Botulinum Toxins, Type A ; therapeutic use ; Humans ; Tennis Elbow ; drug therapy

OBJECTIVETo investigate the patterns of spasmodic dysphonia and the outcome treated with botulinum toxin A injections.

METHODSAll subjects were studied with acoustic analysis, laryngostroboscopy and laryngeal electromyography (EMG) including motor unit potential measure (MUP), recruitment pattern analysis and evoked electromyography. All the patients with spasmodic dysphonia were received botulinum toxin A (BOTOX) injections in each affected muscles and mostly under electromyographic guidance.

RESULTSAmong 22 cases of spasmodic dysphonia, 18 cases of adductor dysphonic patients have strained, strangled voice with intermittent breaks in speech as a consequence of hyperadduction and spasm of the vocal folds during phonation. Two patients had synchronous pharyngeal, lingual and velar tremor. Amplitudes of MUP of thyroarytenoid muscle (TA) were greater in patients group than in normal group (P < 0.01); The recruitment activity was increased and the amplitudes were greater than normal group (700-2500 microV) and the duration of activity of the TA during phonation was also notably greater in patients group than in normal group. Four cases of abductor dysphonic patients have a breathy, effortful hypophonic voice with abrupt termination of voicing. Amplitudes of MUP of posterior cricoarytenoid muscle (PCA) in patients group were increased up to 374 to 538 microV. The recruitment activity was increased and the amplitude was greater than normal(3000-5000 microV). In the adductor dysphonic group, patients who were treated with unilateral toxin injection had good results with 2.5 U or more. The average onset of toxin effect in all adductor dysphonic patients was at 6 hours to 2 days (1.4+/-0. 8) days (x +/- s), with a peak effect at 2 weeks and the follow-up EMG showed fibrillation potentials or electric silence in injected muscle. Duration of benefit was 8 to 24 weeks (15.2 +/- 4.9) weeks. The side-effect of toxin injection were including breathy voice or occasional dysphagia and aspiration. The patients with abductor spasms were less well controlled after PCA injections.

CONCLUSIONSSpasmodic dysphonia was regarded as a neuromuscular diseases, so its diagnosis, classification, treatment and follow-up should depend on not only clinical manifestation but also EMG. Presently, for controlling the dystonic symptoms, the most effective therapy for most of those patients is local BOTOX injections. Repeated injections are required to have a stable results.

Adult ; Botulinum Toxins ; therapeutic use ; Botulinum Toxins, Type A ; therapeutic use ; Case-Control Studies ; Dysphonia ; diagnosis ; drug therapy ; Electromyography ; Female ; Humans ; Middle Aged ; Spasm ; diagnosis ; drug therapy ; Young Adult

Adult ; Aged ; Botulinum Toxins, Type A ; therapeutic use ; Dysphonia ; therapy ; Female ; Humans ; Laryngoscopy ; Male ; Middle Aged

Botulinum Toxins, Type A ; therapeutic use ; Cerebral Palsy ; physiopathology ; rehabilitation ; Child ; China ; Humans

BACKGROUNDOnabotulinumtoxinA is widely used in treating neurogenic detrusor overactivity (NDO). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating NDO.

METHODSWe searched the following databases: Medline, EMBASE, and the Cochrane Controlled Trials Register. All published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of NDO were identified in the analysis. The reference lists of the retrieved studies were also investigated.

RESULTSFour publications involving a total of 807 patients were identified in the analysis, which compared onabotulinumtoxinA with placebo. The changes of the mean number of urinary incontinence per week (the standardized mean difference [SMD] = -10.91, 95% confidence intervals [CIs] = -14.18--7.63, P < 0.0001); maximum cystometric capacity (SMD = 146.09, 95% CI = 126.19-165.99, P < 0.0001) and maximum detrusor pressure (SMD = -32.65, 95% CI = -37.83--27.48, P < 0.0001) indicated that onabotulinumtoxinA was more effective than the placebo, despite the doses of onabotulinumtoxinA. Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with more complications. Urinary tract infections (relative risk [RR] =1.48, 95% CI = 1.20-1.81, P = 0.0002); hematuria (RR = 1.81, 95% CI = 1.00-3.24, P = 0.05) and urinary retention (RR = 5.87, 95% CI = 3.61-9.56, P < 0.0001).

CONCLUSIONSThis meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for NDO with side effects primarily localized to urinary tract.

Botulinum Toxins, Type A ; adverse effects ; therapeutic use ; Humans ; Urinary Bladder, Overactive ; drug therapy

Adolescent ; Botulinum Toxins, Type A ; therapeutic use ; Hirschsprung Disease ; drug therapy ; Humans ; Male

Humans ; Botulinum Toxins, Type A/therapeutic use* ; Esotropia/drug therapy* ; Neuromuscular Agents ; Injections ; Treatment Outcome ; Oculomotor Muscles

The wound healing time, tension of wound edge, proliferation of fibroblast, and extracellular matrix deposition are the important factors of scar formation, and botulinum toxin type A can regulate the above. Prevention and treatment of scar with botulinum toxin type A is one of the hot topics of clinical research in recent years. This paper briefly reviews researches by scholars at home and abroad on the mechanism, clinical application, complications, and adverse effects of botulinum toxin type A in scar prevention and treatment.
Botulinum Toxins, Type A/therapeutic use* ; Cicatrix/prevention & control* ; Extracellular Matrix/pathology* ; Fibroblasts/drug effects* ; Humans ; Wound Healing/drug effects*

Botulinum toxins (BTX) have revolutionised the management of focal post-stroke spastic hypertonia. Published literature has supported the efficacy and safety of BTX in reducing spastic hypertonia but has not convincingly demonstrated the ability to enhance function. While clinicians and stroke survivors have reported impressive clinical outcomes, randomised, controlled trials (RCTs), have demonstrated only significant improvement in muscle tone but not functional changes. This paper will review the evidence supporting the efficacy of BTX for spastic hypertonia and discuss current clinical practice.
Botulinum Toxins, Type A ; administration & dosage ; therapeutic use ; Humans ; Muscle Hypertonia ; drug therapy ; etiology ; Neuromuscular Agents ; administration & dosage ; therapeutic use ; Recovery of Function ; Stroke ; complications ; Treatment Outcome

BACKGROUNDHemifacial spasm (HFS) is a facial nerve disorder characterized by episodic involuntary ipsilateral facial muscle contraction. Information on Chinese patients with HFS has not been well-characterized. This study aimed to evaluate the clinical feature and the treatment status of HFS across China.

METHODSA cross-sectional study including 1003 primary HFS patients had been carried out in 15 movement disorder clinics in China in 2012. The investigated information was acquired from questionnaires and medical records including demographic data, site of onset, aggravating and relieving factors, treatments prior to the investigation, etc.

RESULTSIn this study, the ratio of male to female was 1.0:1.8, the mean age at onset was (46.6 ± 11.5) years. About 1.0% patients were bilaterally affected. The most often site of initial onset was the orbicularis oculi muscle. The most often affected sites were orbicularis oculi, zygomatic, and orbicularis oris muscles. Stress/anxiety and relaxation were most often aggravating and relieving factors, respectively; 2.3% patients had family history, 28.4% cases were combined with hypertension, and 1.4% patients were with trigeminal neuralgia. Botulinum toxin type A (BTX-A) injection was the most commonly used treatment, followed by acupuncture and oral medication. BTX-A maintained the highest repeat treatment ratio (68.7%), while 98.4% patients gave up acupuncture. The mean latency of BTX-A effect was (5.0 ± 4.7) days, the mean total duration of the effect was (19.5 ± 11.7) weeks, and 95.9% patients developed improvements no worse than moderate in both severity and function. The most common side effect was droopy mouth.

CONCLUSIONSThe onset age of HFS in China is earlier than that in western countries. The most often used two treatments are BTX-A injection and acupuncture, while the latter kept the poor repeat treatment ratio because of dissatisfactory therapeutic effect.

Adult ; Botulinum Toxins, Type A ; therapeutic use ; China ; Cross-Sectional Studies ; Female ; Hemifacial Spasm ; diagnosis ; drug therapy ; Humans ; Male ; Middle Aged ; Neuromuscular Agents ; therapeutic use