scholarly journals Effect of treating elbow flexor spasticity with botulinum toxin injection and adjunctive casting on hemiparetic gait parameters: A prospective case series

2020 ◽  
Vol 52 (10) ◽  
pp. jrm00110
Author(s):  
S Jayawarden ◽  
R Sandarage ◽  
J Farag ◽  
C Ganzert ◽  
P Winston ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Elbow Flexor ◽  
Hemiparetic Gait ◽  
Gait Parameters ◽  
Prospective Case Series

Persistent Diplopia in Visually Mature Patients. Is it Intractable or something else? A Review and Case Series

2017 ◽  
pp. 90-108
Keyword(s):  
Botulinum Toxin ◽  
Extraocular Muscle ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Sensory Adaptation ◽  
Single Vision ◽  
Injection Treatment ◽  
Vision Therapy ◽  
Extraocular Muscle Surgery

Diplopia is described as being intractable when there is inability to both fuse the two images and suppress the second image. Intractable diplopia persists despite achieving ocular alignment using either prisms, lenses,vision therapy,extraocular muscle surgery, or botulinum toxin injection. Treatment usually resorts to occluding or fogging the patient’s nondominant eye. Often times, however, adults having other causative mechanisms for supposedly persistent diplopia are able to achieve comfortable single vision with treatment that either establishes fusion or reactivates a preexisting sensory adaptation. This case series reviews these other causes of diplopia.

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.

Unilateral True Vocal Fold Synkinesis Presenting with Airway Obstruction

2009 ◽  
Vol 118 (8) ◽  
pp. 587-591 ◽  
Author(s):  
Roya Azadarmaki ◽  
Natasha Mirza ◽  
Ahmed M. S. Soliman
Keyword(s):  
Botulinum Toxin ◽  
Airway Obstruction ◽  
Vocal Fold ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Nerve Section ◽  
Breathing Therapy ◽  
Vocal Fold Motion

Objectives We present a case series of 10 patients with unilateral true vocal fold paralysis who presented with airway obstruction. Methods A retrospective review of the authors' patients at 2 institutions with unilateral true vocal fold motion impairment was carried out over a 10-year period. Of these, 10 patients were identified who presented with stridor and dyspnea as a result of synkinesis. Six cases were a result of thyroidectomy, 1 case resulted from recurrent laryngeal nerve section for spasmodic dysphonia, 1 case occurred after anterior cervical diskectomy and fusion, and in 2 cases no cause was identified. Results Three patients underwent tracheotomy. Two patients underwent partial arytenoidectomy. Seven patients underwent botulinum toxin injection; 2 were treated with breathing therapy, and in 1 case breathing therapy was recommended. Seven patients underwent treatment with more than 1 method. Conclusions Unilateral vocal fold paralysis may present with airway obstruction as a result of synkinesis. Treatment should be incremental and starts with breathing therapy and botulinum toxin injection. Partial arytenoidectomy or tracheotomy may be necessary for refractory cases.

scholarly journals Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment

2019 ◽  
Vol 44 (9) ◽  
pp. 886-892 ◽  
Author(s):  
Hannah K Tandon ◽  
Pamela Stratton ◽  
Ninet Sinaii ◽  
Jay Shah ◽  
Barbara I Karp
Keyword(s):  
Botulinum Toxin ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Pelvic Floor Muscle ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Pain Medication ◽  
Muscle Spasm ◽  
Open Label ◽  
Topical Anesthetic

Background and objectivesMany women with endometriosis continue to have pelvic pain despite optimal surgical and hormonal treatment; some also have palpable pelvic floor muscle spasm. We describe changes in pain, spasm, and disability after pelvic muscle onabotulinumtoxinA injection in women with endometriosis-associated pelvic pain, a specific population not addressed in prior pelvic pain studies on botulinum toxin.MethodsWe present an open-label proof-of-concept case series of women with surgically diagnosed endometriosis. Under conscious sedation and with topical anesthetic, 100 units of onabotulinumtoxinA was injected transvaginally into pelvic floor muscle spasm areas under electromyography guidance. Changes in pain intensity, muscle spasm, disability, and pain medication use were assessed at periodic visits for up to 1 year after injection.ResultsThirteen women underwent botulinum toxin injection and were followed for at least 4 months. Before injection, 11 of the 13 women had spasm in >4/6 assessed pelvic muscles and reported moderate pain (median visual analog scale (VAS): 5/10; range: 2–7). By 4–8 weeks after injection, spasm was absent/less widespread (≤3 muscles) in all (p=0.0005). Eleven rated their postinjection pain as absent/mild (median VAS: 2; range: 0–5; p<0.0001); 7/13 reduced pain medication. Disability decreased in 6/8 women with at least moderate preinjection disability (p=0.0033). Relief lasted 5–11 months in 7 of the 11 patients followed for up to 1 year. Adverse events were mild and transient.ConclusionsThese findings suggest pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain. Botulinum toxin injection may provide meaningful relief of pain and associated disability.Trial registration numberNCT01553201

scholarly journals The Long-term Efficacy of Botulinum Toxin Injection to Treat Retrograde Cricopharyngeus Dysfunction

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2093834
Author(s):  
Rebecca C. Hoesli ◽  
Melissa L. Wingo ◽  
Robert W. Bastian
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Symptom Relief ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Case ◽  
Duration Of Action ◽  
Cricopharyngeus Muscle ◽  
Cardinal Symptoms

Objectives To report the percentage of patients with symptom relief 6 or more months after botulinum toxin injection into the cricopharyngeus muscle for retrograde cricopharyngeus dysfunction (R-CPD). Study Design Retrospective case series of consecutively treated patients. Setting Tertiary care laryngology clinic. Subjects and Methods A review was performed of the first 200 patients who were diagnosed with R-CPD and treated with botulinum toxin injection into the cricopharyngeus muscle by a single surgeon. The study group was limited to those for whom a minimum of 6 months has elapsed since the injection. Items assessed were efficacy, safety, complications, and duration of benefit. Results Of 200 patients treated, (99.5%) gained the ability to burp and 95% experienced relief of the cardinal symptoms of R-CPD: inability to belch, socially awkward gurgling noises, abdominal/chest pressure and bloating, and excessive flatulence. For those who experienced relief, 159 (79.9%) maintained a satisfactory ability to burp after 6 months. Of those who did not maintain the ability, 12 underwent a second injection, 1 patient underwent 3 subsequent injections, and 3 patients underwent partial myotomy. No patients experienced complications of botulinum toxin injection itself, and 4 patients had complications from esophagoscopy or anesthesia. Conclusion In a case series of 200 patients with retrograde cricopharyngeus dysfunction, 99% experienced relief of the cardinal symptoms and 79.9% experienced lasting relief of their symptoms beyond pharmacologic duration of action after a single injection of botulinum toxin into the cricopharyngeus muscle. Relief can be reestablished in the remainder via additional injection or cricopharyngeus myotomy.

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

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.

Cricopharyngeal Achalasia: Management and Associated Outcomes—A Scoping Review

2020 ◽  
Vol 163 (6) ◽  
pp. 1109-1113
Author(s):  
Karuna Dewan ◽  
Chloe Santa Maria ◽  
Julia Noel
Keyword(s):  
Botulinum Toxin ◽  
Head And Neck ◽  
Scoping Review ◽  
Radiation Treatment ◽  
Botulinum Toxin Injection ◽  
Treatment Options ◽  
Case Series ◽  
Small Sample ◽  
Small Sample Sizes ◽  
Head And Neck Radiation

Objective There is little consensus regarding the efficacy and safety of treatment options for cricopharyngeal (CP) achalasia. The purpose of this scoping review is to assess the literature regarding the various treatments for this disease. Data Sources PubMed was searched for all articles addressing treatment of adult CP achalasia between January 1990 and June 2019. Review Methods In total, 351 peer-reviewed results were reviewed by 3 otolaryngologists for inclusion. After review of titles, abstracts, and full texts, 60 articles were selected. Results Among included studies, 55% were retrospective and 45% were prospective. Forty-five percent of studies were case series. CP achalasia etiologies included idiopathic (28%), cerebrovascular accident (CVA) (28%), neurologic disease (17%), head and neck radiation treatment (11%), Zenker’s diverticulum (10%), and myositis (5%). Most commonly employed treatments were botulinum toxin injection (40%), endoscopic CP myotomy (30%), dilation with either balloon or bougie (25%), and open CP myotomy (15%). A proportion of patients were treated with more than 1 approach. Most studies included both subjective and objective outcome measures. Complications were reported most often in patients with a history of head and neck radiation. Conclusions Small sample sizes and heterogeneity of causes and treatments of CP achalasia, as well as short duration of follow-up, make it challenging to assess the superiority of one treatment over another. There is a need for a prospective study that more directly compares outcomes of administration of botulinum toxin, dilation, and CP myotomy in patients with CP achalasia of similar etiologies.

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