Botulinum toxin in neurological clinical practice

Botulinum toxin is produced by Clostridium botulini bacteria. It has been increasingly used as a boon in medical practice for chemodenervation in conditions like skeletal muscle spasticity, glandular hypersecretion, neuropathic pain and smooth muscle hyperactivity. The action of Botulinum neurotoxin (BoNT) is by blocking the neurotransmission at the cholinergic nerve endings, by inhibiting the docking and fusion of Acetyl Choline (Ach) vesicles for exocytosis into the synaptic area.Botulinum toxin has been used for management of neurological disorders with great patient satisfaction and appreciation. The effect of botulinum toxin wears off in 3-6 months and may require another dose. Frequent dosing may lead to production of antibodies against BoNT with consequent irresponsiveness to therapy in a few cases. Scrupulous use of botulinum toxin in the hands of experts may help a long way in giving much needed relief and respite to neurological patients and increase their quality of life. Its use in cosmetic dermatology in reducing wrinkles, by relaxing the facial muscles is very popular

Modified Putti Procedure for the Surgical Management of Patients with Adult Acquired Cavo-Varus Resulting from Peroneal Tendon Rupture

Background: Peroneal pathology, including trauma, can result in Cavovarus-Drop Foot type deformity, precluding patients from functioning in or attempting bracing. Lateral ankle stabilization and other associated procedures sometimes are not enough to address the resultant deformity, thus many CavoVarus-Dropfoot patients still have gait abnormalities, function minimally in a brace and still have secondary ambulatory pain and loss of function even when braced. We review the results of 9 patients meeting this criteria and electing for a Modified Putti Procedure and lower extremity reconstruction. Materials and Methods: The charts of 9 patients with adult-acquired CavoVarus deformity foot type after peroneal rupture were reviewed, all but 1 had failed previous AFO/bracing. These patients underwent surgical correction all consisting of the Modified Putti procedure, along with other ancillary procedures and the results and outcomes were collected. Additionally, surgical technique was documented. Results: The mean VAS score improved from 9.1 to 2.4 pre- and post-operatively, respectively. The average time to weight bearing was 7.2 weeks. Four of 9 (44.44%) patients experienced some form of complication. Eight of 9 (88.88%) patients relayed the surgery was a success and would opt to undergo it again, given the choice. Conclusion: The Modified Putti Procedure showed promising results, great patient satisfaction and marked improvement in pre-operative and post-operative pain rating. This technique, utilized after severe peroneal trauma and resultant deformity is present, is a considerable option to have in the foot and ankle surgeon’s armament.