Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache

AbstractObjective:To describe our results with botulinum toxin type A injection for headache in carefully selected patients, and to present the rationale behind this therapy.Setting:Tertiary referral centre.Patients and methods:This article describes a case series of 10 consecutive patients with frontally localised headache, whose pain worsened when pressure was applied at the orbital rim near the supratrochlear nerve. The patients received a local anaesthetic nerve block with Xylocaine 2 per cent at this site. If this reduced the pain, they were then offered treatment with botulinum toxin.Intervention:Injection with 12.5 IU of botulinum toxin A into the corrugator supercilii muscle on both sides (a total of 25 IU).Main outcome measure:Pain severity scoring by the patients, ranging from zero (no pain) to 10 (severe pain) on a verbal scale.Results:Following injection, all patients had less pain for approximately two months. This treatment did not appear to have lasting side effects.Conclusion:Xylocaine injection is a good predictor of the effectiveness of botulinum toxin injection into the corrugator muscle as treatment of frontally localised headache. We hypothesise that this pain is caused by entrapment of the supratrochlearis nerve in the corrugator muscle. Furthermore, we found botulinum toxin injection to be a safe and effective means of achieving pain relief in this patient group.

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Randomized controlled study comparing clinical outcomes after injection botulinum toxin type A versus corticosteroids in chronic plantar fasciitis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182744 ◽

2018 ◽

Vol 4 (4) ◽

pp. 672 ◽

Cited By ~ 1

Author(s):

Prakash D. Samant ◽

Sachin Y. Kale ◽

Sohrab Ahmed ◽

Adnan Asif ◽

Mahendra Fefar ◽

...

Keyword(s):

Botulinum Toxin ◽

Clinical Outcomes ◽

Plantar Fasciitis ◽

Botulinum Toxin A ◽

Botulinum Toxin Type A ◽

Plantar Fascia ◽

Botulinum Toxin Type ◽

Toxin A ◽

Pain Scores

Background: The plantar fascia is a common condition, for which there is no consensus on the best treatment option. The aim of this study is to compare the pain and fascia thickness outcomes of patients treated with botulinum toxin A injection versus corticosteroids injection.Methods: 50 patients of plantar fasciitis randomly received injections of either botulinum toxin A (100 units in 2.5 ml normal saline) or methylprednisolone (2 ml of 40 mg/ml) under ultrasonographic guidance. Patients were assessed for pain using the visual analogue scale (VAS) and fascia thickness at baseline, 1 and 3 week, 3, 6 and 12 months post injection. Patients in the two treatment groups were compared for pain scores and thickness at each follow up.Results: There were no significant differences in the patients in both the groups at baseline. Patients in both the groups had significant improvement in VAS pain scores over a 12 months follow- up. At the end of the study (12 month follow up), the VAS pain score was significantly lower in the group of patients who received botulinum toxin A (1.68±0.62 vs. 4.72±1.02, p value=0.001). There was a significantly less plantar fascia thickness in the group of patients who received botulinum toxin as compared to those who received corticosteroids at the 3 week, 3 month, 6 month and 1 year follow up.Conclusions: Better clinical outcomes were observed with botulinum toxin type A as compared to corticosteroids. Similar studies need to be replicated with larger sample sizes before this can be offered as a standard treatment for plantar fasciitis patients.

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Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity

Acta Médica Portuguesa ◽

10.20344/amp.11503 ◽

2020 ◽

Vol 33 (11) ◽

pp. 761

Author(s):

Alexandre Camões- Barbosa ◽

Inês Mendes Ribeiro ◽

Luisa Medeiros

Keyword(s):

Botulinum Toxin ◽

Upper Limb ◽

Botulinum Toxin A ◽

Neuromuscular Block ◽

Botulinum Toxin Type A ◽

Type A ◽

Deltoid Muscle ◽

Botulinum Toxin Type ◽

Toxin A ◽

Limb Weakness

Botulinum toxin type A has been approved for spasticity management in poststroke patients. The adverse effects are generally of two types: those related to local injection; and those related to the systemic effects from spread of the toxin. Contralateral weakness after botulinum toxin A treatment is a rarely reported adverse effect. We report the case of a 33-year-old female who had been receiving regular injections of incobotulinum toxin A due to spasticity of the right limbs after a hemorrhagic stroke. A switch was made to abobotulinum toxin A with an overall conversion ratio of 1:3.83. The patient presented contralateral upper limb paresis, especially of the deltoid muscle, in the second week post-injection. The electroneuromyography showed neuromuscular block due to botulinum toxin A. She recovered completely after eight months. A switch between different formulations of botulinum toxin type A should prompt caution when carrying out unit conversions. Distant side effects may appear, including paresis in the contralateral limbs.

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Oromandibular dystonia in Yemeni patients with khat chewing: a response to botulinum toxin treatment

Neurology International ◽

10.4081/ni.2014.5385 ◽

2014 ◽

Vol 6 (2) ◽

Cited By ~ 4

Author(s):

Hatem S. Shehata ◽

Mohamed S. El-Tamawy ◽

Nevin Mohieldin ◽

Mohammed Edrees ◽

Saeed Bohlega

Keyword(s):

Botulinum Toxin ◽

Rating Scale ◽

Botulinum Toxin A ◽

Botulinum Toxin Type A ◽

Botulinum Toxin Type ◽

Masticatory Muscles ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Oromandibular Dystonia ◽

Toxin A

Khat-(Catha edulis) related oromandibular dystonia is a difficult-to-treat subset of movement disorders that involve masticatory muscles with diverse and incapacitating manifestations. The aim of this study was to evaluate the efficacy of Botulinum toxin-type A therapy in khat chewer Yemeni patients with oromandibular dystonia. This prospective study included 18 khat-chewers Yemeni patients with refractory oromandibular dystonia, who were subjected to Botulinum toxin-A injection and followed up for 3 months thereafter. Primary efficacy outcome was the global impression scale, and secondary outcome measure was the Unified Dystonia Rating Scale. Patients showed improvement of both efficacy measures, maximum satisfactory responses were detected at the forth week after injection. No major adverse events were detected. Botulinum toxin-A is considered an effective and safe treatment option for refractory oromandibular dystonia in khat-chewers.

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Abelchia: inability to belch/burp—a new disorder? Retrograde cricopharyngeal dysfunction (RCPD)

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06790-w ◽

2021 ◽

Author(s):

Yakubu Karagama

Keyword(s):

Botulinum Toxin ◽

General Anaesthesia ◽

Botulinum Toxin A ◽

Botulinum Toxin Injection ◽

Case Series ◽

High Dose ◽

Toxin A ◽

Radiological Investigation ◽

Retrosternal Pain

Abstract Case series This is retrospective case series involving 72 patients who presented with symptoms associated with inability to burp. The following symptoms was described by almost all the patients; retrosternal pain after eating or drinking, bloating feeling in the stomach, gurgling noise in the throat, excessive flatulence. These symptoms are worse with fizzy/carbonated drinks and beer. A full clinical history and examination plus endoscopic and in some cases barium a swallow radiological investigation was done. Procedure The surgery was performed under a general anaesthesia for all cases. Suspension pharyngoscopy in supine position using a Weerda diverticuloscope to identify the cricopharyngeal bar muscle. High dose of botulinum toxin A (botox) 100 iu was injected into the cricopharynxgeus muscle under a general anaesthesia. Results A total of 72 patients were diagnosed and undergone surgery between November 2016 and December 2020. There were 50 male and 22 female patients. Their average age was 30 (range 18–68 years old). All patients were able to burp again within first 4 weeks of the injection. This persisted even after the Botox worn off beyond the 3 months in 96% of cases. The average follow-up was 24 months post injection with longest follow-up 48 months (range 1–48 months). Conclusion The author reported a new condition of inability to burp due to failure of the cricopharyngeal sphincter to relax spontaneously and outcome of treatment using botulinum toxin A injection into the cricopharyngeus muscle. It is expected that the paralysing action of botulinum toxin injection last approximately 3 months. However, this group of patients seem to be cured even after the effect of the botox is worn off. The author therefore postulated that there might me some neural dysfunction that inhibits the brain to send signals to the cricopharyngeal sphincter to initiate burping. Once burping is re-established with the help of botox injection, spontaneous burping seems to occur and sustained even after the botox is worn off.

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Botulinum toxin A injection under electromyographic guidance for treatment of spasmodic dysphonia

The Journal of Laryngology & Otology ◽

10.1017/s0022215107007852 ◽

2007 ◽

Vol 122 (1) ◽

pp. 52-56 ◽

Cited By ~ 10

Author(s):

P Casserly ◽

C Timon

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Botulinum Toxin Type A ◽

Treatment Success ◽

Botulinum Toxin Type ◽

Prognostic Indicator ◽

Spasmodic Dysphonia ◽

Toxin A ◽

Motor Processing ◽

Adductor Spasmodic Dysphonia

AbstractSpasmodic dysphonia is a disabling voice condition caused by a chronic neurological disorder of central motor processing. Present therapy is directed at relief of symptoms rather than cure. Botulinum toxin type A injection into the thyroarytenoid muscle has become the pre-eminent approach for treatment of adductor spasmodic dysphonia. Botulinum toxin A injections can be performed in an out-patient setting under electromyographic guidance. We present our experience with 153 injections in 14 patients with adductor spasmodic dysphonia over a 10-year period. We demonstrate that the electromyography signal is a reliable prognostic indicator in terms of efficacy, and that patients' subjective opinion is a valid indicator of treatment success and future treatment strategy.

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P63 Botulinum toxin a for post craniotomy head pain: a single centre case series of 11 patients

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.126 ◽

2019 ◽

Vol 90 (3) ◽

pp. e39.3-e39

Author(s):

T Lavin

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Botulinum Toxin Injection ◽

Case Series ◽

Intractable Epilepsy ◽

Epileptic Seizures ◽

Small Sample ◽

Single Centre ◽

Toxin A ◽

Head Pain

ObjectivesBotulinum Toxin for post craniotomy head pain is not an established therapy. One small case series commented that it was effective in 3 patients.1 We report our single centre experience.DesignWe performed a retrospective review of case notes of all patients treated with Botox for persistent post craniotomy or craniotomy head pain at Greater Manchester Neurosciences Centre, UK. All patients treated with Botulinum Toxin from 2014 at Greater Manchester Neurosciences Centre are listed on a central database, irrespective of indication. From the database 11 patients were identified who had received Botulinum Toxin A for post craniotomy scalp pain.SubjectsEleven (n=11) patients were identified. The mean age was 43 year. Of the 11 patients; 6 were women and 5 were men. The majority of patients underwent surgery for medically intractable epilepsy (n=7).MethodsInformation obtained: -Demographics -Date, indication and type of initial cranial neurosurgery Headache Characteristics (site, descriptors, duration, frequency) -Previous medical therapy -The presence of Epileptic Seizures -Frequency, dose and site of Botulinum Toxin injection -Response.ResultsA majority of patients (10/11) reported improvement in headache burden with 6 patients reported being pain free with no further daily headache. The duration of this effect varied from 4 to 12 weeks. No specific headache characteristic (site, descriptor) predicted a favourable response. Of the remaining 5 who continue to report daily head pain, 4 felt the burden was more manageable. One patient felt there was no response. Of the 5 patients with persistent headaches, 3 were chronic epileptics with ongoing seizures, compared to only 1 patient in the responder group.ConclusionsThis case series is limited by small numbers and no objective headaches made prior or post therapy. Botulinum Toxin A appears to have a beneficial effect in the management of chronic post craniotomy head pain within this small sample with complete abolition of pain in 55%. The presence of ongoing epileptic seizures may indicate a poor response. Further controlled studies are warranted.

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COMPARATIVE PROSPECTIVE STUDY OF THE EFFECTIVENESS AND SAFETY OF RUSSIAN OF THE RUSSIAN BOTULINUM TOXIN-A RELATOX ® IN ORDER TO CORRECT THE OF MASTICATORY MUSCLES HYPERTONE PATIENTS WITH MYOFASCIAL PAIN SYNDROME

Российский стоматологический журнал ◽

10.18821/1728-2802-2019-23-3-4-180-184 ◽

2019 ◽

Vol 23 (3-4) ◽

pp. 180-184

Author(s):

Marina I. Soykher ◽

O. R Orlova ◽

L. R Mingazova ◽

M. G Soykher ◽

A. A Mammedov

Keyword(s):

Botulinum Toxin ◽

Myofascial Pain ◽

Botulinum Toxin A ◽

Botulinum Toxin Type A ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Botulinum Toxin Type ◽

Masticatory Muscles ◽

Toxin A ◽

Safety And Efficacy

Treatment of diseases of the temporomandibular joint (TMJ), complicated by hypertension of the masticatory muscles, remains one of the unsolved problems of dentistry. The purpose of this clinical study is to assess the safety and efficacy of the first Russian botulinum toxin a (BTA) Relatox® for the correction of masticatory muscle hypertension in patients with myofascial pain syndrome, as well as its comparison with the Lantox® by these parameters. Injections of botulinum toxin type A are a method of treatment in patients with myofascial facial pain syndrome with high therapeutic potential. The analysis of clinical results of using the Russian botulinum toxin type A of Relatox® shows high clinical efficacy. Comparative analysis of Lantox® and Relatox® showed no differences in safety and efficacy.

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TREATMENT OF NECK PAIN AFTER WHIPLASH INJURIES WITH BOTULINUM TOXIN-A INJECTIONS

Journal of Musculoskeletal Research ◽

10.1142/s0218957703001150 ◽

2003 ◽

Vol 07 (03n04) ◽

pp. 221-226 ◽

Cited By ~ 2

Author(s):

Francisco J. Juan

Keyword(s):

Botulinum Toxin ◽

Neck Pain ◽

Botulinum Toxin A ◽

Botulinum Toxin Type A ◽

Chronic Phase ◽

Type A ◽

Botulinum Toxin Type ◽

Whiplash Injuries ◽

Toxin A ◽

Whiplash Associated Disorders

Objective: Botulinum toxin has demonstrated efficacy in a variety of conditions associated with muscle spasm. We report our experience with botulinum toxin-A in patients with neck pain after whiplash associated disorders. Methods: A descriptive epidemiology study and case reports of patients treated with botulinum toxin type-A (Botox®) for neck pain after whiplash injuries were performed over a three-year period. A total of 31 patients who had received botulinum toxin-A for neck pain were studied. Patients were treated with 50–75 units of Botox®. Clinical follow-up evaluation was performed with repeated examinations that included range of movement (ROM), visual analogue scale (VAS), and neck pain disability index (NPDI). After initial assessment and treatment patients were followed-up 8 weeks. Results: Of 31 patients, 67.7% had excellent response rates. There was a significant reduction in pain as well as improvement in the ROM. 77.4% of patients responded significantly (p<0.05) to botulinum toxin-A injection with reduction in pain. Conclusion: The use of botulinum toxin type-A in patients with neck pain associated to whiplash injury resulted in significant improvement in subjective pain. This therapy is safe. These results suggest the need for a double-blind trial on the use of botulinum toxin during chronic phase. Also, the treatment of the subacute or acute phase of whiplash associated disorders should be investigated.

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Lingual Dystonia Treated with Botulinum Toxin - A Case Report

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v24i2.152 ◽

1970 ◽

Vol 24 (2) ◽

pp. 75-78

Author(s):

MA Hayee ◽

QD Mohammad ◽

H Rahman ◽

M Hakim ◽

SM Kibria

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Botulinum Toxin Type A ◽

Botulinum Toxin Type ◽

X Ray ◽

Medical College ◽

Lingual Dystonia ◽

History Of ◽

Chest X Ray

A 42-year-old female presented in Neurology Department of Sir Salimullah Medical College with gradually worsening difficulty in talking and eating for the last four months. Examination revealed dystonic tongue, macerated lips due to continuous drooling of saliva and aspirated lungs. She had no history of taking antiparkinsonian, neuroleptics or any other drugs causing dystonia. Chest X-ray revealed aspiration pneumonia corrected later by antibiotics. She was treated with botulinum toxin type-A. Twenty units of toxin was injected in six sites of the tongue. The dystonic tongue became normal by 24 hours. Subsequent 16 weeks follow up showed very good result and the patient now can talk and eat normally. (J Bangladesh Coll Phys Surg 2006; 24: 75-78)

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