Botulinum toxin: clinical techniques, applications, and complications.

This article outlines practice routines, clinical techniques, applications, and complications of botulinum toxin type A treatment of mimetic facial and neck muscles. Detailed descriptions are provided for each clinical indication that maximize the treatment of the intended muscle groups while minimizing potential complications.

Future trends and new materials.

The variety of products available as injectable fillers and neuromodulators continues to increase. New products are soon to be introduced in the United States that will enable the clinician to treat a greater array of esthetic problems and concerns. In addition, existing materials are being modified to allow for less painful treatments and easier product handling.

[Different botulinum toxins and their specifications]. / Les différentes toxines botuliques et leurs spécificités.

Botulinum neurotoxin A was the first developed for therapeutic and then esthetic uses, Botox first and then Dysport. These two products differ on a few points, explaining their nonequivalence of units: American and British tests of the mouse LD50 units based on solutions that were not identical and 500microg vs 150microg serum albumin dose in the excipient. The neurotoxin- accessory protein complexes were also different: 900 kDa homogeneous for Botox, 500 kDa heterogeneous for Dysport, giving greater diffusion for Dysport, but this is under debate and could result from an excessive conversion ratio. Clinical comparative studies, often with weak methodology, have defined an ideal ratio between these two products, guaranteeing efficacy, but without an overly pronounced diffusion. In the first publications for neurological and ophthalmological indications, the conversion ratio between Dysport and Botox was high, 4:1, and sometimes higher. However, today, particularly for cosmetic indications, the trend is toward a much lower ratio, 2.5:1, or perhaps less for dyshidrosis. This lower ratio has an economic incidence: Dysport is less expensive and therefore more competitive. The price of Dysport's cosmetic product, Azzalure, compared to the price of Vistabel, which is Botox's cosmetic presentation, has not yet been defined in France. The other A toxins, Xeomin, and the Asian toxins, MyoBloc (botulinum toxin type B), tested compared to Botox, have a slightly lower efficacy.

Basic and clinical aspects of BOTOX.

BOTOX is a botulinum toxin type A product from Allergan that is approved in more than 70 countries, where it addresses unmet patient needs across a variety of indications. BOTOX is a well-characterized and highly purified biological product that is not interchangeable with any other botulinum neurotoxin. The pharmacology, efficacy and safety profile of BOTOX has been established in numerous preclinical and clinical studies in addition to meta-analyses. BOTOX exhibits a predictable response, with a concomitant low rate of neutralizing antibody formation. Allergan is committed to the development of new indications and novel biologics that are designed to benefit individuals with unmet medical needs.

Top 60 medications used for orofacial pain treatment.

This article introduces the 60 top pharmacologic treatments provided for chronic orofacial pain patients. It explains that the majority of "chronic" orofacial pain patients will not find a "cure" to their pain with medications but may find a way to manage their pain. The medications in this article are the most commonly utilized "pain" medications and where it exists. This article reviews some of the current evidence supporting their use on chronic orofacial pain disorders.

[Pharmacology and upper limb poststroke spasticity: a review. International Society of Prosthetics and Orthotics]. / Spasticité du membre supérieur après AVC, traitements pharmacologiques. Revue.

OBJECTIVES: The present study, conducted for the consensus conference "Orthotic management of stroke patients", organized by the International Society of Prosthetics and Orthotics, on September 2003, reviews the pharmacological, general, or local treatments available for post-stroke upper-limb spasticity. METHOD: A search of the international literature in the Medline and the Reedoc data banks for papers related to post-stroke upper-limb spasticity. Each paper was given a rating of A, B, or C (in term of quality) according to the instructions of the organization committee. RESULTS: General pharmacological treatments such as use of baclofen, tizanidine and dantrolene, regional treatments such as intrathecal baclofen, and local treatments with use of chemical neurolysis and alcohol or phenol are recommended for conditions described in papers with a grade of B. Neuromuscular blockade with botulinum toxin is recommended for conditions described in papers with a grade of A. DISCUSSION/CONCLUSION: Despite a satisfactory grade of recommendation, general pharmacological treatments are limited by adverse events and lack of evidence of functional benefit. Intrathecal baclofen should be discussed for upper-limb spasticity, but further studies are needed before its use can be recommended. The place of chemical neurolysis with use of alcohol or phenol should be evaluated with surgical neurotomy and botulinum toxin therapy. The use of botulinum toxin is the only treatment supported by scientific results, but many questions remain about the site of injection, how to improve efficacy and influence on neurological recovery.