scholarly journals Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity

2021 ◽  
Vol 2 ◽  
Author(s):  
Sheng Li ◽  
Jean Woo ◽  
Manuel F. Mas
Keyword(s):  
Botulinum Toxin ◽  
Side Effects ◽  
Chart Review ◽  
Early Stage ◽  
Inpatient Rehabilitation ◽  
Average Dose ◽  
Post Stroke ◽  
Pectoral Nerve ◽  
Early Use ◽  
Injection Type

The main objective was to examine practice patterns of phenol neurolysis for post-stroke spasticity management in the early stage. We performed a chart review of patients who were admitted for inpatient rehabilitation within 6 months after first-ever stroke and received phenol neurolysis within 15 months post-stroke. Out of 2,367 stroke admissions from January 2014 and December 2018, 68 patients met the criteria. 52.9% of these patients received phenol neurolysis within 12 weeks, i.e., early stage. The earliest phenol neurolysis procedure was at 19 days after stroke. On average, patients received first phenol injections at 16.3 weeks after stroke with an average dose of 7.3 ml. Most commonly injected nerves were tibial nerve motor branches (41/68), sciatic nerve motor branches (37/68), lateral pectoral nerve (16/68), medial pectoral nerve (15/68), obturator nerve (15/68) and musculocutaneous nerve (15/68). Among 68 patients, 24 received phenol only; 17 received phenol neurolysis first followed by botulinum toxin (BoNT) injections; 19 received BoNT injections first followed by phenol neurolysis; 8 received both phenol and BoNT injections at the same time. The interval from stroke to first procedure was similar between the Phenol-First group (13.3 weeks) and the BoNT-First group (12.6 weeks). The total amount of BoNT was significantly lower in the Phenol-First group (361.3 units) than in the BoNT-First group (515.8 units) (p = 0.005). The total amount of phenol was not statistically different between the Phenol-First group (5.9 ml) and the BoNT-First group (8.3 ml). The interval between the first procedure and its subsequent procedure was not statistically different between the Phenol-First group (18.3 weeks) and the BoNT-First group (10.7 weeks). These long intervals suggest that the subsequent injection (type and dose) was not planned during the first procedure. The general patterns of target areas were similar between BoNT injections and phenol neurolysis, except that phenol neurolysis rarely targeted the upper extremity distal muscles. No side effects after phenol or BoNT injections in the early stage after stroke were observed in the chart review. In summary, phenol neurolysis was started as early as 19 days after stroke. On average, patients received first phenol about 4 months after stroke with an average of 7.3 ml of phenol. Early use of phenol neurolysis likely decreases the total amount of BoNT for management of post-stroke spasticity without increased side effects.

Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma

2019 ◽  
Vol 133 (12) ◽  
pp. 1041-1045 ◽  
Author(s):  
A-L Hamdan ◽  
E Khalifee ◽  
H Jaffal ◽  
A Ghanem
Keyword(s):  
Botulinum Toxin ◽  
Side Effects ◽  
Chart Review ◽  
Botulinum Toxin A ◽  
Retrospective Chart Review ◽  
Complete Regression ◽  
Partial Regression ◽  
Toxin A ◽  
Vocal Process ◽  
The Mean

AbstractObjectivesTo report on the efficacy and adverse effects of interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma.MethodsA retrospective chart review was conducted of eight patients with vocal process granuloma resistant to anti-reflux therapy who underwent interarytenoid botulinum toxin A injection. The mean dosage of botulinum toxin A injected was 6.56 U.ResultsFifty per cent of patients had complete regression of the lesion and 50 per cent had partial regression. The main side effects were breathiness (n = 4), voice breaks (n = 1) and aspiration (n = 1).ConclusionInterarytenoid botulinum toxin A injection for the treatment of vocal process granuloma is an effective mode of therapy, with transient vocal and swallowing side effects.

scholarly journals The early use of botulinum toxin in post-stroke spasticity: study protocol for a randomised controlled trial

Trials ◽  
2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Cameron Lindsay ◽  
Julie Simpson ◽  
Sissi Ispoglou ◽  
Steve G Sturman ◽  
Anand D Pandyan
Keyword(s):  
Botulinum Toxin ◽  
Randomised Controlled Trial ◽  
Study Protocol ◽  
Controlled Trial ◽  
Post Stroke ◽  
Early Use ◽  
Randomised Controlled

Severe Drooling and Treatment With Botulinum Toxin

2012 ◽  
Vol 21 (1) ◽  
pp. 15-21
Author(s):  
Merete Bakke ◽  
Allan Bardow ◽  
Eigild Møller
Keyword(s):  
Botulinum Toxin ◽  
Side Effects ◽  
Health Risk ◽  
Flow Rate ◽  
Clinical Evidence ◽  
Acetylcholine Release ◽  
Psychosocial Problems ◽  
Rate Reduction ◽  
Local Inhibition ◽  
Surgical Treatments

Severe drooling is associated with discomfort and psychosocial problems and may constitute a health risk. A variety of different surgical and non-surgical treatments have been used to diminish drooling, some of them with little or uncertain effect and others more effective but irreversible or with side effects. Based on clinical evidence, injection with botulinum toxin (BTX) into the parotid and submandibular glands is a useful treatment option, because it is local, reversible, and with few side effects, although it has to be repeated. The mechanism of BTX is a local inhibition of acetylcholine release, which diminishes receptor-coupled secretion and results in a flow rate reduction of 25–50% for 2–7 months.

scholarly journals Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation

2021 ◽  
Author(s):  
Gurumayum Sonachand Sharma ◽  
Anupam Gupta ◽  
Meeka Khanna ◽  
Naveen Bangarpet Prakash
Keyword(s):  
Outcome Measures ◽  
Functional Outcomes ◽  
Rating Scale ◽  
Tertiary Care ◽  
Depression Scale ◽  
Inpatient Rehabilitation ◽  
University Hospital ◽  
Post Stroke ◽  
Significant Difference ◽  
Post Stroke Depression

Abstract Objective The aim of the study is to observe the effect of post-stroke depression on functional outcomes during inpatient rehabilitation. Patients and Methods The design involved is prospective observational study. The location involved is Neurological Rehabilitation unit in a tertiary care university hospital. The study period ranges from October 2019 to April 2020. The participants involved are the patients with first ever stroke, male and female with age ≥18 years and duration less than 1 year. All participants were assessed at admission and after 14 sessions of inpatient rehabilitation by depression subscale of Hospital Anxiety and Depression Scale (HADS-D) and Hamilton Depression Rating Scale (HDRS). The stroke outcomes measures used were: Barthel Index (BI), Scandinavian Stroke Scale (SSS), and Modified Rankin Scale (MRS). Results There are a total of 30 participants (18 males) with median stroke duration of 90 days. The median age of the patients was 58 years. Sixteen patients had ischemic and 14 had hemorrhagic stroke. Out of these, 57% (n = 17) had symptoms of depression (HADS-D >7). Participants in both groups (with and without depression) showed improvement in all the functional outcome measures (BI, SSS, MRS) at the time of discharge as compared with admission scores. The changes in the outcome measures were statistically significant within groups (p < 0.05) but not significant between the groups (p > 0.05). Conclusion The post-stroke depression is common among stroke survivors of less than 1 year duration. There was no significant difference in the functional outcomes between stroke patients with depression and those without depression with inpatient rehabilitation program.

Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emma M Loebel ◽  
Mary Rojas ◽  
Connor Mensching ◽  
Danielle Wheelwright ◽  
Laura K Stein
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Mount Sinai Hospital ◽  
Index Admission ◽  
Negative Consequences ◽  
Medical Comorbidities ◽  
Post Stroke ◽  
Increased Risk ◽  
Adjusted Model ◽  
The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

scholarly journals Plastic changes in spinal synaptic transmission following botulinum toxin A in post-stroke spastic patients

2016 ◽  
Vol 59 ◽  
pp. e142
Author(s):  
Marjorie Kerzoncuf ◽  
Laurent Bensoussan ◽  
Jean Michel Viton ◽  
Alain Delarque ◽  
Christiane Rossi Durand
Keyword(s):  
Botulinum Toxin ◽  
Synaptic Transmission ◽  
Botulinum Toxin A ◽  
Toxin A ◽  
Post Stroke ◽  
Plastic Changes

scholarly journals The Effect of Side Effects Tuberculosis Treatment in the Early Stage Towards Compliance with Tuberculosis Patients

2021 ◽  
Vol 5 (01) ◽  
pp. 29-32
Author(s):  
Joko Sapto Pramono ◽  
Nilam Noorma ◽  
Andi Lis Arming Gandini ◽  
Sopia Fitriani
Keyword(s):  
Side Effects ◽  
Pulmonary Tuberculosis ◽  
Health Workers ◽  
Early Stage ◽  
Treatment Compliance ◽  
Tuberculosis Treatment ◽  
Cross Sectional ◽  
Tuberculosis Patients ◽  
Early Stages ◽  
Significant Difference

Pulmonary tuberculosis treatment causes various side effects including nausea and vomiting, itching, vision problems, and anemia. Drug side effects in the early stages are one of the causes of non-adherence to complete treatment. The purpose of this study was to analyze the effect of the side effects Tuberculosis treatment in the early stages on treatment compliance for tuberculosis patients. This study used a cross sectional design. Samples were taken as many as 71 respondents, the instruments used were side effects of early-stage tuberculosis treatment and compliance with tuberculosis treatment in tuberculosis patients from the Morisky Medication Adherence Scale (MMAS). The results of the study found 97.7% adherent and 2.3% non-adherent, 39.5% mild side effects and 60.5% severe side effects. Chi-square test showed that no significant difference between the side effects of TB treatment in the early stages of tuberculosis treatment compliance in patients p = 0.669 at significant level of 95% (α = 0.05). There was no effect between the side effects of Tuberculosis treatment in the early stages of treatment compliance for Tuberculosis patients. It was recommended that health workers continue to monitor the side effects of tuberculosis treatment and provide motivation to carry out treatment completely. Keywords: side effects; early stage; treatment; pulmonary tuberculosis; compliance

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