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

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.

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

2003 ◽  
Vol 07 (03n04) ◽  
pp. 221-226 ◽  
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.

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

2008 ◽  
Vol 123 (4) ◽  
pp. 412-417 ◽  
Author(s):  
J A de Ru ◽  
J Buwalda
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Effective Means ◽  
Case Series ◽  
Botulinum Toxin Type ◽  
Toxin A ◽  
Tertiary Referral Centre ◽  
Corrugator Supercilii

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.

Effect of botulinum toxin type A, motor imagery and motor observation on motor function of hemiparetic upper limb after stroke

Brain Injury ◽  
2010 ◽  
Vol 24 (9) ◽  
pp. 1108-1112 ◽  
Author(s):  
Andrea Santamato ◽  
Francesco Panza ◽  
Serena Filoni ◽  
Maurizio Ranieri ◽  
Vincenzo Solfrizzi ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Motor Function ◽  
Motor Imagery ◽  
Upper Limb ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type

scholarly journals Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Toxins ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 440
Author(s):  
Heli Sätilä
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Neuromuscular Junctions ◽  
Pediatric Population ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Triceps Surae ◽  
Injection Techniques ◽  
The Impact

Botulinum toxin type A (BTXA) has been used for over 25 years in the management of pediatric lower and upper limb hypertonia, with the first reports in 1993. The most common indication is the injection of the triceps surae muscle for the correction of spastic equinus gait in children with cerebral palsy. The upper limb injection goals include improvements in function, better positioning of the arm, and facilitating the ease of care. Neurotoxin type A is the most widely used serotype in the pediatric population. After being injected into muscle, the release of acetylcholine at cholinergic nerve endings is blocked, and a temporary denervation and atrophy ensues. Targeting the correct muscle close to the neuromuscular junctions is considered essential and localization techniques have developed over time. However, each technique has its own limitations. The role of BTXA is flexible, but limited by the temporary mode of action as a focal spasticity treatment and the restrictions on the total dose deliverable per visit. As a mode of treatment, repeated BTXA injections are needed. This literature reviewed BTXA injection techniques, doses and dilutions, the recovery of muscles and the impact of repeated injections, with a focus on the pediatric population. Suggestions for future studies are also discussed.

scholarly journals Successful treatment of lower eyelid epiblepharon by injection of botulinum toxin A in patients under two years of age

2013 ◽  
Vol 5 (2) ◽  
pp. 177-181 ◽  
Author(s):  
CY Chen ◽  
Angel Nava-Castaneda
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Lower Eyelid ◽  
Rank Test ◽  
Orbicularis Muscle

Introduction: Epiblepharon is characterized by a cutaneous horizontal fold adjacent to the lid margin. Some cases showed spontaneous resolution, others required surgical treatment. We propose a medical treatment with botulinum toxin type A (BTX-A). Objective: To provide clinical evidence of the usefulness of botulinum toxin type A (BTX-A) in patients with lower eyelid epiblepharon. Subjects and methods: This was a prospective, non-randomized, nonmasked study. Patients with lower eyelid epiblepharon with corneal eyelash contact were included in the study. The scale proposed by Khwarg & Lee (1997) was used to assess the epiblepharon clinical evaluation. A single dose of 12.5 IU of BTX-A (Dysport ®) was directly injected into the medial pre-tarsal orbicularis muscle region in the lower eyelid. Patients were evaluated before the injection and at 1, 4, 12 and 24 weeks after the injection. We performed descriptive statistics and Wilcoxon Signed Rank Test, comparing prior injection measurements to post injection measurements at the 24th week. A p < 0.05 was considered statistically significant. Each eye was separately analyzed. Results: Fourteen eyes of seven Hispanic patients were treated, five female and two male. The mean age was 8.4 months (4 - 14 months). The height of the skin-fold, the area of the cornea touched by the cilia and the symptoms score improved after the first week of BTX-A injection and remained so until the end of study (p < 0.05). No major complications were noted. Conclusion: The effect of a single 12.5 IU injection of BTX-A (Dysport ®) into the medial orbicularis muscle portion in the lower eyelid epiblepharon patients successfully improves the clinical signs and symptoms. Nepal J Ophthalmol 2013; 5(10): 177-181 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8709

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