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Intervention study (before-after trial) with an observational design.
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For the pilot study, volunteer samples of 23 patients with glabellar wrinkles; for the EMG-guided study, volunteer samples of 57 patients with glabellar wrinkles.
254 adults with chronic migraine were injected with OnabotulinumtoxinA BOTOX as per PREEMPT Protocol between July 2010 and May 2013, their headache data were collected using the Hull headache diary and analysed to look for headache, migraine days decrements, crystal clear days increment in the month post treatment, we looked at the 50% responder rate as well.
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PubMed and Web of Science databases were searched to identify eligible studies by using the terms "cricopharyngeal dysfunction," "cricopharyngeal myotomy," "cricopharyngeal botox," "cricopharyngeal dilation," and their combinations from 1990 to 2013. This was supplemented by hand-searching relevant articles. Eligible articles were independently assessed for quality by two authors. Statistical analysis was performed.
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Our results indicate that BTX-A improved the sharp/shooting type of pain most commonly known to be associated with occipital neuralgia. Additionally, the quality of life measures assessing burden and long-term impact of the headaches, further corroborated improvement seen in daily head pain.
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We determined the safety and efficacy of each of 2 doses of botulinum toxin type A (BTX-A) (200 or 300 U BOTOX) injected into the detrusor for urinary incontinence caused by neurogenic detrusor overactivity of predominantly spinal cord origin.
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Overactive bladder (OAB) is one of the most common bothersome urological diseases. It also has a negative economic impact. Pathophysiology entails changes in neurogenic and myogenic factors, as well as urinary biomarkers such as nerve growth factor (NGF) and prostaglandins (PGs). With symptoms from OAB-Dry to OAB-Wet, the urodynamic pattern of OAB bladder is often characterized by idiopathic detrusor overactivity with lower threshold of sensation, diminished compliance and capacity. Treatment ranges from a combination of behavioral modifications (BM)/ pelvic floor muscle training (PFMT) to combinations of antimuscarinics, Botox injection, nerve stimulation and augmentation cystoplasty. Herein, a contemporary review on the different aspects of management of refractory OAB in patients without neuropathic disorders is presented.
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Five subjects with excessive gingival display due to hyperfunctional upper lip elevator muscles were treated with BTX-A injections.
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Two successive groups of nine total-body CP children were compared in a retrospective study. All patients underwent an orthopedic surgery involving a bone or a multilevel procedure. The second group was treated before surgery with multisite injections of botulinum toxin. The main outcome criteria studied were: efficiency and adverse effects of botulinum toxin, duration of hospital stay and pain, length of level III analgesic treatment (morphine), sleep quality, and skin lesions under cast immobilization. The two groups were similar for mean age (8.7+/-2.04 versus 10.9+/-4.37 years) and mean body weight (20+/-5.6 versus 26+/-7.7 kg). Mean botulinum toxin (Botox/kg) in the second group was 11.6 U (range 9.7-14.8). Average time from preoperative botulinum toxin injections to surgery was 27 days (range 23-31).
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We identified good-quality studies that evaluated onabotulinumtoxinA for all the indications described above in adults; such was not the case with abobotulinumtoxinA. Although this does not imply that onabotulinumtoxinA is more effective than abobotulinumtoxinA, it should be a consideration when counselling patients on the use of botulinum toxin in urologic applications. The two preparations should not be used interchangeably, either in terms of predicting outcome or in determining doses to be used.
Tu evaluate the usefulness of the laparoscopic approach as the standard procedure in the surgical treatment of achalasia. Among different competing options of the treatment of esophageal achalasia, extramucosal myotomy of the lower esophageal sphincter--usually combined with anterior fundoplasty--is the most effective but also the most invasive approach. Minimally invasive performance of this operation reduces invasivity and should make the operative treatment a more attractive alternative to other procedures, such as pneumatic dilatation or botox injection. From 1991 till 1997, 27 patients underwent laparoscopic Heller Dor operation (16 males, 11 females, mean age 37 years). Diagnosis was established in all of them by an esophagogram and esophageal manometry. The main symptom was dysphagia in all of the patients. No mortality was observed in this series. There were no conversions to laparotomy. The single intraoperative complication was one case of iatrogenic mucosal laceration. Post operative complications were found in one case of wound infection, and two cases of pneumomedistinum. After a mean follow-up of 33 months (3-77), all patients are without dysphagia and without pathological gastroesophageal reflux. The mean value of residual LES pressure could be reduced from 21 +/- 6.4 mmHg to 7.44 +/- 2.7 mmHg. Laparoscopic cardiomyotomy is at lesat as safe, in terms of morbidity and mortality, as open surgery and similarily effective in alleviating dysphagia. Short hospitalisation and convalascent periods have provided an attractive alternative to repeated dilations for many patients.
Raynaud's phenomenon is a vasospastic disorder of the palmar and digital vessels of the hand and feet that can lead to ischemic ulcers, pain, and loss of function. This study is a review of patients I have injected with botulinum toxin type A for patients with Raynaud's phenomenon.
Salivation was measured by weighting dental rolls before and 2 minutes after insertion at 6 places of highest secretion of saliva in mouth (buccal vestibule, and sublingual area). PD patients were assessed before and one week after injections of 5 units of BOTOX into each parotid salivary gland and the results were compared to the salivation of controls.
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We conducted a retrospective, noninterventional closed cohort study of cervical dystonia patients within a single U.S. private neurological practice. Patient and payer incurred costs from medical billing records for patients satisfying inclusion and exclusion criteria treated from November 1, 2009, through January 1, 2013, were de-identified and included in the analysis. Forty-seven patients initially treated with at least 3 consecutive cycles of ONA, followed by at least 3 consecutive cycles of ABO were included, representing 282 injection cycles available for analysis. Patients were required to have had a positive response to treatment with both agents and no concomitant treatment with BoNT for any other condition during the analysis period. The analysis compared the primary endpoint of median overall payer and patient incurred costs reimbursed to the clinic under each treatment regimen. For the purposes of this cost analysis, comparable clinical outcomes on both therapies was assumed.
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Synkinesis after facial nerve injury produces functional and cosmetic concerns for patients. The purpose of this study was to review the authors' experience of treating buccinator synkinesis with botulinum toxin.
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Therapeutic preparations of botulinum toxin (BT) consist of botulinum neurotoxin (BNT), complexing proteins, and excipients. Depending on the target tissue, BNT can block cholinergic neuromuscular innervation of intra- and extrafusal muscle fibres or cholinergic autonomic innervation of sweat, lacrimal, and salival glands and smooth muscles. Indirect CNS effects are numerous; direct ones have not been reported after intramuscular application. Botulinum toxin type A is distributed as Botox, Dysport, Xeomin, Hengli/CBTX-A, and Neuronox and BT type B as NeuroBloc/Myobloc. Differences in potency labelling of therapeutic BT preparations can be corrected by introduction of a conversion factor of 1:3 between Botox and Dysport, of 1:1 between Botox and Xeomin, and of 1:40 between Botox and NeuroBloc/Myobloc. Acute adverse effects of BT can be obligate, local or systemic. Adverse effect profiles of the different preparations are similar. However, BT type B frequently produces additional autonomic systemic adverse effects. Long-term application does not produce additional adverse effects. BNT can be partially or completely blocked by antibodies. Risk factors include the amount of BNT applied at each injection series, the interval between injection series, and the specific biological potency (SBP) of the BT preparation used. The SBP is 5 equivalent mouse units/ng BNT for NeuroBloc, 60 for Botox, 100 for Dysport, and 167 for Xeomin. Xeomin should therefore have a particularly low antigenicity. Clinical confirmation of this predicition, however, is lacking.
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To report on the results of conservative and operative treatment of scoliosis associated with RSS, and, based on this, to propose an assessment and treatment protocol for this condition.
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When topical therapy and tap water iontophoresis (TWI) fail, are unavailable, or are deemed unsatisfactory by patients with palmar or plantar hyperhidrosis (HH), the next logical treatment option is botulinum toxin type A (BTX-A). Skill and precision are required to treat palmar and plantar HH because of the dense innervation in the palms and soles. This article describes best practice techniques for BTX-A (Botox), including suggested dilution and syringe selection, injection technique, dose and injection grids, and anesthesia recommendations. In addition, general BTX-A background and special considerations for treating palmar and plantar HH are provided. Insurance reimbursement for treating HH with BTX-A can be challenging; navigating the insurance reimbursement process will be discussed.
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We evaluated 61 frail elderly patients, 63 who were elderly without frailty and 42 younger than 65 years. Large post-void residual urine volume (greater than 150 ml) after onabotulinumtoxinA injection was significantly higher in the frail elderly group than in the other groups (60.7% vs 39.7% and 35.7%, respectively, p = 0.018). Urinary retention developed in 7 frail elderly patients (11.5%), 4 (6.3%) who were elderly without frailty and 1 younger patient (2.4%) (p = 0.203). Recovery duration was significantly longer in frail elderly patients. The cumulative success rate was significantly lower in the frail elderly group than in the other 2 groups (p = 0.009).
Patient demographics included 33% males (59/180) and 67% females (121/180), with a mean age of 29.2 years old (range 12 to 76 years old). Ethnic origin was 67% white (122/180), 19% Asian (34/180), 8% Black (14/180), and 6% Hispanic (10/180). Positive family history of hyperhidrosis was noted in 57%. Preoperatively, 49% patients (86/180) had palmar sweating only, 7% patients (12/180) axillary only, 24% patients (43/180) palmar and axillary, 16% patients (28/180) face/scalp only, and 7% patients (11/180) all of the above; additionally 69% patients (125/180) had plantar hyperhidrosis. All procedures were performed through 3-mm and 5-mm ports, and 98% (177/180) were completed as an outpatient procedure. Complications included a mild temporary Horner's Syndrome (n = 1; 0.5%), air leak requiring chest drainage (n = 9; 5%), and bleeding (n = 3; 1.6%) requiring thoracoscopic reexploration (n = 1) and chest drainage (n = 2). Success rates were palmar 100% (109/109), axillary 98% (48/49), and face/scalp 93% (26/28). Plantar hyperhidrosis responded with improvement in 82% (72/88) of all patients. Seventy-eight percent patients (96/123) experienced compensatory hyperhidrosis, usually affecting the stomach, chest, back, and neck. Overall satisfaction was 94% (139/148).
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BTX-A injections are more successful in patients with anticholinergic intolerability as compared to patients with poor medication efficacy (86% vs. 60%, P = 0.02).
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Intradetrusor injections of abobotulinum toxin 750 U for NDO provided better outcomes than injections of onabotulinum toxin 200 U. Success rates of abobotulinum toxin 750 U and onabotulinum toxin 300 U were similar but interval between injections tended to be longer with onabotulinum toxin 300 U. Neurourol. Urodynam. 36:734-739, 2017. © 2016 Wiley Periodicals, Inc.
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New formulations, emerging uses, and continued research into the science and uses of BoNTA will lead to increasingly refined therapeutic approaches and applications. Continued education is important for physicians to optimize use of the agent according to the most current evidence and approaches.