbreaks. Of patients with type A botulism, 67% required intubation compared with 52% with type B and 39% with type E. Toxin testing was positive for 40%-44% of serum and stool specimens obtained within 3 days of toxin ingestion and for 15%-23% of specimens obtained thereafter, while 37% of stool specimens obtained 3 days after toxin ingestion were positive by culture.

Patients with type A botulism have more severe illness. In general, specimens obtained early are more likely to be positive by toxin assay, and stool cultures are more sensitive than toxin detection for specimens obtained later in the illness.

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12.) Treatment of glabellar frown lines with C. botulinum-A exotoxin.
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SO - J Dermatol Surg Oncol 1992 Jan;18(1):17-21
AU - Carruthers JD; Carruthers JA
AD - Department of Opthalmology, University of British Columbia, Vancouver, Canada.
PT - JOURNAL ARTICLE

AB - Eighteen patients with glabellar frown lines were treated with C. botulinum-A exotoxin. Sixteen of the 17 patients followed showed improvement for periods ranging from 3 months to 11 months. Side-effects were minimal and transient. Because C. botulinum-A exotoxin therapy of glabellar frown lines treats the underlying cause of these lines, it is more effective than soft tissue augmentation although this improvement is temporary. Treatment with C. botulinum-A exotoxin is a simple, safe procedure.

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13.) Botulinum A toxin for (expressionistic) ptosis overcorrection after frontalis sling.
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SO - Ophthal Plast Reconstr Surg 1992;8(2):137-42
AU - Borodic GE
AD - Gunderson Eye Clinic, Boston University, Massachusetts Eye and Ear Infirmary, Boston 02114.
PT - JOURNAL ARTICLE

AB - Botulinum A toxin was injected into the frontalis muscle in two patients with complete third nerve palsies to limit intermittent upper lid retraction after a frontalis sling procedure. This form of lid retraction is noted during periods of active facial movement with occipitofrontalis muscle contraction. Although upper lid position may be symmetric when the facial muscles are adynamic, the upper lid may retract during periods of active facial expression. This type of lid retraction was corrected using Botulinum A toxin injections into the frontalis muscles, without affecting the lid position when the facial muscles are adynamic.

Both improvement in appearance and intermittent exposure were noted in both cases. Additionally, a blunting of the transverse forehead creases occurred over a defined area after this injection, representing a clinical example of a denervation field produced by a point injection of botulinum toxin.

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14.) Botulinum A toxin for the treatment of adult-onset spasmodic torticollis.
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SO - Plast Reconstr Surg 1991 Feb;87(2):285-9
AU - Borodic GE; Mills L; Joseph M
AD - Massachusetts Eye and Ear Infirmary, Boston.
PT - JOURNAL ARTICLE

AB - Thirty-five patients with adult-onset idiopathic torticollis were treated by local injections of botulinum A toxin into dystonic cervical muscles. Substantial improvement with respect to reduction and elimination of pain was found in 81 percent, improvement in posture deformity and involuntary spasms in 70 percent, increased range of motion of the neck in 78 percent, reduction in visible sternocleidomastoid hypertrophy in 86 percent, and improvement in tremor in 65 percent.

The syndrome was divided into four subtypes based on pattern of dystonic muscle groups involved in the dystonia, head and shoulder posture, and sternocleidomastoid muscle hypertrophy. Injection strategy based on this subdivision is described.

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15.) Treatment of idiopathic spasmodic torticollis with botulinum-A toxin: a pilot study of 19 patients.
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SO - Med J Aust 1990 May 21;152(10):528-30
AU - Lorentz IT; Subramaniam SS; Yiannikas C
AD - Westmead Hospital, NSW.
PT - JOURNAL ARTICLE

AB - Nineteen patients with spasmodic torticollis, unresponsive to standard therapy, were administered local injections of botulinum-A toxin into the affected muscles. During an average follow-up period of 11.5 months, a more than 25% improvement was noted in 14 of 19 patients. All those with purely focal dystonia and 9 of 10 patients with a disease history of less than three years benefited from treatment. Side effects were insignificant and transient. Botulinum toxin is a very effective and safe method of treatment for spasmodic torticollis.

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16.) Botulinum A toxin injection. Failures in clinical practice and a
biomechanical system for the study of toxin-induced paralysis.
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SO - Ophthal Plast Reconstr Surg 1990;6(4):252-9
AU - Holds JB; Fogg SG; Anderson RL
AD - Department of Ophthalmology, Bethesda Eye Institute, St. Louis University School, Missouri 63110.
PT - JOURNAL ARTICLE

AB - Botulinum A toxin injection has great utility in the treatment of essential blepharospasm and other facial spasm disorders. Several investigators have noted the failure of botulinum toxin injections to relieve lid spasm in occasional patients and a decrease in effectiveness or duration of effect following multiple injections in other patients. We reviewed the charts of 30 consecutive patients presenting for the evaluation or treatment of facial dystonia. Of 20 patients who had received multiple injections of botulinum toxin, 10 patients were felt to be treatment failures.

A new biomechanical system was developed to investigate the duration and degree of paralysis induced in the gastrocnemius muscle of the rat. Animals were treated with four sequential injections at 6-week intervals to the same muscle, resulting in muscle atrophy and an increase in the duration and degree of muscle paralysis, contrary to clinical findings in humans.

The review of patient data confirms that, for many patients, repeated injection of botulinum toxin results in a decrease in duration and degree of effect despite an increased toxin dose. An opposite effect was noted in our experimental model because of progressive muscle atrophy.

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17.) Treatment of blepharospasm with botulinum toxin.
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SO - Mayo Clin Proc 1989 Sep;64(9):1085-90
AU - Kennedy RH; Bartley GB; Flanagan JC; Waller RR
AD - Oculoplastic Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
PT - JOURNAL ARTICLE

AB - Many therapeutic modalities, including medications, excision of the muscles used in closure of the eyelids (myectomy), and selective extirpation of branches of the facial nerve (neurectomy), have been used for the management of blepharospasm. Because of limited effectiveness and undesirable side effects, none of these treatments has been completely satisfactory.

Recent reports about injection of botulinum toxin indicate that it is safe and effective for most patients. Relief from blepharospasm, however, is usually transient, and repeated injections are usually necessary. The current availability of effective therapy for blepharospasm emphasizes the importance of prompt diagnosis and referral of affected patients to physicians knowledgeable in the use of botulinum toxin and other therapeutic approaches.

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18.) Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis.
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SO - Plast Reconstr Surg 1989 Aug;84(2):353-5
AU - Clark RP; Berris CE
AD - Section of Plastic and Reconstructive Surgery, Mercy General Hospital, Sacramento, Calif.
PT - JOURNAL ARTICLE

AB - Injury to the frontal or other facial nerve branches can result in an asymmetry that can be very distressful to both patient and surgeon. This is especially true following cosmetic procedures such as rhytidectomy. We propose a means to create temporary symmetry while awaiting the possible return of nerve function. Botulinum neurotoxin causes a muscle paralysis lasting for approximately 3 months, and it is well established as the preferred treatment for blepharospasm.

A case is presented in which botulinum toxin type A was injected into the opposite functioning frontalis muscle of a patient with unilateral frontal nerve paralysis. The patient experienced satisfactory relief of the asymmetry caused by onesided forehead wrinkling and brow elevation. Botulinum toxin therapy should be considered for both temporary and permanent facial asymmetries due to facial nerve paralysis as well as spasm.

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19.) Management of facial spasm with Clostridium botulinum toxin, type A (Oculinum) [see comments]
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CM - Comment in: Arch Otolaryngol Head Neck Surg 1989 Jul; 115(7):882
SO - Arch Otolaryngol Head Neck Surg 1988 Dec;114(12):1407-12
AU - Biglan AW; May M; Bowers RA
AD - Department of Ophthalmology, University of Pittsburgh School of Medicine, PA.
PT - JOURNAL ARTICLE; REVIEW (39 references); REVIEW OF REPORTED CASES

AB - One hundred five patients received 391 graded injections of Clostridium botulinum type A toxin (Oculinum) to treat uncontrollable facial muscle spasm. Patients had essential blepharospasm (n = 61), hemifacial spasm (n = 24), or aberrant regeneration of the seventh cranial nerve (n = 20). Muscle spasms were reduced within two days of the first injection of toxin and, in most cases, the drug effect lasted three to four months. Control of facial muscle spasm was achieved in all patients.

Complications related to treatment included transient blepharoptosis (n = 7), diplopia (n = 2), and altered facial expression (n = 11). Systemic side effects were not observed. Select chemodenervation of facial muscles with graded injections of botulinum toxin is a useful adjunct to control blepharospasm, hemifacial spasm, and facial spasm due to aberrant regeneration of the facial nerve.

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20.) Treatment of anismus in intractable constipation with botulinum A toxin.
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SO - Lancet 1988 Sep 24;2(8613):714-7
AU - Hallan RI; Williams NS; Melling J; Waldron DJ; Womack NR; Morrison JF
AD - Surgical Unit, London Hospital, Whitechapel.
PT - JOURNAL ARTICLE
AB - In seven patients with anismus the striated sphincter muscle complex was selectively weakened by local injection of Clostridium botulinum type A toxin. Symptom scores improved significantly and correlated with a significant reduction in the maximum voluntary and canal squeeze pressure and a significant increase in the anorectal angle on straining. Botulinum A toxin seems to be promising treatment for some patients with anismus.
EM - 8812
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21.) Botulinum toxin chemodenervation in infants and children: an
alternative to incisional strabismus surgery.
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SO - J Pediatr 1987 May;110(5):719-22
AU - Magoon E; Scott AB
MJ - Botulinum Toxins; Oculomotor Muscles [innervation]; Strabismus [therapy]
MN - Child, Preschool; Child; Denervation [methods]; Electromyography; Infant; Ketamine
MT - Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.
PT - JOURNAL ARTICLE

AB - Eighty-two children aged 13 years or younger were given injections of botulinum toxin for horizontal strabismus. Improvement was achieved in all but one patient. Children younger than 1 year or older than 6 years of age received only topical drop anesthesia and no sedation. Young children generally required low-dose ketamine sedation. The technique typically undercorrects, so reinjection was necessary in 85% of the patients. There were no systemic complications.

Side effects, lasting up to a few weeks, included transient ptosis and hypertropia caused by involvement of other extraocular muscles.

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22.) Oculinum injection-resistant blepharospasm in young patients.
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SO - Ophthal Plast Reconstr Surg 1994 Sep;10(3):193-4
AU - Gausas RE; Lemke BN; Sherman DD; Dortzbach RK
AD - Department of Ophthalmology, University of Wisconsin-Madison 53792-3220.
PT - JOURNAL ARTICLE

AB - Botulinum toxin has recently been used as a nonsurgical treatment for blepharospasm and other facial dyskinesias.

This report describes four patients between the ages of 32 and 37 years who failed to respond to botulinum injections for severe blepharospasm. Other than age, no other features could be identified in these patients that would differentiate this group. Particularly early age of onset for essential blepharospasm might be an indicator of failure to respond to the injections.

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23.) Botulinum A chemodenervation: a new modality in cerebral palsied hands.
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SO - Br J Plast Surg 1993 Dec;46(8):703-6
AU - Wall SA; Chait LA; Temlett JA; Perkins B; Hillen G; Becker P
AD - Division of Plastic and Reconstructive Surgery, University of the Witwatersrand, South Africa.
PT - JOURNAL ARTICLE

AB - Botulinum A chemodenervation of the Adductor Pollicis muscle for the treatment of the thumb-in-palm deformity in cerebral palsied hands is presented as a new therapeutic option. Early results of a clinical trial in five hemiparetic Cerebral Palsied (C.P.) children are assessed using a prospective nontrialist-biased study design based on an independent panel assessment of pre- and post-intervention photographic and videotaped records of hand function and appearance, in combination with grip dynamometry and goniometry.

All cases are shown to improve in terms of both function and appearance with results approaching statistical significance (p = 0.06) when assessed by the Wilcoxon's matched-pairs signed rank test, despite the small study group.

The modality is shown to be simple, safe and effective over the period reported (229 days). The benefit is sustained beyond the period of muscle paresis and ongoing long term follow-up will document the need for, and timing of, reinjection.

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24.) Botulinum toxin--a possible new treatment for axillary hyperhidrosis.
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Author
Bushara KO; Park DM; Jones JC; Schutta HS
Address
Department of Neurology, University of Wisconsin Hospital and Clinics, Madison
53792-5132, USA.
Source
Clin Exp Dermatol, 21(4):276-8 1996 Jul

Abstract

The inhibitory action of botulinum toxin is not limited to the neuromuscular junction. The toxin also blocks the autonomic cholinergic fibres, including the sympathetic fibres to sweat glands. We have previously demonstrated that the toxin produces localized anhidrosis. To determine the dosage, pattern and duration of the anhidrotic effect of botulinum toxin and to test the efficacy of axillary injections, we further studied seven healthy volunteers. Two individuals had subcutaneous injections of botulinum toxin (20 mouse units, Dysport-Porton Products) in the dorsum of the hand. Five healthy volunteers had 15-50U of botulinum toxin A (Botox) injected in one axilla.

A circular area of complete anhidrosis on the dorsum of the hand was evident on day 2 and persisted for 11 months. By day 3, two of the axillae (injected with 50 U each) were totally dry and in one (injected with 30 U) the sweating was substantially reduced. The effect persisted for 6-8 months before wearing off. No effect was appreciated in two axillae (injected with 15 and 20 U). No significant side-effects were encountered. Subcutaneous injections of botulinum toxin causes chemodenervation of the sweat glands. In normal individuals axillary sweating can be abolished by 50 U of botulinum toxin A (Botox). The results offer a possible novel treatment for severe cases of axillary hyperhidrosis. Language Eng

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25.) Local injection into mimetic muscles of botulinum toxin A for the treatment of facial lines.
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Author
Guerrissi J; Sarkissian P
Address
Service of Plastic Surgery, Argerich Hospital, Buenos Aires, Argentina.
Source
Ann Plast Surg, 39(5):447-53 1997 Nov

Abstract

The purpose of this clinical investigation is to confirm the efficacy of eliminating facial wrinkles by injecting botulinum toxin A into mimetic muscles. Fifty-four patients were injected with BOTOX A-14 in the corrugator superciliaris, 19 in the frontalis muscles, and 13 in the orbicularis oculis.

Dilution was obtained by adding 4 ml preservative-free saline to 100 IU of BOTOX A.

The dose used varied according to the patient. The severity of wrinkles and the intensity of muscle contraction (facial expression) were taken into account. The paralysis obtained in the mimetic muscles was effective for 6 months in 39 patients, 8 months in 10 patients, and 9 months in 1 patient. The results were documented by photographs, videotape, and electromyographies pre- and postinjection.

To preserve the results, 21 patients (39%) demanded a second infiltration to achieve satisfactory results. Neither local nor general adverse effects were noted, except transitory eyebrow palsy in 2 patients, and edema and ecchymosis in 4 patients. The improvement obtained in facial mimetic wrinkles was satisfactory to the patient and to us.
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26.) Long term results of botulinum toxin type A (Dysport) in the treatment of hemifacial spasm: a report of 175 cases.
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Author
Jitpimolmard S; Tiamkao S; Laopaiboon M
Address
Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
[email protected]
Source
J Neurol Neurosurg Psychiatry, 64(6):751-7 1998 Jun

Abstract

OBJECTIVE: To describe the long term efficacy and side effects of the treatment of hemifacial spasm with Dysport and to evaluate two different sites of injection to hopefully reduce side effects.

METHODS: This study was designed as a prospective descriptive study. Injections were made subcutaneously around the eye. Peak improvement was subjectively assessed by using a visual analogue scale and reported in percentages (0-100%). Duration of improvement was assessed subjectively and reported in months.

RESULTS: Of 175 cases, 17 were lost to follow up and were excluded. 855 treatments were injected in the remaining 158 patients with a median of 4 treatments. The response rate was 97%. Of 855 treatments, the adjusted mean peak and duration of improvement was 77.2 (95% confidence interval (95%CI) 74.7-79.4)% and 3.4 (95%CI 3.2-3.6) months respectively. In 158 patients (complete group), the long term results from the first to the 12th treatment showed that the mean peak improvement ranged from 72.70 to 80.10% and the duration of improvement was 2.60 to 3.71 months. It remained constant throughout (p=0.40, p=0.87 respectively).

The most common side effect was ptosis. Of the 158 patients, 21 completed 12 treatments (subgroup). A separate analysis of this group disclosed a mean peak and duration of improvement from the first to 12th treatments ranging from 70.00 to 78.10% and 2.65 to 4.31 months respectively. Analysis of variance with repeated measures showed no significant variation of peak and duration of improvement over the first to the 12th treatments (p=0.38, p=0.38 respectively). Only 3% of the treatments were unsuccessful but responded to subsequent treatments. The incidence of ptosis was reduced from 27.17% to 9.68% by moving the injection site to the lateral part of orbital orbicularis oculi without any loss of efficacy. The yearly cost of Dysport is considerably less than Botox.

CONCLUSION: This study is the first to show, in detail, the long term results of treatments of hemifacial spasm with Dysport. The efficacy is constant throughout orbicularis oculi. The efficacy of Dysport is comparable with Botox in long term follow up.

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27.) Contemporary management of the aging brow and forehead.
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Author
Koch RJ; Troell RJ; Goode RL
Address
Division of Otolaryngology-Head and Neck Surgery, Stanford University, California
94305-5328, U.S.A.
Source
Laryngoscope, 107(6):710-5 1997 Jun

Abstract

Management of the aging brow and forehead has recently evolved based on available innovative technologies. Likewise, procedure-specific indications have changed based on collective surgical experiences. No longer is the approach based solely on hair pattern or degree of brow ptosis.

Patients require varying combinations of brow elevation (prior to blepharoplasty), correction of brow asymmetries, and hairline-preserving forehead elevation. Some may only require excisional or paralytic procedures of the frontalis muscle (horizontal forehead creases), corrugator supercilii muscles (vertical glabellar furrows), and procerus muscle (horizontal glabellar furrows).

We present a 3-year experience using a problem-specific approach. This incorporates endoscopic technology, botulinum toxin type A purified neurotoxin complex (Botox, Allergan, Irvine, CA) intramuscular injection, and traditional procedures such as the coronal, pretrichial, midforehead, and direct browlift. Current indications, patient selection, and results are also discussed.

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28.) Botulinum A toxin therapy: neutralizing and nonneutralizing antibodies--therapeutic consequences.
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Author
G¨oschel H; Wohlfarth K; Frevert J; Dengler R; Bigalke H
Address
Institute of Toxicology, Medical School of Hannover, Germany.
Source
Exp Neurol, 147(1):96-102 1997 Sep

Abstract

Although muscle-relaxant doses of botulinum A toxin (BoNT/A) are generally lower than doses stimulating the immune system, specific antibodies are raised in a substantial number of patients. As a rule, this necessitates the termination of treatment. Therefore, a reliable determination of specific anti-BoNT/A antibodies is helpful and we introduced, for this purpose, a novel in vitro toxin-neutralizing assay based on a nerve-muscle preparation.

We measured the antibody titers in four groups of subjects: Group 1 comprised 75 randomly selected patients of a total of 295 who responded to treatment with Dysport in our local clinic. Five patients, in group 2, were nonresponders. Group 3 consisted of 32 untreated volunteers and group 4 of 8 subjects immunized with a toxoid more than 10 years ago. Two of the responders had marginal titers of neutralizing antibodies, while they were present in all nonresponders. The sera of all responders were also tested for nonneutralizing antibodies by ELISA.

Their occurrence, however, was of no consequence to the therapeutic success. The blood samples of volunteers were free from specific antibodies, whereas antibodies persisted in the immunized subjects for longer than a decade. Patients from various clinics who had been treated unsuccessfully with the toxin-14 patients had received BOTOX, 7 had been treated with Dysport, and 7 with both products-all had neutralizing antibodies. Whether there was an antibody response depended on the amount of toxin administered. We believe, however, the effective toxin dose can be reduced by so much as to make antibody production highly improbable.

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29.) One hundred cases of anal fissure treated with botulin toxin: early and long-term results.
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Author
Jost WH
Address
Department of Neurology and Clinical Neurophysiology, Deutsche Klinik f¨ur Diagnostik,
Wiesbaden, Germany.
Source
Dis Colon Rectum, 40(9):1029-32 1997 Sep

Abstract

PURPOSE: Sphincterotomy still is considered the therapy of choice to eliminate sphincter spasm in the treatment of uncomplicated chronic anal fissure. The surgery is weighted with the possible surgical risk and the risk of subsequent fecal incontinence. This study reports the effect of botulin toxin injections within the first six months.

PATIENTS AND METHODS: One hundred patients were treated (43 females; average age, 34.7 years). The injection of botulin toxin (2.5-5 units of Botox each) was done bilaterally to the fissure, thereby causing paresis of the sphincters for approximately three months. Patients were re-examined after one week and three and six months.

RESULTS: Within the first week, 78 percent of patients were free of pain. In 82 percent of patients, complete healing of the fissure occurred within the first three months. Eight patients experienced relapses within the first six months of therapy, three of whom needed surgical intervention. The healing rate after six months was 79 percent. No healing occurred in 21 patients, and they had to undergo surgery. Transitory fecal incontinence resulted in seven cases.

CONCLUSIONS: Injection of botulin toxin enables us to treat chronic, uncomplicated anal fissures with increased sphincter tone. It is well tolerated, can be administered on an outpatient basis, does not cause any lesion of the continence organ, and subsequently, does not lead to any permanent latent or apparent fecal incontinence.

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30.) Botulinum A toxins: units versus units.
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Author
Wohlfarth K; G¨oschel H; Frevert J; Dengler R; Bigalke H
Address
Department of Neurology, Medical School of Hannover, Germany.
Source
Naunyn Schmiedebergs Arch Pharmacol, 355(3):335-40 1997 Mar

Abstract

We investigated the efficacies and potencies of two commercial preparations of botulinum neurotoxin type A (BoNt/A) reputed to differ in potency. Tests were conducted in vitro using the mouse phrenic nerve-hemidiaphragm which is an approved tool for measuring clostridial toxicity. In addition, in a double-blind trial on volunteers, varying amounts of one product were injected into the Musculus extensor digitorum brevis of the left foot, while equal amounts, i.e. units, of the other preparation were injected into the same muscle of the right foot. Compound muscle action potentials (CMAPs) were recorded before and at various points in time after the injections. As opposed to wide-spread anecdotal reports, no difference in effectiveness was found.

The dose-response curves obtained from the mouse organ preparation with both commercial products equalled one another in potency (number of units) and corresponded to previous toxicity tests in mice conducted elsewhere. Dose-response curves from volunteers were also identical for both commercial preparations. The time course of paralysis and recovery of muscle function did not differ either.

At lower concentrations of toxin, however, restoration of muscle function was more rapid than at higher concentrations. Since the results obtained from man and the animal organ preparation are in excellent accord, we conclude that 1 unit of Botox corresponds to 1 unit of Dysport.
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31.) Reconstituted botulinum toxin type A does not lose potency in humans if it is refrozen or refrigerated for 2 weeks before use.
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Author
Sloop RR; Cole BA; Escutin RO
Address
Department of Neurology, Loma Linda University School of Medicine, CA, USA.
Source
Neurology, 48(1):249-53 1997 Jan

Abstract

Botulinum toxin type A (BTX-A) (Botox, Allergan, Irvine, CA) labeling recommends its use within 4 hours of reconstitution. Since BTX-A is available only in 100-unit vials, a substantial quantity is often discarded. Using eight volunteers, we measured the percent decline in extensor digitorum brevis (EDB) M-wave amplitude (percent paralysis) following injection of freshly reconstituted BTX (right EDB) and compared this with the decline following injection of BTX that was refrozen (-20 degrees C) or refrigerated (+4 degrees C) for 2 weeks (left EDB) after reconstitution.

When analyzed as paired data, there was essentially no difference in the muscle paralysis resulting from fresh BTX compared with refrozen or refrigerated BTX, and no statistical difference between groups was noted. Reconstituted BTX-A that is subsequently refrigerated or refrozen for 2 weeks does not lose potency in humans. ======================================================================
32.) [Mechanism of action, clinical indication and results of treatment of botulinum toxin]
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Author
Lagueny A; Burbaud P
Address
Service de neurologie, h^opital Haut-L´ev´eque, CHRU Bordeaux, Pessoc.
Source
Neurophysiol Clin, 26(4):216-26 1996

Abstract

Botulinum toxin, the most potent of the neurotoxins, produces paralysis by blocking presynaptic release of the neurotransmitter (acetylcholine) at the neuromuscular junction, with reversible chemical denervation of the muscle fibre, thereby inducing partial paralysis and atrophy. Because chemical denervation is reversible, botulinum toxin has temporary effects, the muscle being progressively reinnervated by nerve sproutings. Type A botulinum toxin (Bix-A) is available under two dosage forms: Botox and Dysport.

Although the initial clinical indication was strabismus, subsequent studies have demonstrated the efficacy of Btx-A, mainly in dystonia, hemifacial spasm and spasticity. However, botulinum toxin has been successfully used in various other clinical indications. In regard to spasticity associated with cerebral palsy, Btx-A is a promising treatment requiring a multidisciplinary approach. Btx-A injections lead to effective reduction of muscle hyperactivity with minor side-effects.

They are painless, even though electromyographic guidance may be required for the injection of deep muscles. However, the production of antibodies to Btx-A may compromise the effect of long-term treatment.
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33.) Use of botulinum toxin in stroke patients with severe upper limb spasticity.
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Author
Bhakta BB; Cozens JA; Bamford JM; Chamberlain MA
Address
Rheumatology and Rehabilitation Research Unit, University of Leeds, UK.
Source
J Neurol Neurosurg Psychiatry, 61(1):30-5 1996 Jul

Abstract

OBJECTIVES--Spasticity can contribute to poor recovery of upper limb function after stroke. This is a preliminary evaluation of the impact of botulinum toxin treatment on disability caused by upper limb spasticity after stroke.

METHODS--Seventeen patients with severe spasticity and a non-functioning arm were treated with intramuscular botulinum A neurotoxin (median age at treatment 54.5 years; median time between onset of stroke and treatment 1.5 years). Baseline and assessments two weeks after treatment were compared to assess efficacy. The duration of improvement in disability was documented.

Outcome measures used were; passive range of movement at the shoulder, elbow, wrist, and fingers; modified Ashworth scale to assess spasticity of biceps and forearm finger flexors; an eight point scale to assess the degree of difficulty experienced by the patient or carer for each functional problem defined before treatment; the presence of upper limb pain. The biceps, forearm finger flexors, and flexor carpiulnaris were treated with intramuscular botulinum toxin. Up to a total dose of 400-1000 mouse units (MU) of Dysport (Speywood) or 100-200 MU of BOTOX (Allergan) was used in each patient.

RESULTS--Functional problems reported by the patients before treatment were difficulty with cleaning the palm, cutting fingernails, putting the arm through a sleeve, standing and walking balance, putting on gloves, and rolling over in bed. Hand hygiene improved in 14 of 17 patients; difficulty with sleeves improved in four of 16; standing and walking balance improved in one of four; shoulder pain improved in six of nine; wrist pain improved in five of six. Passive range of movement at shoulder, elbow, and wrist improved after treatment. Benefit was noted within two weeks and lasted one to 11 months. No adverse effects occurred.

CONCLUSION--This preliminary study suggests that intramuscular botulinum toxin is a safe and effective treatment for reducing disability in patients with severe upper limb spasticity.
Language

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34.) Nerve injection injury with botulinum toxin.
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Author
Lu L; Atchabahian A; Mackinnon SE; Hunter DA
Address
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Source
Plast Reconstr Surg, 101(7):1875-80 1998 Jun

Abstract

The therapeutic use of botulinum toxin (Botox) is increasing in popularity. Previous studies have shown that various drugs, especially when injected intrafascicularly, can cause major nerve damage. This study evaluates the potential for neurotoxicity of botulinum toxin in a rat sciatic nerve model. Lewis rats were randomly assigned to one of six groups (n = 10/group). Group 1, 2, and 3 rats received, respectively, an intrafascicular, extrafascicular, and extraneural injection of 50 microl of botulinum toxin (50 UI/ml). Group 4, 5, and 6 rats received 50 microl of 10% phenol as a positive control. Five animals received saline as a negative control.

Animals were sacrificed at 2 and 7 weeks. Nerves were harvested and processed for histology and morphometry. Nerves in all botulinum toxin groups retained a normal architecture without cellular infiltration or demyelination. The number and diameter of fibers, the thickness of myelin, and the percentage of neural tissue were comparable with normal controls.

Nerves injected intraneurally with phenol presented with severe damage, demyelination, and inflammation at 2 weeks and showed signs of early regeneration at 7 weeks.

This study demonstrates that in a rat model, even direct intraneural injection of botulinum toxin caused no damage. This information should encourage the reconstructive surgeon to consider broader applications of this drug.

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35.) DYSBOT: a single-blind, randomized parallel study to determine whether any differences can be detected in the efficacy and tolerability of two formulations of botulinum toxin type A--Dysport and Botox--assuming a ratio of 4:1. ======================================================================
Author
Sampaio C; Ferreira JJ; Sim~oes F; Rosas MJ; Magalh~aes M; Correia AP; Bastos-Lima
A; Martins R; Castro-Caldas A
Address
Institute of Pharmacology and General Therapeutics, Faculty of Medicine, University of
Lisbon, Portugal.
Source
Mov Disord, 12(6):1013-8 1997 Nov

Abstract

BACKGROUND: Elston and Russell discovered a difference in the biological potency of the English formulation of botulinum toxin type A or BTX-A (Dysport) and the American formulation (Botox). Potency of both is expressed in LD50 mouse units, but because of assay differences, these units are not equivalent. Since the first warning by Quinn and Hallet on the clinical importance of this issue, it has been impossible to reach a consensus on the conversion factor for the potency of these formulations.

OBJECTIVE: To test the hypothesis that the conversion factor for the clinical potency of Dysport to Botox is approximately 4:1. DYSBOT is an acronym that results from adding "DYS" from Dysport with "BOT" from Botox.

PATIENTS AND METHODS: Design: A single-blind, randomized, parallel comparison. A total of 91 patients with blepharospasm or hemifacial spasm were randomized to treatment with Dysport or Botox using a fixed potency ratio of 4:1. Clinical evaluations: The patients were evaluated at baseline (day of the treatment). 1 month after treatment, and whenever the effect was judged to be fading. Objective and functional rating scales were used as quantitative measures of the change in clinical status. Adverse reactions were collected using a systematic questionnaire.

RESULTS: Using this ratio between products, both Dysport and Botox groups produced similar clinical efficacy and tolerability. For patients showing a positive response without the need of a booster, the duration of effect was 13.3 +/- 5.9 weeks for the Dysport group and 11.2 +/- 5.8 weeks for the Botox group. Of 48 patients, 11 (23%) needed booster treatment in the Dysport group compared with five (12%) of 43 in Botox group. Adverse events were noted in 24 (50%) of 48 patients in the Dysport group and 20 (47%) of 43 of the Botox-treated group.

CONCLUSIONS: Using a 4:1 conversion ratio for Dysport and Botox, similar results were obtained for the two treatments in an appropriately powered study, suggesting that this conversion factor is a good estimate of their comparative clinical potencies.

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36.) Patient selection in the treatment of glabellar wrinkles with botulinum toxin type A injection.
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Author
Pribitkin EA; Greco TM; Goode RL; Keane WM
Address
Department of Otolaryngology-Head & Neck Surgery, Jefferson Medical College,
Philadelphia, Pa, USA.
Source
Arch Otolaryngol Head Neck Surg, 123(3):321-6 1997 Mar

Abstract

OBJECTIVES: To determine the dose-response characteristics and side-effects profile of Clostridium botulinum type A exotoxin (Botox) used to treat glabellar wrinkles and develop guidelines for patient selection based on the nature and severity of the treated wrinkles. DESIGN: Prospective, nonrandomized pilot and electromyogram (EMG)-guided studies.

SETTING: Two ambulatory care clinics at university hospitals.

PARTICIPANTS: For the pilot study, volunteer samples of 23 patients with glabellar wrinkles; for the EMG-guided study, volunteer samples of 57 patients with glabellar wrinkles.

INTERVENTIONS: For the pilot study, 23 patients were serially injected with up to 10.0 mouse units (MU) of Botox into each corrugator muscle; for the EMG-guided study, 57 patients were injected under EMG guidance with an initial dose of 10.0 MU of Botox into each corrugator muscle. Eleven patients with persistent corrugator activity were reinjected with 10.0 MU of Botox.

MAIN OUTCOME MEASURES: For the pilot study, slide photographs were obtained before and 2 weeks after injection; for the EMG-guided study, slide photographs were obtained before and at 2 weeks and at 2 months after injection. Patients were asked to evaluate results numerically.

RESULTS: For the pilot study, injection of up to 10.0 MU of Botox into each corrugator muscle produced a satisfactory improvement in 12 patients; for the EMG-guided study, 43 patients were satisfied with improvement after full abolition of corrugator or accessory lateral brow muscle activity. Women were more likely to achieve satisfactory results than were men (80% [40/50] vs 43% [3/7]; P < or = .03). Improvement was not age related. No significant side effects or complications were observed.

CONCLUSIONS: Glabellar wrinkles may be satisfactorily treated with Botox injection into the corrugator supercilii muscles. Improvement is temporary, dose dependent, and may not be seen in some patients even with successful denervation of the treated muscles. Clinicians may begin treatment with a dose of 10.0 MU of Botox into each corrugator muscle, and may select candidates for injection by determining the type of wrinkle to be treated and its spreadability (glabellar spread test).

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37.) Botulinum A neurotoxin for axillary hyperhidrosis. No sweat Botox.
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Author
Glogau RG
Address
Department of Dermatology, University of California, San Francisco, USA.
Source
Dermatol Surg, 24(8):817-9 1998 Aug

Abstract

BACKGROUND: Axillary hyperhidrosis causes considerable emotional stress and is associated with extraordinary costs and limitations in clothing. Existing topical and surgical therapies are either ineffective or associated with unacceptable morbidity and sequelae. Botulinum A neurotoxin (Botox) has been shown to decrease sweating in normal skin and in palmar hyperhidrosis.

OBJECTIVE: The current study was undertaken to demonstrate the utility of using Botox in the treatment of axillary hyperhidrosis.

METHODS: Twelve patient with axillary hyperhidrosis underwent intradermal injection with 50 units of Botox in the axillary skin bilaterally.

RESULTS: All patients enjoyed relatively complete anhidrosis of the axillary skin in periods ranging from 4 to 7 months. Repeat injections produced similar results.

CONCLUSION: Botulinum A neurotoxin (Botox) is an elegant and simple treatment for axillary hyperhidrosis. Language

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38.) Botox-induced prostatic involution.
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Author
Doggweiler R; Zermann DH; Ishigooka M; Schmidt RA
Address
Division of Urology, University of Colorado Health Science Center, Denver 80262, USA.
[email protected]
Source
Prostate, 37(1):44-50 1998 Sep 15

Abstract

BACKGROUND: A simple approach to induced prostatic atrophy was explored. Surgical denervation is known to produce profound atrophy of the rat prostate. Because Botulinum toxin type A (Botox) produces a long-term chemical denervation, the potential to induce atrophy of the rat prostate was explored.

METHODS: Thirty rat prostates were injected with varying doses of Botox. Single and serial injections were used, and rats were subsequently sacrificed after either 1 or 4 weeks, respectively. The prostate glands were harvested, weighed, and histologically studied for morphologic and apoptotic changes.

RESULTS: The total prostate volume and weight were found to be reduced in all Botox-injected animals. Histologically, a generalized atrophy of the glands was observed with the H&E stain. There was also diffuse glandular apoptosis evident with the Tunel stain. There were no significant complications (e.g., urinary retention, weight loss, or hind/limb weakness).

CONCLUSIONS: Botulinum toxin type A injection into the prostate gland induces selective denervation and subsequent atrophy of the prostate. Apoptosis was seen diffusely throughout the gland. It may be possible that in the future, this long-acting neurotoxin could be used for the treatment of common pathologies of the human prostate. Language

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39.) Use of botulinum A toxin in patients at risk of wound complications following eyelid reconstruction.
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Author
Choi JC; Lucarelli MJ; Shore JW
Address
Ophthalmic Consultants of Boston, Massachusetts, USA.
Source
Ophthal Plast Reconstr Surg, 13(4):259-64 1997 Dec

Abstract

Our purpose was to determine the efficacy of botulinum A toxin (BOTOX) in promoting wound immobilization and preventing wound dehiscence in patients at risk of wound-healing complications following eyelid reconstruction. In 11 patients at risk of postoperative wound complications, we injected BOTOX into the periocular musculature in addition to standard suture tarsorrhaphy. Each patient experienced excellent wound immobilization and wound healing. There were no complications. Adjuvant use of BOTOX, in conjunction with suture tarsorrhaphy, immobilizes the eyelids and promotes wound healing in patients at risk of wound complications following eyelid reconstruction. Language Eng
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40.) Cosmetic upper-facial rejuvenation with botulinum.
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Author
Ellis DA; Tan AK
Address
Department of Otolaryngology, University of Toronto, Ontario.
Source
J Otolaryngol, 26(2):92-6 1997 Apr

Abstract

OBJECTIVE: This study was conducted to evaluate the cosmetic use of botulinum toxin type A (Botox), which blocks the release of acetylcholine at the presynaptic neuromuscular junction leading to an irreversible, but temporary chemical denervation muscular paralysis and weakness. This produces a significant cosmetic improvement of wrinkling in the upper face due to hyperfunctional animation.

METHOD: A prospective clinical study representing our experience with this new technique is presented. Patient selection and evaluation, classification of animation lines, techniques, results and complications are discussed. In a 15-month period, 23 patients with seven anatomic sites were injected. Twenty-three patients had the lateral aspect and the inferior aspect of their squint lines injected, and 26 patients had their glabellar frownlines injected.

RESULTS: Significant improvement occurred to the average depth and length of the glabellar frownlines. The subjective improvement by the patients was also significant. Regarding the crow's feet, the lateral canthal lines showed more improvement than the inferior lateral canthal lines because the latter has a greater component of zygomaticus major and minor muscle, which contributes to the inferior lateral squint line.

CONCLUSION: Botox is a safe, easy-to-use, effective modality for the temporary elimination of hyperfunctioning upper-facial muscles.
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41.) New Treatment For Sweaty Palms Works for Up To A Year
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SCHAUMBURG, IL -- February 13, 1998 -- People who find no relief from conventional drug treatment for the persistent problem of sweaty palms may get long-term improvement from injections of a potent bacterial toxin, according to a study reported in this month’s issue of the Journal of the American Academy of Dermatology. Botulinum toxin type A is a powerful chemical that in its diluted prescription form (Botox) has been used safely in treating eye muscle disorders, wrinkles and other conditions. It reduces sweating by blocking release of the chemical acetylcholine, which stimulates secretion of the sweat glands.

"Botulinum toxin safely and effectively inhibits excessive sweat production in the palms for as long as 12 months," said Walter Shelley, MD, PhD, a study co-author and dermatologist at the Medical College of Ohio, Toledo.

Earlier studies of botulinum toxin therapy for sweaty palms showed it reduced sweating for up to only three months. Four months was the shortest improvement seen in the study conducted by Shelley, Nickolai Talanin, MD, PhD, and E. Dorinda Shelley, MD.

All patients experienced substantial improvement of their condition after receiving multiple injections of botulinum toxin. The drug was injected close to the sweat glands in the patients' palms after their skin was numbed with an anesthetic. "These results offer good news to patients whose severe palm sweating is resistant to other treatments and who want to avoid surgery," Shelley said.

Persistent sweating of the palms, called palmar hyperhidrosis, is caused by an abnormal sensitivity to acetylcholine. "Palmar hyperhidrosis is not common," Shelley said. "However, individuals with severe cases often suffer social, psychological and occupational problems because of their disease." Endoscopic surgery of the sympathetic nervous system, which controls sweating, provides a permanent solution but requires general anesthesia andcan cause circulatory problems later.

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DATA-MÉDICOS/DERMAGIC-EXPRESS No (21) 04/12/98 DR. JOSÉ LAPENTA R.
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