Could treatment with botulinum toxin protect against subsequent infection with COVID-19?

We report comparative results, over three months, of the impact of SARS-CoV2 in our patients injected with botulinum toxin for functional purposes, compared to the general population. Botulinum neurotoxin type A (BoNT/A) is known to block acetylcholine (ACh) as well as many other neuroreceptors and neuromodulators. The recent mention of a potential protective effect of nicotine in COVID 19, by blocking ACh, attracted our attention and guided the present study. Our results show a significant difference between the number of infected individuals in the general population and the number of patients injected with BoNT/A who showed signs of COVID 19.

Effect of intra-articular Botulinum toxin injections on temporo-mandibular joint pain.

Temporo-mandibular joint dysfunction can be painful and disabling. In some cases, it is refractory to classical treatment. Intra-articular Botulinum toxin injections have been shown to have an anti-inflammatory and analgesic effect. The aim of this study was to evaluate the effectiveness of such injections on severe, refractory temporo-mandibular joint pain. This was a retrospective study. Patients were included if they still had joint pain≥5 on a Visual Analogue Scale following completion of all other treatments. A complete treatment protocol (including physiotherapy, tongue splints, intra muscular injections of Botulinum toxin and injections of hyaluronic acid, excluding surgery) having being done before the injection of 30 Botox* units (Botulinum toxin A), the treatment being considered clinically successful if the Visual Analogue Scale decreases by at least 2 points. Seventy-seven patients were included. Sixty-six percent of patients have a significant reduction in pain at 1 month which lasted at least until 3 months. Mouth opening and quality of life also improved. Moreover, no complications were reported. Further randomized, controlled studies are needed to confirm the results, however this study suggests intra-articular injection of Botulinum toxin is a safe and effective treatment for severe, refractory temporo-mandibular joint pain, avoiding surgery.

The treatment of occipital neuralgia: Review of 111 cases.

OBJECTIVE: To present the current treatment options for occipital neuralgia based on a retrospective series of 111 patients, who were offered one or more treatment methods, not mutually exclusive. METHODS: All patients, who previously had their diagnosis confirmed by undergoing an anesthetic nerve block (0.25mL bupivacaine/2mL cortivazol), were treated by radiofrequency denaturation in 78 cases, injection of botulinum toxin in 37 cases and implantation of a nerve stimulation system in 5 cases. RESULTS: Two serious complications (1 death, 1 permanent hemiplegia) were observed after radiofrequency denaturation, the other methods did not result in any significant complications. Radiofrequency denaturation resulted in 89.4% of good and very good results beyond 6 months, as compared to 80% for the botulinum toxin and 80% after nerve stimulation, no other significant difference occurred between the three techniques, with reservations about the reliability of interpretation for the small sample size in the case of nerve stimulation. CONCLUSIONS: If radiofrequency denaturation seems to remain the leading treatment for occipital neuralgia, in terms of innocuousness and production costs, botulinum toxin could, in principle, represent the preferred initial treatment for this type of pathology.

The use of botulinum toxin in the treatment of the consequences of bruxism on cervical spine musculature.

Hypertonia and hyperactivity of masticatory muscles are involved in pain and contractions of the cervical spine musculature, but their pathophysiology remains nonetheless unknown and its treatment far to be codified. In this study, 8 patients, showing disabling posterior neck muscle contractures linked with bruxism were prospectively treated and followed for an average 15 months period, after having received Injections of botulinum toxin A essentially in masticatory muscles. Injections were made every 3 months, varying from 10 to 100 U Botox* by muscles, without administrating more than 300 U Botox* in the same patient. The angle of cervical lordosis were calculated on lateral sitting radiographs in neutral position, good results being considered to be achieved in the case of a 2 point diminution of VAS score as well as at least a 5° positive gain in the curve. 7 patients out of 8 showed a real improvement in their symptoms after an average of 3 injections, showing a decrease of 4.5 points on the VAS score and an average increment of 15° in cervical lordosis. Although the follow-up period of patients was relatively short and the sample quite small, the general impression, confirmed by the patients' experience, seems to suggest a potential place for the use of botulinum toxin amongst the array of treatments which can be offered in certain selected cases which associate bruxism and posterior cervical contractions.

[Usefulness of botulinum toxin injections in the treatment of postoperative pain after cervical spine surgery: Preliminary results]. / Utilisation de la toxine botulinique dans les cervicalgies postopératoires en chirurgie rachidienne : résultats préliminaires.

BACKGROUND AND PURPOSE: Postoperative neck pain after cervical spinal surgery is a common occurrence, the prevalence of which can reach up to 60%. Since 2005 a prospective study, still in progress, is attempting to show the efficacy of botulinum toxin injections in its treatment. METHODS: Two hundred and fifteen patients operated on in the same institution for cervical spondylotic myelopathy were prospectively followed-up; 38 of them presented postoperative neck pain and were enrolled either in a course of botulinum toxin injections (19) or in conservative treatment (19). The muscles injected, in descending order, were: trapezius, supraspinalis, splenius capitis, and rhomboids. Injections were made using Type A-botulinum toxin (Botox*-Allergan Pharmaceuticals, Westport, Ireland), increasing from 20 to 100U Botox* without exceeding 300U once in the same patient, performed every 3 months if necessary. The conservative treatment consisted of a course of thiocolchicoside (16mg/day) and physical rehabilitation. The lordosis angle was calculated on lateral sitting radiographs in the neutral position immediately postoperatively and 1.5 months after injection and correlated to pain improvement evaluated by the visual analogic scale (VAS). RESULTS: No visible improvement was found on x-rays in three patients after injection, and in 11 after conservative treatment. In 16 cases, after an average of three injections, the gain in lordosis averaged 11.3° and the VAS score was decreased by 4.6 points versus 4.7° and a decrease of 0.6 points after conservative treatment. CONCLUSION: Regardless of its limitations, the present study would seem to show potential value in the use of botulinum toxin in the treatment of postoperative pain after cervical spinal surgery.

[Cranial nerve functional neurosurgery: evaluation of surgical practice]. / La neurochirurgie fonctionnelle des nerfs crâniens Evaluation de l'activité

We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.

[The WSH percutaneous spine fixation device. Actual results and future expectations]. / Le système d'arthrodèse percutanée WSH. Resultats actuels et perspectives de développement futur.

BACKGROUND AND PURPOSE: The purpose of this study was to report our initial experience with a new percutaneous spine fixation system, avoiding open exposure, excessive blood loss and extensive muscle dissection. With the specially designed plates, this system can be used whatever the conformation of the segment instrumented is kyphotic or lordotic. METHODS: Sixteen patients (9 men and 7 women ranging in age from 27 to 78 years, mean 54.9) underwent percutaneous pedicle fixation using this device. Twelve patients underwent single level fusions (discogenic lowback pain in 6 cases, spondylolisthesis in 1), and 4 underwent two-level fusions (2 for lumbar fracture and 2 for spondylolisthesis). TLIF by intersomatic cages were inserted at the same time in two patients with spondylolisthesis. The follow-up period ranged from 3 to 15 months (mean 5 months). RESULTS: Improvement in pain control was assessed using a specially designed scale, allowing qualitative self-evaluation of pain control. Pain control was excellent in 12 patients, good in 3 and poor in one case due to loss of independence related to multiple associated disabling conditions. CONCLUSIONS: Percutaneous pedicule screw insertion using this device is a safe and reliable technique. Further improvements in the system which allows a certain degree of spinal mobility after screw placement are in process. Early results shown in this study illustrate the perspectives.

[Interest of porous biomaterials in spinal surgery]. / Intérêt des biocéramiques en alumine poreuse cellulaire en chirurgie rachidienne.

PURPOSE OF THE STUDY: The aim of this work was to study the behavior of porous alumina ceramic cages in spinal cervical surgery, with or without plate fixation as needed. MATERIAL AND METHODS: The population included 61 patients who underwent spinal surgery between May 1999 and October 2003. There were 48 women and 13 men, mean age 49 years at surgery. 74 implants were used, among them 71 were interbody cages. Ten patients were operated at two levels; C5-C6 and C6-C7 were most frequently instrumented. Patients were reviewed at 1 month, 3 months and 6 months, and, whenever possible more after. Clinical and radiological data were available for all patients. RESULTS: Mean follow-up was 7.2 months. Postoperative clinical data included assessment of neck and arm pain, using a visual analogic scale and fusion status determined by the presence of trabecular bridging bone and the disappearance of lucent lines around the implant on plain anteroposterior and lateral cervical radiographs. Two patients required another intervention, allowing intra-operative assessment of the quality of fusion. Clinical results were in agreement with the usual outcome reported in the literature with 54% of patients free of postoperative neck or arm pain and restriction of function mild or absent in 88%. Bone healing was achieved at 6 months on the average in 58 cases and in all patients at 12 months, including the two patients who required revision. DISCUSSION: The porous alumine cage is a reliable biocompatible and mechanically stable element helpful for achieving bone healing. Integration into bone tissue was radiographically satisfactory. This kind of implant appears to be an attractive alternative in spinal cervical surgery, avoiding donor graft site complications.

[Symptomatic aneurysms of the postero-inferior cerebellar artery. A multicenter retrospective study of 29 cases]. / Anévrysmes symptomatiques de l'artère cérébelleuse postéro-inférieure. Etude rétrospective multicentrique de 29 cas.

A multicenter retrospective study of 29 cases of posterior inferior cerebellar artery is reported. Over a period of 21 years, the frequency of posterior inferior cerebellar artery aneurysm among all intracranial aneurysm was estimated to 1.38 p. 100 of cases of aneurysms followed by 3 University Hospitals. Frequency of rupture appeared to be very high (93 p. 100) in this series probably because of the type of selection. Average grade of presentation according to Hunt and Hess classification being < III in 3 fourth of the cases. Neither clinical presentation nor suspicious etiological factors were specific of this localization. Only two cases were of pseudotumoral appearance. Positive diagnosis of subarachnoid hemorrhage was made by CT scan. Angiograms gave diagnosis of localization of the malformation and its type. Intraventricular hemorrhage was found in 62 p. 100 of our cases: all had hemorrhage of the fourth ventricle. Hydrocephaly was more frequent as compared to supratentorial localizations, Vasospasm was less frequent as in supratentorial localizations. Nimodipin seems to be efficient. Therapeutic possibilities are primary dominated by surgery with good results when it is possible. Endovascular treatment is under evaluation.

[Neurosurgical treatment of complications of intra-disk injections of triamcinolone hexacetonide. Value of a radio-clinical classification]. / Traitement neurochirurgical des complications des nucléorthèses à l'hexacétonide de triamcinolone. Intérêt d'une classification radio-clinique.

Epidural granulomas following intra-discal injection of triamcinolone hexacetonide are a well-known complication of this procedure, which is still encountered, even if its utilization was discontinued several years ago. According to the results of their experience, the authors propose a new radio-clinical grading system: grade I: disc calcification with aspect of "sub-ligamentar hernia" on CT scan; grade II: ascendant or descendant retrosomatic migration of distal content; grade III: pseudotumoral epidural infiltrate producing progressive narrowing of the spinal canal with neurological disturbance. Surgical indications in these cases can be drawn from their evolution: posterior approach can be used, with or without laminectomy, for excision as complete as possible of the involved disc (grades I and II); anterior approach should be preferred in cases of multiples recurrences after medical treatment and failure of classical posterior approach, or in case of necrotico-inflammatory proliferation with narrowing of the spinal canal (grade III).

[Fractures of the sacrum caused by bone insufficiency. Meta-analysis of 508 cases]. / Fractures du sacrum par insuffisance osseuse. Méta-analyse de 508 cas.

OBJECTIVES: Fractures of the sacrum due to bone deficiency are not extremely uncommon although this cause has been overlooked for many years. We performed a meta-analysis of reported cases in order to determine the specific characteristics. METHOD: The characteristics of 493 cases of sacral fractures reported in the literature and those of 15 personal cases were studied. RESULTS: Most of the fractures occurred in women over 60 years of age. No trauma was identified in two-thirds of the cases. Clinical expression was not specific (back pain, sciatica, pelvic pain). Standard x-ray showed a fracture of the obturator frame in 38.8% of the cases but no direct or indirect signs of sacral fracture were seen in more than two-thirds of the cases. Tc99m scintigraphy had excellent sensitivity; a characteristic hyperfixation pattern for ming an "H" was observed but only in 42.7% of the cases. Computed tomography had similar sensitivity and confirmed the diagnosis in doubtful cases. Treatment was usually bed rest until satisfactory pain relief. Of particular importance were neurological complications although they were exceptional. Several factors favoring sacral fracture were found, mainly osteoporosis and prior radiotherapy of the pelvis. CONCLUSION: Clinicians should be aware of this type of fracture which still remains largely over-looked in geriatric care units.

[Proximal aneurysms of the postero-inferior cerebellar artery. Therapeutic consideration upon a multicenter retrospective study of 24 cases]. / Anévrismes proximaux de l'artère cérébelleuse postéro-inférieure (PICA). Considération thérapeutique au vu d'une série rétrospective multi-centrique de 24 cas.

Aneurysms of the postero inferior cerebellar artery (PICA) are relatively rare as it accounts for only 0.5% to 3% of all intracranial aneurysms, even though this localization is in second place for frequency in the posterior fossa, after aneurysms of the basilar artery. Among them, origin from the anterior or latero-medullary segment of PICA would account for 80% of cases. In this retrospective multicenter study, we report 24 cases of PICA aneurysms with their clinical and anatomic features as well as either their surgical or endovascular treatment. We also carried out an exhaustive review of the literature in order to propose the typical clinical features of this type of lesion. Of particular significance: a predominance of female patients of approximately 50 years of age ; posterior direction; constancy of hemorrhage in the fourth ventricle in case of ventricular involvement of subarachnoid hemorrhage. The various therapeutic possibilities are discussed and their results are analyzed. The prognosis for PICA aneurysms would seem to be favorable, depending, of course, on initial clinical grade.

[Use of a transcutaneous neuro-stimulator as peroperative stimulator in neurosurgical treatment of spasticity and traumatic lesions of the peripheral nerves and brachial plexus]. / Utilisation d'un neuro-stimulateur transcutané comme stimulateur per-opératoire dans le traitement neurochirurgical de la spasticité et des lésions traumatiques des nerfs périphériques et du plexus brachial.

We have had the opportunity to use a standard percutaneous stimulator as an intraoperative stimulator, with the use of sterile leads, in order to palliate the sudden failure of our usual surgical stimulator. The simplicity and the possibility of modulation of the device, brought us to use it several times in different purposes of surgical work for spasticity, neurotization of the brachial plexus and treatment of fresh wounds of the nerves. Important features of this new way of using this device are simplicity of programation (width and frequency rates), good stability of chosen parameters, low diffusion allowing selective stimulation, and above all low cost versus standard devices used for this purpose.