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Mojtahedzadeh M, Najmeddin F, Pourheidar E, Najafi A, Bahman R, Yousefi-Mazhin E, Karballaei-Mirzahosseini H, Hassanpour R. Intragastric Botulinum Toxin Injection and Botulism: An Alarm for Clinicians. Case Rep Crit Care 2024; 2024:8183127. [PMID: 38716476 PMCID: PMC11074901 DOI: 10.1155/2024/8183127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/09/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
Clostridium botulinum produces the most potent bacterial toxin, botulinum toxin A (BTXA), which has various therapeutic and cosmetic indications. Intragastric BTXA injection is a new obesity treatment method that was argued to be safe due to the inactivation of BTXA through the liver or metabolization within the gastric wall. However, a 36-year-old woman was admitted to the intensive care unit (ICU) due to developing botulism as a result of an intragastric injection of BTXA. The diplopia, headaches, ptosis, decreased muscle force, and respiratory distress two days after injection were her first chief complaints, and also, she experienced significant dysphagia, hoarse voice, thick tongue, constipation, hyposmia, and hypogeusia after two weeks. This case report highlights the necessity for physicians to have sufficient information about this method and consider possible life-threatening adverse effects including botulism.
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Affiliation(s)
- Mojtaba Mojtahedzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Najmeddin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Pourheidar
- Department of Intensive Care Unit, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Bahman
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Yousefi-Mazhin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rezvan Hassanpour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Hagberg G, Skytøen ER, Nakstad I, O' Sullivan K, Koht J, Johansen TKB, Feruglio SL, Frøyshov S. Iatrogenic botulism. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2024; 144:23-0625. [PMID: 38349108 DOI: 10.4045/tidsskr.23.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
This case study describes severe iatrogenic botulism following treatment with a botulinum toxin injection at a private clinic abroad.
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Affiliation(s)
- Guri Hagberg
- Seksjon for hjerneslag, Nevrologisk avdeling, Oslo universitetssykehus, Ullevål
| | | | - Ingvild Nakstad
- Seksjon for hjerneslag, Nevrologisk avdeling, Oslo universitetssykehus, Ullevål
| | - Kristin O' Sullivan
- Faggruppe for mattrygghet, Norges miljø- og biovitenskapelige universitet Veterinærhøgskolen
| | - Jeanette Koht
- Nevrologisk avdeling, Oslo universitetssykehus, Ullevål
| | | | | | - Sten Frøyshov
- Akuttmedisinsk avdeling, Oslo universitetssykehus, Ullevål
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Karcioglu O, Akman C, Atnis I. Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril? Curr Pharm Des 2024; 30:578-588. [PMID: 38409723 DOI: 10.2174/0113816128284720240212111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/24/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024]
Abstract
Clostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.
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Affiliation(s)
- Ozgur Karcioglu
- Department of Emergency Medicine, Taksim Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ilknur Atnis
- Department of Emergency Medicine, Niğde Omer Halisdemir Education and Research Hospital, University of Health Sciences, Nigde, Turkey
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Raman S, Yamamoto Y, Suzuki Y, Matsuka Y. Mechanism and clinical use of botulinum neurotoxin in head and facial region. J Prosthodont Res 2023; 67:493-505. [PMID: 36740263 DOI: 10.2186/jpr.jpr_d_22_00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Botulinum neurotoxin (BoNT) is a biological toxin produced by Clostridium botulinum. BoNT is a potent toxin extensively used in therapeutic interventions. This review provides an updated overview of the mechanisms of action and clinical applications of BoNT in head and facial region. STUDY SELECTION MEDLINE/PubMed searches were conducted using the terms "botulinum neurotoxin" and "dentistry" along with a combination of other related terms. In addition, studies were manually selected from reference lists of the selected articles. RESULTS The Food and Drug Administration in the United States initially approved BoNT to treat strabismus, blepharospasm, and hemifacial spasms. The use of BoNT in dermatology and cosmetics has been widely established and has created a revolution in these fields. Over the years, its applications in various medical specialties have expanded widely. Owing to its safety, efficacy, and long duration of action, it is well-accepted by patients. BoNT/A and BoNT/B are widely used in clinical practice. Several off-label uses of BoNT in the dental fraternity have yielded promising results. We have elaborated on the speculated mechanism of action, dosage, effective sites of injection, and adverse effects of each therapeutic application. The various clinical indications for BoNT include bruxism, myofascial pain, temporomandibular joint dislocation, hemifacial pain, orofacial dystonia, facial paralysis, chronic migraine, and trigeminal neuralgia. CONCLUSIONS BoNT is a safe treatment that can be used effectively, provided that the clinician has adequate knowledge regarding the mechanism, injection techniques, and local and systemic side effects and that it is administered cautiously and purposefully.
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Affiliation(s)
- Swarnalakshmi Raman
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yumiko Yamamoto
- Department of Bacteriology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yoshitaka Suzuki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshizo Matsuka
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Hwang P, Shin CM, Sherwood JA, Kim D, Vijayan VM, Josyula KC, Millican RC, Ho D, Brott BC, Thomas V, Choi CH, Oh SH, Kim DW, Jun HW. A multi-targeting bionanomatrix coating to reduce capsular contracture development on silicone implants. Biomater Res 2023; 27:34. [PMID: 37087537 PMCID: PMC10122329 DOI: 10.1186/s40824-023-00378-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Capsular contracture is a critical complication of silicone implantation caused by fibrotic tissue formation from excessive foreign body responses. Various approaches have been applied, but targeting the mechanisms of capsule formation has not been completely solved. Myofibroblast differentiation through the transforming growth factor beta (TGF-β)/p-SMADs signaling is one of the key factors for capsular contracture development. In addition, biofilm formation on implants may result chronic inflammation promoting capsular fibrosis formation with subsequent contraction. To date, there have been no approaches targeting multi-facted mechanisms of capsular contracture development. METHODS In this study, we developed a multi-targeting nitric oxide (NO) releasing bionanomatrix coating to reduce capsular contracture formation by targeting myofibroblast differentiation, inflammatory responses, and infections. First, we characterized the bionanomatrix coating on silicon implants by conducting rheology test, scanning electron microcsopy analysis, nanoindentation analysis, and NO release kinetics evaluation. In addition, differentiated monocyte adhesion and S. epidermidis biofilm formation on bionanomatrix coated silicone implants were evaluated in vitro. Bionanomatrix coated silicone and uncoated silicone groups were subcutaneously implanted into a mouse model for evaluation of capsular contracture development for a month. Fibrosis formation, capsule thickness, TGF-β/SMAD 2/3 signaling cascade, NO production, and inflammatory cytokine production were evaluated using histology, immunofluorescent imaging analysis, and gene and protein expression assays. RESULTS The bionanomatrix coating maintained a uniform and smooth surface on the silicone even after mechanical stress conditions. In addition, the bionanomatrix coating showed sustained NO release for at least one month and reduction of differentiated monocyte adhesion and S. epidermidis biofilm formation on the silicone implants in vitro. In in vivo implantation studies, the bionanomatrix coated groups demonstrated significant reduction of capsule thickness surrounding the implants. This result was due to a decrease of myofibroblast differentiation and fibrous extracellular matrix production through inhibition of the TGF-β/p-SMADs signaling. Also, the bionanomatrix coated groups reduced gene expression of M1 macrophage markers and promoted M2 macrophage markers which indicated the bionanomatrix could reduce inflammation but promote healing process. CONCLUSIONS In conclusion, the bionanomatrix coating significantly reduced capsular contracture formation and promoted healing process on silicone implants by reducing myfibroblast differentiation, fibrotic tissue formation, and inflammation. A multi-targeting nitric oxide releasing bionanomatrix coating for silicone implant can reduce capsular contracture and improve healing process. The bionanomatrix coating reduces capsule thickness, α-smooth muscle actin and collagen synthesis, and myofibroblast differentiation through inhibition of TGF-β/SMADs signaling cascades in the subcutaneous mouse models for a month.
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Affiliation(s)
- Patrick Hwang
- Endomimetics, LLC, Birmingham, AL, 35242, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA
| | - Chung Min Shin
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | | | - DongHo Kim
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Vineeth M Vijayan
- Department of Biomedical Engineering, Alabama State University, Montgomery, AL, 36104, USA
| | - Krishna C Josyula
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA
| | | | - Donald Ho
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Brigitta C Brott
- Endomimetics, LLC, Birmingham, AL, 35242, USA
- Department of Medicine and Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Vinoy Thomas
- Department of Material Science and Engineering, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Chul Hee Choi
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Dong Woon Kim
- Department of Anatomy and Cell Biology, Brain Research Institute, College of Medicine, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea.
| | - Ho-Wook Jun
- Endomimetics, LLC, Birmingham, AL, 35242, USA.
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA.
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Azzam SH, Mukari A, Hamed M, Kridin K. Influence of COVID-19 mRNA vaccination on the efficacy and safety of Botulinum Toxin type A injections. J Cosmet Dermatol 2022; 21:3663-3666. [PMID: 35866341 PMCID: PMC9349385 DOI: 10.1111/jocd.15251] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Concerns have been raised recently regarding the efficacy and safety of Botulinum toxin type A (BTA) injections following COVID-19 vaccination. AIMS To assess the influence of BNT162b2 mRNA vaccine on the safety and efficacy of BTA injections performed for aesthetic indications. METHODS A retrospective cohort study followed patients undergoing periodic BTA treatments who completed two doses of BNT162b2 vaccine. The latency between BTA injections before and after getting vaccinated was assessed for all study participants. Efficacy and longevity of BTA was reflected and evaluated by the latency between BTA injections. Patients were longitudinally monitored for the development of adverse events. RESULTS Forty-five patients were eligible for inclusion in the current study. The mean (standard deviation [SD]) age of patients was 48.3 (8.9) years and 40 (88.9%) patients were females. The mean (SD) number of pre- and post- COVID-19 vaccination BTA injections was 5.1 (2.6) and 3.1 (0.4), respectively. The average (SD) interval between BTA injections after COVID-19 vaccination (96.0 [12.3] days) was significantly shorter than before it (118.6 [22.7]; P<0.001). No severe BTA-associated adverse events were registered after the administration of BNT162b2 vaccine. CONCLUSIONS Our findings indicate that BTA might be less effective after COVID-19 vaccination. Further research is required to delineate the pathomechanism underlying this observation.
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Affiliation(s)
- Shirin Hamed Azzam
- Oculoplastic Clinic, Estemed Medical Center, Kfar Kanna, Israel.,Ophthalmology department, Baruch Padeh Medical Center, Poriya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Abed Mukari
- Oculoplastic Clinic, Estemed Medical Center, Kfar Kanna, Israel
| | - Mira Hamed
- Dermatology department, Emek Medical Center, Afula, Israel
| | - Khalaf Kridin
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Poria Medical Center, Israel
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Botulism due to cosmetic injection of botulinum toxin: five-year experience. Plast Reconstr Surg 2022; 150:695e-696e. [PMID: 35816087 DOI: 10.1097/prs.0000000000009409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Off-Label Use of Botulinum Toxin in Dermatology—Current State of the Art. Molecules 2022; 27:molecules27103143. [PMID: 35630620 PMCID: PMC9147387 DOI: 10.3390/molecules27103143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/01/2023] Open
Abstract
Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacteria. Among seven different isoforms, only BoNT-A and BoNT-B are commercially used. Currently, botulinum toxin has been indicated by the U.S. Food and Drug Administration in several disorders, among others: chronic migraine, hyperhidrosis, urinary incontinence from detrusor overactivity, or cosmetics. However, there are numerous promising reports based on off-label BTX usage, indicating its potential effectiveness in other diseases, which remains unknown to many. Among them, dermatological conditions, such as rosacea, annal fissure, Raynaud phenomenon, hypertrophic scars and keloids, and also hidradenitis suppurativa, are currently being investigated. This article aims to provide a comprehensive update on the off-label use of botulinum toxin in dermatology, based on an analysis and summary of the published literature.
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Chow TYA, Chan CK, Ng SH, Tse ML. Hong Kong Poison Information Centre: Annual report 2019. HONG KONG J EMERG ME 2021. [DOI: 10.1177/10249079211038841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The Hong Kong Poison Information Centre (HKPIC) provides consultation service to health care professionals and collect epidemiological data on poisoning in Hong Kong since 2005. Objective: To report and analyse the data of Hong Kong Poison Information Centre on poisoning in 2019. Methods: This was a retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2019. Results: A total of 4016 poisoned cases were analysed, which involved 1698 men (42.3%), 2312 women (57.6%) and 6 sex-unspecified patients (0.1%). Majority of cases (77.3%) were between 13 and 69 years of age, and 10.5% were teenagers 13–19 years of age. Self-harm/suicidal attempt (42.1%), unintentional exposure (18.1%) and abusive substance use (11.1%) were common reasons of poisoning. Excluding ethanol, which was the common co-ingestant, the five most common types of poison were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. While most patients were managed with supportive treatment, 16.5% and 16.8% of the consultation cases were treated with decontamination and antidotes, respectively. Majority of cases recovered uneventfully, but 1.0% died and 4.7% had a major outcome. A total of six interesting cases and two outbreaks were discussed in this report. Conclusion: This 14th annual report provided updated epidemiological information on the pattern of poisoning in Hong Kong and highlighted a number of important changes compared with our previous reports.
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Affiliation(s)
- Tin Yat Anthony Chow
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Kwun Tong, China
| | - Chi Keung Chan
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Kwun Tong, China
| | - Sze Hong Ng
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Kwun Tong, China
| | - Man Li Tse
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Kwun Tong, China
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A Review of Complications Due to the Use of Botulinum Toxin A for Cosmetic Indications. Aesthetic Plast Surg 2021; 45:1210-1220. [PMID: 33051718 DOI: 10.1007/s00266-020-01983-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Botulinum toxin A (botulinum toxin A) was found to provide a wide variety of therapeutic and aesthetic benefits as one of the most potent toxins in the world. Injectable remedies, including soft tissue fillers and botulinum toxin, have become very common in wrinkling and face rejuvenation management. While these methods of treatment are relatively safe, serious side effects can occur. In this review, the complications of BoNTA are highlighted. METHODS A literature research considered published journal articles (clinical trials or scientific reviews). Electronic databases (PubMed, Scopus, Science Direct) were searched using key terms, and for identification of additional relevant studies, reference lists have also been examined. Only articles published in English were included in this review with a time restriction from 2000 to 2020. RESULTS There are various injection-related adverse effects associated (AE) with botulinum toxins such as erythema, oedema, pain, ptosis of eyelid or brow and ecchymosis. The overall majority of adverse events identified are mild and temporary. CONCLUSION As the use of toxins becomes increasingly more common, adverse events can be expected to increase as well. The practitioners need to be aware of such AEs, and the patients should be informed of these before undertaking such procedures. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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A Monoclonal Antibody Combination against both Serotypes A and B Botulinum Toxin Prevents Inhalational Botulism in a Guinea Pig Model. Toxins (Basel) 2021; 13:toxins13010031. [PMID: 33466411 PMCID: PMC7824882 DOI: 10.3390/toxins13010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022] Open
Abstract
Botulinum neurotoxins (BoNT) are extremely potent and can induce respiratory failure, requiring long-term intensive care to prevent death. Recombinant monoclonal antibodies (mAbs) hold considerable promise as BoNT therapeutics and prophylactics. In contrast, equine antitoxin cannot be used prophylactically and has a short half-life. Two three-mAb combinations are in development that specifically neutralize BoNT serotype A (BoNT/A) and B (BoNT/B). The three-mAb combinations addressing a single serotype provided pre-exposure prophylaxis in the guinea pig inhalation model. A lyophilized co-formulation of six mAbs, designated G03-52-01, that addresses both A and B serotypes is in development. Here, we investigated the efficacy of G03-52-01 to protect guinea pigs against an aerosol exposure challenge of BoNT/A1 or BoNT/B1. Previously, it was found that each antibody demonstrated a dose-dependent exposure and reached maximum circulating concentrations within 48 h after intramuscular (IM) or intravenous (IV) injection. Here we show that G03-52-01, in a single IM injection of G03-52-01 administered 48 h pre-exposure, protected guinea pigs against an aerosol challenge of up to 238 LD50s of BoNT/A1 and 191 LD50s of BoNT/B1. These data suggest that a single IM administration of G03-52-01 provides pre-exposure prophylaxis against botulism from an aerosol exposure of BoNT/A1 or BoNT/B1.
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Prehabilitation of complex ventral hernia patients with Botulinum: a systematic review of the quantifiable effects of Botulinum. Hernia 2020; 25:1427-1442. [PMID: 33215244 DOI: 10.1007/s10029-020-02333-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Complex ventral hernia repair (CVHR) encompasses patient optimization, primary fascial closure (PFC), mesh reinforcement and component separation technique (CST), if needed. High rates of complications after CST are still reported. Prehabilitation by managing pre-operative modifiable risk factors, like abdominal wall compliance, possibly reduces these rates. Compliance can be modified by intramuscular injection of Botulinum in the lateral abdominal wall muscles (LAWM). Paralysis leads to elongation of these muscles, which may facilitate PFC and/or prevent CST. Evidence to use Botulinum in hernia patients is scarce and fragmented. An update of evidence for the effect of Botulinum is presented. METHODS A multi-database search was conducted for Botulinum studies in ventral hernia patients. A systematic review was performed to describe its primary effect on compliance (LAWM elongation) and secondary effects like PFC ± CST rate, complications and recurrence. RESULTS 14 studies were included (377 patients) with a HDW of median 12 (10-15) cm. A typical intervention consisted of 200-300 U Botulinum in 3 points per hemi-abdomen under US guidance, > 2 weeks pre-operatively and evaluated by CT just before the operation. The primary effect was a median LAWM elongation of 4.0 cm per side without complications of the injection (four studies, 107 patients). The median PFC rate was 100%, CST rate 38%, wound-related complications 19%, medical complications 18% and recurrence 0% (14 studies). CONCLUSION Botulinum safely elongates the abdominal wall muscles, but the level of evidence available remains low. Any patient in whom PFC is expected to be difficult, could be a candidate for prehabilitation with Botulinum.
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Intramuscular Injection of BOTOX® Boosts Learning and Memory in Adult Mice in Association with Enriched Circulation of Platelets and Enhanced Density of Pyramidal Neurons in the Hippocampus. Neurochem Res 2020; 45:2856-2867. [DOI: 10.1007/s11064-020-03133-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
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Landau M, Nestor MS, Almeida AT, Al‐Niaimi F. Botulinum toxin complications in registered and off‐label aesthetic indications. J Cosmet Dermatol 2020; 19:2484-2490. [DOI: 10.1111/jocd.13667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Mark S. Nestor
- Center for Clinical and Cosmetic Research Aventura FL USA
- Department of Dermatology and Cutaneous Surgery, Department of Surgery, Division of Plastic and Reconstructive Surgery University of Miami Miller School of Medicine Miami FL USA
| | - Ada Trindade Almeida
- Dermatology Clinic Hospital do Servidor Público Municipal de São Paulo São Paulo Brazil
| | - Firas Al‐Niaimi
- Department of Dermatology Aalborg University Hospital Aalborg Denmark
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Abstract
Abstract
Purpose of Review
To provide the reader with a clear overview of facial anatomy as it relates to injection of botulinum toxin.
Recent Findings
The review suggests the presentation of multiple combinations of facial musculature, with the forehead, glabellar, and nasal base areas as particular areas of variation. Differences in musculature result in different wrinkling patterns; with age, these changes first become apparent in the upper face, particularly in the forehead and glabellar area.
Summary
Botulinum toxin is well suited to achieve the optimal outcome: it is popular, safe, and non-invasive and presents with few adverse effects. Though limited, when adverse effects do arise these are primarily related to poor injection technique, often fuelled by poor anatomical knowledge. For clinicians to achieve the best outcomes with botulinum toxin use, an understanding of the facial muscles’ anatomy, actions, and interactions is key. This paper discusses the broad and intricate detail regarding the key target muscles of botulinum toxin, based on both literature review and cadaveric dissection carried out by the authors.
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Abstract
Background: With the flourishing application of botulinum toxin cosmetically and therapeutically is the emergence of iatrogenic botulism, a new type of botulism in addition to the traditional ones. Objectives: We aim at a comprehensive review of the clinical characteristics of iatrogenic botulism. Methods: The available publications are retrieved and studied. Results: Botulinum toxin blocks cholinergic transmission in the neuromuscular junctions and autonomic ganglia. The blockade can spread from the site of tissue injection to adjacent or sometimes far off structures, resulting in inadvertent disabling or even lethal effects. On literature review, weakness and dysphagia are the commonest complications of iatrogenic botulism, whereas ophthalmological and oropharyngeal symptoms are more prevalent in the cosmetic group and dyspnea in the therapeutic group. Antitoxin therapy is required in about 20% of the patients. Diagnosis of iatrogenic botulism is primarily clinical and should not be confused with the neurological diagnoses possessing similar clinical manifestations. Vigilance to the drug formulation, dosage, and administration during botulinum toxin injection are part of the preventive measures in minimizing the occurrence of iatrogenic botulism. Conclusion: While overlapping with the traditional types of botulism, iatrogenic botulism carries its unique clinical characteristics.
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Affiliation(s)
- Hin Tat Fung
- Accident & Emergency Department, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Ka Man Chan
- Accident & Emergency Department, Tuen Mun Hospital, Tuen Mun, Hong Kong
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17
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Kandasamy M. Perspectives for the use of therapeutic Botulinum toxin as a multifaceted candidate drug to attenuate COVID-19. MEDICINE IN DRUG DISCOVERY 2020; 6:100042. [PMID: 32352081 PMCID: PMC7189194 DOI: 10.1016/j.medidd.2020.100042] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/29/2022] Open
Abstract
The recent outbreak of coronavirus disease (COVID-19) resulting from a distinctive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues to evolve in many countries and pose life-threatening clinical issues to global public health. While the lungs are the primary target for the SARS-CoV-2-mediated pathological consequence, the virus appears to invade the brain and cause unpredicted neurological deficits. In the later stage, COVID-19 can progress to pneumonia, acute respiratory failure, neurodegeneration and multi-organ dysfunctions leading to death. Though a significant portion of individuals with COVID-19 has been recovering from clinical symptoms, the pathological impact of the SARS-CoV-2 infection on the structural and functional properties of the lungs, heart, brain and other organs at the post-recovery state remains unknown. Presently, there is an urgent need for a remedial measure to combat this devastating COVID-19. Botulinum toxins (BoNTs) are potent neurotoxins that can induce paralysis of muscle and acute respiratory arrest in humans. However, a mild dose of the purified form of BoNT has been known to attenuate chronic cough, dyspnoea, pneumonia, acute respiratory failure, abnormal circulation, cardiac defects and various neurological deficits that have been recognised as the prominent clinical symptoms of COVID-19. Considering the fact, this review article provides 1) an overview of the SARS-CoV-2 mediated pathological impact on the lungs, heart and brain, 2) signifies the therapeutic uses of BoNTs against pulmonary failure, cardiac arrest and neurological deficits, and 3) emphasize the rationality for the possible use of BoNT to prevent SARS-CoV-2 infection and manage COVID-19.
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Affiliation(s)
- Mahesh Kandasamy
- Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli – 620024, Tamilnadu, India.
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18
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Timmermans G, Depierreux F, Wang F, Hansen I, Maquet P. Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review. Case Rep Neurol 2019; 11:244-251. [PMID: 31572161 PMCID: PMC6751432 DOI: 10.1159/000502350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022] Open
Abstract
Cosmetic or therapeutic use of botulinum toxin type A (BoNT-A) is usually safe but can rarely cause iatrogenic botulism. Iatrogenic botulism and myasthenia gravis (MG) share similar clinical features, because both BoNT-A and anti-acetylcholine receptorantibodies impair neuromuscular transmission. We report a patient who underwent cosmetic BoNT-A injection and later developed serious local and systemic adverse reactions. The peculiarity of this case is that a latent seropositive MG was eventually discovered, suggesting that both iatrogenic botulism and MG contributed to the clinical picture. This patient is one of the less than 10 reported cases worldwide in whom MG was unmasked by BoNT-A injection. He is the first to be assessed in detail by single-fiber electromyography. This case emphasizes the risk associated with BoNT-A injection in patients with subclinical impairment of neuromuscular transmission and prompts the search for MG in case of exaggerated response.
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Affiliation(s)
- Grégory Timmermans
- Department of Neurology, University of Liège, CHU Sart-Tilman, Liège, Belgium
| | | | - François Wang
- Department of Neurophysiology, University of Liège, CHU Sart-Tilman, Liège, Belgium
| | - Isabelle Hansen
- Department of Neurology, University of Liège, CHU Sart-Tilman, Liège, Belgium
| | - Pierre Maquet
- Department of Neurology, University of Liège, CHU Sart-Tilman, Liège, Belgium
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19
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20
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Monoclonal Antibody Combinations Prevent Serotype A and Serotype B Inhalational Botulism in a Guinea Pig Model. Toxins (Basel) 2019; 11:toxins11040208. [PMID: 30959899 PMCID: PMC6520708 DOI: 10.3390/toxins11040208] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 11/16/2022] Open
Abstract
Botulinum neurotoxins (BoNT) are some of the most toxic proteins known, with a human LD50 of ~1 ng/kg. Equine antitoxin has a half-life in circulation of less than 1 day and is limited to a treatment rather than a prevention indication. The development of monoclonal antibodies (mAbs) may represent an alternative therapeutic option that can be produced at high quantities and of high quality and with half-lives of >10 days. Two different three mAb combinations are being developed that specifically neutralize BoNT serotypes A (BoNT/A) and B (BoNT/B). We investigated the pharmacokinetics of the anti-BoNT/A and anti-BoNT/B antibodies in guinea pigs (Cavia porcellus) and their ability to protect guinea pigs against an aerosol challenge of BoNT/A1 or BoNT/B1. Each antibody exhibited dose-dependent exposure and reached maximum circulating concentrations within 48 h post intraperitoneal or intramuscular injection. A single intramuscular dose of the three mAb combination protected guinea pigs against an aerosol challenge dose of 93 LD50 of BoNT/A1 and 116 LD50 of BoNT/B1 at 48 h post antibody administration. These mAbs are effective in preventing botulism after an aerosol challenge of BoNT/A1 and BoNT/B1 and may represent an alternative to vaccination to prevent type A or B botulism in those at risk of BoNT exposure.
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21
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Bertlich M, Jakob M, Send T, Eichhorn K, Bootz F. In response to the letter to the editor regarding management and follow-up results of salivary fistulas treated with botulinum toxin. Laryngoscope 2019; 129:E165. [PMID: 30767220 DOI: 10.1002/lary.27681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Mattis Bertlich
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Munich, Federal Republic of Germany
| | - Mark Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Munich, Federal Republic of Germany
| | - Thorsten Send
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Federal Republic of Germany
| | - Klaus Eichhorn
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Federal Republic of Germany
| | - Friedrich Bootz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Federal Republic of Germany
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22
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The whole truth about botulinum toxin - a review. Postepy Dermatol Alergol 2019; 37:853-861. [PMID: 33603602 PMCID: PMC7874868 DOI: 10.5114/ada.2019.82795] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022] Open
Abstract
Treatment with botulinum toxin is widely viewed as safe, effective and largely devoid of serious side effects. There are two classes of Botox-related adverse events – transient and benign events, and potentially serious events. The aim of this study was to provide an overview of Botox-related side effects and advise potential management and preventive strategies. Benign side effects are well-localized, reversible and self-limited complications which develop within a few days of the injection, and they usually disappear without any treatment. The aesthetic and functional adverse effects are associated with different muscle responses to botulinum toxin or with misplacement of botulinum toxin. The serious events are sequelae due to the systemic spread of toxin leading to botulism.
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