Ethyl Chloride Spray for Sensory Relief for Botulinum Toxin Injections of the Hands and Feet

2009 ◽  
Vol 13 (5) ◽  
pp. 253-256 ◽  
Author(s):  
Robert N. Richards
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Ethyl Chloride ◽  
Special Equipment ◽  
Chloride Medium ◽  
Highly Effective ◽  
Hands And Feet ◽  
Botulinum Toxin Injections ◽  
Painful Injection ◽  
Injection Procedure

Background: Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use. Objective: To study the use of ethyl chloride medium-stream spray in reducing injection discomfort. Methods: We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection. Results: Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay. Conclusion: Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment.

scholarly journals Treatment Efficacy of Electromyography versus Fiberscopy-Guided Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients: A Prospective Comparative Study

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Jae Wook Kim ◽  
Jae Hong Park ◽  
Ki Nam Park ◽  
Seung Won Lee
Keyword(s):  
Botulinum Toxin ◽  
Treatment Efficacy ◽  
Botulinum Toxin Injection ◽  
Spasmodic Dysphonia ◽  
Total Dosage ◽  
Adductor Spasmodic Dysphonia ◽  
Prospective Comparative Study ◽  
The Mean ◽  
Botulinum Toxin Injections ◽  
The Voice

Introduction. This study prospectively evaluates and compares the treatment efficacy of botulinum toxin injection under electromyography guidance (EMG group) and percutaneous botulinum toxin injection under flexible fiberscopic guidance (fiberscopy group).Methods. Thirty patients with adductor spasmodic dysphonia (ADSD), who had never received treatment, were randomly allocated into EMG- or fiberscopy-guided botulinum toxin injections between March 2008 and February 2010. We assessed acoustic and aerodynamic voice parameters, and the voice handicap index (VHI) before injection and at 1, 3, and 6 months after injection.Results. The mean total dosage of botulinum toxin was similar for both groups: 1.7 ± 0.5 U for the EMG group and 1.8 ± 0.4 U for the fiberscopy group (P>0.05). There were no significant differences in outcomes between the two groups in either the duration of effectiveness or complications such as breathy voice and aspiration.Conclusion. Botulinum toxin injection under fiberscopic guidance is a viable alternative to EMG-guided botulinum toxin injection for the treatment of adductor spasmodic dysphonia when EMG equipment is unavailable.

Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial

2010 ◽  
Vol 119 (11) ◽  
pp. 759-763
Author(s):  
Randal C. Paniello ◽  
Julia D. Edgar ◽  
Joel S. Perlmutter
Keyword(s):  
Botulinum Toxin ◽  
Primary Outcome ◽  
Botulinum Toxin Injection ◽  
Primary Outcome Measure ◽  
Adductor Spasmodic Dysphonia ◽  
Related Quality ◽  
Botulinum Toxin Injections ◽  
The Voice ◽  
Dose Injection

Objectives: The intensity of muscle activity immediately following intramuscular botulinum toxin injection may affect the clinical efficacy of the injection. We tested this effect in patients who underwent botulinum toxin injections for adductor spasmodic dysphonia. Methods: Patients were studied over 3 to 5 injection cycles. Cycle 1 was the baseline control; cycle 2 was randomized between a 1-hour reading aloud task (“exercise”) and a 24-hour period of complete voice rest. For cycle 3, the patient completed the task not performed in cycle 2. Patients who were willing to continue for cycles 4 and 5 repeated the experiment at one half the injection dosage. Efficacy was determined with a battery of voice recordings and clinical outcomes instruments administered via telephone at 2- to 4-week intervals. The primary outcome measure was the result of the Voice-Related Quality of Life (VRQOL) instrument. Results: Nine patients (8 women, 1 man) with a mean age of 60.8 years (range, 42 to 76 years) completed at least 3 injection cycles. The VRQOL results were significantly higher for cycles that followed the exercise task. The patients reported subjectively that these were some of the best injection cycles they had ever experienced. Some achieved equivalent results with the half-dose injection plus exercise. The VRQOL results after voice rest cycles were not significantly different from the patients' baseline cycles. Conclusions: These results support the conclusion that a period of intense vocalization immediately following laryngeal botulinum toxin injections improves the efficacy of the injection. Possible mechanisms are proposed.

scholarly journals Intramuscular Neural Distribution of Rhomboid Muscles: Evaluation for Botulinum Toxin Injection Using Modified Sihler’s Method

Toxins ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 289 ◽  
Author(s):  
Kyu-Ho Yi ◽  
Hyung-Jin Lee ◽  
You-Jin Choi ◽  
Ji-Hyun Lee ◽  
Kyung-Seok Hu ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Neurotoxin ◽  
Botulinum Toxin Injection ◽  
Entry Point ◽  
Middle Section ◽  
Essential Information ◽  
Spinous Processes ◽  
Intramuscular Nerve ◽  
Improved Performance ◽  
Botulinum Toxin Injections

This study describes the nerve entry point and intramuscular nerve branching of the rhomboid major and minor, providing essential information for improved performance of botulinum toxin injections and electromyography. A modified Sihler method was performed on the rhomboid major and minor muscles (10 specimens each). The nerve entry point and intramuscular arborization areas were identified in terms of the spinous processes and medial and lateral angles of the scapula. The nerve entry point for both the rhomboid major and minor was found in the middle muscular area between levels C7 and T1. The intramuscular neural distribution for the rhomboid minor had the largest arborization patterns in the medial and lateral sections between levels C7 and T1. The rhomboid major muscle had the largest arborization area in the middle section between levels T1 and T5. In conclusion, botulinum neurotoxin injection and electromyography should be administered in the medial and lateral sections of C7−T1 for the rhomboid minor and the middle section of T1−T7 for the rhomboid major. Injections in the middle section of C7−T1 should also be avoided to prevent mechanical injury to the nerve trunk. Clinicians can administer safe and effective treatments with botulinum toxin injections and other types of injections by following the methods in our study.

Transoral Electromyographic Recordings in Botulinum Toxin—Injected Rat Larynges

1997 ◽  
Vol 106 (11) ◽  
pp. 956-964 ◽  
Author(s):  
Katsuhide Inagi ◽  
Charles N. Ford ◽  
Arthur A. Rodriquez ◽  
Dennis M. Heisey
Keyword(s):  
Botulinum Toxin ◽  
Muscle Function ◽  
Vocal Fold ◽  
Human Subjects ◽  
Botulinum Toxin Injection ◽  
Objective Assessment ◽  
Spasmodic Dysphonia ◽  
Treatment Regimens ◽  
Botulinum Toxin Injections ◽  
Selection Of

Objective assessment of muscle function following botulinum toxin injections in laryngeal muscles is difficult in human subjects. We developed a rat laryngeal model for the study of botulinum toxin injection. A new laryngoscopic technique has made it possible to observe the rat larynx endoscopically and to obtain electromyographic measurements during and after injection of toxin. The electromyographic interference pattern, fibrillation potentials, and vocal fold movement were used for analyzing dose and volume effects of injected toxin. We conclude that the lowest dosage able to produce the maximal duration of functional laryngeal impairment is 0.07 U in a volume of 0.4 μL. This model will enable us to obtain physiologic and histologic parameters that can be used to assess the selection of optimal treatment regimens with botulinum toxin for the treatment of patients with spasmodic dysphonia.

Reduction of self-mutilating behavior and improved oromotor function in a patient with Lesch-Nyhan syndrome following botulinum toxin injection: A case report

2021 ◽  
Vol 14 (1) ◽  
pp. 133-136
Author(s):  
Courtney Gilbert ◽  
Michelle Sauer ◽  
JenFu Cheng
Keyword(s):  
Patient Safety ◽  
Case Report ◽  
Botulinum Toxin ◽  
Functional Status ◽  
Metabolic Disorder ◽  
Speech Therapy ◽  
Botulinum Toxin Injection ◽  
Optimal Dosing ◽  
Botulinum Toxin Injections ◽  
Masseter Muscles

Lesch-Nyhan syndrome is a genetic metabolic disorder often involving dystonia and self-mutilating behavior. This case report describes a 13-year-old boy with Lesch-Nyhan syndrome and self-mutilating behavior who received botulinum toxin injections to his bilateral masseter muscles after failing multiple other treatments. Following injections, the patient had reduction in self-biting, along with improvements in speech, mastication and feeding observed in speech therapy. Botulinum toxin injections to the masseters may help to improve oromotor function and reduce self-mutilating behaviors in children with Lesch-Nyhan syndrome who have failed more conservative treatments, providing opportunity for improved functional status and patient safety. Further investigation is indicated to establish optimal dosing. Additionally, the mechanism for the reduction of self-mutilating behavior is unclear and justifies additional investigation.

Adaptive Changes in Locomotor Activity Following Botulinum Toxin Injection in Ankle Extensor Muscles of Cats

2002 ◽  
Vol 87 (1) ◽  
pp. 229-239 ◽  
Author(s):  
J. E. Misiaszek ◽  
K. G. Pearson
Keyword(s):  
Botulinum Toxin ◽  
Ankle Joint ◽  
Neural Control ◽  
Motor Behavior ◽  
Botulinum Toxin Injection ◽  
Medial Gastrocnemius ◽  
Functional Deficits ◽  
Extensor Muscles ◽  
Botulinum Toxin Injections ◽  
The Impact

The present study investigated the adaptations made in motor behavior following a temporary reduction in ankle extensor activity in the walking cat. Temporary muscle weakness was induced by injecting botulinum toxin into the lateral gastrocnemius (LG), plantaris (PL), and soleus (SOL) muscles, or SOL alone. The medial gastrocnemius (MG) muscle was not injected. Adaptations in the level of muscle activity were recorded using chronically implanted electromyographic (EMG) electrodes. Serial recordings were made prior to botulinum toxin injections and for several days following the injections. Kinematic analysis of ankle joint movements was made from video records to assess the impact of the botulinum toxin injections on the function of the ankle joint during walking. Following injection of the LG, PL, and SOL muscles with botulinum toxin, the amplitude of the MG burst increased over a period of a few days to a week. This increase was similar to the previously reported changes produced in MG following transection of the nerves serving LG, PL, and SOL. Following the weakening of the ankle extensor muscles, there was a temporary deficit in ankle function during walking as evidenced by a marked increase in the amount of ankle flexion that occurred at stance onset. This functional deficit recovered relatively quickly and was not associated with a return of the EMG pattern to the preinjection pattern. After recovery from the initial injections, a second injection of botulinum toxin into SOL alone was performed. No functional deficits were observed in the ankle movements during walking following this second injection. However, weakening SOL produced increases in the burst amplitudes of the MG, LG, and PL muscles over a period of a few days. This suggests that normal movements at the ankle during walking can be generated with more than one pattern of ankle extensor activity and that there is flexibility in how the necessary torque is produced. A final procedure, transection of the nerves serving LG, PL, and SOL, failed to produce any functional deficits in ankle movements. The implication is that adaptations to the neural control of ankle extensor activity that were induced by the initial procedure persisted after the recovery of the injected muscles and were sufficient to compensate for the subsequent challenges.

scholarly journals Anatomic direction of entry for botulinum toxin injection to treat the adductor spasmodic dysphonia in Thais

2010 ◽  
Vol 4 (4) ◽  
pp. 641-644
Author(s):  
Patchareeporn Saeseow ◽  
Akkararat Sartsungnern ◽  
Supaporn Srirompotong ◽  
Kowit Chaisiwamongkol ◽  
Thanarat Chantaupalee
Keyword(s):  
Botulinum Toxin ◽  
Sagittal Plane ◽  
Botulinum Toxin Injection ◽  
Three Dimensional ◽  
Needle Insertion ◽  
Spasmodic Dysphonia ◽  
Male And Female ◽  
Adductor Spasmodic Dysphonia ◽  
The Mean ◽  
Botulinum Toxin Injections

Abstract Background: Botulinum toxin injections into the thyroarytenoid (TA) muscle of the larynx is the most popular treatment for adductor spasmodic dysphonia. Injection is usually done by percutaneous transcricothyroid membrane with either electromyography (EMG) or fiberoptic laryngoscopy (FOL) to verify placement of the needle within the TA muscle. This procedure requires a working knowledge of three-dimensional anatomy of the larynx to establish the direction for the accurate placement of the needle. Objective: Find out the appropriate angles and depth of the needle for placement of percutaneous transcricothyroid membrane method of botulinum toxin injection by means of studying the larynges of Thai cadavers. Methods: The descriptive study was performed in 45 Thai freshly thawed cadavers. The angle of the needle from midline sagittal plane, the angle in superior relation to tracheal plane, and the depth from midline cricothyroid (CT) membrane to midlength of TA muscle were measured from the two views of photographs, anteroposterior and lateral. Results: The mean angle of 24.2±6.76° (mean±SD) from the midline sagittal plane in male and 24.9±7.6° in female were worked out. A mean angle in superior relation to the tracheal plane was 47.7±7.8° and 51.4±9.6° in male and female, respectively. The mean depth was 1.7±0.2 and 1.4±0.1 cm in male and female, respectively. Conclusion: The mean angles and depth of the needle insertion from the midline of CT membrane to the center of TA muscle in Thai laryngeal specimens were evaluated. These values were different from the studies in Caucasians, but it could provide a direct relationship to the build of the races. This knowledge may help laryngologists do this procedure more accurately with better outcome, especially in hospitals that have no EMG or FOL guide.

scholarly journals Effect of the botulinum toxin injections and endoscopic pneumocardiodilation on symptoms severity and treatment outcomes among patients with primary esophageal sphincter achalasia

2021 ◽  
Vol 11 (10) ◽  
pp. 252-262
Author(s):  
A. Kiosov
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Clinical Effectiveness ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Results Of Treatment ◽  
Endoscopic Method ◽  
Undigested Food ◽  
Botulinum Toxin Injections

Achalasia is a disorder of esophageal motility, which is manifested by symptoms of dysphagia, belching undigested food, respiratory symptoms (night cough, recurrent aspiration and pneumonia), chest pain and weight loss. Aim of the study. To determine the possibilities and clinical effectiveness of combined approaches in the treatment of cardiac achalasia using endoscopic pneumocardiodilation and injections of botulinum toxin type A "Dysport" at various stages of the disease. Materials and methods. Injections of the drug botulinum toxin type A "Dysport" and balloon endoscopic pneumocardiodilation (EPCD) were used. The contents of the vial with botulinum toxin were diluted in 0.9% sodium chloride solution to obtain a solution containing 60 UA in 1 ml. In each of the four quadrants of the LES, 2 injections of 0.5 ml of the drug "Dysport" were made with a concentration of a solution of 30 UA in 0.5 ml at a distance of 1 cm from one another. The total dose was 250 units. The technique of isolated EPCD, was carried out with a Witzel balloon dilator, 40 mm in diameter, it required a thorough preoperative examination of the patient, including an assessment of the general condition, the presence and severity of body weight deficiency, water-electrolyte, protein, achlorhydric manifestations of the disease, as well as the propulsive ability of the esophagus through X-ray examination. Results. The combined endoscopic method significantly improves the results of treatment of esophageal cardiac achalasia, having a direct impact on the pathogenetic mechanisms of its development. Given the effectiveness of treatment of esophageal cardiac achalasia by botulinum toxin injection and pneumocardiodilation, this method can be used in patients with comorbid pathology and high surgical risk as an alternative to laparoscopic Heller procedure (cardiomyotomy), especially in older patients. Unsatisfactory results of the combined endoscopic method of treatment of stage III-IV cardiac achalasia for up to 2 months are an indication for surgical treatment of this pathology. Conclusions. Given the significant increase in knowledge about this nosology in recent years, there is a need for a comprehensive, evidence-based study of new promising treatments for patients, covering all aspects of the disease.

Long-Term Effects of Botulinum Toxin Injections in Spasmodic Dysphonia

1996 ◽  
Vol 105 (1) ◽  
pp. 33-42 ◽  
Author(s):  
Bruce J. Davidson ◽  
Christy L. Ludlow
Keyword(s):  
Botulinum Toxin ◽  
Motor Unit ◽  
Muscle Activation ◽  
Botulinum Toxin Injection ◽  
Spasmodic Dysphonia ◽  
Repeated Treatment ◽  
Long Term Effects ◽  
Activation Patterns ◽  
Muscle Activation Patterns ◽  
Botulinum Toxin Injections

The purpose was to examine whether physiological changes can be found in laryngeal muscles following repeated treatment with botulinum toxin injections in spasmodic dysphonia. Seven patients whose treatment consisted of multiple unilateral thyroarytenoid injections were examined more than 6 months following their most recent botulinum toxin injection by fiberoptic laryngoscopy and electromyography. Comparisons were made between injected and contralateral noninjected muscles' motor unit characteristics, muscle activation patterns, and vocal fold movement characteristics. The results demonstrated that motor unit characteristics differed between injected and noninjected muscles and that these differences were greater in patients less than 12 months since last injection. Motor unit duration differences were reduced and motor unit amplitude and numbers of turns were increased in muscles sampled over 1 year after injection. These results suggest that while the physiologic effects of botulinum toxin are reversible, the reinnervation process continues past 12 months following injection.

Sign in / Sign up

Export Citation Format

Share Document