Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Filtrar
2.
Front Hum Neurosci ; 9: 385, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26217209

RESUMO

UNLABELLED: Though the pathophysiology of dystonia remains uncertain, two primary factors implicated in the development of dystonic symptoms are excessive cortical excitability and impaired sensorimotor processing. The aim of this study was to determine the functional efficacy of an intervention combining repetitive transcranial magnetic stimulation (rTMS) and sensorimotor retraining. A randomized, single-subject, multiple baseline design with crossover was used to examine participants with focal hand dystonia (FHD) (n = 9). INTERVENTION: 5 days rTMS + sensorimotor retraining (SMR) vs. Five days rTMS + control therapy (CTL) (which included stretching and massage). The rTMS was applied to the premotor cortex at 1 Hz at 80% resting motor threshold for 1200 pulses. For sensorimotor retraining, a subset of the Learning-based Sensorimotor Training program was followed. Each session in both groups consisted of rTMS followed immediately by 30 min of the therapy intervention (SMR or CTL). Contrary to our hypothesis, group analyses revealed no additional benefit from the SMR training vs. CTL. When analyzed across group however, there was significant improvement from the first baseline assessment in several measures, including tests of sensory ability and self-rated changes. The patient rated improvements were accompanied by a moderate effect size suggesting clinical meaningfulness. These results provide encouragement for further investigation of rTMS in FHD with a need to optimize a secondary intervention and determine likely responders vs. non-responders.

4.
Stud Health Technol Inform ; 173: 457-62, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22357036

RESUMO

Here we introduce a new virtual reality (VR) based simulation system for training the urological procedure of intra-detrusor botulinum toxin (Botox®) injections into the bladder. 6 cases with different bladder anatomy and 3 subtasks are included in the curriculum; this design is guided by several expert urologists according to clinical needs and experience. These virtual bladder models can be deformed by a cystoscope model or penetrated by a needle model. Data of location and dose per injection are collected during the training. After compared among various options, magnetic motion-tracking devices are chosen and integrated onto replicas of cystoscopic instruments as the VR interface for the specific operation. A web/database based learning management platform (LMP) is developed for online data access and validation studies of the training system.


Assuntos
Antitoxina Botulínica/administração & dosagem , Simulação por Computador , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Masculino , Modelos Anatômicos , Interface Usuário-Computador
5.
PM R ; 2(4): 268-76, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20430328

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of botulinum toxin type A (BoNT-A) injected intra-articularly in 60 subjects with moderate pain and functional impairment secondary to knee osteoarthritis. The study investigators hypothesized that intra-articular BoNT-A would result in statistically significant improvements in pain and function at 8 weeks. DESIGN: Double-blind, randomized, single tertiary care academic medical center trial with 6-month follow-up. PATIENTS: Sixty patients aged 40 years or older with painful osteoarthritis of the knee who had failed physical therapy, medications, and/or injection therapy presenting to the musculoskeletal or orthopedic outpatient clinics at a large tertiary care medical institution. All 60 patients completed 8-week follow-up, but only 32 patients completed the 26-week follow-up. METHODS: Subjects were randomized to receive a single injection of corticosteroid, low-dose BoNT-A (100 units), or high-dose BoNT-A (200 units). Outcome measures were compared at baseline, 4, 8, 12, and 26 weeks after injection. MAIN OUTCOME MEASUREMENTS: The primary outcome measure was pain visual analog scale (VAS) at 8 weeks. Secondary outcome measures included Western Ontario McMaster Arthritis Index, Short Form-36 scores, patient global assessment, 40-meter timed walk, and adverse effects. RESULTS: The primary end point was pain VAS score at 8 weeks, which decreased within each group but only reached statistical significance in the low-dose BoNT-A group. In the intra-articular corticosteroid group, VAS decreased from 6.4 +/- 1.8 to 5.4 +/- 2.3 (P = .15); for low-dose BoNT-A, from 6.6. +/- 1.9 to 4.5 +/- 2.2 (P = .01); and for high-dose BoNT-A, from 6.6 +/- 1.4 to 5.9 +/- 2.4 (P = .15). All groups showed statistically significant improvements in Western Ontario McMaster Arthritis Index scores (pain, stiffness, function) at 8 weeks. No serious adverse events were noted in any group. CONCLUSIONS: This pilot study supports a possible role for BoNT-A as a treatment option for symptomatic knee osteoarthritis; however, larger double-blind randomized studies are needed to determine whether BoNT-A is more effective than placebo in this patient population.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/tratamento farmacológico , Idoso , Estudos de Coortes , Método Duplo-Cego , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Projetos Piloto , Recuperação de Função Fisiológica , Resultado do Tratamento
6.
Toxicon ; 54(5): 658-67, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19351542

RESUMO

There is a growing need for novel treatments of refractory arthritis joint pain as the aging population is expanding with many patients who are unable to undergo joint replacement surgery. We are studying the efficacy and safety of intra-articular injection of Botulinum Toxin Type A (IA-BoNT/A) into joints with arthritis pain. In several small open label studies, initial effects for IA-BoNT/A were encouraging because two thirds of the patients had more than 50% reduction in joint pain severity that was associated with a significant improvement in function. Importantly no serious adverse effects of IA-BoN/A were noted. Based on these initial results, we have completed two pilot randomized controlled trials in painful shoulder joints and painful knee joints. In the shoulder study, IA-BoNT/A produced a significant decrease in shoulder pain severity at one month (6.8-4.4 on VAS, p=.002) that was also significantly better than the non-significant change after IA-Saline placebo (1.6 unit difference favoring IA-BoNT/A, p=.014). In the knee study IA-BoNT/A produced a significant 48% decrease in McGill Total Pain Score at one month (p=.01 1) that was still significant at 3 mo after injection (p=.002). There was a strong placebo response in one third of those but the decrease in pain severity was not significant. We are currently conducting a RCT of IA-BoNT/A for painful prosthetic knee joints. Based on these initial studies of IA-BoNT/A we have gone 'back to the bench' to standardize a menu of pain behaviors for mice with acute inflammatory arthritis pain and chronic inflammatory arthritis pain. IA-BoNT/A significantly reduced arthritis joint tenderness (evoked pain score) in acute and chronic inflammatory arthritis and normalized impaired spontaneous wheel running in mice with chronic inflammatory arthritis but not in those with acute inflammatory arthritis. With these models of arthritis and pain behavior methods we will be able to screen potential intra-articular analgesics, define dose response curves and injection schedule, and study the relationships of articular pain and loss of function.


Assuntos
Analgésicos/administração & dosagem , Artrite Experimental/tratamento farmacológico , Artrite/tratamento farmacológico , Comportamento Animal/efeitos dos fármacos , Toxinas Botulínicas Tipo A/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Animais , Artrite/complicações , Toxinas Botulínicas/administração & dosagem , Modelos Animais de Doenças , Feminino , Humanos , Injeções Intra-Articulares , Prótese Articular/efeitos adversos , Masculino , Camundongos , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Dor/tratamento farmacológico , Dor/etiologia , Medição da Dor , Projetos Piloto , Resultado do Tratamento
8.
J Reprod Med ; 51(6): 467-70, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16846084

RESUMO

OBJECTIVE: To evaluate the effects of botulinum toxin type Afor the treatment of provoked vestibulodynia. STUDY DESIGN: Open-label, dose-escalation, pilot study. Primary outcome measure was a standard numeric pain rating scale of 0-10. Secondary measures were improvements in quality of life and change in medication use. RESULTS: The 7 patients who received 35 units of botulinum toxin type A had a baseline mean pain score (0-10) of 8.1 (SD = 0.70). Thirty days after treatment, these patients had a mean pain score of 2.9 (SD= 1.17). The duration of effect was 8 weeks, and there were no side effects. The 12 patients who received 50 units of botulinum toxin type A had a baseline mean pain score of 7.4 (SD = 0.10). Thirty days after treatment, these patients had a mean pain score of 1.8 (SD= 0.72). The duration of effect was 14 weeks, and there were no side effects. Significant improvement was also seen in medication use and quality of life for these patients. CONCLUSION: This study provides further clinical evidence of the nociceptive effects of botulinum toxin type A in pelvic inflammatory pain-related disorders. Doubleblind, placebo-controlled trials to evaluate the efficacy of botulinum toxin in treating patients with provoked vestibulodynia are warranted.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Neurotoxinas/administração & dosagem , Dor/tratamento farmacológico , Doenças da Vulva/tratamento farmacológico , Adulto , Relação Dose-Resposta a Droga , Feminino , Humanos , Injeções Intramusculares , Pessoa de Meia-Idade , Projetos Piloto
9.
Arch Phys Med Rehabil ; 86(4): 830-3, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15827940

RESUMO

We describe 2 patients, one with cervical dystonia (CD) combined with focal hand dystonia (writer's cramp) and another with idiopathic CD, who were unresponsive to oral medications and became resistant to botulinum toxin type A and B injections. Both patients were successfully treated with high cervical (C1-3) continuously infused intrathecal baclofen (ITB). Neck range of motion (ROM) was measured by using a 3-dimensional electromagnetic cervical ROM system. Pain, disability, and severity were assessed by using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The patient with CD and writer's cramp did well on a continuous baclofen dose of 186.1 microg/d. Her total TWSTRS score improved significantly, her electromagnetic measurements showed an increased in total neck flexion and extension, and her handwriting improved. Unfortunately, this patient (a heavy smoker) developed small cell carcinoma of the lung and died 9 months after her pump was placed. Total TWSTRS score and electromagnetic measurements also significantly improved after pump implant in the patient with CD. He continues to do well on a periodic bolus dose using a combination of 50 microg of baclofen and 25 microg of hydromorphone (Dilaudid) every 4 hours. Our findings suggest the potential usefulness of this therapy in other patients with focal dystonia. To our knowledge, this is the first reported successful treatment of CD and CD combined with writer's cramp with high cervical continuously infused ITB.


Assuntos
Baclofeno/administração & dosagem , Distúrbios Distônicos/tratamento farmacológico , Relaxantes Musculares Centrais/administração & dosagem , Torcicolo/tratamento farmacológico , Feminino , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Pescoço/fisiopatologia , Amplitude de Movimento Articular
10.
Artigo em Inglês | MEDLINE | ID: mdl-14677005

RESUMO

The purpose of this study was to determine the efficacy and safety of botulinum toxin type B (BTX-B/Myobloc) in the treatment of patients with overactive bladder. This open-label dose-escalation study enrolled 15 female patients with urinary frequency with or without incontinence. The BTX-B doses used in this study were 2500, 3750, 5000, 10 000 and 15 000 units. Response was defined as a subjective improvement in frequency, urgency and incontinence symptoms. A paired t-test of the pre/post frequency difference indicates that these 15 patients experienced an average of 5.27 fewer frequency episodes per day after treatment with BTX-B. The p value for the paired t-test was <0.001. The longest duration effect was 3 months using 10 000-15 000 units of BTX-B. The correlation between dose and duration was very significant, with a correlation coefficient = 0.96, p<0.001. Based on these findings, we feel the use of botulinum toxin to treat patients with overactive bladder warrants further study.


Assuntos
Toxinas Botulínicas/uso terapêutico , Metaloendopeptidases/uso terapêutico , Transtornos Urinários/tratamento farmacológico , Idoso , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas Tipo A , Feminino , Humanos , Metaloendopeptidases/administração & dosagem , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento
12.
Arch Phys Med Rehabil ; 84(9): 1399-400, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-13680581

RESUMO

We describe a patient with multiple sclerosis (MS) who had detrusor hyperreflexia that was not responsive to oral medications or clean intermittent catheterization. This patient was successfully treated with 2 separate injections of botulinum toxin type B into the bladder. The results of the treatment lasted 4 months and there were no side effects. A cystometrogram (CMG) done before the botulinum toxin type B injections showed significant detrusor instability. A repeat CMG months later showed no detrusor instability. To our knowledge, this is the first reported successful use of botulinum toxin type B in a patient with detrusor hyperreflexia from MS.


Assuntos
Toxinas Botulínicas/uso terapêutico , Esclerose Múltipla/complicações , Hipertonia Muscular/tratamento farmacológico , Bexiga Urinaria Neurogênica/tratamento farmacológico , Adulto , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas Tipo A , Feminino , Humanos , Injeções Intramusculares , Hipertonia Muscular/etiologia , Hipertonia Muscular/fisiopatologia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia
13.
Arch Phys Med Rehabil ; 83(11): 1638-40, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12422338

RESUMO

OBJECTIVES: To determine the residual botulinum toxin remaining in vials after using 3 different extraction methods and to analyze the different techniques for measuring extraction efficacy. DESIGN: Multicentered comparative study. SETTING: Three academic movement disorder clinics. PARTICIPANTS: Thirty physicians were randomly surveyed for their botulinum toxin extraction methods. Three physicians evaluated the most common methods. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Amount of toxin left in vials after each extraction method. RESULTS: Toxin was least successfully extracted by using the vial inversion method. More toxin was extracted by using the 2-in needle method. The top removal method produced the least waste of toxin but is considered unsafe. CONCLUSIONS: The best and safest method for consistently extracting the most botulinum toxin from its vial was to use a long 21-gauge 2-in needle attached to a 3-mL syringe.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Embalagem de Medicamentos/métodos , Injeções Intramusculares/métodos , Fármacos Neuromusculares/administração & dosagem , Sucção/métodos , Composição de Medicamentos/métodos , Composição de Medicamentos/estatística & dados numéricos , Embalagem de Medicamentos/estatística & dados numéricos , Humanos , Injeções Intramusculares/instrumentação , Injeções Intramusculares/estatística & dados numéricos , Agulhas , Padrões de Prática Médica/estatística & dados numéricos , Sucção/instrumentação , Sucção/estatística & dados numéricos , Inquéritos e Questionários , Seringas , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA