Efecto de la toxina botulínica tipo A en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica / Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae

Objetivo: Valorar el efecto del tratamiento con infiltraciones de toxina botulínica tipo A (TXB-A) en la funcionalidad facial, las sincinesias y la calidad de vida en pacientes con secuelas de parálisis facial periférica (PFP). Material y métodos: Presentamos un estudio prospectivo con una muestra de 20 pacientes con secuelas de PFP (15 mujeres, 5 varones) a los que se infiltró TXB-A (Botox® o Xeomin®). Todos los pacientes realizaron previamente un tratamiento personalizado basado en la reeducación neuromuscular. Se realizó una evaluación clínica previa a las infiltraciones y otra al cabo de 4 semanas. El efecto de las infiltraciones sobre la funcionalidad facial fue valorado mediante la escala Sunnybrook Facial Grading System (SFGS); el efecto sobre la calidad de vida se evaluó a través del cuestionario Facial Clinimetric Evaluation Scale (FaCE), y el efecto sobre la reducción de sincinesias se estudió utilizando el Synkinesis Assessment Questionnaire (SAQ). Resultados: La media de los valores del SFGS se incrementó tras el tratamiento con TXB-A, de 64,8 a 69,9 (p = 0,004). También se incrementó la media de los valores del FaCE Total, de 52,42 a 64,5 (p < 0,001), y la media de la subescala Social del FaCE, de 61,15 a 78,44 (p < 0,001). La media de los valores del SAQ disminuyó con las infiltraciones de TXB-A, de 46,22 a 37,55 (p = 0,001). Conclusiones: Las infiltraciones de TXB-A incrementan la funcionalidad facial, mejoran la calidad de vida y reducen las sincinesias en pacientes con secuelas de PFP.(AU)

Objectives: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). Material and methods: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. Results: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P = .004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P < .001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P < .001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P = .001). Conclusions: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.(AU)

Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae.

OBJECTIVES: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox© or Xeomin©) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.

Uso da toxina botulínica tipo A no tratamento da espasticidade em crianças com paralisia cerebral: revisão sistemática / Use of botulinum toxin type A in the treatment of spasticity in children with cerebral palsy: systematic review

Há pouco mais de duas décadas, a toxina botulínica tipo A (TBA) vem sendo utilizada como parte do tratamento multimodal para a redução do tônus muscular em crianças com paralisia cerebral (PC) espástica. Objetivos: determinar a eficácia e segurança, avaliar as doses utilizadas em cada faixa etária e comparar os custos entre as TBA's para tratamento da espasticidade em crianças portadoras de PC. Métodos: foi realizada uma revisão sistemática de estudos publicados nos últimos 6 anos, de 2017 a abril de 2022, através das bases de dados do PubMed, SciELO, Science Direct, Google Acadêmico e Periódicos CAPES, de acordo com os seguintes critérios de inclusão: (1) termos de busca: toxina botulínica, espasticidade e paralisia cerebral; (2) idioma: português, inglês e espanhol; (3) desenho: ensaios clínicos randomizados e duplo-cego, revisões sistemáticas e metanálises; (4) população: crianças e adolescentes com PC espástica; (5) intervenção: TBA; (6) grupo controle com outro tratamento para PC ou sem intervenção; (7) desfecho: alteração na Escala de Ashworth Modificada, efeitos adversos e qualidade de vida. Resultados: foram incluídos 10 artigos nesta revisão, que apresentaram dose mínima terapêutica, o impacto de injeções únicas e repetidas, seleção de músculos e pontos a serem aplicados. Conclusão: a TBA proporcionou uma melhora significativa sobre a espasticidade e funcionalidade da criança com PC espástica, em um período de até 3 meses após sua aplicação. Pode ser considerada uma opção de tratamento segura e eficaz, e a análise econômica da saúde demonstra que essa intervenção possui excelente relação custo-benefício.

For just over two decades, botulinum toxin type A (BoNT-A) has been used as part of a multimodal treatment to reduce muscle tone in children with spastic cerebral palsy (CP). Objectives: to determine the efficacy and safety, to evaluate the doses used in each age group and to compare the costs between the BoNT-A's for the treatment of spasticity in children with CP. Methods: a systematic review of studies published in the last 6 years, from 2017 to april 2022, was carried out through the PubMed, SciELO, Science Direct, Google Scholar and CAPES Periodicals databases, according to the following inclusion criteria: (1) search terms: botulinum toxin, spasticity and cerebral palsy; (2) language: portuguese, english and epanish; (3) design: trials randomized and double-blind clinical trials, systematic reviews and meta-analyses; (4) population: children and adolescents with spastic CP; (5) intervention: BoNT-A; (6) control group with other treatment for CP or without intervention; (7) outcome: change in Modified Ashworth Scale, adverse effects and quality of life. Results: 10 articles were included in this review, which presented the minimum therapeutic dose, the impact of single and repeated injections, selection of muscles and points to be applied. Conclusion: BoNT-A provided a significant improvement in spasticity and functionality in children with spastic CP, within a period of up to 3 months after its application. It can be considered a safe and effective treatment option, and the economic analysis of health demonstrates that this intervention has an excellent cost-benefit ratio.

Uso de la toxina botulinica tipo a versus trihexifenidilo en la hiperextensión axial en niños con parálisis cerebral. Distónica en el centro de rehabilitación e inclusión infantil Estado de México / Use of botulinum toxin type a versus trihexyphenidyl in axial hiperextensión in children with distonic cerebral palsy

La distonía es, tras la espasticidad y los tics, el trastorno del movimiento más frecuente en la infancia. Los niños sufren más frecuentemente que los adultos distonías generalizadas. Las distonías secundarias más habituales son las debidas a parálisis cerebral, a menudo asociada a espasticidad y a otros movimientos anormales. Este estudio compara la efectividad de la aplicación de toxina botulínica tipo A versus trihexifenidilo en el tratamiento de la hiperextensión axial en niños con PC distónica. Hubo dos grupos de estudio, grupo A: toxina botulínica grupo B: trihexifenidilo en ambos grupos se realizó una historia clínica, se aplicó la escala de valoración de distonía (AIMS) para tronco, capacidad motora gruesa (GFCS) y escala de alineamiento y posición. El análisis estadístico se realizó mediante el paquete de SPSS-18 y prueba de U-Mann Whitney. Se incluyeron 14 niños, 7 para el grupo de toxina botulínica (50%) y 7 para el grupo de Trihexifenidilo (50%). El estudio mostró que el uso de toxina botulínica y trihexifenidilo son ´tiles para el tratamiento de hiperextensión axial en niños parálisis cerebral distónica, si embargo hubo superioridad en los resultados con el empleo de toxina botulínica en el alineamiento y posición.

Tratamiento de la epífora funcional con toxina botulínica tipo A frente a la tira tarsal en un ensayo aleatorizado / Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial

Objetivo Comparar la eficacia de la inyección de toxina botulínica A (TBA) en la glándula lagrimal con la tira tarsal lateral (TTL) en la epífora funcional. Material y método Ensayo clínico aleatorizado. Diseño secuencial, paralelo y no ciego. Pacientes de 18 años o más con epífora funcional con un mínimo de 3 en la escala de Munk (EM) se incluyeron a grupo de TBA o TTL. Los cambios en la EM, el test de Schirmer y la calidad de vida se evaluaron a la semana 6 y hasta la semana 30. Se obtuvo el tiempo medio sin epífora y los acontecimientos adversos. Resultados El análisis final incluyó 25 pacientes, 12 (21 ojos) se asignaron a TBA (5U/0,05mL) y 13 (20 ojos) a TTL. A la semana 6 hubo un mayor descenso en la EM en el grupo de TBA frente a TTL (−2.48 vs. −1.55, p=0,0152) y a la semana 12 (−2,68 vs. −1,69, p=0,0267). Se observó un descenso significativo en el test de Shirmer a las semanas 2, 12 y 30 con TBA. La calidad de vida mejoró después de ambas intervenciones, sin diferencias significativas. El tiempo medio sin epífora en el grupo TBA fue de 26,2 semanas (7,7-36,6) y en el grupo TTL de 24,8 semanas (6,7-37,6), p=0,9368. Se observó ptosis temporal en un 25% (3/12) en el grupo TBA y un 23% (3/13) de molestias de la cicatriz quirúrgica en el grupo TTL, p=0,722. Ningún acontecimiento adverso fue severo. Conclusión La inyección de TBA en la glándula lagrimal es efectiva y segura en el tratamiento de la epífora funcional, con mayor descenso en la EM a las 6 y 12 semanas comparado con la TTL (AU)

Objective To compare the efficacy of botulinum toxin A (BoNTA) injection into the lacrimal gland versus lateral tarsal strip (LTS) for functional epiphora Material and methods Randomized clinical trial. Sequential, parallel, non-blinded study design. Patients aged 18 years or older with functional epiphora and a minimum score of 3 in Munk Scale (MS) were randomized to BoNTA or LTS group. Changes in MS, Schirmer test and quality of life were assessed at week 6 and during follow-up until week 30. The mean time without epiphora and the adverse events were recorded. Results The final analysis included 25 patients, 12 (21 eyes) assigned to BoNTA (5U/0.05mL) and 13 (20 eyes) to LTS. At 6 weeks there was an improvement in the MS in BoNTA versus LTS group (−2.48 vs. −1.55, P=.0152) and at 12 weeks (−2.68 vs. −1.69, P=.0267). A significant decrease was noted in the Schirmer test at week 2, 12 and 30 with BoNTA. The quality of life improved after both interventions without statistical significance. The mean duration of effectiveness in BoNTA group was 26.2 weeks (range 7.7-36.6) and in LTS group was 24.8 weeks (range 6.7-37.6), P=.9368. The main adverse events were temporary eyelid ptosis in 25% (3/12) of the BoNTA group and surgical scar discomfort in 23% (3/13) of the LTS group, P=.722. No adverse events were classified as severe. Conclusion BoNTA injection into the lacrimal gland is a safe and effective treatment for functional epiphora, with a greater decrease in MS at 6 and 12 weeks compared with LTS (AU)

Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial.

INTRODUCTION: To compare the efficacy of botulinum toxin A (BoNTA) injection into the lacrimal gland versus lateral tarsal strip (LTS) for functional epiphora. METHODS: Randomized clinical trial. Sequential, parallel, non-blinded study design. Patients aged 18 years or older with functional epiphora and a minimum score of 3 in Munk Scale (MS) were randomized to BoNTA or LTS group. Changes in Munk scale, Schirmer test (ST) and quality of life (QoL) were assessed at week 6 and during follow-up until week 30. The mean time without epiphora and the adverse events (AE) were recorded. RESULTS: The final analysis included 25 patients, 12 (21 eyes) assigned to BoNTA (5U/0.05 mL) and 13 (20 eyes) to LTS. At 6 weeks there was an improvement in the MS in BoNTA versus LTS group (-2.48 vs -1.55, P = .0152) and at 12 weeks (-2.68 vs -1.69, P = .0267). A significant decrease was noted in the ST at week 2, 12 and 30 with BoNTA. The QoL improved after both interventions without statistical significance. The mean duration of effectiveness in BoNTA group was 26.2 weeks (range 7.7-36.6) and in LTS group was 24.8 weeks (range 6.7-37.6), P = .937. The main AE were temporary eyelid ptosis in 25% (3/12) of the BoNTA group and surgical scar discomfort in 23% (3/13) of the LTS groups, P = .722. No AE were classified as severe. CONCLUSION: BoNTA injection into the lacrimal gland is a safe and effective treatment for functional epiphora, with a greater decrease in MS at 6 and 12 weeks compared with LTS.

Comorbidity between chronic headache and depression treated with botulinum toxin: literature review / A comorbidade entre cefaleia crônica e depressão tratada com toxina botulínica: revisão da literatura

ABSTRACT BACKGROUND AND OBJECTIVES: It is estimated that up to 40% of patients with migraine have at least one episode of major depression during their lifetime. On the other hand, patients with depression are twice as likely to suffer from migraine when compared to the population without the mood disorder. The comorbidity of both conditions increases the frequency of pain crises and the individual's disability. A therapy that could act on the disorders, when simultaneous, would offer advantages through a broader and more effective action, such as botulinum toxin (BTX). Due to the lack of a clear definition on the subject, the objective of this study was to review how the concomitant treatment with BTX of the two morbidities behaves. CONTENTS: A review of articles in English, Portuguese, and Spanish indexed in Pubmed/Medline, LILACS and Scielo databases was carried out. Of the eight articles selected, most individuals were women aged 40 to 50 years. The sample size ranged from 30 to 715 subjects. The predominance was of prospective studies. All studies found a significant reduction in pain. Six studies found a significant decrease in depression. The frequency of adverse effects ranged from 4.1% to 30%, with eyelid ptosis and headache being the most frequent. CONCLUSION: BTX seems to be useful for the treatment of chronic headache and depression. There was a tendency to relate the improvement in depression with the decrease in pain. The specific action of the toxin in the treatment of depression was inconclusive. New studies, with high methodological rigor, as well as systematic reviews, should be carried out to reach a greater depth of comprehension of the subject and to determine the real efficacy of BTX in relieving concomitant headache and depression.

RESUMO JUSTIFICATIVA E OBJETIVOS: Estima-se que até 40% dos pacientes com migrânea apresentam, pelo menos, um episódio de depressão maior ao longo da vida. Por outro lado, pacientes com depressão apresentam duas vezes mais chance de ter migrânea quando comparados à população sem transtorno de humor. A comorbidade dos dois quadros aumenta a frequência das crises de dor e a incapacidade do indivíduo. Uma terapêutica que pudesse agir nos transtornos, quando simultâneos, ofereceria vantagens, por uma ação mais ampla e eficaz, a exemplo da toxina botulínica (TXB). Por faltar ainda uma clara definição sobre o tema, o objetivo deste estudo foi revisar como se comporta o tratamento concomitante das duas morbidades com a TXB. CONTEÚDO: Foi realizada revisão de artigos indexados nas bases de dados Pubmed/Medline, LILACS, Scielo nos idiomas inglês, português e espanhol. Dos oito artigos selecionados, a maioria dos indivíduos foram mulheres de 40 a 50 anos. O tamanho das amostras variou de 30 a 715 pacientes. A predominância foi de estudos prospectivos. Todos os estudos encontraram redução significativa da dor. Seis trabalhos encontraram diminuição significativa da depressão. A frequência dos efeitos adversos variou de 4,1% a 30%, sendo ptose palpebral e dor de cabeça os mais frequentes. CONCLUSÃO: A TXB parece ser útil para tratamento da cefaleia crônica e depressão. Houve uma tendência a relacionar a melhora da depressão com a diminuição da dor. A ação específica da toxina no tratamento da depressão foi inconclusiva. Novos estudos, com alto rigor metodológico, assim como revisões sistemáticas, deve ser realizados para alcançar maior aprofundamento do assunto, a fim de determinar a real eficácia da TXB no alívio da cefaleia e depressão concomitantes.

Toxina Botulínica tipo A para el bruxismo del sueño en adultos / Botulinum toxin type A for sleep bruxism in adults

RESUMEN: Introducción: El bruxismo del sueño es un comportamiento que se caracteriza por la actividad repetitiva de los músculos masticadores. Varias terapias para el manejo del bruxismo del sueño se centran en la relajación de los músculos involucrados, incluyendo la inyección intramuscular de Toxina Botulínica tipo A (BoNTA). A pesar de que se ha comprobado la efectividad de esta terapia frente al dolor subjetivo, cuando se asocia a bruxismo del sueño, es necesario determinarla frente a desenlaces objetivos, tanto a nivel craneofacial como sistémico. Además, se debe evaluar también la seguridad de esta intervención frente a eventos adversos tales como afecciones estéticas, debilidad masticatoria y pérdida ósea mandibular, entre otros. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta-análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 11 revisiones sistemáticas que en conjunto incluyeron 9 estudios primarios, de los cuales, 8 corresponden a ensayos aleatorizados. Concluimos que la inyección intramuscular de toxina botulínica tipo A podría disminuir el dolor en reposo, presentar poca o nula diferencia en dolor durante la masticación y mejorar la autoevaluación del bruxismo, pero la certeza de la evidencia es baja. Por otra parte, no es posible establecer con claridad si el uso de Toxina Botulínica Tipo A disminuye el número de eventos de bruxismo, ya que la certeza de la evidencia ha sido evaluada como muy baja. Finalmente y a pesar de la evidencia existente respecto de los potenciales eventos adversos producto de la intervención con Toxina Botulínica Tipo A en los músculos masticatorios, los ensayos clínicos fallan en evaluarlos y reportarlos.

ABSTRACT: Introduction: The sleep bruxism is a behavior that impacts the craniofacial musculoskeletal system characterized by repetitive activity of the masticatory muscles. Several management strategies for sleep bruxism are focused of the relaxation of the involved masticatory muscles, including the intramuscular injection of botulinum toxin type A (BoNTA). Although the effectiveness of BoNTA for myofascial pain, when related with the sleep bruxism in adult patients, it is necessary to determine its effectiveness using objective outcomes at both craniofacial and systemic levels. In addition, it is necessary to determine the safety of this intervention in the context of adverse events such as aesthetic alterations, reduced masticatory function, mandibular bone loss among others. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, with is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE assessment. Results and conclusions: 11 systematic reviews were identified, and 9 primary studies were included. 8 out of these 9 studies corresponded to randomized clinical trials. We conclude that the intramuscular injection of BoNTA may reduce the pain during rest and results in either little or none difference in pain during mastication, when pain is associated with sleep bruxism in adult patients. Also, low evidence is determined for auto-report and subjective evaluation of sleep bruxism among adult patients. Additionally, it is not possible to determine if the BoNTA intervention is effective to reduce the bruxism events due to the low evidence. Finally, although evidence regarding adverse events such as mandibular bone loss after BoNTA intervention in masticatory muscles has been published at preclinical and clinical levels, the clinical trials fail to consider and to report these outcomes.

Experiencia con el uso de toxina botulínica en niños con vejiga hiperactiva neurogénica: Una serie de casos / Experience with Botulinum Toxin in Children with Neurogenic Overactive Bladder: A Case Series

Objetivo Describir la experiencia con la administración de inyección de toxina botulínica en niños con vejiga hiperactiva neurogénica refractaria a manejo de primera línea. Materiales y Métodos Estudio observacional descriptivo (serie de casos) que incluyó a 14 niños con diagnóstico de vejiga hiperactiva neurogénica refractarios a tratamiento de primera línea sometidos a administración intravesical de toxina botulínica entre 2015 y 2021; se realizó el seguimiento teniendo en cuenta las variables clínicas, con evaluación de la respuesta y de los eventos adversos. Se reportaron frecuencias absolutas y porcentajes para las variables cualitativas; para las variables cuantitativas, se reportaron medidas de tendencia central y dispersión. Resultados Se incluyeron 6 niños y 8 niñas, con una media de edad 10,1 (desviación estándar [DE]: ± 4,4) años. Todos los pacientes fueron tratados previamente con anticolinérgico y cateterismos limpios intermitentes, con una media de uso de 2,8 (DE: ± 1.0) pañales al día; 11 (78,5%) pacientes tenían antecedente de infección urinaria, 13 (92,8%), estreñimiento, y 2 (15,3%), incontinencia fecal. En la ecografía, 7 (50,0%) pacientes presentaban engrosamiento de las paredes vesicales, y 6 (42,8%), hidronefrosis. Tras el procedimiento, 1 paciente presentó infección urinaria como complicación, 6 presentaron una respuesta completa, 7, respuesta parcial, y 1 paciente no obtuvo respuesta con la primera inyección, con un tiempo promedio efectivo de la terapia 8 (DE: ± 6,3) meses. Una segunda inyección fue necesaria en 6 (42.8%) pacientes, y, de estos, 3 (50%) requirieron una tercera inyección. Conclusión La inyección de toxina botulinica intravesical como terapia de segunda línea de manejo para vejiga hiperactiva neurogénica tiene buenos resultados, con bajas tasas de complicaciones.

Objective To describe the experience with the administration of botulinum toxin injection in children with neurogenic overactive bladder who were refractory to the first-line management. Materials and Methods A descriptive observational study (case series) which included 14 children with a diagnosis of neurogenic overactive bladder who were refractory to the first-line treatment and were aubmitted to the intravesical administration of botulinum toxin between 2015 and 2021. Follow-up was performed taking into account the clinical variables, wth an evaluation of the response and the adverse events. Absolute frequencies and percentages were reported for the qualitative variables; for the quantitative variables, measures of central tendency and dispersion were reported. Results We included 6 boys and 8 girls with a mean age of 10.1 (standard deviation [SD]: ± 4.4) years. All patients were previously treated with anticholinergics and clean intermittent catheterizations, with a mean use of 2.8 (SD: ± 1.0) diapers per day; 11 (78.5%) had a history of urinary tract infection, 13 (92.8%), constipation, and 2 (15.3%), fecal incontinence. On ultrasound, 7 (50.0%) patients presented bladder wall thickening, and 6 (42.8%), hydronephrosis. After the procedure, 1 patient presented urinary tract infection as a complication, 6 presented complete response, 7, partial response, and 1 patient did not obtain a response with the first injection, with an effective mean time of therapy of 8 (SD: ± 6.3) months. A second injection was required by 6 (42.8%) patients, and of these, 3 (50%) required a third injection. Conclusion Intravesical botulinum toxin injection as a second-line management therapy for neurogenic overactive bladder yileds good results, with low rates of complications.

Grado de riesgo biológico al manipular toxina botulínica como medicamento / Degree of Biohazard When Handling Botulinum Toxin as A Medication

Introducción: El uso de la toxina como medicamento constituye un riesgo biológico, debido a la presencia de la toxina, así como al uso indebido que se le puede dar. Objetivo: Evaluar el grado de riesgo biológico al manipular toxina botulínica como medicamento. Métodos: Estudio descriptivo transversal en el Centro Internacional de Restauración Neurológica, La Habana, Cuba, en 2017. Se aplicó una lista de chequeo de riesgo biológico a 6 profesionales del área de tratamiento de toxina botulínica. El resultado integrado de la lista de chequeo se analizó a través del método semicuantitativo "ERBIO". Resultados: La probabilidad se catalogó de "media", el cumplimiento de medidas de contención como "aceptable" y la exposición se consideró como "muy frecuente". Conclusiones: Se constató un grado de riesgo biológico "tolerable" al manipular la toxina botulínica como medicamento en el Centro Internacional de Restauración Neurológica. Esto implica que se deben considerar mejoras que no supongan una carga económica importante, que requerirán de comprobaciones periódicas para asegurar el mantenimiento de la eficacia de las medidas de control establecidas(AU)

Introduction: The use of the toxin as a medication constitutes a biological risk, due to the presence of the toxin, as well as the potential improper use. Objective: To evaluate the degree of biological risk when Handling botulinum toxin as a medication. Methods: A cross-sectional descriptive study was carried out at the International Center for Neurological Restoration, Havana, Cuba, in 2017. A biological risk checklist was applied to six professionals from the botulinum toxin treatment area. The integrated result of the checklist was analyzed through ERBIO semi-quantitative method. Results: The probability was classified as medium. Compliance with containment measures was assessed as acceptable and the exposure was considered as very frequent. Conclusions: A tolerable degree of biological risk was found when manipulating botulinum toxin as a medication at the International Center for Neurological Restoration. This implies that improvements should be considered not to imply a significant economic burden, which will require periodic checks to ensure the maintenance of the effectiveness of the established control measures(AU)

Toxina botulinica tipo a en el tratamiento del queloide / Botulinic toxin type a in the treatment of keloid

Introducción y objetivo: El proceso de cicatrización, cuando se ve perturbado o interrumpido, puede conllevar una reparación cutánea descontrolada como la observada en los queloides. Son reconocidos como tumores fibroproliferativos únicos en humanos, lesiones difíciles de tratar debido a que la mayoría de los enfoques terapéuticos siguen siendo clínicamente insatisfactorios. Sin embargo, estudios recientes sugieren que la toxina botulínica tipo A (TBA) influye en la apoptosis y proliferación celular, razón por lo cual nos planteamos demostrar si la TBA intralesional produce mejoría no solo clínica, sino también histológica en el queloide.Material y método.Seleccionamos 11 queloides y realizamos biopsias de los mismos, además de medición previa y en 3 controles posteriores a la aplicaciónn de TBA. Hacemos descripción histopatológica de los cambios observados a los 3 meses mediante el Sofware Image Pro Plus, versión 5.0 (Olympus®) y tinciones con hematoxilina-eosina (H/E) y tricrómico de Masson. Aplicamos tratamiento estadístico mediante análisis de las características demográficas y clínicas. A las variables nominales se le determinaron frecuencia y porcentajes, por lo que elaboramos tablas descriptivas. Con las variables cuantitativas trabajamos con medidas de tendencia central (media). Para la comparación y el análisis de las variables utilizamos medidas de tendencia central (media), coeficiente de relación de Pearson y desviación estándar. (AU)

Background and objective: When the healing process is disturbed or interrupted, uncontrolled skin repair can occur, such as that observed in keloid. These are recognized as unique fibroproliferative tumors in humans, always representing difficult-to-treat lesions because most therapeutic approaches remain clinically unsatisfactory. However, recent studies have suggested that botulinum toxin type A (BTA) influences apoptosis and cell proliferation. This is why we set out to demonstrate whether intralesional BTA produces improvement not only clinically but also histologically in the keloid.Methods.Eleven keloids were selected and biopsies were performed as well as previous measurements and 3 controls after the application of BTA. Histopathological description of the changes observed 3 months after therapy using the Software Image Pro Plus, version 5.0 (Olympus®) and stains with hematoxylin-eosin (H/E) and Masson's trichomic. Statistical treatment was applied through analysis of demographic and clinical characteristics.The frequency and percentages were determined for the nominal variables, so descriptive tables were made. With the quantitative variables we worked with measures of central tendency (average). For the comparison and analysis of the variables, measures of central tendency (mean), coefficient of Pearson relation and standard deviation were used. (AU)

Effect of botulinum toxin typeA in functionality, synkinesis and quality of life in peripheral facial palsy sequelae. / Efecto de la toxina botulínica tipoA en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica.

OBJECTIVES: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.

[Notalgia paresthetica: Treatment with botulinum toxin type A]. / Notalgia parestésica, tratamiento con toxina botulínica tipo A.

Notalgia paresthetica is a sensory mononeuropathy caused by compression localized in the dorsal region. The condition is clinically characterised by the presence of pruritus, paresthesias and hyperalgesia associated with a hyperpigmented patch in the correspondingt dermatoma, substantially impairing quality of life. We report the cases of two patients aged between 35 and 65years with chronic symptoms and treated in our service with botulinum toxin type A in the affected areas. We observed a decrease in the EVA pain scale and the intensity of the pruritus after infiltrations, as well as a reduction in the hyperpigmented patch at the first, third and sixth months after the intradermal injections that has been maintained after a year. We conclude that botulinum toxin typeA treatment could be a safe and useful alternative in these patients, as it has been shown to be effective over a longer term than available treatments to date, although further studies are required to confirm our findings.

Tétanos y uso de toxina botulínica: reporte de caso / Tetanus and botulinum toxin use: report of a case

RESUMEN El tétanos es un trastorno del sistema nervioso caracterizado por espasmos musculares causados por las toxinas de Clostridium tetani, un bacilo anaerobio, que se encuentra en el suelo y cuyas esporas sobreviven en el ambiente y causan infección al contaminar las heridas. El objetivo de este reporte de caso es dar a conocer los aspectos básicos de esta enfermedad, hacer un enfoque en la mejoría de la funcionalidad con la aplicación de toxina botulínica tipo A para la espasticidad generalizada y el trismo. Presentamos el caso de una mujer de 81 años con tétanos generalizado y presencia de trismo con antecedente de traumatismo craneal secundario a caída desde su propia altura sin pérdida del conocimiento 15 días previos al ingreso a la institución de salud. Durante su estancia hospitalaria el tratamiento fue multidisciplinario. La paciente egresó en buenas condiciones generales con seguimiento en consulta externa.

ABSTRACT Tetanus is a condition affecting the central nervous system which is characterized by muscle spasms caused by toxins from Clostridium tetani, an anaerobe bacillus which is usually found on soil and whose spores may survive in the environment and lead to infection when contaminating open wounds. The objective of this case report is to review on the basic characteristics of this condition, focusing on functional improvement with the administration of type A botulinum toxin for generalized spasticity and lockjaw (trismus). We present the case of an 81-year-old woman with generalized tetanus and lockjaw after she suffered a head injury, she fell and hurt her head, with no loss of consciousness; and that was 15 days before admission. During her hospital stay she was managed by a multidisciplinary team. The patient did well, and she is currently being followed-up in the outpatient clinic.

Treatment of symptomatic epiblepharon with Botulinum toxin type A in patients under 2years of age. / Experiencia del uso de la toxina botulínica tipo A para el tratamiento sintomático del epiblefaron en pacientes menores de 2 años.

INTRODUCTION: Epiblepharon is a congenital eyelid malposition due to a horizontal skin fold and a redundant orbicular muscle, resulting in the inward positioning of the eyelashes. OBJECTIVE: Personal experience is presented of the non-surgical correction of symptomatic epiblepharon using a pretarsal injection of 5 IU of botulinum toxin type A (BoNT-A) into the orbicular muscle. MATERIAL AND METHODS: Patients with epiblepharon younger than 2 year were included in the study. A review was made of their clinical charts and the symptoms and signs of epiblepharon were evaluated before and after treatment with BoNT-A. RESULTS: A total of 40 patients were included (28 girls [70%]). The mean age at treatment was 11 months (range, 4-24 months). A total of 76 eyelids were treated with BoNT-A. A statistically significant improvement in symptoms, lash-corneal touch, and punctate corneal epitheliopathy were reported after the treatment with 5IU BoNT-A. The mean final follow-up was 25.5 weeks (range, 4-92 months). CONCLUSIONS: The present study provides evidence that a pretarsal BoNT-A injection is an effective and safe treatment for the correction of symptomatic epiblepharon in patients younger than 2 years of age.

[Subcutaneous botulinum toxin in the treatment of peripheral neuropathic pain]. / Toxina botulínica subcutánea en el tratamiento del dolor neuropático periférico.

Neuropathic pain impairs quality of life in affected individuals and poses a challenge to clinicians due to the complexity of its treatment and frequent therapeutic failures. We present 4clinical cases of chronic neuropathic pain (LANSS ≥ 19), refractory to conservative treatment (meralgia paraesthetica, post-surgical pain and 2surgical scars). Subcutaneous botulinum toxin type A was infiltrated periodically over the painful area. All patients experienced subjective improvement in pain and improvement measured by the visual analogic scale. Pain relief started at 5-21 days and continued up to 1.5-3 months, and up to 9 months in one patient. Pain that reappeared was of lower intensity in 3patients and was reduced in area in 2patients.

Emerging therapies in clinical development and new contributions for neuropathic pain. / Terapias emergentes en desarrollo clínico y nuevas aportaciones en dolor neuropático.

Neuropathic pain is very challenging to manage because of the heterogeneity of aetiologies, symptoms, and underlying mechanisms. Conventional oral therapies have been limited by negative factors such as systemic side effects, drug-drug interactions, slow onset of action, the need for titration, multiple daily dosing, as well as the potential risk of addiction, dependence, withdrawal symptoms and abuse. Therefore, new therapeutic perspectives are justified. New drugs that act on different therapeutic targets are currently in preclinical development or in their first phases of clinical development. In this review, focus will be directed specifically on new pharmacological treatments for neuropathic pain for which clinical data are already available, including older and known drugs with new data on their anti-neuropathic activity.

Uso da toxina botulínica na correção do sorriso gengival / Use of botulinal toxin in the correction of gengival smile

Introdução: A beleza do sorriso representa uma expressão primordial na harmonização da face, e está diretamente ligada à autoestima do indivíduo. A atividade do sorriso é determinada pela contração de músculos específicos, e pode apresentar diferentes níveis de exposição gengival. Quando maior que 3mm é denominado sorriso gengival e gera uma condição esteticamente desagradável. Entre as suas diversas causas, a hiperatividade muscular se destaca. Objetivo: apresentar uma revisão de literatura a respeito da toxina botulínica, que se tornou uma ferramenta bastante utilizada como método complementar ou exclusivo na correção do sorriso gengival. Método: Para a pesquisa, foram utilizados os seguintes descritores: toxina botulínica tipo A, estética dentária e clostridium botulinum, utilizando os operadores booleanos AND e OR, inclusos artigos em língua portuguesa, inglesa e espanhola para descrever seu histórico, mecanismo de ação, durabilidade, indicações, contraindicações e técnica de aplicação. Conclusão: Conclui-se que o seu emprego como método de tratamento conservador pelo cirurgião-dentista é viável desde que possua conhecimento da anatomia facial, interações entre os músculos e farmacologia da neurotoxina, garantindo assim segurança, melhoria na estética do sorriso e satisfação do paciente.

Introduction: The beauty of the smile represents a primordial expression in the harmonization of the face and is directly linked to the self-esteem of the individual. Smile activity is determined by the contraction of specific muscles and may present different levels of gingival exposure. When bigger than 3mm, it is called gingival smile, and generates an aesthetically unpleasant condition. Among its many causes, muscular hyperactivity is highlighted. Objective: The objective of this work was to present a literature review about botulinum toxin, which has become a widely used tool as a complementary or exclusive method for gingival smile correction. Method: The following descriptors were used: Botulinum toxin type A, dental aesthetics and clostridium botulinum, using Boolean operators AND and OR, including articles in Portuguese, English and Spanish to describe their history, mechanism of action, durability, indications, contraindications and application technique. Conclusion: It is concluded that its use as a method of conservative treatment by the dental surgeon is feasible if it has a thorough knowledge of facial anatomy, interactions between muscles and neurotoxin pharmacology, thus ensuring safety, improvement in smile aesthetics and patient satisfaction.

Avaliação da percepção e da satisfação estética de pacientes que foram tratados com toxina botulínica tipo A para correção do sorriso gengival / Assessment of patients' perception and satisfaction with the botulinum toxin type A treatment for gummy smile

O sorriso gengival é caracterizado pela exposição excessiva da gengiva ao sorrir. Esta alteração pode ser classificada em anterior, posterior, mista e assimétrica. Sua etiologia está associada a diversos fatores, tais como gengivais, esqueléticos e musculares. A toxina botulínica tipo A tem sido bastante utilizada na Odontologia para a correção do sorriso gengival, tendo como vantagem ser um procedimento pouco invasivo, seguro e eficaz. Esta pesquisa teve como objetivo avaliar, por meio de questionários, a satisfação dos pacientes em relação aos resultados obtidos com a aplicação da toxina botulínica tipo A para a correção do sorriso gengival. O questionário foi respondido antes da aplicação da toxina e 15 dias após. Participaram da pesquisa um total de 15 pacientes. Os resultados obtidos indicaram que os participantes classificaram seus sorrisos, após a aplicação da toxina botulínica, como muito bom e excelente. Todos os participantes da pesquisa relataram que ao sorrir não apresentavam exposição gengival e sentiam-se confortáveis durante o sorriso após a aplicação da toxina. Portanto, concluiu-se que os participantes da presente pesquisa apresentaram alto grau de satisfação com os resultados obtidos no tratamento do sorriso gengival com a aplicação da toxina botulínica tipo A (AU).

Gummy smile is characterized by gingival tissue excessive exposure while smiling. It can be classified as anterior, posterior, mixed, and asymmetric. Its etiology is associated with several factors, such as gingival, skeletal, and muscular. Botulinum toxin type A has been widely used in Dentistry for gingival smile correction with the advantage of being a less invasive, safe, and effective procedure. The purpose of this study was to investigate patient satisfaction in relation to the results obtained with botulinum toxin type A application for gummy smile correction using questionnaires. The questionnaire was answered before and after 15 days of the toxin application. A group of 15 patients participated of the study. The results showed that the participants classified their smiles, after the application of botulinum toxin, as very good and excellent. All study participants reported no more discomfort with gingival exposure when smiling and everyone felt comfortable with the smile after botulinum toxin application. Therefore, it was concluded that all participants were satisfied with the results obtained after botulinum toxin type A gummy smile treatment (AU).

Blepharospasm with elevated anti-acetylcholine receptor antibody titer / Blefaroespasmo com título elevado de anticorpos antirreceptores de acetilcolina

ABSTRACT Objective: To determine whether serum levels of anti-acetylcholine receptor antibody (anti-AChR-Abs) are related to clinical parameters of blepharospasm (BSP). Methods: Eighty-three adults with BSP, 60 outpatients with hemifacial spasm (HFS) and 58 controls were recruited. Personal history, demographic factors, response to botulinum toxin type A (BoNT-A) and other neurological conditions were recorded. Anti-AChR-Abs levels were quantified using an enzyme-linked immunosorbent assay. Results: The anti-AChR Abs levels were 0.237 ± 0.022 optical density units in the BSP group, which was significantly different from the HFS group (0.160 ± 0.064) and control group (0.126 ± 0.038). The anti-AChR Abs level was correlated with age and the duration of response to the BoNT-A injection. Conclusion: Patients with BSP had an elevated anti-AChR Abs titer, which suggests that dysimmunity plays a role in the onset of BSP. An increased anti-AChR Abs titer may be a predictor for poor response to BoNT-A in BSP.

RESUMO Objetivo: Determinar se os níveis séricos do anticorpo antirreceptor de acetilcolina (anti-AChR-Abs) estão relacionados aos parâmetros clínicos do blefaroespasmo (BSP). Métodos: Fora recrutados 83 adultos com BSP, 60 pacientes ambulatoriais com espasmo hemifacial (HFS) e 58 controles. Foi aplicado um questionário para registrar história pessoal, fatores demográficos, resposta à toxina botulínica tipo A (BoNT-A) e outras condições neurológicas. Os níveis de anti-AChR-Abs foram quantificados usando um ensaio imunoenzimático. Resultados: O nível de anti-AChR-Abs foi de 0,237 ± 0,022 unidades de densidade óptica (OD) no grupo BSP, significativamente diferente em comparação com o grupo HFS (0,160 ± 0,064) e o grupo controle (0,126 ± 0,038). O nível de anti-AChR-Abs se correlacionou com a idade e a duração da resposta à injeção de BoNT-A. Conclusão: Pacientes com BSP apresentaram títulos elevados de anti-AChR-Abs, o que sugere que a desimunidade desempenha um papel no surgimento de BSP. O aumento do título de anti-AChR-Abs pode ser um preditor de resposta insuficiente à BoNT-A em BSP.