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2.
Rev. Col. Bras. Cir ; 49: e20213152, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365380

ABSTRACT

ABSTRACT Introduction: the botulinum toxin A (BTA) has been used to achieve a chemical component separation, and it has been used with favorable outcomes for the repair of complex ventral hernia (CVH) with and without loss of domain (LD). The aim of this study is to describe our early experience with the chemical component separation in the United Sates. Methods: a retrospective observational study of all patients who underwent ventral hernia repair for CVH with or without LD between July 2018 and June 2020. Preoperative BTA was injected in all patients via sonographic guidance bilaterally, between the lateral muscles to achieve chemical denervation before the operation. Patient demographics, anatomical location of the hernia, perioperative data and postoperative data are described. Results: 36 patients underwent this technique before their hernia repair between July 2018 to June 2020. Median age was 62 years (range 30-87). Median preoperative defect size was 12cm (range 6-25) and median intraoperative defect size was 13cm (range 5-27). Median preoperative hernia sac volume (HSV) was 1338cc (128-14040), median preoperative abdominal cavity volume (ACV) was 8784cc (5197-18289) and median volume ration (HSV/ACV) was 14%. The median OR time for BTA administration was 45 minutes (range 28-495). Seroma was the most common postoperative complication in 8 of the patients (22%). Median follow up was 43 days (range 0-580). Conclusion: preoperative chemical component separation with BTA is a safe and effective adjunct to hernia repair in CVH repairs where a challenging midline fascial approximation is anticipated.


RESUMO Introdução: a toxina botulínica A (TBA) tem sido usada para alcançar a separação química dos componentes, com resultados favoráveis para o reparo de hérnias ventrais complexas (HVC) com ou sem perda de domínio (PD). O objetivo deste estudo é descrever nossa experiência inicial com a separação química dos componentes nos Estados Unidos. Métodos: estudo retrospectivo observacional com todos os pacientes submetidos a reparo de hérnia ventral complexa com ou sem PD entre julho de 2018 e junho de 2020. A TBA pré-operatória foi injetada em todos os pacientes, guiada por ultrassonografia, bilateralmente entre os músculos laterais para alcançar a denervação química antes da operação. Dados demográficos dos pacientes, local da hérnia, dados peri-operatórios e pós-operatórios são descritos. Resultados: 36 pacientes foram submetidos a esta técnica antes do reparo da hérnia. A idade mediana foi 62 anos (30-87). O tamanho mediano pré-operatório do defeito herniário foi 12cm (6-25) e o defeito mediano intra-operatorio foi 13cm (5-27). O volume mediano do saco herniário pré-operatório foi 1.338mL (128-14.040), o volume mediano da cavidade abdominal pré-operatório foi 8.784 (5.197-18.289) mL e a razão dos volumes foi 14%. A duração mediana da operação para aplicação da TBA foi 45 minutos (28-495). O seroma foi a complicação mais comum no pós-operatório, em oito pacientes (22%). O seguimento pós-operatório mediano foi de 43 dias (0-580). Conclusão: a separação pré-operatória de componentes com TBA é tratamento adjuvante seguro e eficaz em reparos de HVC em que aproximação da fáscia é antecipadamente desafiadora.


Subject(s)
Humans , Adult , Aged , Aged, 80 and over , Botulinum Toxins, Type A/therapeutic use , Abdominal Wall/surgery , Neuromuscular Agents/therapeutic use , Preoperative Care , New York , Abdominal Muscles/surgery , Herniorrhaphy , Hernia, Ventral/surgery , Middle Aged
3.
Rev. méd. Urug ; 37(3): e37303, set. 2021. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1341551

ABSTRACT

Resumen: Introducción: la parálisis cerebral (PC) es la causa más frecuente de discapacidad motriz en niños y adolescentes. En el 85% de los casos, la manifestación motora predominante es la espasticidad. Las inyecciones de toxina botulínica tipo A (TB-A) se han usado para reducir la espasticidad en niños con PC. No existen investigaciones a nivel nacional que comprueben si los resultados son comparables a los reportados en la literatura. Objetivo: determinar el efecto del tratamiento con TB-A en el tríceps sural en conjunto con la rehabilitación física en niños con PC espástica durante los años 2017-2018 en el Centro de Rehabilitación Infantil Teletón, Uruguay. Métodos: se realizó un estudio descriptivo, retrospectivo, de cohorte histórica única con seguimiento longitudinal, mediante la revisión de historias clínicas de los pacientes con PC con marcha independiente o asistida que recibieron tratamiento con TB-A para el tratamiento de la espasticidad del tríceps sural durante el período 2017-2018. Resultados: se analizaron 40 procedimientos de inyección de TB-A. Se observó una buena respuesta al mes y a los 3 meses del tratamiento con TB-A, con mejoría del ángulo de dorsiflexión del pie con la rodilla en flexión y en extensión, mejoría del puntaje de la escala de espasticidad de Ashworth modificada y, en el 95% de los procedimientos, de la percepción subjetiva de los padres. Se observó una disminución del efecto hacia los 6 meses de la aplicación. Conclusión: la aplicación de TB-A en el Centro Teletón muestra resultados positivos, comparables con los reportados en la bibliografía internacional.


Abstract: Introduction: cerebral palsy (CP) is the most common source of motor disability in children and adolescents. In 85% of cases, the prevailing motor manifestation is spasticity. Botulinum toxin Type A injections (TB-A) have been used to reduce spasticity in children with cerebral palsy (CP). There are no studies at the national level that show whether the results are comparable to those reported in literature. Objective: to determine the effect of TB-A therapy in the triceps surae along with the physical rehabilitation in children with spastic cerebral palsy (CP) during 2017-2018 at the Teleton Children´s Rehabilitation Center, Uruguay. Method: retrospective, descriptive study of a single cohort with a longitudinal follow-up was conducted, through the review of medical records belonging to patients with CP with independent or assisted gait, who received TB-A therapy to treat sural triceps spasticity during 2017-2018. Results: 40 TB-A injection procedures were analysed. A good response was observed one month and three months after being treated with TB-A, evidencing improvement in the dorsiflexion angle between the foot and the knee in flexion and extension, improvement on the modified Ashworth spasticity scale score and, in 95% of procedures, the subjective perception of parents. The effect was observed to decrease towards 6 months after the procedure. Conclusion: application of TB-A at the Teletón Center shows positive results, comparable to those reported by international blibliography.


Resumo: Introdução: a paralisia cerebral (PC) é a causa mais freqüente de deficiência motora em crianças e adolescentes. Em 85% dos casos, a manifestação motora predominante é a espasticidade. As injeções de toxina botulínica tipo A (TB-A) têm sido usadas para reduzir a espasticidade em crianças com PC. Não há pesquisas nacionais que verifiquem se os resultados são comparáveis aos relatados na literatura. Objetivo: determinar o efeito do tratamento da TB-A no tríceps sural em conjunto com a reabilitação física em crianças com PC espástica durante os anos 2017-2018 no Centro de Rehabilitación Infantil Teletón, Uruguai. Métodos: estudo descritivo, retrospectivo, com coorte histórica única com acompanhamento longitudinal, realizado por meio da revisão de prontuários de pacientes com PC com deambulação independente ou assistida que receberam tratamento com TB-A para o tratamento da espasticidade do tríceps sural, no período 2017-2018. Resultados: 40 procedimentos de injeção de TB-A foram analisados. Observou-se boa resposta um mês e três meses após o tratamento com TB-A, com melhora no ângulo de dorsiflexão do pé com o joelho em flexão e extensão, melhora no escore da escala de espasticidade de Ashworth modificada e, em 95% dos procedimentos, a partir da percepção subjetiva dos pais. Uma diminuição no efeito foi observada 6 meses após a aplicação. Conclusão: a aplicação do TB-A no Centro de Rehabilitación Infantil Teletón apresentou resultados positivos, comparáveis aos relatados na literatura internacional.


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Cerebral Palsy/therapy , Botulinum Toxins, Type A/therapeutic use , Muscle Spasticity
6.
J. appl. oral sci ; 29: e20201035, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250187

ABSTRACT

Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey's post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.


Subject(s)
Humans , Female , Acupuncture Therapy , Botulinum Toxins, Type A/therapeutic use , Myofascial Pain Syndromes/drug therapy , Pain , Treatment Outcome , Pain Threshold , Masseter Muscle , Masticatory Muscles
8.
Rev. inf. cient ; 99(4): 359-366, jul.-ago. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1139196

ABSTRACT

RESUMEN Introducción: No se encuentran antecedentes de investigaciones que aborden resultados de la aplicación de toxina botulínica tipo A en pacientes con espasmo hemifacial en la provincia Guantánamo. Objetivo: Evaluar los resultados terapéuticos de la aplicación de toxina botulínica tipo A en pacientes con espasmo hemifacial atendidos en consulta de Neurología. Método: Se realizó un estudio descriptivo longitudinal de 21 pacientes atendidos en servicio de Neurología con espasmo hemifacial y tratamiento con toxina botulínica tipo A, desde enero 2018 hasta enero 2019. Las variables estudiadas fueron: edad, sexo, hemicara afectada, periodo de latencia, duración, desaparición del efecto clínico de toxina botulínica tipo A, y porciento de incapacidad funcional en pacientes al aplicar la escala de discapacidad antes y después de la aplicación del tratamiento. Resultados: Predominó el sexo femenino con 57,1%, edad mayor de 55 años con 57,14 %, lado afectado predominante el izquierdo con 57,14 %, el periodo de latencia de la toxina botulínica tipo A fue entre el tercer y décimo día con 14 pacientes para un 66,67 %, el tiempo máximo de duración del tratamiento fue de uno a dos meses con un 57,14 %, y la desaparición del efecto terapéutico de la toxina fue entre el tercer y cuarto mes con un 52,38%. Luego de la aplicación de la escala de evaluación clínica del espasmo hemifacial se evidenció disminución del porcentaje de pacientes con incapacidad funcional. Conclusiones: La toxina botulínica tipo A es efectiva en el tratamiento del espasmo hemifacial.


ABSTRACT Introduction: No research records were founded dressing the results of the application of botulinum toxin type A in patients with hemifacial spasm in Guantanamo province. Objective: to evaluate the therapeutic results of the application of botulinum toxin type A in patients with hemifacial spasm treated in a Neurology consultation. Method: a descriptive and longitudinal study was carried out in 21 patients attended in Neurology service with hemifacial spasm and botulinum toxin type A treatment, fromJanuary 2018 to January 2019. The variables studied were: age, gender, hemiface affected, latency period, duration, disappearance of the clinical effects of botulinum toxin type A, and percentage of functional disability in patients when applying the disability scale before and after the treatment. Results: Female cases predominated (57.1%), agesover 55 years (57.14 %), the most common affected side of the face was the left, with 57.14 %, the latency period of botulinum toxin type A was between the third to the tenth day in 14 of the patients (66.67 %), the maximum time of duration of treatment ranged from one to two months (57.14 %), and the disappearance of the therapeutic effect of the toxin in the patients was between the third to the fourth month (52.38%). After the application of the clinical assessment scale of hemifacial spasm, a decrease in the percentage of patients with functional disability was evidenced. Conclusions: Botulinum toxin type A is effective in the treatment of hemifacial spasm.


Subject(s)
Humans , Treatment Outcome , Botulinum Toxins, Type A/therapeutic use , Hemifacial Spasm/therapy , Epidemiology, Descriptive , Longitudinal Studies
9.
Rev. bras. odontol ; 77(1): 1-8, jan. 2020. Ilus, Tab
Article in English | LILACS | ID: biblio-1104154

ABSTRACT

Objetivo: o objetivo desse trabalho foi, através de uma revisão de literatura, discutir o mecanismo de ação, as características de uso das toxinas botulínicas, suas indicações estéticas e terapêuticas, elaborando um conteúdo prático e ilustrado a fim de que graduandos em Odontologia e cirurgiões-dentistas possam ter um primeiro contato com o tema. Materiais e Métodos: foi realizado um levantamento nas bases de dados Google Scholar, Pubmed e Scielo, com a palavras chave: Toxinas Botulínicas, Odontologia, Botulinum Toxins, Dentistry. Foram selecionados 32 artigos em português e inglês, publicados de 2008 até 2019, em sua versão completa e gratuita. Foram excluídos artigos que não abordassem diretamente o tema. Resultados: verificou-se que no meio odontológico a aplicação de Toxina Botulínica do Grupo A (TBX-A) apresenta inúmeras indicações estéticas e também terapêuticas. A toxina se mostrou eficaz no tratamento de bruxismo, disfunções temporomandibulares, hipertrofia do masseter, sorriso gengival, assimetria do sorriso, sialorreia e na implantodontia e por possuir tantas aplicações tende a estar cada vez mais presente nos consultórios odontológicos. Conclusão: foi possível concluir que, quando utilizada por profissionais capacitados, que sigam protocolos adequados, é um tratamento minimamente invasivo, seguro, capaz de melhorar a qualidade de vida dos pacientes.


Objective: the aim of this study was, through a literature review, to discuss the mechanism of action, the botulinum toxins use characteristics, their aesthetic and therapeutic indications, preparing a practical and illustrated content so that undergraduate dentistry students and dental surgeons have a first contact with the topic. Materials and Methods: a survey was conducted in Google Scholar, Pubmed and Scielo databases, using the keywords: Botulinum Toxins, Dentistry, Botulinum Toxins, Dentistry. 32 articles in Portuguese and English, published from 2008 to 2019, in their full and free versions, were selected. Articles that did not directly address to the topic were excluded. Results: it is known that Botulinum Toxin Type-A (BTX-A) has numerous applications, and in dentistry it presents numerous aesthetic and therapeutic indications. The toxin was effective in the treatment of bruxism, temporomandibular disorders, masseter hypertrophy, gingival smile, smile asymmetry, sialorrhea and implantology. Because of that, it tends to be increasingly present in dental offices. Conclusion: it was possible to conclude that, when used by trained professionals who follow proper protocols, it is a minimally invasive and safe treatment, capable of improving patients' quality of life.


Subject(s)
Botulinum Toxins, Type A , Botulinum Toxins, Type A/therapeutic use , Esthetics, Dental , Dentistry
10.
s.l; RedARETS; ene. 2020.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-1095210

ABSTRACT

INTRODUCCIÓN: Se puede formar tejido cicatricial después de una cirugía, trauma o diversas afecciones inflamatorias. Las cicatrices pueden crear muchas funciones adversas, efectos cosméticos y estructurales, y a veces efectos psicológicos, eso puede afectar la vida diaria de los pacientes (Kerwin et al., 2014). El mecanismo de reparación de cicatrices a nivel molecular no es bien comprendido (Gladstone et al., 2010). BÚSQUEDA: Ensayos randomizados controlados o ensayos no randomizados, meta-análisis y evaluaciones de tecnologías que evalúen el uso de toxina botulínica en el tratamiento de las heridas y/o cicatrices cutáneas. MÉTODOS: De las 3 revisiones sistemáticas con metaanálisis encontradas se seleccionaron dos con alto nivel de confianza de acuerdo con la herramienta AMSTAR-2 que evaluaron Toxina botulínica A frente a placebo. Se evaluó el sesgo de los estudios incluidos y se realizaron perfiles de evidencia utilizando la metodología GRADE con el programa GRADE-PRO GDT teniendo en cuenta los desenlaces seleccionados como criticos o importantes. RESULTADOS: a. Evaluado en postquirúrgico de cirugía reciente, sobre piel previamente sana. b. Heterogeneidad entre estudios I2 27% y p 0,10. c. Evaluado en cocatriz hipertrófica o queloide.


Subject(s)
Humans , Wounds and Injuries/drug therapy , Burns/drug therapy , Botulinum Toxins, Type A/therapeutic use , Technology Assessment, Biomedical , Cost-Benefit Analysis
11.
Arq. neuropsiquiatr ; 77(5): 346-351, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011339

ABSTRACT

ABSTRACT Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. Objective: To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. Methods: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. Results: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. Conclusion: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.


RESUMO A dor neuropática é uma síndrome crônica que é difícil de tratar e freqüentemente afeta pacientes com hanseníase. O tratamento recomendado inclui o uso de drogas analgésicas, codeína, antidepressivos tricíclicos, neurolépticos, anticonvulsivantes e talidomida, mas sem consenso sobre dose uniforme e resultados plenamente satisfatórios. Objetivo: Busca-se analisar a efetividade da toxina botulínica tipo A no tratamento da dor neuropática crônica hansênica refratária. Método: Estudo de intervenção do tipo ensaio clínico em portadores de dor neuropática crônica hansênica. Foram coletados dados epidemiológicos, protocolo DN4, escala analógica da dor (EVA), avaliação sensitiva, motora a avaliação do WHOQOL-Bref. Realizado intervenção terapêutica com toxina botulínica tipo A 100U. Os pacientes foram avaliados nos dias de 0, 10 e 60. A dor neuropática foi mais frequente no sexo masculino, na faixa etária de 40 à 49 anos. Resultados: Da forma Dimorfa, multibacilar com baciloscopia positiva e incapacidades presentes. Os escores EVA variam entre 5 e 10, todos os pacientes apresentaram alterações sensoriais. O WHOQOL-Bref apresentou melhora após o tratamento com TxBA. A TxBA foi bem tolerada o único efeito adverso notável foi dor leve. E com apenas uma única aplicação de TxBA promoveu efeitos analgésicos a longo prazo em pacientes com dor associada à alodinia, sugerindo que a analgesia observada pode ser causada por um efeito periférico da TxBA em terminações nociceptivas. Conclusão: O estudo sugere que a TxBA é uma boa opção para os casos de dor neuropática crônica hansênica, no entanto, novos estudos são necessários para confirmar estes resultados.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality of Life , Botulinum Toxins, Type A/therapeutic use , Chronic Pain/drug therapy , Analgesics/therapeutic use , Leprosy/drug therapy , Neuralgia/drug therapy , Time Factors , Pain Measurement , Surveys and Questionnaires , Reproducibility of Results , Treatment Outcome , Leprosy/physiopathology , Neuromuscular Agents/therapeutic use
12.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 535-540, Apr. 2019.
Article in English | LILACS | ID: biblio-1003065

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Cystitis, Interstitial/drug therapy , Pentosan Sulfuric Polyester/therapeutic use , Administration, Intravesical , Brazil , Dimethyl Sulfoxide/therapeutic use , Chondroitin Sulfates/therapeutic use , Treatment Outcome , Botulinum Toxins, Type A/therapeutic use , Diterpenes/therapeutic use , Clinical Decision-Making , Hyaluronic Acid/therapeutic use , Lidocaine/therapeutic use , Mycobacterium bovis
13.
Clinics ; 74: e776, 2019. tab, graf
Article in English | LILACS | ID: biblio-989643

ABSTRACT

OBJECTIVES: To compare signs and symptoms of dysphagia in individuals with cervical dystonia (CD) before and after application of botulinum toxin (BTX). METHODS: A prospective study was conducted with 20 patients diagnosed with CD with indications for BTX application. We selected 18 patients who met the study inclusion criteria. All individuals were patients from the Movement Disorders Unit, Department of Neurology, Federal University of São Paulo. BTX was applied in the cervical region at the necessary dose for each individual. To identify signs/complaints of changes in swallowing, we used a specific questionnaire that was completed by patients and/or their companions on the day of BTX injection and repeated 10 to 15 days after BTX injection. RESULTS: Among the 18 study subjects, 15 (83.3%) showed primary and three (16.7%) showed secondary cervical dystonia. The most frequent dystonic movements were rotation (18), tilt (5), forward shift (3), backward shift (7), shoulder elevation (12), shoulder depression (2), and cervical tremor (6). The main complaints reported before BTX application were voice changes in 10 (55.6%), need for adjustment of eating position in 10 (55.6%), coughing and/or choking while eating in nine (50%), and increased eating time in nine (50%) individuals. The main complaints reported after BTX application were coughing and/or choking while eating in 11 (61.1%), voice changes in nine (50%), sensation of food stuck in the throat in eight (44%), and increased eating time in eight (44%) individuals. CONCLUSION: The administration of a swallowing-specific questionnaire to individuals with CD before and after BTX application enabled the identification of possible dysphagia symptoms prior to drug treatment resulting from CD, which are often subsequently interpreted as side effects of the drug treatment. Thus, dysphagia can be managed, and aspiration symptoms can be prevented.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Deglutition Disorders/diagnosis , Botulinum Toxins, Type A/pharmacology , Deglutition/drug effects , Dystonia/congenital , Neuromuscular Agents/pharmacology , Perception , Deglutition Disorders/psychology , Deglutition Disorders/drug therapy , Case-Control Studies , Prospective Studies , Treatment Outcome , Botulinum Toxins, Type A/therapeutic use , Dystonia/psychology , Dystonia/drug therapy , Eating/psychology , Neuromuscular Agents/therapeutic use
14.
Gac. méd. Méx ; 155(supl.1): 56-61, dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1286566

ABSTRACT

Resumen Introducción: La osteoartritis de cadera es una enfermedad articular inflamatoria de bajo grado y etiología múltiple que tiene un manejo conservador limitado y poco explorado. La aplicación de toxina botulínica tipo A (BoNT-A) produce en el músculo aplicado una parálisis flácida temporal, delimitable y reversible, que aplicada de manera estratégica logra liberar estrés mecánico y dolor Objetivo: Evaluar el efecto en la percepción de dolor, funcionalidad y rigidez y los cambios en la flexión, rotación interna y externa, antes y 90 días después de la aplicación de BoNT-A. Métodos: Estudio clínico, experimental, longitudinal, abierto, con un total de 35 pacientes y 45 caderas tratadas. Se aplicó BoNT-A de 500 U en músculos ilíaco, músculo aductorbrevis y longus. Resultados: Se utilizó la prueba de Wilcoxon comparando los puntajes de evaluación en los días 0 a 90 observando disminución significativa del dolor referido (p < 0.0001), rigidez (p < 0.002), mejoró la función percibida (p < 0.001) y los arcos de movilidad: flexión, rotación interna y externa (p < 0.0001). Conclusiones: El tratamiento con BoNT-A otorga una opción conservadora y segura para el manejo de los síntomas y restricción física causada por la OA de cadera.


Abstract Introduction: Osteoarthritis (OA) of the hip is a low-grade inflammatory disease of multiple etiology that has a limited conservative management and insufficiently explored. The application of botulinum toxin type A (BoNT-A) produces in the applied muscle a temporary, delimitable and reversible flaccid paralysis, which applicated in a strategic way achives to reduce mechanical stress and pain. Objective: To evaluate the effect on pain perception, functionality and rigidity and changes in flexibility, internal and external rotation, before and 90 days after the application of BoNT-A. Methods: Clinical, experimental, longitudinal, open study, with a total of 35 patients and 45 hips treated. BoNT-A of 500 U was applied in iliac, adductor brevis and longus muscles. Results: The Wilcoxon test was used to compare the evaluation scores on days 0-90, observing the decrease in referred pain (p < 0.0001), rigidity (p < 0.002), improved perceived function (p < 0.001) and mobility arcs: flexion, internal and external rotation (p < 0.0001). Conclusions: The treatment with BoNT-A provides a conservative and safe option for the management of symptoms and physical restraint caused by hip OA.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Osteoarthritis, Hip/drug therapy , Botulinum Toxins, Type A/therapeutic use , Conservative Treatment , Neuromuscular Agents/therapeutic use , Osteoarthritis, Hip/physiopathology , Longitudinal Studies , Range of Motion, Articular/drug effects
15.
Odovtos (En línea) ; 20(3): 43-50, Sep.-Dec. 2018.
Article in English | LILACS, BBO | ID: biblio-1091458

ABSTRACT

ABSTRACT The Trigeminal Neuralgia (TN) is described as neuropathic pain at the orofacial level, characterized by unbearable pain that can last from a few seconds to several minutes. The different treatments used for these patients are to numb the nerve, surgical, pharmacological, and the administration at extra and intraoral level of botulinum toxin, which is a neurotoxin produced in cultures of the bacterium Clostridium botulinum in a natural way; in the sporulation process are 7 subtypes being the subtype A the most used in neurological problems. The botulinum toxin acts as a neuromuscular blocker, by inhibiting the release of acetylcholine at the synaptic space, which is an important neurotransmitter to produce local muscle relaxation, and the patients report reductions in the frequency and intensity of pain with minimal side effects. The injection of botulinum toxin produces an effective pain reduction of neuropathic origin in the hyperalgesic tissue and is used as adjuvant therapy when oral medications do not give adequate control of pain. Over time it is expected to reduce the drugs as the patient tells that the pain has decreased or is being controlled. Patients are indicated the variation of time in which they can obtain relief of their pain. In patients with uncontrolled pain of the trigeminal nerve, the toxin is placed extraoral in the orofacial region with high effectiveness, but there is a lack of studies on the administration in the intraoral submucosal.


RESUMEN La Neuralgia del Trigémino (NT) se describe como un dolor neuropático a nivel orofacial, caracterizado por un dolor insoportable y que puede durar de pocos segundos a varios minutos. Los diferentes tratamientos utilizados para estos pacientes son insensibilizar el nervio, quirúrgico, farmacológico y la administración de toxina botulínica a nivel extra e intraoral, que es una neurotoxina producida en cultivos de la bacteria Clostridium botulinum de manera natural; en el proceso de esporulación se encuentran 7 subtipos siendo el subtipo A el más empleado en problemas neurológicos. Este trabajo se realiza para mantener informada a los profesionales en salud, en especial a los de odontología, sobre los avances de la aplicación de la toxina botulínica, como una alternativa acertada en los pacientes con NT. La toxina botulínica funciona como bloqueador neuromuscular, inhibiendo la liberación de la acetilcolina al espacio sináptico, que es un importante neurotransmisor para producir relajación muscular local, y los pacientes informan de reducciones en la frecuencia e intensidad del dolor con mínimos efectos secundarios. La inyección de toxina botulínica produce una eficaz reducción del dolor de origen neuropático en el tejido hiperalgésico y se usa como terapia adyuvante principalmente cuando los medicamentos orales no dan el adecuado control del dolor. Con el tiempo se espera ir reduciendo los fármacos a medida que el paciente refiera que el dolor ha disminuido o se encuentra controlado. A los pacientes se les indica la variación de tiempo en que pueden obtener alivio de su dolor. En pacientes con dolor no controlado del nervio trigémino, la toxina botulínica se coloca de forma extraoral en la región orofacial, con alta efectividad, pero faltan estudios sobre la administración en la submucosa intraoral.


Subject(s)
Trigeminal Neuralgia/drug therapy , Botulinum Toxins, Type A/therapeutic use , Facial Pain/drug therapy
16.
Arq. neuropsiquiatr ; 76(10): 663-667, Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-973926

ABSTRACT

ABSTRACT The aim of this work was to evaluate patients with chronic migraine treated with botulinum toxin A (BT-A) and compare this with low level laser therapy (LLLT), referencing: pain days, pain intensity, intake of drugs/self-medication, anxiety and sleep disorders. Methods: Patients were randomized into two groups: BT-A group (n = 18) and LLLT group (n = 18). Each patient kept three pain diaries: one before (baseline) (30 days), one during treatment (30 days) and one after the post-treatment phase (30 days). Repeated ANOVA plus the Bonferroni post-test, Student's t test, and factorial analysis were applied, and p < 0.05 was accepted as significant. Results: Our data showed that both treatments were able to reduce headache days, acute medication intake and decrease the intensity of pain. Anxiety was reduced in the BT-A group, while sleep disturbance was reduced in the LLLT group. Conclusion: Our data showed that both treatments can be used to treat chronic migraine, without notable differences between them.


RESUMO O estudo comparou pacientes com cefaleia crônica (CM) tratados com toxina botulínica A (BT-A) versus terapia a laser de baixa intensidade (LLLT), relativos a: dias de dor, automedicação, nervosismo e distúrbios do sono. Métodos: Os pacientes foram randomizados em dois grupos: Grupo BT-A (n = 18) e Grupo LLLT (n = 18). Cada paciente preencheu três diários de dor, sendo um antes do início do tratamento (30 dias), durante o tratamento (30 dias) e um após tratamento (30 dias). ANOVA e pós-teste Bonferroni, teste T de Student e análise fatorial foram utilizados e valores de p < 0,05 foram considerados significativos. Resultados: Ambos os tratamentos foram capazes de reduzir os dias de dor e a ingestão aguda de medicação. Além disso, a ansiedade foi reduzida no grupo BT-A, enquanto que o distúrbio do sono foi reduzido no grupo LLLT. Conclusão: Nossos resultados mostraram que ambos os tratamentos são eficientes contra CM, sem diferença entre eles.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Botulinum Toxins, Type A/therapeutic use , Low-Level Light Therapy/methods , Acetylcholine Release Inhibitors/therapeutic use , Migraine Disorders/therapy , Anxiety/therapy , Sleep Wake Disorders/therapy , Pain Measurement , Pilot Projects , Chronic Disease , Treatment Outcome , Botulinum Toxins, Type A/administration & dosage , Acetylcholine Release Inhibitors/administration & dosage
17.
Arq. neuropsiquiatr ; 76(8): 522-526, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-950582

ABSTRACT

ABSTRACT Objective: To determine whether serum levels of anti-acetylcholine receptor antibody (anti-AChR-Abs) are related to clinical parameters of blepharospasm (BSP). Methods: Eighty-three adults with BSP, 60 outpatients with hemifacial spasm (HFS) and 58 controls were recruited. Personal history, demographic factors, response to botulinum toxin type A (BoNT-A) and other neurological conditions were recorded. Anti-AChR-Abs levels were quantified using an enzyme-linked immunosorbent assay. Results: The anti-AChR Abs levels were 0.237 ± 0.022 optical density units in the BSP group, which was significantly different from the HFS group (0.160 ± 0.064) and control group (0.126 ± 0.038). The anti-AChR Abs level was correlated with age and the duration of response to the BoNT-A injection. Conclusion: Patients with BSP had an elevated anti-AChR Abs titer, which suggests that dysimmunity plays a role in the onset of BSP. An increased anti-AChR Abs titer may be a predictor for poor response to BoNT-A in BSP.


RESUMO Objetivo: Determinar se os níveis séricos do anticorpo antirreceptor de acetilcolina (anti-AChR-Abs) estão relacionados aos parâmetros clínicos do blefaroespasmo (BSP). Métodos: Fora recrutados 83 adultos com BSP, 60 pacientes ambulatoriais com espasmo hemifacial (HFS) e 58 controles. Foi aplicado um questionário para registrar história pessoal, fatores demográficos, resposta à toxina botulínica tipo A (BoNT-A) e outras condições neurológicas. Os níveis de anti-AChR-Abs foram quantificados usando um ensaio imunoenzimático. Resultados: O nível de anti-AChR-Abs foi de 0,237 ± 0,022 unidades de densidade óptica (OD) no grupo BSP, significativamente diferente em comparação com o grupo HFS (0,160 ± 0,064) e o grupo controle (0,126 ± 0,038). O nível de anti-AChR-Abs se correlacionou com a idade e a duração da resposta à injeção de BoNT-A. Conclusão: Pacientes com BSP apresentaram títulos elevados de anti-AChR-Abs, o que sugere que a desimunidade desempenha um papel no surgimento de BSP. O aumento do título de anti-AChR-Abs pode ser um preditor de resposta insuficiente à BoNT-A em BSP.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Autoantibodies/blood , Blepharospasm/blood , Receptors, Cholinergic/immunology , Hemifacial Spasm/blood , Reference Values , Blepharospasm/physiopathology , Blepharospasm/drug therapy , Enzyme-Linked Immunosorbent Assay , Case-Control Studies , Sex Factors , Analysis of Variance , Age Factors , Botulinum Toxins, Type A/therapeutic use , Hemifacial Spasm/physiopathology , Hemifacial Spasm/drug therapy , Electromyography , Neuromuscular Agents/therapeutic use
18.
Int. j. odontostomatol. (Print) ; 12(2): 103-109, jun. 2018. graf
Article in Spanish | LILACS | ID: biblio-954249

ABSTRACT

RESUMEN: Los Trastornos Temporomandibulares (TTM) consisten en un conjunto de condiciones patológicas que afectan la articulación temporomandibular (ATM), los músculos de la masticación y las estructuras asociadas. Estudios epidemiológicos estiman que 40 % a 75 % de la población adulta presenta por lo menos un signo de TTM, como ruido articular y 33 % por lo menos un síntoma, como dolor facial o en la ATM. La toxina botulínica (BoNT) es una neurotoxina producida por la bacteria anaerobia Clostridium botulinum, solo la toxina A y B son utilizadas en la práctica clínica después de la aprobación de la Food and Drug Administration en 1989 y 2000; actualmente continúan siendo utilizadas para tratar varias condiciones de dolor, incluyendo la espasticidad muscular, distonia, dolor de cabeza y dolor miofascial. Las propuestas del mecanismo de acción fueron sugeridas a mediados de 1950 manifestando que esta neurotoxina posee alta afinidad con la sinapsis colinérgicas, ocasionando un bloqueo en la liberación de acetilcolina de esos terminales nerviosos, sin alterar la conducción neural de las señales eléctricas o en la síntesis de almacenamiento de acetilcolina. La inyección intramuscular en dosis y localización apropiada, provoca denervación química parcial y disminución de la contractura, sin ocasionar parálisis completa a lo que se le atribuye ser un innovador y eficaz método de tratamiento para el dolor crónico asociada con hiperactividad de los músculos masticatorios. La toxina botulínica tipo A es ser una alternativa para el control de la sintomatología dolorosa presente en los TTMs de etiología miogénica. Los autores recomiendan realizar un correcto diagnóstico, ya que la indicación de este tipo de tratamiento con diagnósticos incorrectos lleva a resultados inciertos.


ABSTRACT: Temporomandibular Disorders (TMD) is a term that was used to describe a set of pathological conditions that affect temporomandibular joint (TMJ), muscles of mastication and associated structures. Epidemiological studies estimates that 40 % to 75 % of the adult population has at least one sign of TMD, such as joint noise and 33 % presented some symptom such as facial or joint pain. Botulinum toxin is a neurotoxin produced by the anaerobic bacterium Clostridium botulinum. There are two types of toxin (A and B) used in clinical practice that were approved by Food and Drug Administration in 1989 and 2000. These medications are in use to treat various diseases including muscle spasticity, dystonia, headache and myofascial pain. The mechanisms of action were suggested in the mid-1950s, this neurotoxin seems to have an action at cholinergic synapses, causing a block in the release of acetylcholine from the nerve terminals without altering the neural conduction of the electrical signals. The synthesis and storage of acetylcholine were preserved. Intramuscular injection in appropriate doses and location causes partial chemical denervation and decreased contracture, without causing complete paralysis of muscles. Due to this features, it has been considered an innovative and effective method to treat chronic pain associated with hyperactivity of masticatory muscles. The botulinum toxin type A appears to be an alternative method for pain control present in TMDs that have myogenic etiology. The authors recommend a correct diagnosis, since the indication of this type of treatment associated with an incorrect diagnosis leads to uncertain outcomes, creating false conclusions.


Subject(s)
Humans , Temporomandibular Joint Disorders/drug therapy , Botulinum Toxins, Type A/therapeutic use , Analgesia/methods , Pain/drug therapy , Pain Measurement , Temporomandibular Joint Disorders/complications , Temporomandibular Joint Disorders/epidemiology , Chlorhexidine/therapeutic use , Analgesics/therapeutic use
19.
Rev. bras. neurol ; 54(2): 34-39, abr.-jun. 2018. ilus, tab
Article in Portuguese | LILACS | ID: biblio-907028

ABSTRACT

A paraparesia espástica é caracterizada pela perda de função total ou parcial dos membros inferiores associado ao aumento do tônus muscular velocidade-dependente. A toxina botulínica é utilizada no tratamento de diversos padrões de espasticidade, sejam em flexão, extensão ou adução. Objetivo: determinar a eficácia e segurança do bloqueio químico com toxina botulínica em pacientes com paraparesia espástica. Método: foi realizada uma revisão sistemática com busca nas bases de dados do PUBMED, MEDLINE, LILACS e SCIELO. Os critérios de inclusão foram: ensaios clínicos que utilizaram a toxina botulínica para o tratamento de pacientes com paraparesia espástica e publicados em inglês a partir da década de 1980. Os desfechos considerados foram: a pontuação na Escala de Ashworth Modificada, a amplitude de movimento passiva e ativa e os efeitos adversos da toxina botulínica. Resultados: foram incluídos cinco artigos. Todos mostraram melhora da espasticidade nos pacientes estudados. Quatro artigos mostraram aumento da amplitude de movimento passivo e três relataram aumento da amplitude de movimento ativo. Três artigos trouxeram relatos de efeitos adversos após o uso da toxina botulínica, mas a maioria deles não eram graves e cessaram espontaneamente. Conclusão: os estudos analisados mostraram que a toxina botulínica é eficaz e segura em pacientes com paraparesia espástica.(AU)


Spastic paraparesis is the loss of total or partial lower limb function associated with increased speed-dependent muscle tone. Botulinum toxin is used in the treatment of several spasticity presentations that include flexion, extension and adduction. Objective: To determine both safety and efficacy of botulinum toxin as a blocking agent in the treatment of spastic paraparesis. Method:A systematic review was carried out with a search on PUBMED, MEDLINE, LILACS and SCIELO databases. The inclusion criteria were: clinical trials that used botulinum toxin for the treatment of patients with spastic paraparesis and published in English from the 1980s. The following outcomes were assessed by the studies: the Ashworth Modified scale score, the range of passive and active motion and botulinum toxin adverse effects. Results:Five articles were included. All of them showed spasticity improvements in the patients. Four studies showed increases in passive range of motion and three articles showed increase in active range of motion. Three papers reported adverse effects after botulinum toxin use but they were mostly mild and ceased spontaneously. Conclusion: Most analyzed studies indicated that botulinum toxin is safe and efficient inthe treatment of spastic paraparesis. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Botulinum Toxins, Type A/therapeutic use , Paraparesis, Spastic/diagnosis , Paraparesis, Spastic/drug therapy , Multiple Sclerosis/diagnosis , Multiple Sclerosis/drug therapy , Review Literature as Topic , Randomized Controlled Trials as Topic , Treatment Outcome
20.
Arq. neuropsiquiatr ; 76(3): 183-188, Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-888373

ABSTRACT

ABSTRACT Motor and non-motor manifestations are common and disabling features of hereditary spastic paraplegia (HSP). Botulinum toxin type A (Btx-A) is considered effective for spasticity and may improve gait in these patients. Little is known about the effects of Btx-A on non-motor symptoms in HSP patients. Objective To assess the efficacy of Btx-A on motor and non-motor manifestations in HSP patients. Methods Thirty-three adult patients with a clinical and molecular diagnosis of HSP were evaluated before and after Btx-A injections. Results Mean age was 41.7 ± 13.6 years and there were 18 women. Most patients had a pure phenotype and SPG4 was the most frequent genotype. The Btx-A injections resulted in a decrease in spasticity at the adductor muscles, and no other motor measure was significantly modified. In contrast, fatigue scores were significantly reduced after Btx-A injections. Conclusion Btx-A injections resulted in no significant functional motor improvement for HSP, but fatigue improved after treatment.


RESUMO Manifestações motoras e não motoras são comuns e incapacitantes nas paraparesias espásticas hereditárias (PEH). Toxina botulínica do tipo A (TB-A) é considerada eficaz no tratamento da espasticidade e pode melhorar a marcha nesses pacientes. Pouco se sabe sobre os efeitos da TB-A sobre sintomas não-motores. Objetivo avaliar a eficácia da TB-A sobre manifestações motoras e não-motoras nas PEH. Método trinta e três pacientes adultos com PEH foram avaliados antes e depois das aplicações de TB-A. Resultados A média de idade foi 41,7 ± 13,6 anos e havia 18 mulheres. A maioria dos pacientes portava a forma pura e o genótipo mais comum foi SPG4. Houve diminuição da espasticidade dos músculos adutores da coxa sem melhora da marcha. A pontuação da fadiga reduziu após as injeções. Conclusão As aplicações de TB-A não melhoraram a marcha nos pacientes mas a redução da fadiga foi significativa após o tratamento.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Spastic Paraplegia, Hereditary/physiopathology , Spastic Paraplegia, Hereditary/drug therapy , Botulinum Toxins, Type A/therapeutic use , Motor Disorders/physiopathology , Motor Disorders/drug therapy , Neuromuscular Agents/therapeutic use , Reproducibility of Results , Treatment Outcome , Age of Onset , Muscle Fatigue/drug effects , Muscle Fatigue/physiology , Gait/drug effects , Gait/physiology , Injections, Intramuscular , Muscle Spasticity/drug therapy
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