Could treatment with botulinum toxin protect against subsequent infection with COVID-19?

We report comparative results, over three months, of the impact of SARS-CoV2 in our patients injected with botulinum toxin for functional purposes, compared to the general population. Botulinum neurotoxin type A (BoNT/A) is known to block acetylcholine (ACh) as well as many other neuroreceptors and neuromodulators. The recent mention of a potential protective effect of nicotine in COVID 19, by blocking ACh, attracted our attention and guided the present study. Our results show a significant difference between the number of infected individuals in the general population and the number of patients injected with BoNT/A who showed signs of COVID 19.

Effect of intra-articular Botulinum toxin injections on temporo-mandibular joint pain.

Temporo-mandibular joint dysfunction can be painful and disabling. In some cases, it is refractory to classical treatment. Intra-articular Botulinum toxin injections have been shown to have an anti-inflammatory and analgesic effect. The aim of this study was to evaluate the effectiveness of such injections on severe, refractory temporo-mandibular joint pain. This was a retrospective study. Patients were included if they still had joint pain≥5 on a Visual Analogue Scale following completion of all other treatments. A complete treatment protocol (including physiotherapy, tongue splints, intra muscular injections of Botulinum toxin and injections of hyaluronic acid, excluding surgery) having being done before the injection of 30 Botox* units (Botulinum toxin A), the treatment being considered clinically successful if the Visual Analogue Scale decreases by at least 2 points. Seventy-seven patients were included. Sixty-six percent of patients have a significant reduction in pain at 1 month which lasted at least until 3 months. Mouth opening and quality of life also improved. Moreover, no complications were reported. Further randomized, controlled studies are needed to confirm the results, however this study suggests intra-articular injection of Botulinum toxin is a safe and effective treatment for severe, refractory temporo-mandibular joint pain, avoiding surgery.

[Different types of injection in temporomandibular disorders (TMD) treatment]. / Les différents types d'injection pour traiter les dysfonctions de l'articulation temporomandibulaire.

INTRODUCTION: Intramuscular injections of botulinum toxin of type A (BoNTA) can release tension from masticatory and cervical muscles. Intra-articular injections relieve pain and sometimes diminish joint clicking and locking that occur during mouth opening. METHODS: Intramuscular injection of BoNTA is performed in our department since 2002. Injected muscles are masseter and temporal muscles. Later on, intra-articular injections of sodium hyaluronate were added, followed on a later stage by intra-articular injections of BoNTA for patients presenting with pain higher than 5/10 on an analogic visual scale. RESULTS: Eighty-five percent of the patients treated with intramuscular BoNTA injection improved. Total or partial pain relief was obtained in 95 % of the patients after intra-articular sodium hyaluronate injections. Seventy-six percent of the 56 patients treated by mean of intra-articular BoNTA injections improved, sometimes with a complete pain relief. DISCUSSION: These different techniques allow for good results, even if they do not represent a revolution in the treatment of temporomandibular disorders. In the hands of experienced practitioners, they have a low morbidity, are well accepted and are cost-effective.

The treatment of occipital neuralgia: Review of 111 cases.

OBJECTIVE: To present the current treatment options for occipital neuralgia based on a retrospective series of 111 patients, who were offered one or more treatment methods, not mutually exclusive. METHODS: All patients, who previously had their diagnosis confirmed by undergoing an anesthetic nerve block (0.25mL bupivacaine/2mL cortivazol), were treated by radiofrequency denaturation in 78 cases, injection of botulinum toxin in 37 cases and implantation of a nerve stimulation system in 5 cases. RESULTS: Two serious complications (1 death, 1 permanent hemiplegia) were observed after radiofrequency denaturation, the other methods did not result in any significant complications. Radiofrequency denaturation resulted in 89.4% of good and very good results beyond 6 months, as compared to 80% for the botulinum toxin and 80% after nerve stimulation, no other significant difference occurred between the three techniques, with reservations about the reliability of interpretation for the small sample size in the case of nerve stimulation. CONCLUSIONS: If radiofrequency denaturation seems to remain the leading treatment for occipital neuralgia, in terms of innocuousness and production costs, botulinum toxin could, in principle, represent the preferred initial treatment for this type of pathology.

The use of botulinum toxin in the treatment of the consequences of bruxism on cervical spine musculature.

Hypertonia and hyperactivity of masticatory muscles are involved in pain and contractions of the cervical spine musculature, but their pathophysiology remains nonetheless unknown and its treatment far to be codified. In this study, 8 patients, showing disabling posterior neck muscle contractures linked with bruxism were prospectively treated and followed for an average 15 months period, after having received Injections of botulinum toxin A essentially in masticatory muscles. Injections were made every 3 months, varying from 10 to 100 U Botox* by muscles, without administrating more than 300 U Botox* in the same patient. The angle of cervical lordosis were calculated on lateral sitting radiographs in neutral position, good results being considered to be achieved in the case of a 2 point diminution of VAS score as well as at least a 5° positive gain in the curve. 7 patients out of 8 showed a real improvement in their symptoms after an average of 3 injections, showing a decrease of 4.5 points on the VAS score and an average increment of 15° in cervical lordosis. Although the follow-up period of patients was relatively short and the sample quite small, the general impression, confirmed by the patients' experience, seems to suggest a potential place for the use of botulinum toxin amongst the array of treatments which can be offered in certain selected cases which associate bruxism and posterior cervical contractions.

[Contribution of botulinum toxin to maxillo-facial surgery]. / Apport de la toxine botulique en chirurgie maxillo-faciale.

Botulinum toxin has a wide range of use in maxillo-facial surgery due to its action on muscles, on the glandular system, and against pain. It already has been given several market authorizations as indicated for: blepharospasm, spasmodic stiff neck, and glabellar lines. Furthermore, several studies are ongoing to prove its effectiveness and usefulness for many other pathologies: treatment of pain following cervical spine surgery; action on salivary glands after trauma, hypertrophy, or hyper-salivation; analgesic action (acknowledged but still being experimented) on neuralgia, articular pain, and keloids scars due to its anti-inflammatory properties. Botulinum toxin injections in the cervico-facial area are more and more used and should be to be correctly assessed.

[Usefulness of botulinum toxin injections in the treatment of postoperative pain after cervical spine surgery: Preliminary results]. / Utilisation de la toxine botulinique dans les cervicalgies postopératoires en chirurgie rachidienne : résultats préliminaires.

BACKGROUND AND PURPOSE: Postoperative neck pain after cervical spinal surgery is a common occurrence, the prevalence of which can reach up to 60%. Since 2005 a prospective study, still in progress, is attempting to show the efficacy of botulinum toxin injections in its treatment. METHODS: Two hundred and fifteen patients operated on in the same institution for cervical spondylotic myelopathy were prospectively followed-up; 38 of them presented postoperative neck pain and were enrolled either in a course of botulinum toxin injections (19) or in conservative treatment (19). The muscles injected, in descending order, were: trapezius, supraspinalis, splenius capitis, and rhomboids. Injections were made using Type A-botulinum toxin (Botox*-Allergan Pharmaceuticals, Westport, Ireland), increasing from 20 to 100U Botox* without exceeding 300U once in the same patient, performed every 3 months if necessary. The conservative treatment consisted of a course of thiocolchicoside (16mg/day) and physical rehabilitation. The lordosis angle was calculated on lateral sitting radiographs in the neutral position immediately postoperatively and 1.5 months after injection and correlated to pain improvement evaluated by the visual analogic scale (VAS). RESULTS: No visible improvement was found on x-rays in three patients after injection, and in 11 after conservative treatment. In 16 cases, after an average of three injections, the gain in lordosis averaged 11.3° and the VAS score was decreased by 4.6 points versus 4.7° and a decrease of 0.6 points after conservative treatment. CONCLUSION: Regardless of its limitations, the present study would seem to show potential value in the use of botulinum toxin in the treatment of postoperative pain after cervical spinal surgery.

[Cerebral thrombophlebitis: parotidectomy complication in a child]. / Thrombophlébite cérébrale: complication d'une parotidectomie chez un enfant.

INTRODUCTION: Onset of cerebral thrombophlebitis following parotidectomy in a child is reported. OBSERVATION: A seven-year-old boy presenting apparently benign tumefaction in the right parotid gland area had undergone a conservative right total parotidectomy. The histological examination of the operative specimen suggested a diffuse neurofibroma as part of a clinical picture of Recklinghausen's neurofibromatosis. The immediate postoperative follow-up was marked by a pyramidal syndrome in the left hemibody, with the CT scan showing thrombophlebitis. After treatment combining an anticoagulant, a vasodilator and an antibiotic, the patient progressed toward partial recovery of left hemibody motor activity. COMMENTS: This cerebral vascular accident is related to the angiodysplasia encountered in Recklinghausen's disease. Anticoagulants initialized rapidly are the only demonstrated therapy to improve the prognosis in this type of complication.

[Non-surgical management of parotid gland and duct injuries: interest of botulinum toxin]. / Prise en charge non chirurgicale des plaies de la glande parotide et du canal de Stenon: intérêt de la toxine botulinique.

Salivary fistulas and sialoceles are rare complications of post-traumatic or postoperative parotid gland and duct injuries. Local injections of type A botulinum toxin represent a new and effective treatment for complications of these injuries, which is less invasive, stressful and lengthy than conventional methods. The authors report five cases in which three salivary fistulas and two sialoceles were successfully treated by botulinum toxin injections. The therapeutic protocol is described; it allows simple management of these complications and use of smaller doses than those described in the literature for treatment of sialoceles. The authors recommend use of botulinum toxin injections in first intention for management of salivary fistulas and sialoceles.