Tratamiento del síndrome de Raynaud con toxina botulínica tipo A / Treatment of Raynaud's syndrome with botulinum toxin type A

El fenómeno de Raynaud es un trastorno vasoespástico de las arterias digitales por la exposición al frío o al estrés, el cual genera isquemia que se manifiesta con cianosis o palidez, dolor y úlceras crónicas; es una afección incapacitante para el paciente y de difícil manejo para el cirujano de mano. Se clasifica en primario y secundario. El primario es la forma de presentación más frecuente. Las modalidades de tratamiento están dirigidas a prevenir el vasoespasmo exagerado, fomentando la respuesta vasodilatadora y con ello disminuyendo la sintomatología, que es en la mayoría de los casos incapacitante. Se ha descrito el uso de la toxina botulínica A para aquellos casos severos y refractarios, con mala evolución, con el que se obtuvieron buenos resultados. Este sería un tratamiento de baja morbilidad, con escasos efectos adversos, que puede ofrecer un alivio del dolor rápido y duradero, contribuyendo además a la cicatrización de úlceras crónicas. De esta manera mejora la calidad de vida de los pacientes y evita tratamientos invasivos y la amputación. El propósito de este trabajo fue realizar una revisión bibliográfica incluyendo a los trabajos más importantes y relevantes hasta el momento en el tratamiento de la toxina botulínica A en el síndrome de Raynaud. Se presenta además un caso clínico refractario al tratamiento médico que fue tratado en la Cátedra de Cirugía Plástica, Reparadora y Estética del Hospital de Clínicas, Montevideo, Uruguay

Raynaud's phenomenon is a vasospastic disorder of the digital arteries due to exposure to cold or stress, which generates ischemia that manifests with cyanosis or paleness, pain, and chronic ulcers; it is a disabling condition for the patient and difficult to manage for the hand surgeon. It is classified into primary and secondary. Primary is the most common form of presentation. Treatment modalities are aimed at preventing exaggerated vasospasm, promoting the vasodilator response and thereby reducing symptoms, which are disabling in most cases. The use of botulinum toxin A has been described for those severe and refractory cases, with poor evolution, with which good results were obtained. This would be a low morbidity treatment, with few adverse effects, which can offer rapid and long-lasting pain relief, also contributing to the healing of chronic ulcers. In this way, it improves the quality of life of patients and avoids invasive treatments and amputation. The purpose of this work was to carry out a bibliographic review including the most important and relevant works to date on the treatment of botulinum toxin A in Raynaud's syndrome. In addition, a clinical case refractory to medical treatment that was treated in the Chair of Plastic, Reconstructive and Aesthetic Surgery of the Hospital de Clínicas, Montevideo, Uruguay, is also presented.

Clinical trial combining botulinum toxin A injection and fissurectomy for chronic anal fissure: a dose-dependent study

ABSTRACT Background Anal fissure is a common surgical disease that is usually treated conservatively. The golden surgical treatment for anal fissure is lateral internal sphincterotomy, but it may result in multiple complications. Therefore, other treatment methods have recently been introduced, and one of them is the injection of botulinum toxin A (BTA) and fissurectomy. In the present study, we aim to evaluate the effectiveness of the combination of fissurectomy and BTA injection in the treatment of chronic anal fissure by single surgeon. Materials and Methods The present is a non-randomized prospective cohort study conducted by a single surgeon in Saudi Arabia. Our sample was composed of 116 female patients, with mean age of 36.57 ± 11.52 years, who presented to our Surgical Outpatient Clinic with chronic anal fissure between October 2015 and July 2020, and were treated with BTA injection combined with fissurectomy. They were followed up for 1, 2, 3, 4, and 8 weeks, and after one year to evaluate the efficacy and safety of the treatment. The main outcomes analyzed were symptomatic relief, complications, recurrence, and the need for further surgical intervention. Results The treatment with BTA injection combined with fissurectomy was effective and safe in 115 patients (99.1%) at 1 year of follow-up. A total of 5 patients experienced recurrence at 8 weeks, which resolved completely with pharmacological sphincterotomy, and 12 patients experienced minor incontinence, which disappeared later. Conclusion In total, 70 units of BTA injection combined with fissurectomy is a suitable second-line treatment of choice for chronic anal fissure, with a high degree of success and a low rate of major morbidity. (AU)

Esfinterotomía lateral interna vs. toxina botulínica como tratamiento de la fisura anal / Lateral Internal Sphincterotomy versus Botulinum Toxin as Treatment of Anal Fissure

Introducción: La fisura anal crónica es una entidad frecuente que produce molestias durante y después de la defecación, su fisiopatología no es clara y su manejo es variado. La esfinterotomia lateral interna es una de las técnicas más utilizadas, aunque su elevado porcentaje de incontinencia no es aceptado y la inyección de toxina botulínica es una alternativa tentadora. Objetivo: Comparar los resultados de la inyección de toxina botulínica tipo A con la esfinterotomia lateral interna para tratamiento de la fisura anal en cuanto a dolor postoperatorio, recurrencia, curabilidad e incontinencia. Métodos: Se realizó un estudio tipo cohorte. A un grupo de 40 pacientes se trató con inyección de 50 UI de Toxina Botulínica tipo A y el otro grupo de 42 pacientes se le realizó esfinterotomia lateral interna. Los resultados se comparan estadísticamente para CI95 y error de 0,05. Resultados: La esfinterotomia vs toxina botulínica, resultó en cuanto a curabilidad en un 85,4 por ciento de los casos contra un 77,5 por ciento. Las recidivas se presentaron en 4,8 por ciento / 12,5 por ciento, la incontinencia ocurrió en 9,5 por ciento / 2,5 por ciento y el dolor posoperatorio estuvo presente en el 14,8 por ciento / 5,0 por ciento. Conclusiones: La esfinterotomia resultó mejor en cuanto a curabilidad y recidivas, mientras la aplicación de la toxina botulínica presentó mejores resultados en la incontinencia fecal y el dolor posoperatorio(AU)

Introduction: Chronic anal fissure is a frequent entity that produces discomfort during and after defecation. Its pathophysiology is not clear and its management is varied. Lateral internal sphincterotomy is one of the most used techniques, although its high percentage of incontinence is not accepted; botulinum toxin injection is therefore a tempting alternative. Objective: To compare the results of botulinum toxin type A injection or lateral internal sphincterotomy for treatment of anal fissure in terms of postoperative pain, recurrence, healing and incontinence. Methods: A cohort study was carried out. One group of 40 patients were treated with injection of 50 IU of botulinum toxin type A and another group of 42 patients underwent lateral internal sphincterotomy. The results were statistically compared with a confidence interval of 95 percent and error of 0.05. Results: Sphincterotomy and botulinum toxin were effective in terms of healing in 85.4 percent and 77.5 percent of cases, respectively. Recurrences occurred in 4.8 percent and 12.5 percent of cases, respectively. Incontinence occurred in 9.5 percent and 2.5 percent of cases, respectively. Postoperative pain was present in 14.8 percent and 5.0 percent of cases, respectively. Conclusions: Sphincterotomy was better in terms of healing and recurrence, while botulinum toxin application showed better results regarding fecal incontinence and postoperative pain(AU)

Research advances on application of botulinum toxin type A in scar prevention and treatment / 中华烧伤杂志

The wound healing time, tension of wound edge, proliferation of fibroblast, and extracellular matrix deposition are the important factors of scar formation, and botulinum toxin type A can regulate the above. Prevention and treatment of scar with botulinum toxin type A is one of the hot topics of clinical research in recent years. This paper briefly reviews researches by scholars at home and abroad on the mechanism, clinical application, complications, and adverse effects of botulinum toxin type A in scar prevention and treatment.

Preoperative botulinum A toxin as an adjunct for abdominal wall reconstruction: a single-center early experience at an Academic Center in New York / Toxina botulínica A pré-operatória como adjuvante na reconstrução da parede abdominal: experiência inicial em Centro Acadêmico em Nova York

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.

Tratamiento con toxina botulínica en niños con parálisis cerebral espástica. Análisis del tratamiento en tríceps sural durante 2017-2018 en el / Centro de Rehabilitación Infantil Teletón, Uruguay / Botulinum toxin in the treatment of children with spastic cerebral palsy. Analysis of sural tricep therapy during 2017-2018 at the Teletón Children's Rehabilitation Center, Uruguay / Tratamento com toxina botulínica em crianças com paralisia cerebral espástica. Análise do tratamento do tríceps sural durante 2017-2018 no Centro de Rehabilitación Infantil Teletón, Uruguai

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.

Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial

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.

Tratamiento efectivo de la toxina botulínica tipo A en el espasmo hemifacial, Guantánamo 2018-2019 / Botulinum toxin type A efficient treatment in patients with hemifacial spasm, Guantanamo 2018-2019

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.

Utilidad de la toxina botulínica en el tratamiento de heridas / Usefulness of botulinum toxin in wound treatment

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.

Toxina Botulínica em Odontologia: Uma Revisão de Literatura / Botulinum Toxin in Dentistry: A Literature Review

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.

Botulinum toxin type A in chronic neuropathic pain in refractory leprosy / Toxina Botulínica Tipo A em Dor Neuropática Crônica em Hanseníase

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.

Interstitial cystitis - intravesical treatment

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.

Specific characteristics of the medical history of swallowing before and after application of botulinum toxin in patients with cervical dystonia

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.

Tratamiento conservador de la osteoartrosis de cadera con toxina botulínica tipo A / Conservative treatment of hip osteoarthritis with botulinum toxin type A

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.