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1.
Health Qual Life Outcomes ; 18(1): 51, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131842

RESUMO

BACKGROUND: We evaluated quality of life among subjects with upper- and lower-limb spasticity who received escalating doses of incobotulinumtoxinA (total body doses up to 800 U) in the prospective, single-arm, dose-titration TOWER study. METHODS: In this exploratory trial, subjects (N = 155; 18-80 years of age) with upper- and lower-limb spasticity due to cerebral causes who were deemed to require total body doses of up to 800 U incobotulinumtoxinA received three consecutive injection cycles of incobotulinumtoxinA (400, 600, and up to 800 U), each with 12 to 16 weeks' follow-up. QoL was assessed using the EuroQol 5-dimensions questionnaire, three-level (EQ-5D), before and 4 weeks post-injection in each injection cycle and at the end of injection cycle 3. RESULTS: The mean EQ-5D visual analog scale scores of 155 participants continuously improved from study baseline to 4 weeks post-injection in all injection cycles (mean [standard deviation] change 6.7 [14.1], 9.6 [16.3], and 8.6 [17.0] for injection cycles 1, 2, and 3, respectively; p < 0.0001 for all, paired sample t-test). In general, among those with a change in the EQ-5D rating of their condition, the proportion of subjects with 'improvement' was greater than that with 'worsening' for individual EQ-5D dimensions across all injection cycles. At the end of injection cycle 3, the proportion of subjects rating their condition as 'normal' increased from study baseline for all dimensions, and there was a ≥ 46% reduction in the proportion of subjects with a rating of 'severe impairment'. CONCLUSION: These preliminary results suggest that escalating incobotulinumtoxinA doses up to 800 U are associated with improvement in quality of life ratings in subjects with multifocal upper- and lower-limb spasticity, and form a basis for future comparator studies. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01603459. Date of registration: May 22, 2012.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Qualidade de Vida , Adolescente , Adulto , Idoso , Relação Dose-Resposta a Droga , Extremidades/fisiopatologia , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
2.
Plast Reconstr Surg ; 145(2): 345-353, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985619

RESUMO

BACKGROUND: Horizontal neck wrinkles develop as a result of the aging process. Stromal vascular fraction (SVF) gel, which is rich in extracellular matrix and functional cells, can be produced by a series of simple mechanical processes, including intersyringe shifting and centrifugation. This study aimed to assess stromal vascular fraction gel in the treatment of horizontal neck wrinkles. METHODS: This single-center study included female patients with horizontal neck wrinkles (Fitzpatrick types II to IV) treated with either SVF gel or botulinum toxin type A (BTX A) injection. SVF gel was first diffusely distributed subcutaneously along the neck line and then injected in a diluted way intracutaneously at points 0.5 cm apart along the horizontal lines. BTX A was injected at points 1.5 cm apart (2 U in each injection site). Satisfaction and improvement scores were compared between the two groups, and the collagen content of the neck wrinkle was compared by histologic evaluation before and after treatment. RESULTS: Twenty-eight patients received SVF gel and 22 received BTX A. In patients with type II neck wrinkles, BTX A and SVF gel treatment resulted in similar improvement scores and patient satisfaction in the first 3 months. In patients with type III and IV neck wrinkles, SVF gel resulted in significantly higher improvement scores and better patient satisfaction. A longer duration of adverse events was seen in the SVF gel treatment group. Histologic assessment suggested that SVF gel increased the collagen density of neck wrinkles. CONCLUSION: SVF gel is an effective treatment for horizontal neck wrinkles, particularly in patients with type III and IV wrinkles. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Matriz Extracelular , Células-Tronco Mesenquimais , Fármacos Neuromusculares/administração & dosagem , Envelhecimento da Pele , Adulto , Terapia Baseada em Transplante de Células e Tecidos/métodos , Feminino , Géis , Humanos , Injeções Subcutâneas , Pescoço , Satisfação do Paciente , Resultado do Tratamento
3.
Urology ; 135: 38-43, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31600558

RESUMO

OBJECTIVE: To evaluate differences in adverse events (AE) in asymptomatic patients with a positive urine dip (UD) at time of intradetrusor onabotulinumtoxinA (BTX-A) injection vsthose with a defined negative UD. MATERIALS AND METHODS: All intradetrusor BTX-A injections were retrospectively reviewed at a single institution between 2016 and 2018. Exclusion criteria included an indwelling catheter, recent positive urine culture, recent antibiotic course, or absence of UD on the day of injection. A positive UD was defined using 7 different definitions with varying combinations of any level of positive blood, leukocyte esterase, or nitrite. Negative UDs were defined those excluded from the positive UD group. We compared multiple positive UD-defined groups to their respective negative UD cohorts with regards to outcomes and demographics. RESULTS: A total of 212 patients underwent 335 cycles of BTX-A injections over a 2-year period. The average age was 65 years (range: 21-90). The majority received 100 units (73%) of BTX-A for a non-neurogenic diagnosis (73%). The overall rate of AEs, urinary tract infection, and urinary retention was 14.6%, 9%, and 3%, respectively. In all groups, the most common AE was urinary tract infection followed by urinary retention. There were no major Clavien-Dindo-defined complications. There was no statistically significant difference in the total or categorical AE rates between positive and negative UD groups using all 7 definitions of a positive UD (P = .05-1.0). CONCLUSION: These data do not support the practice of obtaining a preprocedure UD in asymptomatic patients undergoing intradetrusor BTX-A injection for any indication; test results are unable to predict outcomes or AEs.


Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Fármacos Neuromusculares/efeitos adversos , Bexiga Urinária Hiperativa/tratamento farmacológico , Retenção Urinária/epidemiologia , Infecções Urinárias/epidemiologia , Administração Intravesical , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas/terapia , Toxinas Botulínicas Tipo A/administração & dosagem , Feminino , Humanos , Injeções Intramusculares/efeitos adversos , Injeções Intramusculares/métodos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Estudos Retrospectivos , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Retenção Urinária/etiologia , Infecções Urinárias/etiologia , Infecções Urinárias/urina , Urodinâmica/efeitos dos fármacos , Adulto Jovem
4.
Urology ; 135: 32-37, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31626856

RESUMO

OBJECTIVE: To ascertain whether a poor response and adverse events (voiding dysfunction and urinary tract infection) were predictable for first time botulinum toxin-A (BTX-A) injections in a patient cohort of refractory idiopathic overactive bladder with detrusor overactivity. METHODS: Patients who received BTX-A injections for the first time between the dates of March 2004-August 2017 were analyzed in this single center study. Urogenital Distress Inventory short form (UDI-6) questionnaires were collected both preinjection and postinjection prospectively. A poor response was defined as a decrease of less than 16.7 on the UDI-6 questionnaire. Additional information was gathered from patient records in a retrospective fashion. Predictors of poor response, voiding dysfunction, and UTI were analyzed with multivariate logistic regression analysis. RESULTS: Seventy-four patients were analyzed. The only predictor of poor response was male gender (OR, 5.45; 95% CI 1.83-16.47; P = .002). Lower maximum urinary flow rates (OR, 0.91; 95% CI, 0.83-0.99; P = .023), male gender (OR, 5.14; 95% CI 1.41-18.72; P = .013), and hysterectomy in females (OR, 4.55; 95% CI, 1.09-18.87; P = .038) were predictors of clean intermittent self catheterisation (CISC). There was an increased risk of UTIs in patients who performed CISC (OR, 5.26; 95% CI 1.38-20.0; P = .015). CONCLUSION: Male gender was associated with a poor response to BTX-A injections and increased risk of CISC. Lower maximum urinary flow rates and women with hysterectomies were at increased risk of requiring CISC postinjection. Performing CISC was associated with increased risk of UTI. These factors could be helpful when counselling or selecting patients.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Bexiga Urinária Hiperativa/terapia , Administração Intravesical , Toxinas Botulínicas Tipo A/efeitos adversos , Feminino , Humanos , Injeções Intramusculares/métodos , Cateterismo Uretral Intermitente/efeitos adversos , Cateterismo Uretral Intermitente/métodos , Cateterismo Uretral Intermitente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/efeitos adversos , Prognóstico , Estudos Retrospectivos , Autocuidado/métodos , Autocuidado/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Resultado do Tratamento , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/fisiopatologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Transtornos Urinários/diagnóstico , Transtornos Urinários/epidemiologia , Transtornos Urinários/etiologia
5.
Artigo em Espanhol | IBECS | ID: ibc-FGT-3956

RESUMO

INTRODUCCIÓN: La infección por SARS-CoV-2y la situación de pandemia hacen necesario un cambio en nuestra práctica clínica, en relación con la adopción de nuevas estrategias que permitan la asistencia integral de los pacientes con cefalea y neuralgia. MATERIAL Y MÉTODOS: Ante la elevada capacidad de transmisión del virus, determinados procedimientos, como la infiltración de OnabotulinumtoxinA y la realización de bloqueos anestésicos, deben realizarse adoptando medidas que garanticen un nivel adecuado de seguridad. RESULTADOS: Nuestro objetivo es presentar una serie de recomendaciones basadas en las medidas establecidas por nuestro sistema sanitario para evitar el contagio. Diferenciaremos entre aquellas medidas relacionadas con el paciente y el facultativo, con la técnica, con la infraestructura (sala de espera y consulta) y con la gestión asistencial


INTRODUCTION: The COVID-19 pandemic has given rise to the need for changes in clinical practice, with new strategies to enable integrated care for patients with headache and neuralgia. METHODS: Given the high spreadability of SARS-CoV-2, new safety measures are required in such procedures as onabotulinumtoxinA infiltration and nerve blocks. RESULTS: We present a series of recommendations based on the measures implemented to prevent infection in our healthcare system. We differentiate between measures related to patients and physicians, to technique, to infrastructure (waiting room and consultation), and to healthcare managemen


Assuntos
Humanos , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Bloqueio Nervoso/métodos , Bloqueio Nervoso/normas , Segurança do Paciente/normas , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias , Cefaleia/tratamento farmacológico , Neuralgia/tratamento farmacológico
6.
Expert Opin Drug Saf ; 19(1): 83-91, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31868020

RESUMO

Introduction: Botulinum toxin (BoNT) is a protein secreted by the anaerobic Gram-negative bacterium Clostridium botulinum. Among the seven known subtypes, type A is the most commonly used in women to treat diseases. It primarily blocks presynaptic release of acetylcholine at the neuromuscular junction, resulting in temporary muscle paralysis; thus, it is suitable for treating dystonia and other systemic diseases. BoNT is used widely for treating diseases that persist throughout, and may worsen during, pregnancy, such as cervical dystonia and achalasia. Thus, it is important to investigate whether BoNT injection during pregnancy causes side effects in pregnant women, fetuses, or newborns.Areas covered: This review highlights the efficiency and safety of BoNT injection in pregnancy. and assessed current literature with respect to the use of BoNT for disease treatment during pregnancy.Expert opinion: BoNT injection does not increase the risk of complications in pregnant women and fetuses. However, the use of BoNT to treat disease during pregnancy requires fully informed consent from patients. In addition, further research is needed to determine how to reduce the side effects of BoNT injection during pregnancy (e.g., by improving drug composition, or adjusting the amount of BoNT or the injection interval).


Assuntos
Toxinas Botulínicas/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Complicações na Gravidez/tratamento farmacológico , Inibidores da Liberação da Acetilcolina/administração & dosagem , Inibidores da Liberação da Acetilcolina/efeitos adversos , Inibidores da Liberação da Acetilcolina/farmacologia , Animais , Toxinas Botulínicas/efeitos adversos , Toxinas Botulínicas/farmacologia , Feminino , Humanos , Recém-Nascido , Injeções , Fármacos Neuromusculares/efeitos adversos , Fármacos Neuromusculares/farmacologia , Gravidez
7.
Medicine (Baltimore) ; 98(45): e17855, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702647

RESUMO

Botulinum toxin (Botox) was introduced for the management of internal anal sphincter (IAS) achalasia after a pull-through procedure in Hirschsprung disease (HD). We conducted a prospective evaluation of the efficacy and safety of this Botox treatment.Our study group included 15 patients with HD (median age, 4.8 years; range, 1.7-7.4 years) who experienced persistent constipation after pull-through surgery. Rectal biopsy and colon study were performed before Botox injection to exclude agangliosis. Intersphincteric Botox injections (dose, 4 IU/kg) were performed at 3 sites, (3, 6, and 9 o'clock) under general anesthesia. Measured outcomes of efficacy included anorectal manometry, Wexner constipation score and the quality of life score for defecation, measured at baseline and at 2 weeks and 3 months after injection. The Holschneider incontinence score and an assessment of pain, bleeding, heating sensation, and swelling were also performed at follow-up as outcomes of safety.There was no significant change in measured outcomes with Botox treatment. Botox did decrease the number of patients who experienced abdominal distension at 3 months, compared to 2-weeks, post-injection. No major complications were identified, with only 2 cases of anal bleeding that resolved spontaneously. Local tenderness at the injection site was reported by 4 patients, recovering without treatment.The efficacy of Botox, injected into the IAS, for the treatment of achalasia is questionable on short-term follow-up. Larger studies with a longer follow-up period and the use of repeated injections are required to evaluate the evidence for this treatment.


Assuntos
Canal Anal/anormalidades , Toxinas Botulínicas Tipo A/administração & dosagem , Constipação Intestinal/tratamento farmacológico , Doença de Hirschsprung/cirurgia , Doenças Musculares/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Feminino , Humanos , Lactente , Injeções , Masculino , Doenças Musculares/complicações , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(45): e17933, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702679

RESUMO

Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, causes considerable distress and worsens outcomes in rehabilitation. Although they have received the treatments such as anti-inflammatory drugs or physical therapy, many of the individuals remain suffering from shoulder pain 6 months after acute stroke event. In this retrospective study, we evaluated the effectiveness of ultrasound guided subacromial-subdeltoid (SASD) bursa injections with botulinum toxin type A (BoNT/A) compared to steroids for refractory HSP.The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. In total, 38 patients who received ultrasound guided SASD bursa injection (BoNT/A group, n = 18; corticosteroid group, n = 20) were included. The pain visual analog scale (VAS) score at rest and during arm passive abduction, Fugl-Meyer score of upper limbs (F-M score) were evaluated before, 2, 4, 8, and 12 weeks after injection.Both 2 groups obtained a significant improvement of VAS score at rest or during arms passive abduction compared to baseline score (within group compare, P < .05). There were no significant differences of pain score improvement between two groups at week 2, 4, 8, and 12 after injection either at rest or during passive arm abduction (between 2 groups compare, P > .05). There were also no differences in results of the post treatment F-M score between 2 groups (between 2 groups compare, P > .05). Similarly, during the follow-up period no collateral effects were reported after BoNT/A injection.SASD bursa BoNT/A injection can substantially reduce the pain as corticosteroid in patients with HSP. BoNT/A injection could be a useful strategy for replacing steroids as a treatment for refractory HSP especially in the patients who cannot tolerate the steroids injection.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Dor de Ombro/tratamento farmacológico , Idoso , Anti-Inflamatórios/administração & dosagem , Betametasona/administração & dosagem , Betametasona/análogos & derivados , Bolsa Sinovial/efeitos dos fármacos , Estudos de Casos e Controles , Feminino , Hemiplegia/complicações , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dor de Ombro/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
9.
Korean J Ophthalmol ; 33(5): 430-435, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612653

RESUMO

PURPOSE: To compare the efficacy and safety of Botox and Neuronox in the management of benign essential blepharospasm (BEB). METHODS: We performed a triple-masked, randomized control study to compare Botox and Neuronox in 48 eyes of 24 patients with BEB. All 24 patients randomly received Botox or Neuronox in the periorbital region in a masked, randomized split-face manner, keeping the injection sites and doses uniform. The toxin preparation, injection, and clinical evaluations were done by three independent observers. Objective outcome measures included improvement in the severity of spasm, grading of the functional visual status, changes in palpebral fissure height, lagophthalmos, superficial punctate keratitis and Schirmer's test at 2 weeks, 6 weeks, and upon conclusion of the effect of the toxin. Subjective outcome measures included duration of the effect and a forced choice stating which half of the face was better. Evaluations were performed through clinical measurements, external digital photography, and high-definition videography. RESULTS: The mean duration of relief from spasms was 3.78 months (standard deviation, 1.58 months; range, 1 to 6 months). The improvement in the objective parameters like severity of spasm and functional visual status was statistically significant at the 2-week and 6-week follow-up visits (p < 0.001). The changes in palpebral fissure height, lagophthalmos, and superficial punctate keratitis were equally observed in both groups. At 2 and 6 weeks, three of 24 (12.5%) and one of 24 (4%) patients, respectively, reported an unequal effect between the two sides of the face, but this difference was not statistically significant. At final follow-up (conclusion of the toxin effect), patients reported equal effect with no preference for either hemiface. No statistically significant differences were found in the comparative analysis between the Neuronox and Botox groups. CONCLUSIONS: Neuronox and Botox are comparable in terms of their safety and efficacy in the management of BEB.


Assuntos
Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas Tipo A/administração & dosagem , Blefarospasmo/fisiopatologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Estudos Prospectivos , Resultado do Tratamento , Gravação em Vídeo
10.
Semin Ophthalmol ; 34(7-8): 541-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31657259

RESUMO

Regarding the review article by Escuder AG, Hunter DG, entitled "The Role of Botulinum Toxin in the Treatment of Strabismus" Seminars in Ophthalmology. 2019;34(4): 198-204, we cannot agree with you more with your point of view about the dosage preparation for botulinum toxin A (BTA) in the strabismus surgery. Moreover, we also included a case series that used BTA as an adjunct in the surgery for large-angle sensory exotropia and abducens nerve palsy.


Assuntos
Doenças do Nervo Abducente/terapia , Toxinas Botulínicas Tipo A/administração & dosagem , Exotropia/terapia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Exotropia/fisiopatologia , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Adulto Jovem
12.
Expert Rev Clin Pharmacol ; 12(11): 1013-1018, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31639317

RESUMO

Introduction: Lambert-Eaton myasthenic syndrome is an autoimmune disease of the neuromuscular junction characterized by a presynaptic defect of neuromuscular transmission resulting in muscle weakness and fatigability. Diagnostic features are specific neurophysiological alterations and autoantibody detection. The present review is focused on the use of Amifampridine Phosphate to treat LEMS patients.Areas covered: Medline search from 1990 to 2019 was examined using the free subject terms: Lambert-Eaton myasthenic syndrome, LEMS, Amifampridine, 3,4-diaminopyridine, which were then combined with Treatment, Therapy, Clinical Trial, Controlled Clinical Trial, Randomized Clinical Trial and Cochrane Review. The author has done a supervised analysis of the retrieved articles and focused on those subjectively evaluated as most relevant.Expert commentary: Data from randomized clinical trials and case series have demonstrated that Lambert-Eaton myasthenic syndrome symptoms were successfully treated by Amifampridine Phosphate. Hence, the drug represents a substantial step forward in the symptomatic treatment of the disease due to its efficacy, safety and reliable GMP formulation. As Amifampridine Phosphate works by enhancing the release of acetylcholine at the neuromuscular junction by blocking K+ efflux at the pre-synaptic membrane, it is also conceivable to use it for other diseases of the neuromuscular junction in which such an effect is searched for.


Assuntos
Amifampridina/administração & dosagem , Síndrome Miastênica de Lambert-Eaton/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Amifampridina/efeitos adversos , Amifampridina/farmacologia , Humanos , Síndrome Miastênica de Lambert-Eaton/fisiopatologia , Fármacos Neuromusculares/efeitos adversos , Fármacos Neuromusculares/farmacologia , Bloqueadores dos Canais de Potássio/administração & dosagem , Bloqueadores dos Canais de Potássio/efeitos adversos , Bloqueadores dos Canais de Potássio/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Comprimidos
13.
Rev. neurol. (Ed. impr.) ; 69(5): 199-206, 1 sept., 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184457

RESUMO

Objetivo. Evaluar la efectividad de la toxina botulínica en el tratamiento de la espasticidad de los miembros superiores e inferiores en pacientes pediátricos en un entorno clínico real. Pacientes y métodos. Se realizó un estudio retrospectivo basado en el historial clínico de 79 pacientes pediátricos con espasticidad en diferentes formas clínicas y grados de afectación tratados con toxina botulínica tipo A. La mejoría de la rigidez y movilidad fue estimada por el médico tratante mediante exploración física, evaluando la marcha, la calificación en la escala de Ashworth y la medición de los ángulos de movilidad articular mediante un goniómetro. Se registró el número de inyecciones, el intervalo entre ellas, el sitio de aplicación y la dosis, y se consideró una respuesta positiva al tratamiento la disminución del al menos un punto en la escala de Ashworth o un incremento en los grados de movilidad articular. Resultados. Los pacientes recibieron inyecciones en 10 ± 7 músculos diferentes en intervalos de 4 a 50 semanas (media: 13 ± 9 semanas). Un 90% de los pacientes recibió rehabilitación. Las articulaciones de la rodilla, el tobillo y la muñeca presentaron un mayor porcentaje de mejoría. En el 24% de los pacientes se encontró mejoría en los grados de movimiento articular. Conclusión. La aplicación de toxina botulínica tipo A fue efectiva para el tratamiento de la espasticidad en la población pediátrica


Aim. To evaluate the effectiveness of botulinum toxin in the treatment of upper and lower limb spasticity in pediatric patients in a real clinical setting. Patients and methods. A retrospective study was conducted based on information from clinical records of 79 pediatric patients with spasticity in different clinical forms and severity treated with botulinum toxin type A. The improvement of rigidity and mobility was estimated by the attending physician through physical examination, evaluating the gait, rating on the Ashworth scale and measurement of joint mobility angles using a goniometer. The number of injections, the interval between them, the site of application and the dose were recorded, considering the reduction of at least one point on the Ashworth scale or an increase in the degrees of joint mobility as treatment response. Results. Patients received injections in a mean of 10 ± 7 muscles at intervals of 4 to 50 weeks (average: 13 ± 9 weeks). A 90% also received rehabilitation. The knee, ankle and wrist showed presented a higher percentage of improvement. An improvement in the degrees of movement was found in 24% of patients. Conclusion. The application of botulinum toxin type A was effective for the treatment of spasticity in the pediatric population


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Resultado do Tratamento , Estudos Retrospectivos
14.
NeuroRehabilitation ; 45(1): 67-78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403954

RESUMO

BACKGROUND: There are limited evidence of instrumented measures of gait and balance to determine the functional effects of botulinum toxin injections (BoNT-A) in spasticity after stroke. OBJECTIVE: To evaluate the functional changes in gait and balance following upper limb and lower limb BoNT-A in persons with stroke. METHODS: A pre-post prospective study of 35 stroke patients with upper and/or lower limb spasticity after focal treatment with BoNT-A. Assessments were at baseline (T0), 6-weeks (T1) and 12-weeks (T2), using validated subjective and objective physical activity measures. RESULTS: After BoNT-A injections, significant improvements in most measures of impairments, activity and participation domains were found at T1 (p < 0.05, effect sizes (r) = 0.5-0.9). There was a significant increase in low intensity physical activity (at T1) and sedentary time reductions at both follow-up periods. Instrumented gait/balance measures showed a significant increase in cadence and turn velocity, but no changes in sway measures were found using posturography. Improvements in most outcome measures were maintained at 12-weeks. CONCLUSION: BONT-A improved scores in most clinical measures but only in some of the objective gait/balance and physical activity measures. Further robust studies should utilize a larger sample size to better determine the benefits of BoNT-A for stroke-related spasticity.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Marcha , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Acidente Vascular Cerebral/complicações , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Exercício Físico , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Fármacos Neuromusculares/administração & dosagem , Extremidade Superior/fisiopatologia
15.
Biopharm Drug Dispos ; 40(8): 294-301, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31419315

RESUMO

Lambert-Eaton myasthenic syndrome (LEMS) is characterized by muscle weakness, amyotrophy, easy fatigability, and depressed tendon reflexes. 3,4-Diaminopyridine (3,4-DAP) is the recommended therapy for the treatment of LEMS. However, estimations of 3,4-DAP pharmacokinetics in human and animals, such as rats, are rarely reported because 3,4-DAP is an orphan drug for the treatment of a very rare disease (LEMS). In particular, little is known about its tissue distribution. Therefore, the pharmacokinetics of 3,4-DAP were studied, with particular focus on tissue distribution, in rats. After intravenous administration of 3,4-DAP to rats, the half-life of 3,4-DAP was 15.9 ± 3.9 min and the volume of distribution at steady-state was 2.8 ± 0.7 L/kg. The tissue-to-plasma partition coefficient (Kp) was high in the kidney, heart, and muscle. In addition, with increased steady state plasma concentration (Css), a tendency toward increased Kp was found in most tissues. In the muscle, a likely target region of 3,4-DAP in LEMS patients, the Kp was higher than in the plasma. Furthermore, more than 68% of 3,4-DAP was distributed to the muscle as determined by the ratio of 3,4-DAP distribution calculated from the apparent volumes of distribution. Hence, 3,4-DAP may provide for more effective and long-lasting effects.


Assuntos
Amifampridina/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Administração Intravenosa , Amifampridina/farmacocinética , Animais , Meia-Vida , Masculino , Fármacos Neuromusculares/farmacocinética , Ratos , Ratos Wistar , Distribuição Tecidual
16.
Medicine (Baltimore) ; 98(34): e16952, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441893

RESUMO

BACKGROUND: Botulinum toxin type A (BoNTA) is known to prevent fibroblast proliferation and expression of transforming growth factor beta 1 (TGF-ß1). It also induces temporary muscle paralysis and decreases tension vectors. Fibroblasts induce scar contracture and hypertrophy by producing collagen fibers in wound healing processes. The aim of this study is to identify the effect of BoNTA on the scar formation. METHODS: Forty-five patients with forehead laceration were enrolled in this study and randomized into 2 groups with or without injection of BoNTA. When the patients presented to the clinic to remove the stitches, BoNTA was injected to the BoNTA group with 24 patients and saline was injected to the control group with 21 patients. The BoNTA was injected on dermal layer with 5 IU/cm. After that, follow-up was done in 1, 3, and 6 months. The scars were analyzed with the patient and observer scar assessment scale, Stony Brook scar evaluation scales (SBSESs), and visual analog scale (VAS) and analyzed with independent T-test, along with clinical photographs, cutometer, and biopsies. RESULTS: In all scar scales, the scores changed into favorable direction in both groups and the changes were larger in BoNTA group compared with the control group. On SBSES and VAS, better improvements on BoNTA group showed statistical significance. Skin biopsy showed less collagen deposition on dermal layer in BoNTA group. CONCLUSION: Improvement of aesthetic, functional, and emotional aspect of the scar formation in the groups treated with BoNTA was illustrated. The application of BoNTA may be expanded to prevent hypertrophic scar after trauma, burns, or operations.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Cicatriz Hipertrófica/prevenção & controle , Testa/lesões , Lacerações/terapia , Fármacos Neuromusculares/administração & dosagem , Adulto , Toxinas Botulínicas Tipo A/farmacologia , Método Duplo-Cego , Feminino , Fibroblastos/efeitos dos fármacos , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/farmacologia , Estudos Prospectivos , Técnicas de Sutura , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
17.
Indian J Ophthalmol ; 67(9): 1405-1409, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31436182

RESUMO

Purpose: The purpose of this study was to assess the effect of long-lasting botulinum A toxin injections on ocular surface parameters and to further investigate the relationship between these parameters and the duration of the treatment. Methods: In this retrospective study, patients with unilateral hemifacial spasm who were receiving botulinum A toxin injections for at least 1 year were analyzed. Healthy contralateral eyes acted as controls. The ocular surface examination included Ocular Surface Disease Index questionnaire, Schirmer test type I, tear film break-up time (TFBUT), tear osmolarity, corneal sensitivity, and corneal fluorescein staining. Results: Twenty-six patients (6 males and 20 females; mean age 76.4 ± 8.9 years) were included in the study. The mean duration of the treatment was 7.2 ± 5.4 years, and the mean frequency of injections was of one every 3.3 ± 0.4 months. TFBUT, Schirmer test, and corneal sensitivity were significantly lower in the eye homolateral to hemifacial spasm compared with the contralateral one (5.9 ± 3.2 vs 7.5 ± 4.2 s, P = 0.001; 6.2 ± 3.4 vs 9.2 ± 6.6 mm, P = 0.031; 50.8 ± 3.7 mm vs 52.3 ± 2.9 mm, P = 0.048, respectively). One month after the last injection, TFBUT further decreased from 5.9 ± 3.2 to 2.3 ± 1.2 s (P = 0.028). A significant positive correlation was found between the duration of treatment and tear osmolarity (ρ = 0.542, P = 0.025). Conclusion: Patients with hemifacial spasm under long-lasting treatment with serial botulinum A toxin injections showed a reduction in tear film production and stability, as well as corneal sensitivity in the treated eye compared with the contralateral one. Tear film stability further decreased 1 month after the last injection.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Córnea/patologia , Síndromes do Olho Seco/etiologia , Previsões , Espasmo Hemifacial/tratamento farmacológico , Lágrimas/metabolismo , Idoso , Preparações de Ação Retardada , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/metabolismo , Feminino , Seguimentos , Espasmo Hemifacial/complicações , Humanos , Injeções Intramusculares , Masculino , Fármacos Neuromusculares/administração & dosagem , Concentração Osmolar , Estudos Retrospectivos , Resultado do Tratamento
19.
Plast Reconstr Surg ; 144(3): 390e-396e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461011

RESUMO

BACKGROUND: Asian Indians usually have wide lower faces because of masseter hypertrophy. The authors evaluated the efficacy of botulinum toxin type A in long-term management of bilateral masseter hypertrophy in Asian Indian patients. METHODS: Fifty patients were enrolled in the study and injected with 30 U of botulinum toxin type A to each side of the face, at baseline. Based on masseter muscle thickness and response to the injections, 25 patients underwent a second injection session at week 12, and the other 25 patients underwent additional third sessions, at week 24 after the first injection, respectively. Standardized photography and ultrasonography were performed to assess facial contour and masseter muscle thickness at baseline and at 1-, 2-, 3-, and 4-year follow-ups. A p value < 0.05 was considered statistically significant. RESULTS: The authors observed 12 percent (p < 0.0001) average masseter muscle size reduction at week 12. The maximum reduction (26.6 percent; p < 0.0001) was observed at week 24 for the patients who received two injections and maintained an average 24.43 percent (p < 0.0001) reduction until follow-up at year 4. Patients who received three injections exhibited very high reduction (42.52 percent; p < 0.0001) of masseter volume at week 36 and maintained an average 40.64 percent (p < 0.0001) reduced volume until year 4. CONCLUSIONS: Botulinum toxin type A treatment is effective for long-term management of bilateral masseter hypertrophy. Doses repeated at 12-week intervals accentuate masseter volume reduction and also help maintain reduced masseter volume for 4-year follow-up, with satisfactory facial contour.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Técnicas Cosméticas , Face/anatomia & histologia , Hipertrofia/tratamento farmacológico , Músculo Masseter/anormalidades , Fármacos Neuromusculares/administração & dosagem , Adulto , Grupo com Ancestrais do Continente Asiático , Beleza , Esquema de Medicação , Face/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Índia , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Fotografação , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
20.
Eklem Hastalik Cerrahisi ; 30(2): 155-62, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291865

RESUMO

OBJECTIVES: This study aims to evaluate the clinical outcomes of children with spastic type cerebral palsy (CP) treated with botulinum toxin type A (BoNT-A) injection for lower limb contracture and the influence of age, gender, functional level and degree of initial contracture on treatment outcomes. PATIENTS AND METHODS: Clinical records at pre-BoNT-A injection and post-BoNT-A injections of 153 sessions of a total of 118 consecutive children (67 boys, 51 girls; mean age 5.9±2.6 years; range, 2.5-16 years) were retrospectively evaluated. Degrees of pre- and post-injection contracture were evaluated. Post-injection supplemental casting for 10 days was recorded in all cases. Less than 20° of hip flexion contracture, more than 30° of hip abduction, a negative prone Ely test, less than 50° of popliteal angle and at least 5° of ankle dorsiflexion values at post-injection were accepted as sufficient clinical improvement. RESULTS: Sufficient post-injection range of motion (ROM) was observed in 80% of cases with hip flexion contracture, in 45% of cases with hip adduction contracture, in 84% of cases with knee flexion contracture and in 77% of cases with ankle equinus contracture. Prone Ely test that was positive in 60% of cases with knee extension contracture was negative at post-injection. Improvement in contractures were prominent in children with lesser degree initial contractures. CONCLUSION: Botulinum toxin type A injection increases ROM in hip, knee and ankle joint contractures in CP. Although age, gender and functional level may influence the clinical outcomes, pre-treatment level of contracture is the main determinant in improvement in ROM at post-injection.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/complicações , Contratura/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Adolescente , Articulação do Tornozelo/fisiopatologia , Toxinas Botulínicas Tipo A/administração & dosagem , Criança , Pré-Escolar , Contratura/etiologia , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Fármacos Neuromusculares/administração & dosagem , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
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