Botulinum toxin therapy in hemifacial spasm: clinical and electrophysiologic studies.

Three patients with idiopathic hemifacial spasm were studied clinically and electrophysiologically before and after injections of botulinum toxin into the involved periocular and facial muscles. The spasms were improved for approximately 3 months, and the effect was repeatable on reinjection. The spasms diminished only as long as the muscles were clinically weak, and spasms were observed electromyographically even though therapy eliminated the clinical spasms. Uninjected muscles continued to have spasms. Transmission of excitation from the zygomatic branch to the marginal mandibular branch of the facial nerve and vice versa in all patients was unaltered after therapy, but the amplitude of the response was decreased. The efficacy of botulinum toxin in hemifacial spasm appears to be related to the production of muscle weakness; there is no demonstrable effect on phenomena believed to be ectopic excitation or ephaptic transmission in the facial nerve.

Treatment of focal dystonias of the hand with botulinum toxin injections.

The effects of botulinum toxin injections have been studied on 19 patients with hand dystonia. The dystonic muscles were identified by clinical examination and EMG findings of localised bursts of muscle activation with fine wire electrodes during the tasks that precipitated the dystonia. Injections into the most active muscles were given to each patient every 2 weeks in increasing doses (up to 20 U the first week, up to 40 U the second week, and up to 80 U the third week) until performance improvement was achieved. Subjective improvement of cramping, pain and/or tension was associated with temporary weakness in injected muscles. Benefit was seen in 16 patients, lasted between 1 and 6 months, and was reproducible.

Multicentric study of beclomethasone dipropionate nasal aerosol in adults with seasonal allergic rhinitis.

A double-blind, parallel-design multicentric study, in two phases, was conducted to examine the safety and efficacy of 2-wk treatment with various doses of beclomethasone dipropionate nasal aerosol (BDNA) and placebo in adults with seasonal allergic rhinitis. In phase I, 162 patients received BDNA, 33.5 micrograms/burst (o.d.,b.i.d., t.i.d., q.i.d.), or placebo; in phase II, 189 patients received BNDA 42, micrograms/burst (b.i.d. q.i.d.), or placebo. In both phases, statistically significant (p less than 0.05) differences favoring BDNA over placebo were found for all efficacy measures (global evaluation and total and individual symptom scores). In phase I, response to treatment increased as BDNA dosage increased, with a leveling off at t.i.d. dosage. In both phases, marked improvements were seen by week 1, with maximum improvement during week 2. Eighty-seven patients had adverse reactions-sneezing and nasal burning were most common. No suppression in morning cortisol levels was seen, nor were Candida infections promoted. A 2-wk treatment with BDNA was safe and effective in the treatment of seasonal allergic rhinitis in adults.

immunoglobulin and histamine-sensitivity response of mice to live Bordetella pertussis.

Mice injected intranasally (it.n.) and intraperitoneally (i.p.) with a nonlethal dose (2.5 x 10(5) colony-forming units) of live Bordetella pertussis were examined for 50 days for infection, respiratory tract immunoglobulins (Ig), changes in serum Ig, and histamine sensitivity. With mice infected it.n., respiratory infection markedly declined between day 20 and day 30. Ig classes (A, G(1), G(2a), G(2b), but no M), which had specificity for B. pertussis, were present in tracheobronchial wash (TBW) by day 15; by day 50, TBW immunodiffusion and immunoelectrophoretic precipitin bands were more intense. A sharp rise in serum IgA after day 30 was the only significant change relative to controls among the five serum Ig examined. A high degree of histamine sensitivity developed by day 15 to 20 and persisted for the 50 days. With mice inoculated i.p., no bacteria were recovered, no Ig or only traces were found in TBW and IgA only was specific, and no significant changes in the serum Ig relative to controls occurred. Histamine sensitivity developed somewhat more slowly and to a lesser degree than in it.n.-injected mice but persisted for the 50 days. A similar small number of killed bacteria (pertussis vaccine) injected it.n. or i.p. likewise induced slowly developing histamine sensitivity in contrast to published reports of 4 to 5 day peak sensitivity and decline following i.p. injection of 10(9) or more killed bacteria.