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2.
Rev. Salusvita (Online) ; 39(1): 229-254, 2020.
Article in Portuguese | LILACS | ID: biblio-1140577

ABSTRACT

Uma grande parcela de odontólogos está optando pelo uso de toxina botulínica (TxB) em seus pacientes. Sua aplicação é diversa, podendo tanto ser utilizada para fins estéticos, como terapêuticos. Em estudos preliminares, a TxB tem sido usada com sucesso para tratar várias síndromes de dor, incluindo o disfunção temporomandibular (DTM). O objetivo deste trabalho é discutir a aplicação da toxina botulínica como forma de tratamento das disfunções temporomandibulares, além de revisar alguns estudos e técnicas de aplicação. Trata-se de uma revisão de literatura, realizada no mês de janeiro de 2019, referente aos últimos cinco anos, por meio das bases de dados online PubMED/Medline, Lilacs e Scielo. Os descritores utilizados foram: treatment and Botulinum toxins and disorders and temporomandibular joint como mecanismo de busca, sendo selecionados apenas os disponíveis em sua versão completa (Full Text). Um total de 136 artigos foram levantados, sendo 118 no Pubmed, com 58 selecionados disponíveis em sua versão completa (Full Text), após uma cautelosa seleção sobre o assunto. No Lilacs, foram encontrados 12 artigos, dos quais apenas 6 condiziam com assunto, e no Scielo, foram encontrados 6 artigos, nos quais 5 eram duplicados e 1 não condizia com o assunto. Mesmo existindo outras soluções tradicionais disponíveis, a toxina botulíca pode ser um tratamento viável, seguro e eficaz para muitas disfunções da musculatura facial e oral, principalmente em casos refratários ao tratamento convencional.


The use of botulinum toxin by dentists, in their patients, increased in recent times.It's a diverse treatment, it can be used both in esthetic or therapeutic purpose. In previous studies, botulinum toxin has been used successfully in the treatment of several pathological pains, including temporomandibular joint (TMJ) dysfunction. To discuss botulinum toxin use as a treatment for temporomandibular joint (TMJ) dysfunction, also review some studies and application techniques. This paper is a review of a recent articlein temporomandibular joint (TMJ) dysfunction treatment using botulinum toxin. The bibliographic research was done in January, 2019, in the last five years, through the online data bases PubMED / Medline, Lilacs and Scielo. The key words used in the search were "treatment" and "Botulinum toxin" and "dysfunction" and "temporomandibular ". Overall of 136 items were found. In the PubMED/Medline was found 118 papers and of those were selected only the available in Full text. After a careful selection on the papers about the subject, and limiting the search between the period from 1976 to 2019, 58 papers were chosen. In the other hand, on Lilacs, 12 papers were found, of which only 6 corresponded to the subject, and on the Scielo were found 6 papers in which 5 were duplicated and 1 did not agree to the subject. Even if other traditional solutions exists, the research shows that botulinum toxin is a viable, safe and effective treatment for many facial and oral musculature dysfunctions, mainly in refractory cases to conventional treatment.


Subject(s)
Temporomandibular Joint Disorders , Botulinum Toxins
3.
Rev. méd. Minas Gerais ; 30(supl.2): 22-25, 2020.
Article in Portuguese | LILACS | ID: biblio-1151068

ABSTRACT

Introdução: A Toxina Botulínica (TB) possui importantes aplicabilidades no tratamento de doenças oftalmológicas. Este trabalho apresenta a aplicação da TB no manejo da epífora, relacionada à obstrução baixa das vias de drenagem lacrimal, refratária à duas dacriocistorrinostomias (DCR). Descrição do caso: Paciente de 70 anos, sexo feminino, comparece ao serviço com queixa de epífora em ambos os olhos (AO) e histórico de dacriocistite aguda. Submetida à sondagem de vias lacrimais (AO), que sugeriu diagnóstico de obstrução baixa de vias lacrimais, e a duas DCR, em cada olho, ambas com resultado precário no controle da epífora. Foi então, realizada aplicação de TB em glândulas lacrimais em AO, com resultado satisfatório e remissão das queixas da paciente. Discussão: A aplicação da TB na glândula lacrimal gera inibição da excreção do conteúdo lacrimal e, consequente, redução dos efeitos da disfunção na drenagem causada pela obstrução baixa de vias lacrimais. Configura-se, portanto, como uma opção terapêutica relevante para o tratamento da epífora - principalmente para casos refratários ao tratamento cirúrgico convencional. O tratamento cirúrgico para epífora apresenta taxas de sucesso variando de 58-68%, já a aplicação de TB apresenta eficácia de 86%. Conclusão: O uso da TB em oftalmologia possui resultados promissores no tratamento de inúmeras doenças, como no caso relatado. Contudo, novos estudos são fundamentais para a definição de protocolos de utilização dessa droga, visando a otimizar sua eficácia e sua segurança para cada condição clínica. (AU)


Subject(s)
Humans , Female , Aged , Botulinum Toxins , Botulinum Toxins/therapeutic use , Lacrimal Apparatus Diseases , Lacrimal Apparatus Diseases/drug therapy
5.
Int. j. morphol ; 37(3): 1016-1022, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1012390

ABSTRACT

To allow students and surgeons to learn the sites for botulinum toxin injection, new types of educational images are needed because MRI, CT, and sectioned images are inadequate. This article describes browsing software that displays face peeled images that allow layers along the curved surface of the face to be peeled gradually in even depths across the surface. Two volume models of the head were reconstructed from sectioned images and segmented images of Visible Korean, respectively. These volume models were peeled serially at a thickness of 0.2 mm along the curved surface of the facial skin to construct the peeled images and peeled segmented images. All of the peeled images were marked with botulinum toxin injection sites, facial creases and wrinkles, and fat compartments. All peeled images and the text information were entered into browsing software. The browsing software shows 12 botulinum toxin injection sites on all peeled images of the anterior and lateral views. Further, the software shows 23 anatomic landmarks, 13 facial creases and wrinkles, and 7 face fat compartments. When a user points at any structure on the peeled images, the name of the structure appears. Our software featuring the peeled images will be particularly effective for helping medical students to quickly and easily learn the accurate facial anatomy for botulinum toxin injection sites. It will also be useful for explaining plastic surgery procedures to patients and studying the anatomic structure of the human face.


Para permitir que los estudiantes y cirujanos aprendan los sitios para la inyección de toxina botulínica, se necesitan nuevos tipos de imágenes educativas ya que las imágenes de MRI, CT e imágenes seccionadas son inadecuadas. Este artículo describe el software de navegación que muestra imágenes de cara sin piel que permiten que las capas a lo largo de la superficie curva de la cara se despeguen gradualmente en profundidades uniformes a lo largo de la superficie. Se reconstruyeron dos modelos de volumen de la cabeza a partir de imágenes seccionadas e imágenes segmentadas visibles, respectivamente. En estos modelos de volumen se retiró la piel en serie con un grosor de 0,2 mm a lo largo de la superficie curva de la cara para construir las imágenes sin piel y las imágenes segmentadas sin piel. Todas las imágenes sin piel se marcaron con puntos de inyección de toxina botulínica, arrugas y arrugas faciales y compartimientos de grasa. Todas las imágenes despegadas y la información de texto se ingresaron en el software de navegación. El software de navegación muestra 12 sitios de inyección de toxina botulínica en todas las imágenes de las vistas anterior y lateral. Además, el software muestra 23 puntos de referencia anatómicos, 13 pliegues y arrugas faciales y 7 compartimentos de grasa facial. Cuando un usuario selecciona cualquier estructura en las imágenes sin piel, aparece el nombre de la estructura. Nuestro software con las imágenes sin piel será particularmente efectivo para ayudar a los estudiantes de medicina a aprender rápida y fácilmente la anatomía facial precisa para los sitios de inyección de toxina botulínica. También será útil para explicar los procedimientos de cirugía plástica a pacientes y estudiar la estructura anatómica del rostro humano.


Subject(s)
Humans , Surgery, Plastic/education , Visible Human Projects , Face/anatomy & histology , Botulinum Toxins , Cadaver , Image Interpretation, Computer-Assisted , Color , Anatomic Landmarks , Models, Anatomic
6.
Rev. bras. cir. plást ; 34(3): 419-422, jul.-sep. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1047172

ABSTRACT

Procedimentos de rejuvenescimento facial substitutos da cirurgia tradicional tornaram-se cada vez mais populares para promover uma aparência jovial com procedimentos minimamente invasivos, como toxina botulínica injetável, preenchimento de tecidos moles e peelings químicos. No entanto, complicações podem ocorrer mesmo na presença de um injetor habilidoso e experiente. Apresentamos o caso de uma paciente submetida a reanimação labial estática usando retalho dermoadiposo para lesão do nervo facial direito após remoção de nódulos como complicação de preenchimento. A "abordagem modificada de bull horn" foi realizada para elevação do lábio superior em torno das asas nasais e columela e ao longo do sulco nasolabial direito. O retalho foi desepitelizado e obtido. Usando a ponta aberta de uma pequena cânula de lipoaspiração, a porção distal do retalho foi encapsulada e fixada diretamente em C-loop e foram utilizados pontos U, transfixando o retalho para o periósteo do arco zigomático. Nos três anos de seguimento não foram observadas complicações significativas e a paciente não relatou nenhuma limitação funcional ou insatisfação com o aspecto das cicatrizes no sulco nasolabial e ao redor das asas nasais e da columela.


Facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular to promote a youthful appearance with minimally invasive procedures such as injectable botulinum toxin, soft-tissue fillers, and chemical peels. Nevertheless, complications can occur even with an astute and experienced injector. Here we present the case of a patient who underwent static lip reanimation using a dermoadiposal flap for right facial nerve damage following nodule removal as a filler complication. A "modified bulls horn approach" to the upper lip lift was performed around the nasal wings and columella and along the right nasolabial fold. The flap was de-epithelized and harvested. Using the open tip of a small liposuction cannula, the distal portion of the flap was tunneled and fixed directly in a C-loop fashion using U stitches, transfixing the flap to the periosteum of the zygomatic arch. At 3 years follow-up, no significant complications were observed, and the patient reported no functional limitations or dissatisfaction with the scars in the nasolabial fold or around the nasal wings and columella.


Subject(s)
Humans , Female , Middle Aged , History, 21st Century , Rejuvenation , Surgery, Plastic , Botulinum Toxins , Reconstructive Surgical Procedures , Face , Facial Injuries , Facial Paralysis , Dermatologic Surgical Procedures , Dermal Fillers , Lip , Surgery, Plastic/adverse effects , Surgery, Plastic/methods , Botulinum Toxins/analysis , Botulinum Toxins/adverse effects , Botulinum Toxins/therapeutic use , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/rehabilitation , Face/surgery , Facial Injuries/surgery , Facial Injuries/complications , Facial Injuries/rehabilitation , Facial Paralysis/surgery , Facial Paralysis/complications , Dermatologic Surgical Procedures/methods , Dermal Fillers/analysis , Dermal Fillers/adverse effects , Lip/abnormalities , Lip/surgery
7.
Arq. neuropsiquiatr ; 77(8): 568-573, Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019471

ABSTRACT

ABSTRACT Motor impairments in stroke survivors are prevalent and contribute to dependence in daily activities, pain and overall disability, which can further upper-limb disability. Treatment with botulinum toxin A (BoNT-A) is indicated for focal spasticity and requires knowledge of biomechanics and anatomy to best select muscles to be injected in the limb. Objective: We aimed to describe the frequency of posture patterns in a Brazilian sample of stroke survivors and correlate them with recommendations of muscle selection for treatment with BoNT-A. Methods: Fifty stroke patients with spastic upper limbs scheduled for neuromuscular block were photographed and physically examined, to be classified by three independent evaluators according to Hefter's classification. Muscles that were injected with BoNT-A by their routine doctors were retrieved from medical charts. Results: Pattern III and IV were the most common (64.7%, 21.6%). We further subclassified pattern III according to the rotation of the shoulder, which effectively interfered in muscle choice. The muscles most frequently treated were shoulder adductors and internal rotators, elbow flexors and extensors, in forearm, the pronator teres and finger and wrist flexors, and, in the hand the adductor pollicis. Conclusion: Frequencies of upper-limb postures differed from previous reports. Other clinical features, besides spasticity, interfered with muscle choice for BoNT-A injection, which only partially followed the recommendations in the literature.


RESUMO As deficiências motoras que ocorrem nos indivíduos com doença cerebrovascular (DCV) são prevalentes e contribuem para dependência, dor e incapacidade, o que pode atrasar a reabilitação do membro superior e sua funcionalidade. O tratamento com toxina botulínica do tipo A (BoNT-A) é indicado para a espasticidade focal e requer conhecimento da biomecánica e anatomia para melhor selecionar os músculos a serem injetados. Objetivo: Descrever a frequência de padrões posturais numa amostra de brasileiros com sequelas de DCV e correlacioná-los com as recomendações de seleção de músculos. Métodos: Cinquenta pacientes com comprometimento do membro superior devido a DCV do ambulatório de bloqueios neuromusculares foram fotografados e examinados para categorização de acordo com a Classificação de Hefter. Os músculos tratados pelos seus médicos de rotina foram obtidos a partir dos prontuários. Resultados: Os padrões III e IV de Hefter foram mais comuns (64,7%; 21,6%). Nós propusemos a subclassificação do padrão III de acordo com a rotação do ombro, pois isso interferiu na escolha dos músculos tratados. Os músculos tratados com maior frequência foram os adutores e rotadores internos do ombro; flexores e extensores do cotovelo; no antebraço, o pronador redondo, flexores dos dedos e do carpo e na mão, o adutor do polegar. Conclusão: As frequências das posições do membro superior diferiram de relatos prévios. Além da espasticidade, outros fatores interferiram na escolha dos músculos tratados, que seguiram parcialmente as recomendações da literatura.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Botulinum Toxins/administration & dosage , Upper Extremity , Patient Positioning/methods , Acetylcholine Release Inhibitors/administration & dosage , Stroke Rehabilitation/methods , Muscle Spasticity/drug therapy , Treatment Outcome , Stroke/complications , Injections, Intramuscular , Muscle Spasticity/etiology
8.
Article in English | WPRIM | ID: wpr-763094

ABSTRACT

Lingual dystonia is a rare type of dystonia, the main symptom of which varies from intermittent to sustained tongue fixation. Several studies have suggested that the cerebellum may be implicated in dystonia. There are several treatment options available for dystonia, including medication, botulinum toxin injection, and surgical intervention. We chose to inject botulinum toxin into the styloglossus muscle, and the symptoms of the lingual dystonia were improved. We report a case of lingual dystonia following a bilateral cerebellar stroke that responded to treatment with botulinum toxin.


Subject(s)
Botulinum Toxins , Cerebellum , Dystonia , Infarction , Stroke , Tongue
10.
Article in English | WPRIM | ID: wpr-762795

ABSTRACT

Post-traumatic hematoma formation is a common complication of contusion. If the hematoma is large enough to aspirate or drain, it can be treated quickly and appropriately. However, if the hematoma is small or concealed by local swelling, it may be overlooked and left untreated. In most cases, a hematoma will resolve following conservative treatment; however, associated infection or muscle fibrosis can occur. Herein, we present the case of a patient with a chin deformity caused by a post-traumatic hematoma. The deformity was treated using botulinum toxin and triamcinolone acetonide injections as minimally invasive treatments. The course of treatment was good.


Subject(s)
Botulinum Toxins , Chin , Congenital Abnormalities , Contusions , Facial Asymmetry , Fibrosis , Hematoma , Humans , Triamcinolone Acetonide
11.
Article in English | WPRIM | ID: wpr-762734

ABSTRACT

BACKGROUND: Because many cosmetic surgery clinics are not adequately equipped to handle emergent conditions, patients often come to a university hospital when problems occur during or after cosmetic surgery. However, few in-depth studies have been conducted of this issue. Therefore, we investigated emergency department visits due to complications associated with cosmetic surgery. METHODS: A retrospective chart review was conducted of 38 patients who visited the emergency department of the authors' institution due to complications associated with cosmetic surgery from July 2014 to June 2017. RESULTS: There were more women than men (30 women vs. 8 men). Their mean age was 32.4 years (range, 19–57 years). Upon presentation to the emergency department, patients' vital signs and mental status were usually normal (27 normal vs. 11 abnormal). The types of surgery included blepharoplasty, rhinoplasty, malar/orthognathic surgery, mammaplasty, liposuction, fat grafting, and filler and botulinum toxin injections. Most patients required hospitalization (26 admitted vs. 12 discharged). Eight of the hospitalized patients required intensive care unit care, of whom two died and three experienced brain death or had permanent neurologic sequelae. CONCLUSIONS: The complications were usually minor problems, despite the need for hospitalization, but some complications were life-threatening. We recommend close monitoring and maintaining an adequate injection capacity for intravenous sedative anesthesia. When any symptom or sign of a complication occurs, it is best to transfer the patient to a university hospital as soon as possible. Taking a careful medical history is always needed, even for minor procedures.


Subject(s)
Anesthesia , Blepharoplasty , Botulinum Toxins , Brain Death , Cardiomyopathies , Emergencies , Emergency Service, Hospital , Epinephrine , Female , Hospitalization , Humans , Intensive Care Units , Lipectomy , Male , Mammaplasty , Retrospective Studies , Rhinoplasty , Surgery, Plastic , Transplants , Vital Signs
12.
Article in English | WPRIM | ID: wpr-762639

ABSTRACT

Deep brain stimulation (DBS) in internal globus pallidus is considered to be a good option for controlling generalized dystonia in patients with this condition. In this relation, it is known that DBS has already been shown to have significant effects on primary dystonia, but is seen as controversial in secondary dystonia including cerebral palsy (CP). On the other hand, intrathecal baclofen (ITB) has been known to reduce spasticity and dystonia in patients who did not respond to oral medications or botulinum toxin treatment. Here, we report a patient with dystonic CP, who received the ITB pump implantation long after the DBS and who noted remarkable improvement in the 36-Item Short Form Health Survey, Dystonia Rating Scale, Modified Barthel Index, and visual analog scale scores for pain after an ITB pump implantation was used as compared with DBS. To our knowledge, the present case report is the first to demonstrate the effects of an ITB pump on reducing pain and dystonia and improving quality of life and satisfaction, compared with DBS in a patient with CP.


Subject(s)
Baclofen , Botulinum Toxins , Cerebral Palsy , Deep Brain Stimulation , Dystonia , Dystonic Disorders , Globus Pallidus , Hand , Health Surveys , Humans , Muscle Spasticity , Quality of Life , Visual Analog Scale
13.
Article in Korean | WPRIM | ID: wpr-761586

ABSTRACT

The prevalence of small bowel cancer is relatively low. The abdominal pain that patients with small bowel cancer present as a symptom is non-specific and often interpreted as a normal finding on radiographic studies. To prevent delayed diagnosis of small bowel cancer, practitioners must maintain a certain level of suspicion. We report a case of delayed diagnosis of jejunal cancer as it was misdiagnosed as gastroparesis. A 69-year-old woman complained of recurrent nausea and vomiting. At the beginning of her hospitalization, we could not diagnose mechanical obstruction through esophagogastroduodenoscopy and abdominal computed tomography. A gastric emptying study revealed delayed gastric emptying. Although the patients received treatments, including administration of prokinetics and botulinum toxin injection, for gastroparesis, her symptoms aggravated. Subsequently, plain radiography of the abdomen revealed a double-bubble sign. Abdominal computed tomography was performed under the suspicion of small bowel obstruction; however, the diagnosis was not clear. Consequently, exploratory laparoscopy was performed. She underwent surgical management, including small bowel segmental resection and duodenojejunostomy, due to the jejunal mass with involvement of the stomach, pancreatic head, and mesentery of the transverse colon. The postoperative pathological results revealed a moderately differentiated adenocarcinoma of the jejunum.


Subject(s)
Abdomen , Abdominal Pain , Adenocarcinoma , Aged , Botulinum Toxins , Colon, Transverse , Delayed Diagnosis , Diagnosis , Endoscopy, Digestive System , Female , Gastric Emptying , Gastroparesis , Head , Hospitalization , Humans , Jejunal Neoplasms , Jejunum , Laparoscopy , Mesentery , Nausea , Prevalence , Radiography , Stomach , Vomiting
14.
Article in Korean | WPRIM | ID: wpr-766594

ABSTRACT

Strabismus is a pathologic condition in which the eyes do not properly align with each other forming different images on the corresponding retinal points. Early diagnosis and appropriate management of strabismus in the sensitive period of visual maturation is critical for the development of normal binocular vision in children. Therefore, it is important to perform ophthalmologic examinations including cycloplegic refraction and ocular alignment as early as possible to detect risk factors for amblyopia and strabismus. Strabismus could also be a sign of intraocular pathology, brain diseases or myasthenia gravis which may require urgent treatment. Strabismus can be treated by surgical and non-surgical methods. The first step in the management of strabismus is to correct amblyogenic refractive errors and prescribe glasses if necessary. Bifocal lenses, prism glasses, occlusion therapy, and botulinum toxin injection could also be considered. Surgery is usually performed if non-surgical treatments are unsuccessful. Making an accurate diagnosis and setting practical goals and limitations of treatment is the key to success in the treatment of strabismus.


Subject(s)
Amblyopia , Botulinum Toxins , Brain Diseases , Child , Diagnosis , Early Diagnosis , Eyeglasses , Glass , Humans , Myasthenia Gravis , Pathology , Refractive Errors , Retinaldehyde , Risk Factors , Strabismus , Vision, Binocular
15.
Article in English | WPRIM | ID: wpr-765849

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the efficacy of globus pallidus interna deep brain stimulation (GPi-DBS) for treating dystonia due to the GNAL mutation. METHODS: We provide the first report of a dystonia patient with a genetically confirmed GNAL mutation in the Korean population and reviewed the literature on patients with the GNAL mutation who underwent GPi-DBS. We compared the effectiveness of DBS in patients with the GNAL mutation compared to that in patients with DYT1 and DYT6 in a previous study. RESULTS: Patients with the GNAL mutation and those with DYT1 had higher early responder rates (GNAL, 5/5, 100%; DYT1, 7/7, 100%) than did patients with DYT6 (p = 0.047). The responder rates at late follow-up did not differ statistically among the three groups (p = 0.278). The decrease in the dystonia motor scale score in the GNAL group was 46.9% at early follow-up and 63.4% at late follow-up. CONCLUSION: GPi-DBS would be an effective treatment option for dystonia patients with the GNAL mutation who are resistant to medication or botulinum toxin treatment.


Subject(s)
Botulinum Toxins , Deep Brain Stimulation , Dystonia , Follow-Up Studies , Globus Pallidus , Humans
16.
Article in English | WPRIM | ID: wpr-765841

ABSTRACT

OBJECTIVE: To determine whether the use of unique customized spectacles provided with modified side arms may be helpful in reducing benign essential blepharospasm (BEB) in patients describing periocular sensory tricks (ST). METHODS: A prospective descriptive study of patients with BEB with positive periocular or temporal region ST phenomenon response under the care of the Botox Clinic at Moorfields Eye Hospital, London, UK. Nine consecutive patients with BEB describing ST were recruited, and the disease frequency and severity were assessed with the Jankovic Rating Scale (JRS) and the Blepharospasm Disability Index (BSDI) before and after the use of the sensory trick frames (STF). RESULTS: A reduction in the score was noted in both severity (p = 0.0115) and frequency patterns (p = 0.0117) in the JRS in patients using the STF. A significant reduction of the BSDI score was also observed (p = 0.0314). CONCLUSION: All the patients selected and fitted with the STF had a reduction in spasms and related symptoms. This new device may be helpful in some selected BEB patients who previously responded positively to periocular pressure alleviating maneuvers.


Subject(s)
Arm , Blepharospasm , Botulinum Toxins , Dystonic Disorders , Eyeglasses , Humans , Prospective Studies , Spasm , Temporal Lobe
17.
Article in English | WPRIM | ID: wpr-765836

ABSTRACT

Deep brain stimulation (DBS) of the zona incerta has shown promising results in the reduction of medically refractory movement disorders. However, evidence supporting its efficacy in movement disorders secondary to hemorrhagic stroke or hemichoreoathetosis is limited. We describe a 48-year-old man who developed progressive hemichoreoathetosis with an arrhythmic, proximal tremor in his right arm following a thalamic hemorrhagic stroke. Pharmacological treatment was carried out with no change in the Abnormal Involuntary Movement Scale (AIMS) score after 4 weeks (14). After six sessions of botulinum toxin treatment, a subtle improvement in the AIMS score (13) was registered, but no clinical improvement was noted. The arrhythmic proximal movements were significantly improved after DBS of the zona incerta with a major decrease in the patient’s AIMS score (8). The response to DBS occurring after the failure of pharmacological and botulinum toxin treatments suggests that zona incerta DBS may be an alternative for postthalamic hemorrhage movement disorders.


Subject(s)
Abnormal Involuntary Movement Scale , Arm , Botulinum Toxins , Chorea , Deep Brain Stimulation , Hemorrhage , Herpes Zoster , Humans , Middle Aged , Movement Disorders , Stroke , Tremor , Zona Incerta
18.
Article in Korean | WPRIM | ID: wpr-758527

ABSTRACT

Botulinum toxin (BTX) has been widely used to treat muscle spasms in many voice disorders. Most commercially available forms of BTX require reconstitution before use, which may increase the risk of contamination and requires careful titration. Recently, a liquid-type BTX type A (BTX-A) has been developed, which should simplify the procedure and enhance its efficacy. In this session, I will discuss about the differences of BTX-A from existing types and the practical issues associated with it.


Subject(s)
Botulinum Toxins , Dysphonia , Spasm , Voice Disorders
19.
Article in Korean | WPRIM | ID: wpr-758526

ABSTRACT

Functional dysphonia (FD) is a disease entity which includes various voice disorders in the absence of structural or neurologic laryngeal pathology. Muscle tension dysphonia (MTD), psychogenic dysphonia are representative FD with completely different pathogenesis. Therefore there is no standard treatment modality for FD, the first step of treatment of FD is differentiating patient's voice symptoms from other organic voice disorders and other functional voice problems. MTD is a functional voice disorder caused by hyperfunction of intrinsic and extrinsic laryngeal musculature. Symptoms include increased vocal effort, roughness, fatigue and odynophonia. First line for MTD is indirect or direct voice therapy. Unfortunately, many patients with MTD improve with voice therapy alone. For these patients, various modalities tried; lidocaine application, surgical excision of the false vocal folds, and botulinum toxin injection, etc. Botulinum toxin injections are widely used in the field of otolaryngology, especially for spasmodic dysphonia. However, its use in FD or MTD has only been described in few case reports. The aim of this lecture is to evaluate the feasibility of botulinum toxin injection for FD, especially MTD.


Subject(s)
Botulinum Toxins , Dysphonia , Fatigue , Humans , Lidocaine , Muscle Tonus , Otolaryngology , Pathology , Vocal Cords , Voice , Voice Disorders
20.
Article in English | WPRIM | ID: wpr-760058

ABSTRACT

PURPOSE: To compare the efficacy and safety of Botox and Neuronox in the management of benign essential blepharospasm (BEB). METHODS: We performed a triple-masked, randomized control study to compare Botox and Neuronox in 48 eyes of 24 patients with BEB. All 24 patients randomly received Botox or Neuronox in the periorbital region in a masked, randomized split-face manner, keeping the injection sites and doses uniform. The toxin preparation, injection, and clinical evaluations were done by three independent observers. Objective outcome measures included improvement in the severity of spasm, grading of the functional visual status, changes in palpebral fissure height, lagophthalmos, superficial punctate keratitis and Schirmer's test at 2 weeks, 6 weeks, and upon conclusion of the effect of the toxin. Subjective outcome measures included duration of the effect and a forced choice stating which half of the face was better. Evaluations were performed through clinical measurements, external digital photography, and high-definition videography. RESULTS: The mean duration of relief from spasms was 3.78 months (standard deviation, 1.58 months; range, 1 to 6 months). The improvement in the objective parameters like severity of spasm and functional visual status was statistically significant at the 2-week and 6-week follow-up visits (p < 0.001). The changes in palpebral fissure height, lagophthalmos, and superficial punctate keratitis were equally observed in both groups. At 2 and 6 weeks, three of 24 (12.5%) and one of 24 (4%) patients, respectively, reported an unequal effect between the two sides of the face, but this difference was not statistically significant. At final follow-up (conclusion of the toxin effect), patients reported equal effect with no preference for either hemiface. No statistically significant differences were found in the comparative analysis between the Neuronox and Botox groups. CONCLUSIONS: Neuronox and Botox are comparable in terms of their safety and efficacy in the management of BEB.


Subject(s)
Blepharospasm , Botulinum Toxins , Botulinum Toxins, Type A , Clothing , Follow-Up Studies , Humans , Keratitis , Masks , Outcome Assessment, Health Care , Photography , Spasm
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