Botulinum A Toxin Injection as a Treatment for Blepharospasm

In this chapter a case series is described of the use of botulinum A toxin for the treatment of blepharospasm in thirty-nine patients with blepharospasm due to various causes—essential, Meige’s syndrome, hand apraxia, cerebrovascular disease, and parkinsonism. A reduction of abnormal movement occurred in all patients, lasting up to 170 days. Both the amount and the duration of effect were dose dependent. Tearing, dry-eye symptoms, or transient ptosis occurred in 20% of injections, especially in patients who had had previous eyelid surgery. Botulinum A toxin injection into the orbicularis oculi muscle was found to be a safe, simple, and symptomatically helpful treatment for blepharospasm that can be repeated at intervals as required.

Botulinum A Toxin Injection into Extraocular Muscles as an Alternative to Strabismus Surgery

In this chapter a case series is described of the use of botulinum A toxin for the treatment of strabismus in 19 patients with multiple types of strabismus with different etiologies. The maximum follow-up following botulinum injection was six months. Injection of botulinum A toxin into extraocular muscle to weaken the muscle was found to be a safe and effective alternative (or adjunct) to surgery for strabismus correction. The maximum time of paralysis occurred four to five days following the injection, and then gradually diminished, depending on the dose. The maximum correction of strabismus was 40 prism diopters. This was the first case series describing the use of botulinum A toxin for strabismus correction, and it led the way to further studies on the subject, which eventually led to FDA approval in 1990.

Evaluation of Intra-Detrusor Injection of Botulinum A Toxin in Neurogenic Bladder in Patients with Multiple Sclerosis

Background Early diagnosis and amelioration of lower urinary tract symptoms is a key focus in the management of multiple sclerosis. Untreated LUTS can lead to increased morbidity and mortality, for instance as a result of irreversible changes in the lower urinary tract itself, recurrent UTIs, renal stones, renal function impairment, and lowered HR-QoL. Aim of the Work to assess the effects of intradetrusor muscle injection of botulinum A toxin on urgency & urgency urinary incontinence, urodynamic variables, and quality of life in patients with MS and voiding dysfunction. Patients and Methods This prospective randomized control study was conducted on 40 patients recruited after signing a formal consent. The patients had been subjected to cystoscopy and intradetrusor injection of 200 U of botulinum A toxin, sparing the trigon, with consent to do CIC if needed. We had compared between the results of urodynamics and patients’ satisfaction before and after botulinum A toxin injection. Results The study showed highly statistically significant difference over the periods through UI episodes per week in the study group; In addition to significant reductions in UI, IDCs were absent at week 12 in approximately 65% of patients; and in those patients with an IDC, PdetmaxIDC decreased to levels traditionally considered safe for the upper urinary tract. Improved QOL scores were observed following onabotulinumtoxin A, and the mean change (26.07) was substantially higher than the reported minimally important difference. Conclusion in patients with UI in association with MS, the use of intradetrusor onabotulinumtoxinA after failure with antimuscarinics is efficacious and generally well tolerated and represents a valuable development in the management of UI in these patients. Intradetrusor onabotulinumtoxinA produces sustained improvement in symptoms and HR-QoL. Further studies of repeat injections over a longer time frame will be of considerable interest.