Botulinum-toxin-A injection following conservative management in patients with dyssynergic defaecation only improves symptoms in the short term: a retrospective study

Objective: Dyssynergic defaecation (DD) is an important cause of chronic constipation. In patients where conservative treatments fail, injections of botulinum toxin A (BTX-A) into the puborectalis and anal sphincter muscles can be effective. Complications of this procedure are reported to be rare and generally mild. This study aimed to identify the complication rates and short- to medium-term success rates of BTX-A injections as a treatment for DD. Methods: A retrospective review was conducted on patients diagnosed with DD who had undergone BTX-A injections at a functional colorectal unit. Patient demographics, manometric assessment, conservative management, and injection technique were collected through a chart review. Subjective patient reports and comparison of pre- and postprocedure symptom scores were used to determine efficacy. Results: The 21 patients included (24 procedures, with 3 patients receiving BTX-A on two separate occasions) all received stool modification and dietary advice, and 20 patients underwent pelvic floor physiotherapy, averaging 8 sessions. The injections were universally applied under general anesthetic, primarily targeting the anal sphincter and/or puborectalis muscles. There were 6 reports of faecal urge/incontinence, with all but one being resolved within weeks. The BTX-A injection was subjectively reported as beneficial in 19 cases, averaging 4.7 months (range 1-32) of improvement. Only 2 were sustained beyond 12 months. Despite overall improvements in symptom scores from pre- to postprocedure, none were statistically significant. Conclusion: Following a course of conservative management, the BTX-A injection appears to be a safe treatment for DD, but only has short term efficacy. (AU)

Efficacy and safety of Botulinum toxin A for improving esthetics in facial complex: A systematic review

Abstract Aim: To evaluate efficacy and safety of Botulinum toxinA for improving esthetics in the facial complex and correlating them to the dosage and side effects through a systematic review. Methods: A literature search was performed using PubMed, Medline, Web of Sciences, and Scopus databases. Quality of studies was appraised through the GRADE system. This review follows the 'Preferred reporting items for systematic review and meta-analysis protocols' (PRISMA-P) 2015 statement. Efficacy was analyzed through improvement rate and effect sizes. Graphical comparison of efficacy and ocular adverse effects (adverse effects around the eye) at various anatomical locations was made by calculating the average improvement rate and adverse events. Results: Twenty-five studies were included in this systematic review after application of the inclusion criteria. Moderate to severe cases in glabellar, lateral canthal, and forehead regions showed higher improvement rates between 20U to 50U, with an effect lasting up to 120 days. Gender and age seemed to have a direct effect on efficacy. Headaches were the most common adverse effect, followed by injection site bruising; all adverse effects resolved within 3-4 days. Conclusions: Treatment with Botulinum toxinA to enhance esthetics of facial complex is efficient and safe at all recommended dosages. Presence of complexing proteins influenced the efficacy of BoNT-A. undesirable muscular adverse effects around the eyes were more predominant when treating the glabellar region. There was no correlation found between the BoNT-A dosage and side effects, however, an increase in dosage did not always lead to an increase in efficacy.

Resumo Objetivo: Avaliar a eficácia e segurança da toxina botulínica-A para melhorar a estética no complexo facial e correlacioná-la com a dosagem e os efeitos secundários através de uma revisão sistemática. Métodos: Foi realizada uma pesquisa bibliográfica utilizando bases de dados PubMed, Medline, Web of Sciences, e Scopus. A qualidade dos estudos foi avaliada através do sistema GRADE. Esta revisão segue a declaração "Preferred reporting items for systematic review and meta-analysis protocols" (PRISMA-P) 2015. A eficácia foi analisada através da taxa de melhoria e da dimensão dos efeitos.A comparação gráfica da eficácia e dos efeitos adversos oftalmológicos (efeitos adversos em torno do olho) em vários locais anatômicos foi feita através do cálculo da taxa média de melhoria e dos eventos adversos. Resultados: Vinte e cinco estudos foram incluídos nesta revisão sistemática após a aplicação dos critérios de inclusão. Casos moderados a graves em regiões glabelares, canais laterais e testa mostraram taxas de melhoria mais elevadas entre 20U a 50U, com um efeito que durou até 120 dias. O sexo e a idade mostraram ter efeito direto na eficácia. As dores de cabeça foram o efeito adverso mais comum, seguido de hematomas no local da injecção; todos os efeitos adversos foram resolvidos em 3-4 dias. Conclusões: O tratamento com toxina botulínica-A para melhorar a estética do complexo facial é eficiente e seguro em todas as dosagens recomendadas. A presença de proteínas complexas influenciou a eficácia do BoNT-A. Os efeitos adversos musculares indesejáveis à volta dos olhos foram mais predominantes no tratamento da região glabelar. Não foi encontrada qualquer correlação entre a dosagem de BoNT-A e os efeitos secundários, contudo, um aumento da dosagem nem sempre levou a um aumento da eficácia.

Intravesical injection of botulinum toxin A for treatment of interstitial cystitis/bladder pain syndrome: 13 years of experience / 中华泌尿外科杂志

Objective To evaluate the efficacy of the intravesical injection of botulinum toxin A (BTX-A) and bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation in patients with interstitial cystitis/bladder pain syndrome (IC/BPS).Methods We retrospectively reviewed 153 women with IC/BPS from January 2003 to December 2015.Of the 153 patients,77 were treated with BTX-A(group A),the average age was (56.0 ± 4.1) years old.76 underwent bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation (group B),the average age was (58.0 ± 3.3) years old.The patients were evaluated using the O'Leafy-Saint score,visual analog scale pain score,urinary frequency record and quality of life questionnaire before treatment and 1 week,1,3,6 and 12 months after treatment.Results In group A,only 2 had acute urinary retention,27 received a repeat injection,and 28 were lost to follow-up.In group B,3 had urinary tract infection,15 switched to BTX-A injection at 6 months because the treatment of hydrodistention plus Cystistat instillation is not good.31 were lost to follow-up.BTX-A was shown to remain effective for up to 6 months after treatment.After repeated Chinese BTX-A injections,symptoms improved significantly.Hydrodistention plus Cystistat remained effective for up to 3 months after treatment.Conclusions Intravesical injection of BTX-A is a effective therapeutic option for patients with IC/BPS.The average duration of the effect of one dose of Chinese BTX-A was 6 months.Repeated injection of BTX-A is effective.

S100 and p65 expression are increased in the masseter muscle after botulinum toxin-A injection / 대한악안면성형재건외과학회지

BACKGROUND: The purpose of this study was to compare the expression levels of p65 and S100 in the rat masseter muscle after the injection of different concentrations of botulinum toxin-A (BTX-A). METHODS: We injected either 5 or 10 U of BTX-A into both masseter muscle of rats. As a control group, the same volume of saline was injected. After 14 days, the animals were sacrificed. Subsequently, a biopsy and immunohistochemical staining of the samples were performed using a p65 or S100 antibody. RESULTS: The cross-sectional area of each myofibril was significantly reduced by BTX-A injection (P < 0.001). The expression of p65 and S100 increased significantly with increasing concentrations of BTX-A (P < 0.001). CONCLUSIONS: The injection of BTX-A into the masseter muscle induced muscle atrophy. Subsequently, p65 and S100 expression in myoblasts were increased for the protection of muscle cells.

Effect of Botulinum Toxin-A Injection on Upper Limb Pain after Stroke:A Case Report / 中国康复理论与实践

Objective To observe the effect of Botulinum toxin-A (BTX-A) injection on upper limb pain after stroke. Methods A case with upper limb pain after stroke was reported. The symptom, the location and dosage of injection, and the prognosis were recorded. Results The pain relieved after injection, and disappeared 4 weeks after injection. Conclusion BTX-A injection is effective on upper limb pain after stroke.

Botulinum toxin injection for the treatment of lower urinary tract dysfunction / 中华物理医学与康复杂志

Objective To investigate the effectiveness of botulinum toxin A (BTX-A) injection to the external urethral sphincter guided by ultrasound in the treatment of various types of lower urinary tract dysfunction.Methods Twenty-two patients with urinary retention caused by neurological dysfunction (neurogenic bladder) were recruited,of which 18 were men and 4 women.They had various types of lower urinary tract dysfunction including detrusor external sphincter dyssynergia (DESD) in 7,nonrelaxing urethral sphincters in 5,and detrusor underactivity in 10.BTX-A (100 U) was injected into the external urethral sphincter at three different points guided by ultrasound.Clinical effects and urodynamic parameters were compared at baseline and after treatment.Results After treatment the urinary function and urodynamic parameters in each group improved significantly compared with the baseline.Maximum efficacy was observed at the 4th week.In the DESD group,3 patients (43％) had an excellent result and 3 (43％) had significant improvement; in the nonrelaxing sphincter group 3 (60％) had excellent results and 2 (40％) showed significant improvement; in the detrusor underactivity group 5 (50％) had excellent results and 3 (30％) had significant improvement.There were no obvious side effects.Conclusions BTX-A injections guided by ultrasound can accurately locate the external urethral sphincter.It is a simple and repeatable method for the treatment of lower urinary tract dysfunction.

The effect of motor point blocking on spasticity in children with cerebral palsy / 中华物理医学与康复杂志

Objective To compare the advantages and disadvantages of botulinum toxin A (BTX-A) and phenol block in the treatment of spasticity in children with cerebral palsy. Methods Four hundred and twenty children with spastic cerebral palsy were divided into an experimental group (375 cases) and a control group (45 cases).The children were aged from 1 to 22 years ( average age 6 years).The children in the experimental group were treated with BTX-A block at a dosage of 55 to 350 IU (average 130.5 IU).The children in the control group were treated with a 5％ phenol solution block at a dosage of 0.5 to 4.6 ml ( average 2.2 ml).Children of both groups were given systematic functional rehabilitation training. All the children were evaluated with a physician rating scale (PRS) and the modified Ashworth scale (MAS) before and after the blocking.Effectiveness rates,effectiveness durations and side effects rates were calculated. Results Before treatment there was no significant difference in terms of motor disorder or spasticity between the 2 groups.After treatment,spasticity had been significantly reduced in both groups.The effectiveness rate was 98.4％ in the experimental group and 95.6％ in the control group,a difference which was not significant.The average effectiveness duration was ( 24.9 ± 5.76 ) weeks in the experimental group and ( 69.2 ± 13.76) weeks in the control group,significantly longer.The side effects rate was 5.33 ％ in the experimental group and 15.56％ in the control group,also a significant difference. Conclusion BTX-A could be more widely used because of its safety and credibility.

Comparison of clinical effects between botulinum toxin injection and radiofrequency thermal rhizotomy in treatment of primary hemifacial spasm / 中华医学美学美容杂志

Objective To compare the clinical effects of botulinum toxin injection and radiofre quency thermal rhizotom in the treatment of primary hemifacial spasm.Methods A total 118 primary hemifacial spasm patients were randomly divided into two groups,who were received botulinum toxinA injections and radiofrequency thermal rhizotom treatment,respectively.Patients were followed up,and the curative effect,complications and recurrence rates of the two treatments were statistically compared.Results The early curative effect (1 month) for primary hemifacial spasm in botulinum toxin injection group was better than that in radiofrequency thermal rhizotom treatment group:recurrence rate of long-term (6 months) was 72.5 ％,but caused a very low risk of facial paralysis; radiofrequency thermal rhizotom treatment had a long-term effect as compared with botulinum toxin injection,6 months recurrence rate was 21.4 ％,with a low rate of postoperative facial paralysis.Conclusions Botulinum toxin injections is higher in short-term effectiveness and smaller in side effects as compared with the treatment of radiofrequency thermal rhizotom. However,radiofrequency thermal rhizotom treatment is more stable in the prospective efficacy.

Botulinum Toxin-A Injection into Detrusor to Treat Neurogenic Detrusor Overactivity in Patients with Spinal Cord Injury / 中国康复理论与实践

Objective To evaluate the effectiveness and safety of Botulinum toxin-A (BTX-A) injection into detrusor to treat neurogenic detrusor overactivity in patients with spinal cord injury (SCI).Methods A total of 78 patients with SCI were treated with transurethral injection of BTX-A (300 IU dissolved in 15 ml of saline) into 30 different points of detrusor with 15 ml in every patients. Urodynamic parameters and voiding diary were assessed at baseline and 3 weeks and 3 months after the injections. Adverse events were recorded after the injection if present.Results After the first injection, 78 patients showed that the mean frequencies of incontinence decreased from 13.5 to 2.7 times per day, the mean volume of intermittent catheterization (IC) increased from 131 ml to 389 ml per time, the mean volume of incontinence decreased from 1 690 ml to 281 ml per day, the mean getting effect time was 7.6 days. 10 patients received second injection at 8.9 months after first injection, the results showed that the mean frequencies of incontinence decreased from 9.7 to 3.7 times per day, the mean IC volume increased from 108 ml to 387 ml. 6 patients received third injection at 5.8 months after second injection, the results showed that the mean frequencies of incontinence decreased from 9.2 to 3.9 times per day, the mean IC volume increased from 116 ml to 364 ml. No side effects were observed during the follow-up.Conclusion BTX-A injection into detrusor to treat neurogenic detrusor overactivity in patients with SCI seems to be an effective, safe and miniinvasive solution.

Effect of Botulinum Toxin A on Bruxism after Brain Injury

We wanted to report three cases of bruxism who were intractable to conventional management such as dental protection or medication but responded to motor point blocks (MPB) with botulinum toxin-A (BTX-A) on mastication muscles. Untreated, bruxism causes unfavorable complications of masseter hypertrophy, headache, temporomandibular joint destruction, and furthermore total dental wear and malnutrition. Our three patients had no previous history of bruxism or any neuromuscular disorder. They were presented with decreased cognitive function and severe bruxism about 6 months after brain injury. We managed the patients with MPB of BTX-A on each masseter and temporalis muscles. Bruxisms were markedly improved about 2 weeks after MPB without any complications. On follow-up 6 months after MPB, two of three patients remained free of bruxism and another patient revealed attenuated bruxism with decreased severity and frequency. Therefore, we think that MPB with BTX-A could be considered as a treatment option for severe bruxism in brain-injured patients.

Treatment of Paradoxical Puborectalis Contraction (PPC) Using Botulinum Toxin-A

PURPOSE: Paradoxical puborectalis contraction (PPC) or Anismus is known to have a pathogenesis of abnormal contraction of puborectalis at defecation and its managements are not satisfactory. Recently, therapy of PPC and its associated symptoms using Botulinum toxin-A (BTX-A) has been introduced. we evaluate the effect of BTX-A injection to the puborectalis for the patients with PPC. METHODS: Fourteen patients were diagnosed as paradoxical puborectalis contraction on defecography and/or anorectal manometry and electromyography (EMG) during September 1998 to January 2001 in Daegu Catholic Medical Centre, Catholic University of Daegu. All patients were underwent 30 (15 15) units of BTX-A injection on each side of puborectalis guided by EMG. Among them, five patients needed further injection of 20 (10 10) units because the expected results were not satisfied. Follow-up were conducted on one month and one year after BTX-A injection and the patients were assessed for the constipation score and anorectal manometry. RESULTS: After injection of BTX-A, constipation score was significantly decreased from 15.5 +/- 3.5 (mean SD) to 5.7 +/- 4.3. Maximal resting and squeezing pressure also decreased from 48.4 +/- 22 mmHg, 96.9 +/- 39.8 to 41.2 +/- 17, 68.3 +/- 38.2, respectively. Twelve patients who were followed up more than one year after injection, the constipation score (n=12) increased up to 7.7 +/- 2.9 (mean SD). Among them, three patients have had stool softeners or laxatives to evacuate and the remained nine patients did not have any kinds of drug or food for defecation. There was no complication for the injection BTX-A. CONCLUSIONS: BTX-A injection seems to be effective for the treatment of PPC and the long term therapeutic effect can be defined through double blind placebo-controlled trials.

Effect of botulinum toxin-A on lower esophageal sphincter in dogs / 第二军医大学学报

[ABSTRACT] Objective: To investigate the effect of botulinum toxin-A (BTA) on lower esophageal sphinctor (LES) in dogs,providing scientific base for treating achalasia with BTA. Methods:BTA was endoscopically injected into the LES in 10 dogs,and saline injection was taken as control group(10 dogs). LES pressure was measured before and after injection. Contents of Ach and activity of AchE were determined in LES samples. By means of Karnovsky-Roots technique,ultrastructure of nerve terminal and vesicles containing Ach were studied under light and transmission electronic microscopy. Results:LES pressure obviously decreased in BTA-treated dogs after injection (P