Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystonias and hemifacial spasm.

Jankovic, Joseph; Schwartz, Kenneth S.; Donovan, D T

doi:10.1136/jnnp.53.8.633

Cited by 334 publications

(166 citation statements)

References 19 publications

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“…9,11 This duration of action was the same as that of BTx in its other indications, 6,7 the transitoriness of the e ect being due to synaptic regrowth after injection. 7 However, in two patients in our series, the clinical e ect lasted beyond the usual duration of action of BTx, which might signify a more durable modi®cation of the re¯ex status and urethral behaviour.…”

Section: Discussionmentioning

confidence: 63%

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Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease

Petit

Wiart²,

Gaujard³

et al. 1998

Spinal Cord

134

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We studied the e cacy of endoscopic injection of Botulinum A toxin (150 I.U. Dysport 1 ) in the treatment of detrusor-sphincter dyssynergia in 17 patients with spinal cord disease. One month after the injection, the postvoiding residual urine volume (7176 ml, P50.001), the bladder pressure on voiding (719 cm water, P50.01), and the urethral pressure (724 cm water, P50.001) were signi®cantly decreased. The modality of voiding was improved in 10 patients (ie micturition by suprapubic tapping was easier to induce, discontinuation of indwelling catheter use, or decrease in frequency of intermittent catheterizations). The tolerance of the treatment was excellent. The therapeutic e ect lasted 2 to 3 months on the average. The low doses used in this study probably explain in part why the treatment sometimes failed. Botulinum A toxin could become an alternative treatment for detrusorsphincter dyssynergia in certain patients, notably in those who are refractory to sphincterotomy or in patients, such as those who are tetraplegic, and who are incapable of performing intermittent self-catheterization.

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Section: Discussionmentioning

confidence: 63%

“…6,7 It was ®rst evaluated as a treatment for DSD by Dykstra et al 8,9 in 16 patients, then by Schurch et al 10,11 in 24 patients. These studies showed that BTx relaxes the external urethral sphincter (EUS) and reduces DSD in approximately 80% of cases.…”

Section: Introductionmentioning

confidence: 99%

Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease

Petit

Wiart²,

Gaujard³

et al. 1998

Spinal Cord

134

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“…A duração média do efeito foi de 2,9 meses (em torno de 12 semanas). Jankovic e col. 10 , obtiveram melhora em 94% dos pacientes, com média de duração de 15,7 semanas. Três dos nossos pacientes não apresentaram qualquer melhora, sendo que 2 em duas sessões.…”

Section: Discussionunclassified

Experiência com aplicação de toxina botulínica A em 115 pacientes

Andrade

Borges

Ferraz

et al. 1997

Arq. Neuro-Psiquiatr.

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RESUMO -A toxina botulínica A é a forma mais eficaz de tratar algumas distonias focais e o espasmo hemifacial. Devido a seu custo ainda elevado no nosso país, seu uso ainda não é disseminado. Mostramos nossa experiência com a toxina botulínica A em 115 pacientes, sendo 45 com espasmo hemifacial que apresentaram melhora acentuada ou total em 100%. Em 20 pacientes com blefaroespasmo essencial houve melhora acentuada ou total em 70% . Na síndrome de Meige, representada por 14 pacientes, a melhora acentuada ou total foi observada em 71,4%. Em 23 pacientes com distonia cervical observou-se melhora acentuada em 65,2%. Distonia da mão, com 6 pacientes, apresentou o menor índice de melhora acentuada (2 pacientes, 33,3%). As complicações de caráter transitório ocorreram, sendo as mais frequentes ptose palpebral e diminuição da força palpebral e a mais grave, pneumonia aspirativa. Acreditamos que a toxina é forma eficaz e habitualmente segura de tratamento destas condições clínicas. PALAVRAS-CHAVE: toxina botulínica A, Botox, distonias focais, espasmo hemifacial.A toxina botulínica A é considerada a mais potente toxina natural existente, atuando de maneira a bloquear a transmissão neuromuscular de acetilcolina. Sua utilização clínica se iniciou na década de 80 pelo oftalmologista Allan Scott, na Califórnia (USA) 15 , para a correção de estrabismo. Após isso passou a ser utilizada em movimentos involuntários como o blefaroespasmo 2 e espasmo hemifacial, tornando-se o tratamento de primeira escolha nestas condições; posteriormente passou a ser utilizada em distonia cervical, disfonia espástica, distonias focais das mãos e pernas, distonia de ação específica e tremores 7 .0 espectro das indicações de tratamento pela toxina botulínica aumentou consideravelmente nos últimos anos, passando a ser indicado em tratamento da espasticidade, em Botulinum toxin A: experience in the treatment of 115 patientsABSTRACT -Botulinum toxin A is the more efficient therapy of focal dystonias and hemifacial spasm. Our experience with botulinum toxin A injections in 115 patients is reported. Marked or total improvement was achieved in all 45 patients with hemifacial spasm, in 70% of 20 patients with essential blepharospasm and in 71.4% of 14 patients with Meige's syndrome. In 65.2% of 23 patients with cervical dystonia marked but no total improvement was obtained. The worse results were seen in the 6 patients with hand dystonia (writers cramp), in whom marked improvement was obtained in just two. Mild and transient complications occurred in up to 24.4%, eyelid ptosis and eyelid weakness being the most frequent. One patient with Meige's syndrome had an aspiration pneumonia following dysphagia. Our results are in agreement with others, showing that botulinun toxin A is a useful and safe treatment for these conditions. KEY WORDS: botulinun toxin A, Botox, focal dystonias, hemifacial spasm.

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“…Способность БТ влиять на аффе-рентные проводящие пути используется при лечении мигрени и болевых синдромов. Парадоксально, что реги-страция новых показаний к применению БТ происходила к моменту, когда в мире уже накапливался и обобщался достаточно большой независимый опыт ботулинотерапии по данному показанию [12,13]. И сейчас медицинское сообщество продолжает поиск новых показаний к при-менению БТ как на уровне международных контролируе-мых клинических протоколов, так и на уровне независи-мых пилотных исследований.…”

Section: клиническое применениеunclassified