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Hosgor H, Altindis S, Sen E. Comparison of the efficacy of occlusal splint and botulinum toxin therapies in patients with temporomandibular disorders with sleep bruxism. J Orofac Orthop 2024; 85:102-108. [PMID: 37843582 DOI: 10.1007/s00056-023-00498-8] [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: 03/22/2023] [Accepted: 08/12/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with temporomandibular disorders (TMD) with sleep bruxism (SB). MATERIALS AND METHODS A retrospective cohort study was conducted based on clinical record reviews of patients with TMD symptoms (e.g., temporomandibular joint [TMJ] pain, masticatory muscle pain, TMJ internal derangements, joint sounds, and limited mouth opening) and SB. The patients were divided into two groups: occlusal splint group and BTX group. Maximum unassisted mouth opening (MMO) and pain score on a visual analogue scale (VAS) before treatment and at 1‑, 3‑, and 6‑month follow-up were analyzed to evaluate the clinical outcomes. RESULTS A total of 60 patients (49 women and 11 men, mean age 34.63 ± 11.85 years) were enrolled. Each group had 30 patients. The comparisons of the groups at 1 and 3 months after treatment indicated that the BTX group had higher MMO values (P = 0.013 and 0.034, respectively) and lower VAS scores than the occlusal splint group (P = 0.000 and 0.001, respectively). No difference between the two groups was observed 6 months after treatment (P > 0.05). CONCLUSIONS Both occlusal splint and BTX treatment methods were successful in treating TMD with SB. BTX provided patients with rapid relief in the early period; therefore, BTX can be recommended as a primary treatment option in patients with greater pain.
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Affiliation(s)
- Hatice Hosgor
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kocaeli University, 41190, Kocaeli, Turkey.
| | - Sezen Altindis
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kocaeli University, 41190, Kocaeli, Turkey
| | - Esengul Sen
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Tokat Gaziosmanpasa University, Tokat, Turkey
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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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3
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Facciorusso S, Spina S, Picelli A, Baricich A, Francisco GE, Molteni F, Wissel J, Santamato A. The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis. Toxins (Basel) 2024; 16:184. [PMID: 38668609 PMCID: PMC11053519 DOI: 10.3390/toxins16040184] [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: 02/27/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024] Open
Abstract
Botulinum toxin type-A (BoNT-A) has emerged as a key therapeutic agent for the management of spasticity. This paper presents a comprehensive bibliometric and visual analysis of research concerning BoNT-A treatment of spasticity to elucidate current trends and future directions in this research area. A search was conducted in the Web of Science database for articles focused on the use of BoNT-A in spasticity published between 2000 and 2022. We extracted various metrics, including counts of publications and contributions from different countries, institutions, authors, and journals. Analytical methods in CiteSpace were employed for the examination of co-citations, collaborations, and the co-occurrence of keywords. Our search yielded 1489 publications. Analysis revealed a consistent annual increase in research output. The United States, United Kingdom, and Italy were the leading contributors. The top institution in this research was Assistance Publique Hopitaux, Paris. The journal containing the highest number of relevant publications was Toxins. Key frequently occurring keywords were 'stroke', 'cerebral palsy', 'adult spasticity', and 'upper extremity'. This study identified 12 clusters of keywords and 15 clusters of co-cited references, indicating the main focus areas and emerging themes in this field. This study comprehensively analyzed and summarized trends in BoNT-A research in the field of spasticity over the past 22 years.
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Affiliation(s)
- Salvatore Facciorusso
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Stefania Spina
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy;
| | - Alessio Baricich
- Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Gerard E. Francisco
- Department of Physical Medicine & Rehabilitation, University of Texas Health McGovern Medical School, Houston, TX 77030, USA;
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital Como, 23845 Costa Masnaga, Italy;
| | - Jörg Wissel
- Department of Neurorehabilitation and Physical Therapy, Vivantes Hospital Spandau, 13585 Berlin, Germany;
| | - Andrea Santamato
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
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Katsimperis S, Kapriniotis K, Manolitsis I, Bellos T, Angelopoulos P, Juliebø-Jones P, Somani B, Skolarikos A, Tzelves L. Early investigational agents for the treatment of benign prostatic hyperplasia'. Expert Opin Investig Drugs 2024; 33:359-370. [PMID: 38421373 DOI: 10.1080/13543784.2024.2326023] [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: 10/25/2023] [Accepted: 02/28/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH), as a clinical entity that affects many people, has always been in the forefront of interest among researchers, pharmaceutical companies, and physicians. Patients with BPH exhibit a diverse range of symptoms, while current treatment options can occasionally cause adverse events. All the aforementioned have led to an increased demand for more effective treatment options. AREAS COVERED This review summarizes the outcomes of new medications used in a pre-clinical and clinical setting for the management of male lower urinary tract symptoms (LUTS)/BPH and provides information about ongoing trials and future directions in the management of this condition. More specifically, sheds light upon drug categories, such as reductase‑adrenoceptor antagonists, drugs interfering with the nitric oxide (NO)/cyclic guanosine monophosphate (GMP) signaling pathway, onabotulinumtoxinA, vitamin D3 (calcitriol) analogues, selective cannabinoid (CB) receptor agonists, talaporfin sodium, inhibitor of transforming growth factor beta 1 (TGF-β1), drugs targeting the hormonal control of the prostate, phytotherapy, and many more. EXPERT OPINION Clinical trials are being conducted on a number of new medications that may emerge as effective therapeutic alternatives in the coming years.
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Affiliation(s)
- Stamatios Katsimperis
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioannis Manolitsis
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Themistoklis Bellos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Angelopoulos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Andreas Skolarikos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Urology, University College of London Hospitals (UCLH), London, UK
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Hudson C, Wilson P, Lieberman D, Mittelman H, Parikh S. Analysis of Breast Milk Samples in Lactating Women After Undergoing Botulinum Toxin Injections for Facial Rejuvenation: A Pilot Study. Facial Plast Surg Aesthet Med 2024. [PMID: 38306172 DOI: 10.1089/fpsam.2023.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Abstract Background: There are little data on the risk to a breastfeeding infant after facial botulinum toxin injections to the mother. Objective: To detect the presence of botulinum toxin in breast milk from lactating subjects treated with facial botulinum toxin injections, as measured by enzyme-linked immunosorbent assay (ELISA). Methods: For this pilot study, lactating women were injected with standardized facial botulinum toxin type A (BTXA) (range 40-92 U). Collected breast milk samples over 5 days were analyzed for the presence of botulinum toxin. Exclusion criteria included (1) lactating women still using their breast milk for their infant, (2) muscular disorders, (3) any medication that could interfere with neuromuscular function, (4) uncontrolled systemic disease, (5) pregnant, and (6) neuromodulator injection in the past 90 days. Results: Four lactating women were recruited. Eight samples had no BTXA detected, whereas 8 of the 16 total had detectible amounts, which were well below the reported lethal oral dose for an infant. Conclusion: Although the exclusion of lactating women from receiving cosmetic botulinum toxin injections is out of an abundance of caution to the theoretical risk to the infant, this study helps support the notion that facial botulinum toxin injections do not warrant an interruption in breastfeeding. Further studies with larger sample sizes are needed.
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Affiliation(s)
| | | | | | - Harry Mittelman
- Mittelman Plastic Surgery Center, Los Altos, California, USA
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de Jong DLC, Wegdam JA, Van der Wolk S, Nienhuijs SW, de Vries Reilingh TS. Prevention of component separation in complex abdominal wall surgery by Botox prehabilitation: a propensity-matched study. Hernia 2024:10.1007/s10029-023-02929-2. [PMID: 38172376 DOI: 10.1007/s10029-023-02929-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024]
Abstract
AIM To facilitate midline fascial closure in complex abdominal wall surgery, component separation techniques (CST) are usually required. However, CST is associated with an enlarged morbidity. Prehabilitation could increase the compliance of the abdominal wall and thereby decrease the necessity of myofascial release. This can be accomplished by administration of botulinum toxin type A (BTA) in the lateral abdominal wall musculature. The aim of this study was to determine the effect of BTA on the subsequent necessity to perform CST in patients with complex abdominal wall hernias. METHODS Patients with a complex abdominal wall hernia, planned to undergo CST between July 2020 and November 2022 were included. Outcome of procedures with 300U of BTA 4 (2-6) weeks prior to surgery, were retrospectively analyzed by comparison with propensity matched subjects of an historical group. Hernia width difference was assessed by CT and operative details were included. RESULTS A total of 13 patients with a median hernia width of 12 cm (IQR 9-14, range 24) were prehabilitated with BTA between July 2020 and November 2022. A CST was planned for all, however not required in 6/13 patients (46%) to accomplish midline fascial closure. A mean elongation of lateral abdominal wall musculature of 4.01 cm was seen in patients not requiring CST. Compared to the propensity score matched control group, a 27% reduction (p = 0.08) in the need for CST was observed. CONCLUSION There is a tendency for decrease of necessity for CST by preoperatively administered BTA in patients with complex abdominal wall defects. Although small, as this study used propensity matched comparison, further exploration of BTA should be encouraged.
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Affiliation(s)
| | - J A Wegdam
- Elkerliek Ziekenhuis, Helmond, The Netherlands
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Mousavi Ghahfarrokhi SS, Mahdigholi FS, Amin M. Collateral beauty in the damages: an overview of cosmetics and therapeutic applications of microbial proteases. Arch Microbiol 2023; 205:375. [PMID: 37935975 DOI: 10.1007/s00203-023-03713-7] [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: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
Microbial proteases are enzymes secreted by a variety of microorganisms, including bacteria and fungi, and have attracted significant attention due to their versatile applications in the food and pharmaceutical industries. In addition, certain proteases have been used in the development of skin health products and cosmetics. This article provides a review of microbial proteases in terms of their classification, sources, properties, and applications. Moreover, different pharmacological and molecular investigations have been reviewed. Various biological activities of microbial proteases, such as Arazyme, collagenase, elastin, and Nattokinase, which are involved in the digestion of dietary proteins, as well as their potential anti-inflammatory, anti-cancer, antithrombotic, and immunomodulatory effects have been included. Furthermore, their ability to control infections and treat various disorders has been discussed. Finally, this review highlights the potential applications and future perspectives of microbial proteases in biotechnology and biomedicine, and proposes further studies to develop new perspectives for disease control and health-promoting strategies using microbial resources.
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Affiliation(s)
- Seyed Sadeq Mousavi Ghahfarrokhi
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Pharmaceutical Microbiology Group, Pharmaceutical Quality Assurance Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Fateme Sadat Mahdigholi
- Department of Biomaterials, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Amin
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
- Pharmaceutical Microbiology Group, Pharmaceutical Quality Assurance Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.
- Room No. 1-221, Faculty of Pharmacy, 16th Azar Street, Tehran University of Medical Sciences, Tehran, Iran.
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Pini Prato A, Faticato MG, Mazzola C, Arrigo S, Mattioli G, Arnoldi R, Mosconi M. Intrasphincteric Botox injections in Hirschsprung's disease: indications and outcome in 64 procedures over a ten-year period. Minerva Pediatr (Torino) 2023; 75:482-489. [PMID: 30419742 DOI: 10.23736/s2724-5276.18.05238-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Intrasphincteric botulinum toxin (Botox) injection for symptomatic postoperative anal achalasia in Hirschsprung's disease (HSCR) has found wide application in the last twenty years. The aim of this study was to describe effectiveness and functional outcome of a series of patients treated over a 10-year period. METHODS All consecutive HSCR patients who received intrasphincteric Botox injections between January 2007 and December 2016 were included. Demographic data and clinical features were collected. A detailed questionnaire focusing on outcome in the medium and long-term was administered to all families. RESULTS In the study period 64 intrasphincteric Botox injections were performed in 31 patients. Completed questionnaires were returned by 27 out of 28 eligible patients (96%) reporting improvement or symptoms resolution in 16 (59%). The highest success rates were experienced by patients younger than 4, with long HSCR forms and with recurrent enterocolitis (75%, 100% and 100% of success rates, respectively). No major complications occurred. Minor complications were described by 7 patients (26%). CONCLUSIONS Intrasphincteric Botox injection proved to be feasible, safe and reasonably effective in children with HSCR and postoperative anal achalasia. Infants and toddlers with long HSCR forms and recurrent bouts of enterocolitis are those who would benefit most from this treatment.
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Affiliation(s)
- Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy -
| | - Maria G Faticato
- Department of Pediatric Surgery, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
- Department of Neuroscience, Ophthalmology, Rehabilitation, Genetics and Maternal-Infant Science - DINOGMI, University of Genoa, Genoa, Italy
| | - Cinzia Mazzola
- Department of Pediatric Surgery, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Serena Arrigo
- Unit of Pediatric Gastroenterology, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Girolamo Mattioli
- Department of Pediatric Surgery, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
- Department of Neuroscience, Ophthalmology, Rehabilitation, Genetics and Maternal-Infant Science - DINOGMI, University of Genoa, Genoa, Italy
| | - Rossella Arnoldi
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Manuela Mosconi
- Department of Pediatric Surgery, Institute for Scientific Research, Giannina Gaslini Children's Hospital, Genoa, Italy
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Sullivan DA, da Costa AX, Del Duca E, Doll T, Grupcheva CN, Lazreg S, Liu SH, McGee SR, Murthy R, Narang P, Ng A, Nistico S, O'Dell L, Roos J, Shen J, Markoulli M. TFOS Lifestyle: Impact of cosmetics on the ocular surface. Ocul Surf 2023; 29:77-130. [PMID: 37061220 DOI: 10.1016/j.jtos.2023.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
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Affiliation(s)
| | | | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | | | - Sihem Lazreg
- Lazreg Cornea and Ocular Surface Center, Blida, Algeria
| | - Su-Hsun Liu
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Alison Ng
- Centre for Ocular Research & Education, School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Steven Nistico
- Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | | | | | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
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10
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Chen C, Xu M, Yu H, Li Y, Yu X. Improvement in health-related quality of life with Botulinum toxin A injection in acquired superior oblique palsy. Front Med (Lausanne) 2023; 10:1198380. [PMID: 37457574 PMCID: PMC10339737 DOI: 10.3389/fmed.2023.1198380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose This study aimed to investigate the outcomes of Botulinum toxin A (BTA) injection into the inferior oblique (IO) muscle for the management of unilateral acute acquired superior oblique palsy (SOP) and to evaluate changes in health-related quality of life post-injection using the Adult Strabismus-20 (AS-20) questionnaire. Methods A prospective cohort study was performed in patients with unilateral acute acquired SOP who received BTA injections. Four units of BTA were injected into the ipsilateral IO muscle. Ocular examinations were performed pre-and post-injection, including alignment, ocular movement, and cyclotorsion deviation. The patients' AS-20 questionnaire scores were analyzed. Results A total of 21 patients with acute acquired SOP were included. The initial median vertical deviation was 5 PD (range 1-16), which was improved to 0 PD (range 0-10) at both 1 and 6 months post-injection (p < 0.001 and p < 0.001, respectively). The median torsional deviation was 7° (range 2-18) at baseline and resolved to 0 degrees (range -3-5) at the 1-month and 0° (range -2-7) at the 6-month follow-up (p < 0.001 and p < 0.001, respectively). There were significant increases in the overall score (OAS), psychosocial subscale score (PSS), and functional subscale score (FSS) from baseline values at both the 1-month (p < 0.001, p < 0.001, and p = 0.001, respectively) and 6-month follow-up (all p < 0.001). Conclusion Injecting BTA into the ipsilateral IO muscle successfully resolved vertical and torsional deviations and significantly improved quality-of-life scores. Our findings show that BTA treatment, as an early treatment for acute acquired SOP, can help patients by significantly improving their quality of life.
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Affiliation(s)
- Chonglin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Meiping Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Huanyun Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yipao Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xinping Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Belvisi D, Leodori G, Costanzo M, Conte A, Berardelli A. How does botulinum toxin really work? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:441-479. [PMID: 37482400 DOI: 10.1016/bs.irn.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Over the past 30 years, Botulinum toxin (BoNT) has emerged as an effective and safe therapeutic tool for a number of neurological conditions, including dystonia. To date, the exact mechanism of action of BoNT in dystonia is not fully understood. Although it is well known that BoNT mainly acts on the neuromuscular junction, a growing body of evidence suggests that the therapeutic effect of BoNT in dystonia may also depend on its ability to modulate peripheral sensory feedback from muscle spindles. Animal models also suggest a retrograde and anterograde BoNT transportation from the site of injection to central nervous system structures. In humans, however, BoNT central effects seem to depend on the modulation of afferent input rather than on BoNT transportation. In this chapter, we aimed to report and discuss research evidence providing information on the possible mechanisms of action of BoNT in relation to treatment of dystonia.
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Affiliation(s)
- Daniele Belvisi
- Department of Human Neurosciences, Sapienza, University of Rome, Viale dell' Università 30, Rome, Italy; IRCCS Neuromed, via Atinense 18, Pozzilli, IS, Italy
| | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza, University of Rome, Viale dell' Università 30, Rome, Italy; IRCCS Neuromed, via Atinense 18, Pozzilli, IS, Italy
| | | | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Viale dell' Università 30, Rome, Italy; IRCCS Neuromed, via Atinense 18, Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza, University of Rome, Viale dell' Università 30, Rome, Italy; IRCCS Neuromed, via Atinense 18, Pozzilli, IS, Italy.
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Liu Z, Lee PG, Krez N, Lam KH, Liu H, Przykopanski A, Chen P, Yao G, Zhang S, Tremblay JM, Perry K, Shoemaker CB, Rummel A, Dong M, Jin R. Structural basis for botulinum neurotoxin E recognition of synaptic vesicle protein 2. Nat Commun 2023; 14:2338. [PMID: 37095076 PMCID: PMC10125960 DOI: 10.1038/s41467-023-37860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/03/2023] [Indexed: 04/26/2023] Open
Abstract
Botulinum neurotoxin E (BoNT/E) is one of the major causes of human botulism and paradoxically also a promising therapeutic agent. Here we determined the co-crystal structures of the receptor-binding domain of BoNT/E (HCE) in complex with its neuronal receptor synaptic vesicle glycoprotein 2A (SV2A) and a nanobody that serves as a ganglioside surrogate. These structures reveal that the protein-protein interactions between HCE and SV2 provide the crucial location and specificity information for HCE to recognize SV2A and SV2B, but not the closely related SV2C. At the same time, HCE exploits a separated sialic acid-binding pocket to mediate recognition of an N-glycan of SV2. Structure-based mutagenesis and functional studies demonstrate that both the protein-protein and protein-glycan associations are essential for SV2A-mediated cell entry of BoNT/E and for its potent neurotoxicity. Our studies establish the structural basis to understand the receptor-specificity of BoNT/E and to engineer BoNT/E variants for new clinical applications.
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Affiliation(s)
- Zheng Liu
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, 92697, USA
| | - Pyung-Gang Lee
- Department of Urology, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Nadja Krez
- Institute of Toxicology, Hannover Medical School, Hannover, 30623, Germany
| | - Kwok-Ho Lam
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, 92697, USA
| | - Hao Liu
- Department of Urology, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Adina Przykopanski
- Institute of Toxicology, Hannover Medical School, Hannover, 30623, Germany
| | - Peng Chen
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, 92697, USA
| | - Guorui Yao
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, 92697, USA
| | - Sicai Zhang
- Department of Urology, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | | | - Kay Perry
- NE-CAT and Department of Chemistry and Chemical Biology, Cornell University, Argonne National Laboratory, Argonne, IL, 60439, USA
| | | | - Andreas Rummel
- Institute of Toxicology, Hannover Medical School, Hannover, 30623, Germany
| | - Min Dong
- Department of Urology, Boston Children's Hospital, Boston, MA, 02115, USA.
- Department of Microbiology and Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA.
| | - Rongsheng Jin
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, 92697, USA.
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13
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Aldridge JHR. Botulinum neurotoxin: A therapeutic powerhouse with broad clinical implications. JAAPA 2023; 36:39-41. [PMID: 36976032 DOI: 10.1097/01.jaa.0000921280.56648.da] [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: 03/29/2023]
Abstract
ABSTRACT Clostridium botulinum is a Gram-positive bacterium that produces one of the most deadly chemodenervating toxins in the world. To date, six distinct neurotoxins are available for prescription use in the United States. Decades of data across aesthetic therapeutic areas and therapeutic disease states support the safety and efficacy of C. botulinum, providing good symptom management and improved quality of life in appropriately chosen patients. Unfortunately, many clinicians are slow to progress patients to toxin therapy from more conservative measures, and others wrongly interchange the products despite characteristics unique to each. Commensurate with an improved understanding of the complex pharmacology and clinical implications of botulinum neurotoxins is the importance for clinicians to appropriately identify, educate, refer, and/or treat candidate patients. This article provides an overview of the history, mechanism of action, differentiation, indications, and uses for botulinum neurotoxins.
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Affiliation(s)
- Jamie H R Aldridge
- Jamie H. R. Aldridge is a medical science liaison for argenx USA, Inc., in Boston, Mass., and practices at Moses H. Cone Memorial Hospital in Greensboro, N.C. The author has disclosed no potential conflicts of interest, financial or otherwise
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14
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Petracca M, Lo Monaco MR, Ialongo T, Di Stasio E, Cerbarano ML, Maggi L, De Biase A, Di Lazzaro G, Calabresi P, Bentivoglio AR. Efficacy and safety of long-term botulinum toxin treatment for acquired cervical dystonia: a 25-year follow-up. J Neurol 2023; 270:340-347. [PMID: 36068376 PMCID: PMC9813057 DOI: 10.1007/s00415-022-11343-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 01/09/2023]
Abstract
Botulinum toxin A (BoNT/A) is the first-line treatment for idiopathic cervical dystonia (ICD) and is widely used in the clinical setting. To date, scanty data are available on the effectiveness of BoNT in treating acquired cervical dystonia (ACD). Here we present a long-term follow-up of ACD patients treated with BoNT/A that focused on safety and efficacy. The study included subjects who had received at least six treatments of three commercially available BoNT/A drugs [abobotulinumtoxinA (A/Abo), incobotulinumtoxinA (A/Inco) and onabotulinumtoxinA (A/Ona)]. Safety and efficacy were assessed based on patients' self-reports regarding adverse effects (AE), duration of improvement of dystonia and/or pain relief. Global clinical improvement was measured on a six-point scale. 23 patients with ACD were administered 739 treatments (A/Abo in 235, A/Inco in 72, A/Ona in 432) with a mean number of treatments of 31 ± 20 (range 6-76) and duration of 10 ± 6 weeks (range 2-25). The mean dose was 737 ± 292 U for A/Abo, 138 ± 108 U for A/Inco and 158 ± 80 U for A/Ona. The average benefit duration was 89 ± 26 (A/Abo), 88 ± 30 days (A/Inco), and 99 ± 55 days (A/Ona) (p = 0.011); global clinical improvement for all sessions was 4 ± 1. ANOVA one-way analysis indicated that A/Ona had the best profile in terms of duration (p < 0.05), whereas A/Abo had the best pain relief effect (p = 0.002). Side effects were reported in 9% of treatments (67/739), with ten treatments (1%) complicated by two side effects. Most side effects were rated mild to moderate; severe side effects occurred following three treatments with the three different BoNT; two required medical intervention. No allergic reactions were reported. Even after 25 years of repeated treatments, all serotypes of BoNT demonstrate positive effects in treating ACD with long-lasting efficacy and safety.
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Affiliation(s)
- Martina Petracca
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Maria Rita Lo Monaco
- Medicine of the Ageing, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Largo A Gemelli, 8, 00168, Rome, Italy.
| | - Tamara Ialongo
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Enrico Di Stasio
- Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Rehabilitation and Physical Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Maria Luana Cerbarano
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Loredana Maggi
- Rehabilitation and Physical Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Alessandro De Biase
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Giulia Di Lazzaro
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Calabresi
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Bentivoglio
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Oo WM, Hunter DJ. Efficacy, Safety, and Accuracy of Intra-articular Therapies for Hand Osteoarthritis: Current Evidence. Drugs Aging 2023; 40:1-20. [PMID: 36633823 DOI: 10.1007/s40266-022-00994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
The lifetime risk of symptomatic hand osteoarthritis (OA) is 39.8%, with one in two women and one in four men developing the disease by age 85 years and no disease-modifying drug (DMOAD) available so far. Intra-articular (IA) therapy is one of the options commonly used for symptomatic alleviation of OA disease as it can circumvent systemic exposure and potential side effects of oral medications. The current narrative review focuses on the efficacy and safety profiles of the currently available IA agents in hand OA (thumb-base OA or interphalangeal OA) such as corticosteroids and hyaluronic acid (HA), as well as the efficacy and safety of IA investigational injectates in phase 2/3 clinical trials such as prolotherapy, platelet-rich plasma, stem cells, infliximab, interferon-? and botulinum toxin, based on the published randomized controlled trials on PubMed database. The limited published literature revealed the short-term symptomatic benefits of corticosteroids in interphalangeal OA while long-term data are lacking. Most of the short-term studies showed no significant difference between corticosteroids and hyaluronic acid in thumb-base OA, usually with a faster onset of pain relief in the corticosteroid group and a slower but greater (statistically insignificant) pain improvement in the HA group. The majority of studies in investigational agents were limited by small sample size, short-term follow-up, and presence of serious side effects. In addition, we reported higher accuracy rates of drug administrations under imaging guidance than landmark guidance (blind method), and then briefly describe challenges for the long-term efficacy and prospects of IA therapeutics.
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Affiliation(s)
- Win Min Oo
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar.
- Rheumatology Department, Faculty of Medicine and Health, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia.
| | - David J Hunter
- Rheumatology Department, Faculty of Medicine and Health, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia
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16
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Zhou K, Luo W, Liu T, Ni Y, Qin Z. Neurotoxins Acting at Synaptic Sites: A Brief Review on Mechanisms and Clinical Applications. Toxins (Basel) 2022; 15:18. [PMID: 36668838 PMCID: PMC9865788 DOI: 10.3390/toxins15010018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Neurotoxins generally inhibit or promote the release of neurotransmitters or bind to receptors that are located in the pre- or post-synaptic membranes, thereby affecting physiological functions of synapses and affecting biological processes. With more and more research on the toxins of various origins, many neurotoxins are now widely used in clinical treatment and have demonstrated good therapeutic outcomes. This review summarizes the structural properties and potential pharmacological effects of neurotoxins acting on different components of the synapse, as well as their important clinical applications, thus could be a useful reference for researchers and clinicians in the study of neurotoxins.
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Affiliation(s)
- Kunming Zhou
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, College of Pharmaceutical Sciences, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Weifeng Luo
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Tong Liu
- Institute of Pain Medicine and Special Environmental Medicine, Nantong University, Nantong 226019, China
| | - Yong Ni
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Zhenghong Qin
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, College of Pharmaceutical Sciences, Suzhou Medical College of Soochow University, Suzhou 215123, China
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17
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Sutherland E, Hill B, Singer BJ, Ashford S, Hoare B, Hastings-Ison T, Fheodoroff K, Berwick S, Dobson F, Williams G. Do randomised controlled trials evaluating functional outcomes following botulinum neurotoxin-A align with focal spasticity guidelines? A systematic review. Disabil Rehabil 2022; 44:8515-8523. [PMID: 34982603 DOI: 10.1080/09638288.2021.2011437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The impact of botulinum neurotoxin-A (BoNT-A) on functional outcomes when managing focal muscle spasticity remains unclear. It is possible that randomised controlled trial (RCT) design and/or reporting may be a contributing factor. The objective of this review was to determine the extent to which RCTs evaluating functional outcomes following BoNT-A align with focal spasticity guidelines. MATERIALS AND METHODS RCTs published from 2010 were included if they targeted focal spasticity, included BoNT-A, randomised a physical intervention to the upper/lower limb, or the primary outcome(s) related to the activity/participation domains of the International Classification of Functioning, Disability, and Health. Data extraction and quality appraisal using the Modified PEDro and Modified McMasters Tool were performed independently by two reviewers. General research practices were also extracted such as compliance with therapy reporting guidelines. RESULTS Fifty-two RCTs were eligible. Individualised goal setting was uncommon (25%). Six studies (11.5%) included multi-disciplinary management, and five (9.6%) included patient/caregiver education. Four studies (7.7%) measured outcomes beyond 6 months. The Median Modified PEDro score was 11/15. CONCLUSIONS Alignment with focal spasticity guidelines in RCTs was generally low. Our understanding of the impact of focal spasticity management on functional outcomes may be improved if RCT design aligned more closely with guideline recommendations.IMPLICATIONS FOR REHABILITATIONThe influence of BoNT-A on improved functional outcomes is yet to be determined.Individualised goal setting with a multi-disciplinary team is uncommon in an RCT design, despite it being a key guideline recommendation.Given the long-term nature of spasticity management, guidelines recommend short as well as long-term reviews following intervention however RCTs rarely assess beyond 6 months.
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Affiliation(s)
- Edwina Sutherland
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia.,Faculty of Medicine, School of Physiotherapy, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Bridget Hill
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia.,Faculty of Medicine, School of Physiotherapy, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Barby J Singer
- Centre for Training in Subacute Care, WA Health, Fremantle Hospital, Fremantle, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.,Centre for Nurse, Midwife and Allied Health Led Research, University College London Hospitals, London, UK.,Faculty of Nursing, Midwifery and Palliative Care, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Brian Hoare
- School of Occupational Therapy, La Trobe University, Bundoora, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - Tandy Hastings-Ison
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Parkville, Australia
| | | | - Steffen Berwick
- Speciality Clinic for Paediatric Neurology, Neurorehabilitation and Epilepsy, Schön Clinic Vogtareuth, Vogtareuth, Germany.,von Hauners' Children's Hospital, Munich University, Munich, Germany
| | - Fiona Dobson
- Faculty of Medicine, School of Physiotherapy, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Gavin Williams
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia.,Faculty of Medicine, School of Physiotherapy, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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18
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Gul M, Bocu K, Serefoglu EC. Current and emerging treatment options for premature ejaculation. Nat Rev Urol 2022; 19:659-680. [PMID: 36008555 DOI: 10.1038/s41585-022-00639-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/08/2022]
Abstract
Premature ejaculation (PE) is a prevalent male sexual dysfunction. Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine and other selective serotonin reuptake inhibitors (SSRIs). Most of the pharmacotherapeutic options target neurotransmitters (such as serotonin and oxytocin) that have a role in the ejaculation mechanism. However, these treatments are mildly effective and only provide a temporary delay in the ejaculation latency time, and PE recurs when the treatment is stopped. Thus, a treatment for PE is urgently needed and research is ongoing to find the ideal PE therapy. The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials. Both preclinical and clinical studies on new-generation SSRIs are ongoing. Moreover, promising results came from clinical trials in which the efficacy of on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, was assessed. Surgical intervention and neuromodulation have been proposed as potential treatment options for PE; however, current PE guidelines do not recommend these treatments owing to safety concerns.
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Affiliation(s)
- Murat Gul
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | - Kadir Bocu
- Department of Urology, Silopi State Hospital, Sirnak, Turkey
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.
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19
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Gazerani P. How Does Botulinum Toxin Inhibit Itch? Toxins (Basel) 2022; 14:toxins14100701. [PMID: 36287970 PMCID: PMC9610088 DOI: 10.3390/toxins14100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Two decades after reports of the anti-pruritic effects of botulinum neurotoxins (BoNTs), there is still no approved product for the anti-itch indication of BoNTs, and most clinical case reports still focus on the off-label use of BoNTs for various itchy conditions. Few randomized clinical trials have been conducted with controversial results, and the beneficial effects of BoNTs against itch are mainly based on case studies and case series. These studies are valuable in presenting the potential application of BoNTs in chronic pruritic conditions, but due to the nature of these studies, they are categorized as providing lower levels of evidence or lower grades of recommendation. To obtain approval for the anti-pruritic indication of BoNTs, higher levels of evidence are required, which can be achieved through conducting large-scale and well-designed studies with proper control groups and established careful and reliable primary and secondary outcomes. In addition to clinical evidence, presenting the mechanism-based antipruritic action of BoNTs can potentially strengthen, accelerate, and facilitate the current efforts towards further investments in accelerating the field towards the potential approval of BoNTs for itchy conditions. This review, therefore, aimed to provide the state-of-the-art mechanisms underlying the anti-itch effect of BoNTs from basic studies that resemble various clinical conditions with itch as a hallmark. Evidence of the neuronal, glial, and immune modulatory actions of BoNTs in reducing the transmission of itch are presented, and future potential directions are outlined.
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Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; or
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg East, Denmark
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20
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Crystal Structures of the Clostridium botulinum Neurotoxin A6 Cell Binding Domain Alone and in Complex with GD1a Reveal Significant Conformational Flexibility. Int J Mol Sci 2022; 23:ijms23179620. [PMID: 36077016 PMCID: PMC9456117 DOI: 10.3390/ijms23179620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022] Open
Abstract
Clostridium botulinum neurotoxin A (BoNT/A) targets the soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex, by cleaving synaptosomal-associated protein of 25 kDa size (SNAP-25). Cleavage of SNAP-25 results in flaccid paralysis due to repression of synaptic transmission at the neuromuscular junction. This activity has been exploited to treat a range of diseases associated with hypersecretion of neurotransmitters, with formulations of BoNT/A commercially available as therapeutics. Generally, BoNT activity is facilitated by three essential domains within the molecule, the cell binding domain (HC), the translocation domain (HN), and the catalytic domain (LC). The HC, which consists of an N-terminal (HCN) and a C-terminal (HCC) subdomain, is responsible for BoNT’s high target specificity where it forms a dual-receptor complex with synaptic vesicle protein 2 (SV2) and a ganglioside receptor on the surface of motor neurons. In this study, we have determined the crystal structure of botulinum neurotoxin A6 cell binding domain (HC/A6) in complex with GD1a and describe the interactions involved in ganglioside binding. We also present a new crystal form of wild type HC/A6 (crystal form II) where a large ‘hinge motion’ between the HCN and HCC subdomains is observed. These structures, along with a comparison to the previously determined wild type crystal structure of HC/A6 (crystal form I), reveals the degree of conformational flexibility exhibited by HC/A6.
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21
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Goal-Setting in Multiple Sclerosis-Related Spasticity Treated with Botulinum Toxin: The GASEPTOX Study. Toxins (Basel) 2022; 14:toxins14090582. [PMID: 36136520 PMCID: PMC9504895 DOI: 10.3390/toxins14090582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Spasticity is one of the most disabling symptoms in multiple sclerosis (MS). Botulinum toxin injection (BTI) is a first-line treatment for focal spasticity. There is a lack of evidence of a functional improvement following BTI in MS-related spasticity. To describe goal-setting for BTI in MS, and evaluate the degree of attainment, using goal attainment scaling (GAS) 4-to-6 weeks after injection session, a one-year multi-center retrospective observational study assessing goal-setting and achievement during BTI session in spastic patients with MS was set up. Following the GAS method, patients and their physicians set up to three goals and scored their achievement 4 to 6 weeks thereafter. Commonly used goals from three centers were combined into a standardized list and 125 single BTI sessions were analyzed. The most frequent goals regarded lower limb (LL) impairments (equinovarus foot, toe claw) or locomotion (stability, walking distance, clinging) and accounted for 89.1%, versus 10.9% for upper limb (UL), mostly for mild-to-moderate MS. Overall, goals were frequently achieved (85.77%) mainly when related to gait and mobility rather than hygiene and ease of care. This study gives an overview on the most frequent, relevant, and achievable goals to be set in real-life practice of BTI for spasticity management in MS.
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22
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Lalaurie CJ, Splevins A, Barata TS, Bunting KA, Higazi DR, Zloh M, Spiteri VA, Perkins SJ, Dalby PA. Elucidation of critical pH-dependent structural changes in Botulinum Neurotoxin E. J Struct Biol 2022; 214:107876. [PMID: 35738335 DOI: 10.1016/j.jsb.2022.107876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 10/18/2022]
Abstract
Botulinum Neurotoxins (BoNT) are the most potent toxins currently known. However, they also have therapeutic applications for an increasing number of motor related conditions due to their specificity, and low diffusion into the system. Although the start- and end- points for the BoNT mechanism of action are well-studied, a critical step remains poorly understood. It is theorised that BoNTs undergo a pH-triggered conformational shift, activating the neurotoxin by priming it to form a transmembrane (TM) channel. To test this hypothesis, we combined molecular dynamics (MD) simulations and small-angle x-ray scattering (SAXS), revealing a new conformation of serotype E (BoNT/E). This conformation was exclusively observed in simulations below pH 5.5, as determined by principal component analysis (PCA), and its theoretical SAXS profile matched an experimental SAXS profile obtained at pH 4. Additionally, a localised secondary structural change was observed in MD simulations below pH 5.5, in a region previously identified as instrumental for membrane insertion for serotype A (BoNT/A). These changes were found at a critical pH value for BoNTs in vivo, and may be relevant for their therapeutic use.
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Affiliation(s)
- Christophe J Lalaurie
- Department of Biochemical Engineering, Bernard Katz Building, University College London, Gordon Street, London WC1H 0AH, UK
| | - Andrew Splevins
- Evox Therapeutics Ltd, Oxford Science Park, Medwar Center, Oxford, England OX4 4HG, UK; Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, Oxfordshire OX14 4RY UK
| | - Teresa S Barata
- FairJourney Biologics, 823 Rua do Campo Alegre, Porto, Porto 4150-180, Portugal; Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, Oxfordshire OX14 4RY UK
| | - Karen A Bunting
- Ipsen Bioinnovation, 102 Park Drive, Milton Park, Abingdon, Oxfordshire OX14 4RY UK
| | - Daniel R Higazi
- Ipsen Biopharm Ltd., Wrexham Industrial Estate, 9 Ash Road, LL13 9UF, UK
| | - Mire Zloh
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Valentina A Spiteri
- Department of Structural and Molecular Biology, Division of Biosciences, Darwin Building, University College London, Gower Street, London WC1E 6BT, UK
| | - Stephen J Perkins
- Department of Structural and Molecular Biology, Division of Biosciences, Darwin Building, University College London, Gower Street, London WC1E 6BT, UK
| | - Paul A Dalby
- Department of Biochemical Engineering, Bernard Katz Building, University College London, Gordon Street, London WC1H 0AH, UK.
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23
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Byun J, Kwak S, Kwon JH, Shin M, Lee DK, Rhee CH, Kang WH, Oh JW, Cruz DJM. Comparative Pharmacodynamics of Three Different Botulinum Toxin Type A Preparations following Repeated Intramuscular Administration in Mice. Toxins (Basel) 2022; 14:toxins14060365. [PMID: 35737026 PMCID: PMC9227525 DOI: 10.3390/toxins14060365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022] Open
Abstract
Botulinum neurotoxin type A (BoNT/A) causes muscle paralysis by blocking cholinergic signaling at neuromuscular junctions and is widely used to temporarily correct spasticity-related disorders and deformities. The paralytic effects of BoNT/A are time-limited and require repeated injections at regular intervals to achieve long-term therapeutic benefits. Differences in the level and duration of effectivity among various BoNT/A products can be attributed to their unique manufacturing processes, formulation, and noninterchangeable potency units. Herein, we compared the pharmacodynamics of three BoNT/A formulations, i.e., Botox® (onabotulinumtoxinA), Xeomin® (incobotulinumtoxinA), and Coretox®, following repeated intramuscular (IM) injections in mice. Three IM injections of BoNT/A formulations (12 U/kg per dose), 12-weeks apart, were administered at the right gastrocnemius. Local paresis and chemodenervation efficacy were evaluated over 36 weeks using the digit abduction score (DAS) and compound muscle action potential (CMAP), respectively. One week after administration, all three BoNT/A formulations induced peak DAS and maximal reduction of CMAP amplitudes. Among the three BoNT/A formulations, only Coretox® afforded a significant increase in paretic effects and chemodenervation with a prolonged duration of action after repeated injections. These findings suggest that Coretox® may offer a better overall therapeutic performance in clinical settings.
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Affiliation(s)
- Jaeyoon Byun
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea
| | - Seongsung Kwak
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Jin-Hee Kwon
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Minhee Shin
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Dong-Kyu Lee
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Chang-Hoon Rhee
- Medytox Osong R&D Center, 102 Osongsaengmyeong 4-ro, Osong-eup, Heungdeok-gu, Cheongju-si 28161, Korea;
| | - Won-ho Kang
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
| | - Jae-Wook Oh
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea
- Correspondence: (J.-W.O.); (D.J.M.C.); Tel.: +82-2-2049-6271 (J.-W.O.); +82-31-8065-8254 (D.J.M.C.)
| | - Deu John M. Cruz
- Medytox Gwanggyo R&D Center, 114 Central town-ro, Yeongtong-gu, Suwon-si 16506, Korea; (J.B.); (S.K.); (J.-H.K.); (M.S.); (D.-K.L.); (W.-h.K.)
- Correspondence: (J.-W.O.); (D.J.M.C.); Tel.: +82-2-2049-6271 (J.-W.O.); +82-31-8065-8254 (D.J.M.C.)
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Aravind L, Iyer LM, Burroughs AM. Discovering Biological Conflict Systems Through Genome Analysis: Evolutionary Principles and Biochemical Novelty. Annu Rev Biomed Data Sci 2022; 5:367-391. [PMID: 35609893 DOI: 10.1146/annurev-biodatasci-122220-101119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Biological replicators, from genes within a genome to whole organisms, are locked in conflicts. Comparative genomics has revealed a staggering diversity of molecular armaments and mechanisms regulating their deployment, collectively termed biological conflict systems. These encompass toxins used in inter- and intraspecific interactions, self/nonself discrimination, antiviral immune mechanisms, and counter-host effectors deployed by viruses and intragenomic selfish elements. These systems possess shared syntactical features in their organizational logic and a set of effectors targeting genetic information flow through the Central Dogma, certain membranes, and key molecules like NAD+. These principles can be exploited to discover new conflict systems through sensitive computational analyses. This has led to significant advances in our understanding of the biology of these systems and furnished new biotechnological reagents for genome editing, sequencing, and beyond. We discuss these advances using specific examples of toxins, restriction-modification, apoptosis, CRISPR/second messenger-regulated systems, and other enigmatic nucleic acid-targeting systems. Expected final online publication date for the Annual Review of Biomedical Data Science, Volume 5 is August 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- L Aravind
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA;
| | - Lakshminarayan M Iyer
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA;
| | - A Maxwell Burroughs
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA;
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An JM, Shahriar SMS, Lee DY, Hwang SR, Lee YK. Pore Size-Dependent Stereoscopic Hydrogels Enhance the Therapeutic Efficiency of Botulinum Toxin for the Treatment of Nerve-Related Diseases. ACS APPLIED MATERIALS & INTERFACES 2022; 14:19139-19153. [PMID: 35452222 DOI: 10.1021/acsami.2c01738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Botulinum toxin (BoNT) is a major neurotherapeutic protein that has been used at low doses for diverse pharmacological applications. However, the pleiotropic effect of BoNT depends on multiple periodic injections owing to its rapid elimination profile, short-term therapeutic effect, and high mortality rate when administered at high doses. In addition to low patient compliance, these drawbacks represent the significant challenges that limit the further clinical use of BoNT. This study developed a new hydrogel-based single dosage form of BoNT by employing a one-step cross-linking chemistry. Its controlled porous structures and composition facilitated uniform drug distribution inside the hydrogel and controllable release of BoNT mediated by slow diffusion. A single dose remained stable for at least 2.5 months and showed sustained effect for at least 20 weeks, meeting the requirements for a single-dose form of BoNT. Additionally, this dosage form was evaluated as safe from all aspects of toxicology. This delivery system resulted in a 100% survival rate after administering a BoNT dose of 30 units, while a dose of more than 5 units of naked BoNT caused a 100% mortality rate within a few days. Overall, this strategy could provide patients with the first single-dose treatment option of BoNT and improve their quality of life.
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Affiliation(s)
- Jeong Man An
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
| | - S M Shatil Shahriar
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198-5940, United States
| | - Dong Yun Lee
- Department of Bioengineering, College of Engineering, and BK FOUR Biopharmaceutical Innovation Leader for Education and Research Group, Hanyang University, Seoul 04763, Republic of Korea
- Institute of Nano Science and Technology (INST), Hanyang University, Seoul 04763, Republic of Korea
| | - Seung Rim Hwang
- College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
| | - Yong-Kyu Lee
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
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Hwang DI, Won KJ, Kim DY, Kim MJ, Won YL, Kim NY, Kim YG, Kim B, Lee HM. Erigeron annuus flower absolute prolongs botulinum neurotoxin A-induced muscle paralysis and inhibits neurotransmitter release-linked responses. Nat Prod Res 2022; 36:6428-6432. [DOI: 10.1080/14786419.2022.2036147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dae Il Hwang
- Division of Cosmetic and Biotechnology, College of Life and Health Sciences, Hoseo University, Asan, Republic of Korea
| | - Kyung Jong Won
- Department of Physiology and Medical Science, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Do Yoon Kim
- Division of Cosmetic and Biotechnology, College of Life and Health Sciences, Hoseo University, Asan, Republic of Korea
| | - Mi Jung Kim
- Division of Cosmetic and Biotechnology, College of Life and Health Sciences, Hoseo University, Asan, Republic of Korea
| | - Yu Lim Won
- Division of Cosmetic and Biotechnology, College of Life and Health Sciences, Hoseo University, Asan, Republic of Korea
| | - Nan Young Kim
- Division of Cosmetic and Biotechnology, College of Life and Health Sciences, Hoseo University, Asan, Republic of Korea
| | - Young Geol Kim
- Division of Cosmetic and Biotechnology, College of Life and Health Sciences, Hoseo University, Asan, Republic of Korea
| | - Bokyung Kim
- Department of Physiology and Medical Science, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Hwan Myung Lee
- Division of Cosmetic and Biotechnology, College of Life and Health Sciences, Hoseo University, Asan, Republic of Korea
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Chueluecha C, Moore AP. LIVECHART
Patient‐Reported Outcome Tool for Botulinum Toxin Treatment in Cervical Dystonia. Mov Disord Clin Pract 2022; 9:198-205. [PMID: 35141354 PMCID: PMC8810418 DOI: 10.1002/mdc3.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Chuenchom Chueluecha
- Department of Rehabilitation Medicine, Faculty of Medicine Thammasat University Bangkok Thailand
| | - Austen Peter Moore
- Department of Neurology The Walton Centre NHS Foundation Trust Liverpool United Kingdom
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Immunogenicity of botulinum toxin. Arch Plast Surg 2022; 49:12-18. [PMID: 35086302 PMCID: PMC8795657 DOI: 10.5999/aps.2021.00766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 11/07/2021] [Indexed: 11/08/2022] Open
Abstract
Botulinum toxin treatment is the most common non-surgical cosmetic treatment. Although there are many available treatments using botulinum toxin, their effects are temporary and repeated injections are required. These frequent injections can trigger an immunological response. In addition, botulinum toxin acts as an antigen in the body; thus, its effect disappears progressively due to this immunological reaction, which may cause treatment failure. Active botulinum toxin consists of a core neurotoxin and complexing proteins, the exact effects of which remain unclear. However, the complexing proteins are closely related to the immune response and the formation of neutralizing antibodies. Since neutralizing antibodies can lead to treatment failure, their formation should be prevented. Furthermore, various methods of detecting neutralizing antibodies have been used to predict treatment failure.
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Botulinum Toxin Injection for Painful Adductor Pollicis Contracture after Thumb Carpometacarpal Resection Arthroplasty. LIFE (BASEL, SWITZERLAND) 2022; 12:life12010110. [PMID: 35054501 PMCID: PMC8779259 DOI: 10.3390/life12010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/17/2022]
Abstract
Pollux adductus deformity is an accompanying symptom of thumb carpometacarpal osteoarthritis. We describe a case of a patient who presented with increased muscle tone of the adductor pollicis muscle and chronic pain in the thenar musculature, i.e., recurrence of an adduction deformity. The patient reported a symptom-free period of 5.5 years after having received resection-suspension-arthroplasty for stage IV thumb carpometacarpal osteoarthritis until spasmodic pain appeared. Due to the functional impairment of this condition, we administered therapy including 100 units of Botox® (onabotulinumtoxinA, Allergan, Dublin, Ireland) injected with a fanning technique into the adductor pollicis muscle. Thus, we observed a substantial improvement in the patient-reported outcome measures as well as pain levels compared with initial values. The current case shows the pivotal role of the adductor pollicis muscle when patients report pain at the base of the thumb, which can cause considerable impairments despite the complication-free surgical treatment of thumb CMC OA.
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Ham HJ, Yeo IJ, Jeon SH, Lim JH, Yoo SS, Son DJ, Jang SS, Lee H, Shin SJ, Han SB, Yun JS, Hong JT. Botulinum Toxin A Ameliorates Neuroinflammation in the MPTP and 6-OHDA-Induced Parkinson's Disease Models. Biomol Ther (Seoul) 2022; 30:90-97. [PMID: 34078752 PMCID: PMC8724835 DOI: 10.4062/biomolther.2021.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
Recently, increasing evidence suggests that neuroinflammation may be a critical factor in the development of Parkinson's disease (PD) in addition to the ratio of acetylcholine/dopamine because dopaminergic neurons are particularly vulnerable to inflammatory attack. In this study, we investigated whether botulinum neurotoxin A (BoNT-A) was effective for the treatment of PD through its anti-neuroinflammatory effects and the modulation of acetylcholine and dopamine release. We found that BoNT-A ameliorated MPTP and 6-OHDA-induced PD progression, reduced acetylcholine release, levels of IL-1β, IL-6 and TNF-α as well as GFAP expression, but enhanced dopamine release and tyrosine hydroxylase expression. These results indicated that BoNT-A had beneficial effects on MPTP or 6-OHDA-induced PD-like behavior impairments via its anti-neuroinflammation properties, recovering dopamine, and reducing acetylcholine release.
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Affiliation(s)
- Hyeon Joo Ham
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - In Jun Yeo
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Seong Hee Jeon
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Jun Hyung Lim
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Sung Sik Yoo
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Dong Ju Son
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
| | | | - Haksup Lee
- ATGC Co., Seoul 06372, Republic of Korea
| | | | - Sang Bae Han
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Jae Suk Yun
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Jin Tae Hong
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju 28644, Republic of Korea
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Handa S, Shaefer JR, Keith DA. Oromandibular dystonia and temporomandibular disorders. J Am Dent Assoc 2021; 153:899-906. [PMID: 34863506 DOI: 10.1016/j.adaj.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to characterize clinical features of patients with oromandibular dystonia (OMD) who had temporomandibular disorder (TMD) symptoms. METHODS A retrospective chart review of patients seeking treatment at a tertiary-level orofacial pain clinic from January 2015 through December 2020 was undertaken. The inclusionary criteria consisted of a diagnosis of OMD (International Classification of Diseases, Revision 10 code G24.4), which had been confirmed by a neurologist. RESULTS Eleven patients met the inclusion criteria. Focal dystonia and jaw deviation OMD were the most frequent diagnoses. A dental procedure was a triggering or aggravating factor in 36.4% of patients. All but 2 patients had a sensory trick, or tactile stimulus to a particular body part, and approximately one-half of the patients used an oral appliance as a sensory trick device. All but 1 patient had received a diagnosis of TMD, with myofascial pain of the masticatory muscles being the most prevalent diagnosis. Four patients had received a recommendation for orthodontic treatment. About one-half of the patients had undergone 1 or more invasive dental or maxillofacial surgical interventions to address their dystonia. Anxiety was the most common psychological comorbidity. CONCLUSIONS Because patients with OMD commonly experience TMD symptoms, they can receive a misdiagnosis of TMD while the OMD is overlooked. PRACTICAL IMPLICATIONS Owing to concomitant TMD symptoms, patients most often seek dental consultations and undergo treatments such as orthodontic interventions and temporomandibular joint surgeries. A dentist's competency in recognizing these patients can prevent unnecessary procedures and facilitate appropriate patient care.
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Chiu YH, Chang KV, Wu WT, Hsu PC, Özçakar L. Comparative Effectiveness of Injection Therapies for Hemiplegic Shoulder Pain in Stroke: A Systematic Review and Network Meta-Analysis. Pharmaceuticals (Basel) 2021; 14:ph14080788. [PMID: 34451885 PMCID: PMC8401803 DOI: 10.3390/ph14080788] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 01/13/2023] Open
Abstract
Hemiplegic shoulder pain (HSP) hampers post-stroke functional recovery and is not well managed with conservative treatments. This systematic review aimed to examine the various injection therapies for HSP and investigate their effectiveness at different time points. The protocol of this meta-analysis was registered on INPLASY with a registration number of INPLASY202180010. PubMed, EMBASE, and Scopus were searched from their inception to 4 August 2021 for the clinical studies investigating comparative effectiveness of different injection regimens for treating hemiplegic shoulder pain in patients with stroke. The primary outcome was the weighted mean difference (WMD) on the visual analog scale (VAS) of pain reduction in the fourth-week and between the fourth and twenty-fourth weeks. Ranking probabilities of the WMD for each treatment were obtained using simulations. Seventeen studies with 595 participants were included. The network meta-analysis showed that at the fourth-week, intra-muscular botulinum toxin (BoNT) injections and suprascapular nerve blocks (SSNB) were superior to a placebo, with WMDs of 1.55 (95% CI, 0.09 to 3.01) and 1.44 (95% CI, 0.07 to 2.80), respectively. SSNB possessed the highest probability (53.3%) and appeared to be the best treatment in the fourth-week, followed by intra-muscular BoNT injections (42.6%). Intramuscular BoNT injections were better than the placebo, with a WMD of 1.57 (95% CI, 0.30 to 2.84) between the 4th and 24th weeks. Intramuscular BoNT injections had the highest probability (79.8%) as the best treatment between the 4th and 24th weeks. SSNB was likely to rank first in relieving HSP at the fourth post-treatment week, whereas intra-muscular BoNT injections had the highest probability to achieve the best treatment effectiveness in the post-injection period between the fourth and twenty-fourth weeks. However, as some of the included studies used a non-randomized controlled design, more randomized controlled trials are needed in the future to validate and better understand the short- and long-term efficacy of different injection therapies for management of HSP.
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Affiliation(s)
- Yi-Hsiang Chiu
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (P.-C.H.)
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
- Correspondence:
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (P.-C.H.)
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (P.-C.H.)
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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Seretis F, Chrysikos D, Samolis A, Troupis T. Botulinum Toxin in the Surgical Treatment of Complex Abdominal Hernias: A Surgical Anatomy Approach, Current Evidence and Outcomes. In Vivo 2021; 35:1913-1920. [PMID: 34182463 DOI: 10.21873/invivo.12457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Abdominal wall hernias represent a common problem in surgical practice. A significant proportion of them entails large defects, often difficult to primarily close without advanced techniques. Injection of botulinum toxin preoperatively at specific points targeting lateral abdominal wall musculature has been recently introduced as an adjunct in achieving primary fascia closure rates. MATERIALS AND METHODS A literature search was conducted investigating the role of botulinum toxin in abdominal wall reconstruction focusing on anatomic repair of hernia defects. RESULTS Injecting botulinum toxin preoperatively achieved chemical short-term paralysis of the lateral abdominal wall muscles, enabling a tension-free closure of the midline, which according to anatomic and clinical studies should be the goal of hernia repair. No significant complications from botulinum injections for complex hernias were reported. CONCLUSION Botulinum is a significant adjunct to complex abdominal wall reconstruction. Further studies are needed to standardize protocols and create more evidence.
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Affiliation(s)
- Fotios Seretis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Samolis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Ueda K, Black KJ. A Comprehensive Review of Tic Disorders in Children. J Clin Med 2021; 10:2479. [PMID: 34204991 PMCID: PMC8199885 DOI: 10.3390/jcm10112479] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/13/2023] Open
Abstract
Tics are characterized by sudden, rapid, recurrent, nonrhythmic movement or vocalization, and are the most common movement disorders in children. Their onset is usually in childhood and tics often will diminish within one year. However, some of the tics can persist and cause various problems such as social embarrassment, physical discomfort, or emotional impairments, which could interfere with daily activities and school performance. Furthermore, tic disorders are frequently associated with comorbid neuropsychiatric symptoms, which can become more problematic than tic symptoms. Unfortunately, misunderstanding and misconceptions of tic disorders still exist among the general population. Understanding tic disorders and their comorbidities is important to deliver appropriate care to patients with tics. Several studies have been conducted to elucidate the clinical course, epidemiology, and pathophysiology of tics, but they are still not well understood. This article aims to provide an overview about tics and tic disorders, and recent findings on tic disorders including history, definition, diagnosis, epidemiology, etiology, diagnostic approach, comorbidities, treatment and management, and differential diagnosis.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Kevin J. Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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Rodrigues FB, Duarte GS, Castelão M, Marques RE, Ferreira J, Sampaio C, Moore AP, Costa J. Botulinum toxin type A versus anticholinergics for cervical dystonia. Cochrane Database Syst Rev 2021; 4:CD004312. [PMID: 33852744 PMCID: PMC8092669 DOI: 10.1002/14651858.cd004312.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This is an update of a Cochrane Review first published in 2005. Cervical dystonia is the most common form of focal dystonia and is a highly disabling movement disorder, characterised by involuntary, usually painful, head posturing. Currently, botulinum toxin type A (BtA) is considered the first line therapy for this condition. Before BtA, anticholinergics were the most widely accepted treatment. OBJECTIVES To compare the efficacy, safety, and tolerability of BtA versus anticholinergic drugs in adults with cervical dystonia. SEARCH METHODS We searched the Cochrane Movement Disorders' Trials Register to June 2003, screened reference lists of articles and conference proceedings to September 2018, and searched CENTRAL, MEDLINE, and Embase, with no language restrictions, to July 2020. SELECTION CRITERIA Double-blind, parallel, randomised trials (RCTs) of BtA versus anticholinergic drugs in adults with cervical dystonia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed records, selected included studies, extracted data using a paper pro forma, and evaluated the risk of bias and quality of the evidence. We resolved disagreements by consensus or by consulting a third review author. If enough data had been available, we were to perform meta-analyses using a random-effects model for the comparison of BtA versus anticholinergic drugs to estimate pooled effects and corresponding 95% confidence intervals (95% CI). The primary efficacy outcome was improvement in cervical dystonia-specific impairment. The primary safety outcome was the proportion of participants with any adverse event. MAIN RESULTS We included one RCT of moderate overall risk of bias (as multiple domains were at unclear risk of bias), which included 66 BtA-naive participants with cervical dystonia. Two doses of BtA (Dysport; week 0 and 8; mean dose 262 to 292 U) were compared with daily trihexyphenidyl (up to 24 mg daily). The trial was sponsored by the BtA producer. BtA reduced cervical dystonia severity by an average of 2.5 points (95% CI 0.68 to 4.32) on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscale 12 weeks after injection, compared to trihexyphenidyl. More participants reported adverse events in the trihexyphenidyl treatment group (76 events), compared with the BtA group (31 events); however, the difference in dropouts due to adverse events was inconclusive between groups. There was a decreased risk of dry mouth, and memory problems with BtA, but the differences were inconclusive between groups for the other reported side effects (blurred vision, dizziness, depression, fatigue, pain at injection site, dysphagia, and neck weakness). AUTHORS' CONCLUSIONS We found very low-certainty evidence that BtA is more effective, better tolerated, and safer than trihexyphenidyl. We found no information on a dose-response relationship with BtA, differences between BtA formulations or different anticholinergics, the utility of electromyography-guided injections, or the duration of treatment effect.
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Affiliation(s)
- Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Mafalda Castelão
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Raquel E Marques
- Department of Ophthalmology, Hospital de Santa Maria, Lisboa, Portugal
| | - Joaquim Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | | | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Park MY, Ahn KY. Scientific review of the aesthetic uses of botulinum toxin type A. Arch Craniofac Surg 2021; 22:1-10. [PMID: 33714246 PMCID: PMC7968983 DOI: 10.7181/acfs.2021.00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 01/02/2023] Open
Abstract
Botulinum toxin type A (BoNT-A), onabotulinumtoxinA (Botox) was approved by the United States Food and Drug Administration for temporary improvement of glabellar lines in patients 65 years and younger in 2002, and has also been used widely for aesthetic purposes such as hyperhidrosis, body shape contouring, and other noninvasive facial procedures. BoNT-A inhibits presynaptic exocytosis of acetylcholine (ACh)-containing vesicles into the neuromuscular junction at cholinergic nerve endings of the peripheral nervous system, thereby paralyzing skeletal muscles. ACh is the most broadly used neurotransmitter in the somatic nervous system, preganglionic and postganglionic fibers of parasympathetic nerves, and preganglionic fibers or postganglionic sudomotor nerves of sympathetic nerves. The scientific basis for using BoNT-A in various cosmetic procedures is that its function goes beyond the dual role of muscle paralysis and neuromodulation by inhibiting the secretion of ACh. Although the major target organs for aesthetic procedures are facial expression muscles, skeletal body muscles, salivary glands, and sweat glands, which are innervated by the somatic or autonomic nerves of the peripheral cholinergic nerve system, few studies have attempted to directly explain the anatomy of the areas targeted for injection by addressing the neural physiology and rationale for specific aesthetic applications of BoNT-A therapy. In this article, we classify the various cosmetic uses of BoNT-A according to the relevant component of the peripheral nervous system, and describe scientific theories regarding the anatomy and physiology of the cholinergic nervous system. We also review critical physiological factors and conditions influencing the efficacy of BoNT-A for the rational aesthetic use of BoNT-A. We hope that this comprehensive review helps promote management policies to support long-term, safe, successful practice. Furthermore, based on this, we look forward to developing and expanding new advanced indications for the aesthetic use of BoNT-A in the future.
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Affiliation(s)
- Mee Young Park
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Ki Young Ahn
- Dr. Ahn’s Aesthetic and Plastic Surgical Clinic and Botulinum Center, Daegu, Korea
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Abstract
A new complexing protein-free botulinum toxin Type A (CBoNT) with the same mechanism of action as the botulinum toxin complex onabotulinumtoxinA (OBoNT) and complexing protein-free incobotulinumtoxinA (IBoNT) was recently developed.
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Alshamlan FT, Al Abdulhadi HA, Alwalmany MM, Alotaibi KS. The Efficacy of Dose Increments of Botulinum Toxin A in the Treatment of Childhood Esotropia. Clin Ophthalmol 2021; 15:113-120. [PMID: 33469257 PMCID: PMC7811462 DOI: 10.2147/opth.s294396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background Botulinum toxin is known to have a powerful chemodenervation effect, and it is a well-established alternative to incisional surgery for strabismus. This study aims to investigate the efficacy of dose increments of botulinum toxin A (BTA) for the treatment of specific ranges of angle deviation. Methods This was a prospective study that included patients presenting with esotropia to Dhahran Eye Specialist Hospital between 2016 and 2020, who were managed by a single surgeon. Botulinum toxin was given in different dosages (2.5, 5, 7.5, 10 international units (IU)) according to the size of deviation (11–19, 20–29, 30–39, and ≥40 prism diopters (PD)), respectively. A successful outcome was defined as deviation ≤10 PD in the last visit (a minimum of 6 months) following a single injection. Results A total of 56 patients with esotropia were included. The mean pre-treatment angle of deviation was 38.6 ± 2.5 PD. BTA injection in a dose of 2.5 IU for the 11–19 PD angle of deviation showed the highest rate of successful outcomes (75%). According to the type of esotropia, partially accommodative esotropia showed the best response to the use of dose increments (59%). The incidence of ptosis post-BTA injection was the least (37.5%) with the smallest dose (2.5 IU). Conclusion BTA usage in dose increments is safe, efficient, and might be more cost-effective with less incidence of BTA associated complications. Different esotropia diagnoses have different clinical responses. However, larger studies are necessary to better predict the outcome of using dose increments.
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Affiliation(s)
- Fatemah T Alshamlan
- Pediatric Ophthalmology and Strabismus Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Halla A Al Abdulhadi
- Pediatric Ophthalmology and Strabismus Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Mofi M Alwalmany
- Pediatric Ophthalmology and Strabismus Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Khalid S Alotaibi
- Pediatric Ophthalmology and Strabismus Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
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Meglio M, Olivola E, Santilli M, Lena F, Centonze D, Bologna M, Modugno N. Effects of Prismatic Lenses on Lateral Axial Dystonia in Parkinson's Disease: A Pilot Study. INNOVATIONS IN CLINICAL NEUROSCIENCE 2021; 18:39-42. [PMID: 34150363 PMCID: PMC8213334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE: In Parkinson's disease (PD), postural abnormalities such as lateral axial dystonia (LAD) are relatively common. Evidence suggests that both peripheral and central mechanisms contribute to these postural abnormalities. We previously reported an improvement in LAD following the use of prisms in two PD patients. Here, we further investigate the effects of prismatic lenses in a case series of nine patients with PD and LAD. METHODS: Nine patients underwent an orthoptic evaluation and were provided with prismatic lenses. Patients were evaluated at baseline and after one and three months of permanent prismatic lens use and again re-evaluated one month after the discontinuation of prismatic lens use. RESULTS: We found a linear relationship between disease duration and LAD severity. Compared to basal measurements, we observed a slight improvement in LAD. Furthermore, we found a significant reduction in self-perceived back pain due to the use of prismatic lenses. There was no significant association between the individual effects of prismatic lenses in patients with PD and their baseline LAD or other clinical and demographic features (all P>0.05). CONCLUSION: The present pilot study provides novel data on the possible effectiveness of prismatic lenses for LAD treatment in PD patients.
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Affiliation(s)
- Michele Meglio
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Enrica Olivola
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Marco Santilli
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Francesco Lena
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Diego Centonze
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Matteo Bologna
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
| | - Nicola Modugno
- Dr. Meglio is with IRCCS Neuromed in the Unit of Neuro-Ophthalmology in Pozzilli, Italy; he's a PhD student in Neuroscience at University of Rome Tor Vergata in Rome, Italy
- Drs. Olivola, Santilli, Lena, Centonze, Bologna, and Modugno are with the IRCCS Neuromed in their Department of Neurology
- Dr. Modugno is the head of the Parkinson Center in the same Institute. Prof. Centonze is Full Professor of Neurology at the University of Rome Tor Vergata and Director of the Department of Neurology at the IRCCS Neuromed
- Dr. Bologna is with the Department of Human Neurosciences at Sapienza University in Rome, Italy
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Duarte GS, Rodrigues FB, Marques RE, Castelão M, Ferreira J, Sampaio C, Moore AP, Costa J. Botulinum toxin type A therapy for blepharospasm. Cochrane Database Syst Rev 2020; 11:CD004900. [PMID: 33211907 PMCID: PMC8094161 DOI: 10.1002/14651858.cd004900.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This is an update of a Cochrane Review first published in 2005. Blepharospasm is the second most common form of focal dystonia. It is a disabling disorder, characterised by chronic, intermittent or persistent, involuntary eyelid closure, due to spasmodic contractions of the orbicularis oculi muscles. Currently, botulinum toxin type A (BtA) is considered the first line of therapy for this condition. OBJECTIVES To compare the efficacy, safety, and tolerability of BtA versus placebo in people with blepharospasm. SEARCH METHODS We searched Cochrane Movement Disorders' Trials Register, CENTRAL, MEDLINE, Embase, reference lists of included articles, and conference proceedings. We ran all elements of the search, with no language restrictions, in July 2020. SELECTION CRITERIA Double-blind, parallel, randomised, placebo-controlled trials (RCTs) of BtA versus placebo in adults with blepharospasm. DATA COLLECTION AND ANALYSIS Two review authors independently assessed records, selected included studies, extracted data using a paper pro forma, and evaluated the risk of bias. We resolved disagreements by consensus, or by consulting a third review author. We performed meta-analyses using a random-effects model, for the comparison of BtA versus placebo, to estimate pooled effects and corresponding 95% confidence intervals (95% CI). We did not carry out any prespecified subgroup analyses. The primary efficacy outcome was improvement on any validated symptomatic rating scale. The primary safety outcome was the proportion of participants with any adverse event. MAIN RESULTS We included three RCTs, assessed at low to moderate overall risk of bias, which randomised 313 participants with blepharospasm. Two studies excluded participants with poorer prior responses to BtA treatment, therefore, they included an enriched population with a higher probability of benefiting from this therapy. All trials were industry-funded. All RCTs evaluated the effect of a single BtA treatment session. BtA resulted in a moderate to large improvement in blepharospasm-specific severity, with a reduction of 0.93 points on the Jankovic Rating Scale (JRS) severity subscale at four to six weeks after injection (95% confidence interval (CI) 0.61 to 1.25; I² = 9%) compared to placebo. BtA was also resulted in a moderate to large improvement in blepharospasm-specific disability and blepharospasm-specific involuntary movements at four to six weeks after injection (disability: 0.69 JRS disability subscale points, 95% CI 0.18 to 1.19; I² = 74%; blepharospasm-specific involuntary movements: standardised mean difference (SMD) 0.79, 0.31 to 1.27; I² = 58%) compared to placebo. BtA did not show a risk of adverse events (risk ratio (RR) 1.18, 95% CI 0.87 to 1.60; I² = 0%). However, BtA increased the risk of vision complaints and eyelid ptosis (vision complaints: RR 5.73, 95% CI 1.79 to 18.36; I² = 51%; eyelid ptosis: RR 4.02, 95% CI 1.61 to 10.00; I² = 39%). There was no distinction between BtA and placebo in the number of participants who dropped out of the trial. A single trial estimated the duration of effects to be 10.6 weeks (range 6.1 to 19.1). We found no evidence supporting the existence of a clear dose-response relationship with BtA. We found no data reporting the impact of BtA on health-related quality of life, or the development of secondary non-responsiveness. AUTHORS' CONCLUSIONS We are moderately certain that a single BtA treatment resulted in a clinically relevant reduction of blepharospasm-specific severity and disability, and have low certainty that it is well tolerated, when compared with placebo. There is low-certainty evidence that people treated with BtA are not at an increased risk of developing adverse events, though BtA treatment likely increases the risk of visual complaints and eyelid ptosis. There are no data from RCTs evaluating the effectiveness and safety of repeated BtA injection cycles. There is no evidence from RCTs to allow us to draw definitive conclusions on the optimal treatment intervals and doses, or the impact on quality of life.
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Affiliation(s)
- Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Raquel E Marques
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Ophthalmology University Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Mafalda Castelão
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Joaquim Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | | | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Duarte GS, Rodrigues FB, Castelão M, Marques RE, Ferreira J, Sampaio C, Moore AP, Costa J. Botulinum toxin type A therapy for hemifacial spasm. Cochrane Database Syst Rev 2020; 11:CD004899. [PMID: 33211908 PMCID: PMC8078498 DOI: 10.1002/14651858.cd004899.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This is an update of a Cochrane Review, first published in 2005. Hemifacial spasm (HFS) is characterised by unilateral, involuntary contractions of the muscles innervated by the facial nerve. It is a chronic disorder, and spontaneous recovery is very rare. The two treatments routinely available are microvascular decompression and intramuscular injections with botulinum toxin type A (BtA). OBJECTIVES To compare the efficacy, safety, and tolerability of BtA versus placebo in people with HFS. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, reference lists of articles, and conference proceedings in July 2020. We ran the electronic database search, with no language restrictions, in July 2020. SELECTION CRITERIA Double-blind, parallel, randomised, placebo-controlled trials (RCTs) of BtA versus placebo in adults with HFS. DATA COLLECTION AND ANALYSIS Two review authors independently assessed records. We planned to select included studies, extract data using a paper pro forma, and evaluate the risk of bias. We resolved disagreements by consensus, or by consulting a third review author. We planned to perform meta-analyses. The primary efficacy outcome was HFS-specific improvement. The primary safety outcome was the proportion of participants with any adverse event. MAIN RESULTS We found no parallel-group randomised controlled trials comparing BtA and placebo in HFS. AUTHORS' CONCLUSIONS We did not find any randomised trials that evaluated the efficacy and safety of botulinum toxin type A in people with hemifacial spasm, so we are unable to draw any conclusions. Observational data show a strong association between BtA treatment and symptom improvement, and a favourable safety profile. While it is unlikely that future placebo-controlled RCTs will evaluate absolute efficacy and safety, they should address relevant questions for both people with HFS (such as long-term effects, quality of life, and other patient-reported outcomes), and clinicians (such as relative effectiveness of different BtA formulations and schemes of treatment) to better guide clinical practice.).
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Affiliation(s)
- Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Mafalda Castelão
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Raquel E Marques
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Ophthalmology University Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Joaquim Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | | | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Rodrigues FB, Duarte GS, Marques RE, Castelão M, Ferreira J, Sampaio C, Moore AP, Costa J. Botulinum toxin type A therapy for cervical dystonia. Cochrane Database Syst Rev 2020; 11:CD003633. [PMID: 33180963 PMCID: PMC8106615 DOI: 10.1002/14651858.cd003633.pub4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This is an update of a Cochrane Review first published in 2005. Cervical dystonia is the most common form of focal dystonia, and is a highly disabling movement disorder, characterised by involuntary, usually painful, head posturing. Currently, botulinum toxin type A (BtA) is considered the first line therapy for this condition. OBJECTIVES To compare the efficacy, safety, and tolerability of BtA versus placebo, in people with cervical dystonia. SEARCH METHODS We searched Cochrane Movement Disorders' Trials Register, CENTRAL, MEDLINE, Embase, reference lists of articles, and conference proceedings in July 2020. All elements of the search, with no language restrictions, were last run in July 2020. SELECTION CRITERIA Double-blind, parallel, randomised, placebo-controlled trials (RCTs) of BtA versus placebo in adults with cervical dystonia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed records, selected included studies, extracted data using a paper pro forma, and evaluated the risk of bias. We resolved disagreements by consensus or by consulting a third review author. We performed meta-analyses using a random-effects model, for the comparison of BtA versus placebo, to estimate pooled effects and corresponding 95% confidence intervals (95% CI). We performed preplanned subgroup analyses according to BtA dose used, the BtA formulation used, and the use (or not) of guidance for BtA injections. The primary efficacy outcome was improvement in cervical dystonia-specific impairment. The primary safety outcome was the proportion of participants with any adverse event. MAIN RESULTS We included nine RCTs, with moderate, overall risk of bias, that included 1144 participants with cervical dystonia. Seven studies excluded participants with poorer responses to BtA treatment, therefore, including an enriched population with a higher probability of benefiting from this therapy. Only one trial was independently funded. All RCTs evaluated the effect of a single BtA treatment session, using doses from 150 U to 500 U of onabotulinumtoxinA (Botox), 120 U to 240 U of incobotulinumtoxinA (Xeomin), and 250 U to 1000 U of abobotulinumtoxinA (Dysport). BtA resulted in a moderate to large improvement from the participant's baseline clinical status, assessed by the investigators, with a mean reduction of 8.09 points in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS total score) at week four after injection (95% CI 6.22 to 9.96; I² = 0%) compared to placebo. This corresponded, on average, to a 18.4% improvement from baseline. The mean difference (MD) in TWSTRS pain subscore at week four was 2.11 (95% CI 1.38 to 2.83; I² = 0%) compared to placebo. Overall, both participants and clinicians reported an improvement of subjective clinical status. It was unclear if dropouts due to adverse events differed (risk ratio (RR) 2.51; 95% CI 0.42 to 14.94; I² = 0%) However, BtA treatment increased the risk of experiencing an adverse event (R) 1.23; 95% CI 1.05 to 1.43; I² = 28%). Neck weakness (14%; RR 3.40; 95% CI 1.19 to 9.71; I² = 15%), dysphagia (11%; RR 3.19; 95% CI 1.79 to 5.70; I² = 0%), and diffuse weakness or tiredness (8%; RR 1.80; 95% CI 1.10 to 2.95; I² = 0%) were the most common treatment-related adverse events. Treatment with BtA resulted in a decreased risk of dropouts. We have moderate certainty in the evidence across all of the aforementioned outcomes, with the exception of subjective assessment and tolerability, in which we have high confidence in the evidence. We found no evidence supporting the existence of a clear dose-response relationship between BtA and improvement in cervical dystonia-specific impairment, a destinction between BtA formulations, or a variation with use of EMG-guided injection for efficacy outcomes. Due to clinical heterogeneity, we did not pool health-related quality of life data, duration of clinical effect, or the development of secondary non-responsiveness. AUTHORS' CONCLUSIONS We are moderately certain in the evidence that a single BtA treatment session resulted in a clinically relevant reduction of cervical dystonia-specific impairment, and pain, and highly certain that it is well tolerated, compared with placebo. There is moderate-certainty evidence that people treated with BtA are at an increased risk of developing adverse events, most notably, dysphagia, neckweakness and diffuse weakness or tiredness. There are no data from RCTs evaluating the effectiveness and safety of repeated BtA injection cycles. There is no evidence from RCTs to allow us to draw definitive conclusions on the optimal treatment intervals and doses, the usefulness of guidance techniques for injection, the impact on quality of life, or the duration of treatment effect.
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Affiliation(s)
- Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Raquel E Marques
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Ophthalmology University Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Mafalda Castelão
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Joaquim Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | | | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Lin L, Olson ME, Sugane T, Turner LD, Tararina MA, Nielsen AL, Kurbanov EK, Pellett S, Johnson EA, Cohen SM, Allen KN, Janda KD. Catch and Anchor Approach To Combat Both Toxicity and Longevity of Botulinum Toxin A. J Med Chem 2020; 63:11100-11120. [PMID: 32886509 PMCID: PMC7581224 DOI: 10.1021/acs.jmedchem.0c01006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Botulinum neurotoxins have remarkable persistence (∼weeks to months in cells), outlasting the small-molecule inhibitors designed to target them. To address this disconnect, inhibitors bearing two pharmacophores-a zinc binding group and a Cys-reactive warhead-were designed to leverage both affinity and reactivity. A series of first-generation bifunctional inhibitors was achieved through structure-based inhibitor design. Through X-ray crystallography, engagement of both the catalytic Zn2+ and Cys165 was confirmed. A second-generation series improved on affinity by incorporating known reversible inhibitor pharmacophores; the mechanism was confirmed by exhaustive dialysis, mass spectrometry, and in vitro evaluation against the C165S mutant. Finally, a third-generation inhibitor was shown to have good cellular activity and low toxicity. In addition to our findings, an alternative method of modeling time-dependent inhibition that simplifies assay setup and allows comparison of inhibition models is discussed.
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Affiliation(s)
- Lucy Lin
- Departments of Chemistry and Immunology, The Skaggs Institute for Chemical Biology, Worm Institute of Research and Medicine (WIRM), Scripps Research, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Margaret E. Olson
- Departments of Chemistry and Immunology, The Skaggs Institute for Chemical Biology, Worm Institute of Research and Medicine (WIRM), Scripps Research, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Takashi Sugane
- Departments of Chemistry and Immunology, The Skaggs Institute for Chemical Biology, Worm Institute of Research and Medicine (WIRM), Scripps Research, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Lewis D. Turner
- Departments of Chemistry and Immunology, The Skaggs Institute for Chemical Biology, Worm Institute of Research and Medicine (WIRM), Scripps Research, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Margarita A. Tararina
- Program in Biomolecular Pharmacology, Boston University School of Medicine, Boston, Massachusetts 02118, United States
| | - Alexander L. Nielsen
- Departments of Chemistry and Immunology, The Skaggs Institute for Chemical Biology, Worm Institute of Research and Medicine (WIRM), Scripps Research, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Elbek K. Kurbanov
- Department of Chemistry and Biochemistry, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Sabine Pellett
- Department of Bacteriology, University of Wisconsin, 1550 Linden Drive, Madison, Wisconsin 53706, United States
| | - Eric A. Johnson
- Department of Bacteriology, University of Wisconsin, 1550 Linden Drive, Madison, Wisconsin 53706, United States
| | - Seth M. Cohen
- Department of Chemistry and Biochemistry, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Karen N. Allen
- Department of Chemistry, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts 02215, United States
| | - Kim D. Janda
- Departments of Chemistry and Immunology, The Skaggs Institute for Chemical Biology, Worm Institute of Research and Medicine (WIRM), Scripps Research, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
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Parsi MA, Jirapinyo P, Abu Dayyeh BK, Bhutani MS, Chandrasekhara V, Krishnan K, Kumta NA, Melson J, Pannala R, Trikudanathan G, Trindade AJ, Sethi A, Watson RR, Maple JT, Lichtenstein DR. Techniques and devices for the endoscopic treatment of gastroparesis (with video). Gastrointest Endosc 2020; 92:483-491. [PMID: 32684298 DOI: 10.1016/j.gie.2020.03.3857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Several endoscopic treatment modalities have been described that aim to improve gastric emptying and/or symptoms associated with gastroparesis refractory to dietary and pharmacologic management. METHODS In this report we review devices and techniques for endoscopic treatment of gastroparesis, the evidence regarding their efficacy and safety, and the financial considerations for their use. RESULTS Endoscopic modalities for treatment of gastroparesis can be broadly categorized into pyloric, nonpyloric, and nutritional therapies. Pyloric therapies such as botulinum toxin injection, stent placement, pyloroplasty, and pyloromyotomy specifically focus on pylorospasm as a therapeutic target. These interventions aim to reduce the pressure gradient across the pyloric sphincter, with a resultant improvement in gastric emptying. Nonpyloric therapies, such as venting gastrostomy and gastric electrical stimulation, are intended to improve symptoms. Nutritional therapies, such as feeding tube placement, aim to provide nutritional support. CONCLUSIONS Several endoscopic interventions have shown utility in improving the quality of life and symptoms of select patients with refractory gastroparesis. Methods to identify which patients are best suited for a specific treatment are not well established. Endoscopic pyloromyotomy is a relatively recent development that may prove to be the preferred pyloric-directed intervention, although additional and longer-term outcomes are needed.
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Affiliation(s)
- Mansour A Parsi
- Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Manoop S Bhutani
- Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinay Chandrasekhara
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nikhil A Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
| | - Joshua Melson
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rahul Pannala
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Guru Trikudanathan
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Arvind J Trindade
- Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amrita Sethi
- Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Rabindra R Watson
- New York-Presbyterian Medical Center/Columbia University Medical Center, New York, New York, USA
| | - John T Maple
- Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - David R Lichtenstein
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Leese C, Bresnahan R, Doran C, Simsek D, Fellows AD, Restani L, Caleo M, Schiavo G, Mavlyutov T, Henke T, Binz T, Davletov B. Duplication of clostridial binding domains for enhanced macromolecular delivery into neurons. Toxicon X 2020; 5:100019. [PMID: 32140681 PMCID: PMC7043326 DOI: 10.1016/j.toxcx.2019.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/25/2019] [Accepted: 12/19/2019] [Indexed: 12/03/2022] Open
Abstract
Neurological diseases constitute a quarter of global disease burden and are expected to rise worldwide with the ageing of human populations. There is an increasing need to develop new molecular systems which can deliver drugs specifically into neurons, non-dividing cells meant to last a human lifetime. Neuronal drug delivery must rely on agents which can recognise neurons with high specificity and affinity. Here we used a recently introduced ‘stapling’ system to prepare macromolecules carrying duplicated binding domains from the clostridial family of neurotoxins. We engineered individual parts of clostridial neurotoxins separately and combined them using a strong alpha-helical bundle. We show that combining two identical binding domains of tetanus and botulinum type D neurotoxins, in a sterically defined way by protein stapling, allows enhanced intracellular delivery of molecules into neurons. We also engineered a botulinum neurotoxin type C variant with a duplicated binding domain which increased enzymatic delivery compared to the native type C toxin. We conclude that duplication of the binding parts of tetanus or botulinum neurotoxins will allow production of high avidity agents which could deliver imaging reagents and large therapeutic enzymes into neurons with superior efficiency. Macromolecules carrying duplicated clostridial binding domains (Hc) were produced. Double tetanus Hc increased protein delivery into cultured rodent neurones. Double tetanus Hc increased enzyme delivery into rodent spinal cord and brain area. Double BoNT/D Hc increased enzyme delivery into rat and human neurones in culture. Recombinant double-Hc BoNT/C was engineered, increasing delivery in cell cultures.
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Affiliation(s)
- Charlotte Leese
- Department of Biomedical Science, University of Sheffield, Sheffield, S10 2TN, UK
| | - Rebecca Bresnahan
- Department of Biomedical Science, University of Sheffield, Sheffield, S10 2TN, UK
| | - Ciara Doran
- Department of Biomedical Science, University of Sheffield, Sheffield, S10 2TN, UK
| | - Deniz Simsek
- Department of Biomedical Science, University of Sheffield, Sheffield, S10 2TN, UK
| | - Alexander D Fellows
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Laura Restani
- CNR Neuroscience Institute, Pisa, 1-56124 Pisa, Italy
| | - Matteo Caleo
- CNR Neuroscience Institute, Pisa, 1-56124 Pisa, Italy
| | - Giampietro Schiavo
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK.,UK Dementia Research Institute, University College London, London, WC1E 6BT, UK
| | - Timur Mavlyutov
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Tina Henke
- Institute of Cellular Biochemistry, Hannover Medical School, Hannover, 30625, Germany
| | - Thomas Binz
- Institute of Cellular Biochemistry, Hannover Medical School, Hannover, 30625, Germany
| | - Bazbek Davletov
- Department of Biomedical Science, University of Sheffield, Sheffield, S10 2TN, UK
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Symptomatic Brain Hemorrhages from Cavernous Angioma After Botulinum Toxin Injections, a Role of TLR/MEKK3 Mechanism? Case Report and Review of the Literature. World Neurosurg 2020; 136:7-11. [PMID: 31917316 DOI: 10.1016/j.wneu.2019.12.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cavernous angiomas (CAs) are vascular malformations that may result in stroke. CASE DESCRIPTION Herein, we evaluate a CA patient with chronic migraine who experienced 2 documented symptomatic hemorrhages after receiving respective high doses of botulinum toxin (Btx). CONCLUSIONS Recently, bacterial lipopolysaccharide has been reported to contribute to CA development through Toll-like receptor signaling, causing hemorrhagic angiogenic proliferation. Lipopolysaccharide and Btx share a common intracellular signaling pathway driving CA development and hemorrhage. Significance of these observations is demonstrated by previous works on plasma molecules showing prognostic associations with symptomatic hemorrhages in human CA, related to the same canonical pathways. Authors suggest careful tracking of the association of Btx and hemorrhage in CA patients.
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47
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Bölük C, Gökçe Y, Gündüz A, Adatepe N, Savrun F, Kaytaz A, Kızıltan M. Botulinum toxin injections for neurological disorders: Experience between 1994 and 2019. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_36_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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48
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Hefter H, Rosenthal D, Bigalke H, Moll M. Clinical relevance of neutralizing antibodies in botulinum toxin long-term treated still-responding patients with cervical dystonia. Ther Adv Neurol Disord 2019; 12:1756286419892078. [PMID: 31897089 PMCID: PMC6918489 DOI: 10.1177/1756286419892078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background: The aim of the study was to test the clinical relevance of neutralizing antibodies (NABs) in patients with cervical dystonia (CD) still responding to repeat injections with botulinum toxin type A (BoNT/A). Methods: Enzyme-linked immunosorbent assay (ELISA)-test evidence from a cross-sectional study on 221 CD-patients with treatment durations of between 2 and 21 years and still responding to repeat BoNT/A-injections showed the presence of antibodies against BoNT/A in 39 patients. A mouse hemi-diaphragm (MHDA) confirmation test was performed in these 39 ELISA-positive patients, and demographic (age, sex, age at onset of CD) and treatment-related (duration of treatment, mean dose of the last 10 injections, TSUI-score, patient’s subjective scoring of the treatment effect, patient’s scoring of quality of life by means of the CDQ24-questionnaire) data from these 39 patients were compared with data from ELISA-negative patients. Paralysis time, the MHDA outcome measure, was correlated with clinical data. Results: The ELISA-positive CD-patients had significantly higher TSUI-scores (p < 0.015), and had been treated for significant longer (p < 0.022) and with significantly higher doses (p < 0.001). Patient’s rating of BoNT/A-treatment effect and quality of life tended to be worse in ELISA-positive compared with ELISA-negative patients. The paralysis time of ELISA-positive patients was significantly correlated with the mean dose of the last 10 injections (p < 0.027) and the pain subscore of the CDQ24 (p < 0.012). Conclusions: Presence of NABs is clinically relevant in CD, leading to a significantly worse head position, therapy with significantly higher BoNT/A doses, and a correlation between the CDQ24 pain-subscore and antibody titers.
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Affiliation(s)
- Harald Hefter
- Department of Neurology, Heinrich-Heine-Universitat Dusseldorf, Moorenstrasse 5, Düsseldorf, 40225, Germany
| | - Dietmar Rosenthal
- Department of Neurology, Heinrich-Heine-Universitat Dusseldorf, Düsseldorf, Germany
| | | | - Marek Moll
- Department of Neurology, Heinrich-Heine-Universitat Dusseldorf, Düsseldorf, Germany
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49
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Chao YYY, Tseng FW, Yang YL, Chen YH, Hsu NJ, Chang LY. IncobotulinumtoxinA for the Treatment of Glabellar Frown Lines: A Prospective, Multicenter, Single-arm Study in Taiwan. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2019; 12:E53-E57. [PMID: 32038766 PMCID: PMC7002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: We assessed clinical effectiveness, longevity of treatment effects, and patient satisfaction with incobotulinumtoxinA for glabellar frown lines (GFL) treatment in Asian patients. Design, Setting, and Participants: This was a prospective, multicenter, single-arm, open-label study at six sites in Taiwan. Patients aged 20 to 65 years with mild to very severe GFLs (Merz scale: 1-4 points) were eligible; 45 patients [including 23 BoNT/A-naïve and 22 previously-treated ("switch") patients were enrolled. Patients received intramuscular incobotulinumtoxinA injection at up to five injection points. Total doses ranged from 12 to 20U. Measurements: Investigators assessed improvements in dynamic GFLs at Days 14 and 120 using the validated five-point Merz scale (0=no lines; 4=very severe lines). Treatment satisfaction was self-reported by patients via questionnaire. Results: All patients showed excellent response to treatment in that Merz scores at Day 14 were 0 or 1 point(s). Both groups showed a mean improvement of 2.9 points; the response rate (1-point improvement or more from baseline) was 100 percent. GFL improvement was maintained over at least four months in both groups (mean improvements at Day 120: 1.5 points, naïve; 1.7 points, switch). Patient satisfaction ratings remained high (almost 100% in both groups) throughout the study. There were no statistically significant differences between groups regarding treatment satisfaction or GFL improvement (Merz score) at Days 14 and 120. No adverse events occurred. Conclusion: In Asian patients, incobotulinumtoxinA treatment for dynamic GFLs is effective and long lasting, with no expected differences between BoNT/A-naïve patients and those switching from other BoNT/As. IncobotulinumtoxinA yields consistent and natural-looking results for first and subsequent treatments.
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Affiliation(s)
- Yates Yen-Yu Chao
- Dr. Chao is with the CHAO Institute of Aesthetic Medicine in Taipei, Taiwan
- Dr. Tseng is with the Milano Aesthetic Clinic in Taipei, Taiwan
- Dr. Yang is with the MED Aesthetic Clinic in Kaohsiung, Taiwan
- Dr. Chen is with the YaSkin Dermatology Clinic in Kaohsiung, Taiwan
- Dr. Hsu is with the Nai Jen Hsu Dermatology Clinic in Tainan, Taiwan
- Dr. Chang is with Liyen's Clinic of Plastic Surgery in Taichung, Taiwan
| | - Fang-Wen Tseng
- Dr. Chao is with the CHAO Institute of Aesthetic Medicine in Taipei, Taiwan
- Dr. Tseng is with the Milano Aesthetic Clinic in Taipei, Taiwan
- Dr. Yang is with the MED Aesthetic Clinic in Kaohsiung, Taiwan
- Dr. Chen is with the YaSkin Dermatology Clinic in Kaohsiung, Taiwan
- Dr. Hsu is with the Nai Jen Hsu Dermatology Clinic in Tainan, Taiwan
- Dr. Chang is with Liyen's Clinic of Plastic Surgery in Taichung, Taiwan
| | - Yu-Li Yang
- Dr. Chao is with the CHAO Institute of Aesthetic Medicine in Taipei, Taiwan
- Dr. Tseng is with the Milano Aesthetic Clinic in Taipei, Taiwan
- Dr. Yang is with the MED Aesthetic Clinic in Kaohsiung, Taiwan
- Dr. Chen is with the YaSkin Dermatology Clinic in Kaohsiung, Taiwan
- Dr. Hsu is with the Nai Jen Hsu Dermatology Clinic in Tainan, Taiwan
- Dr. Chang is with Liyen's Clinic of Plastic Surgery in Taichung, Taiwan
| | - Ya-Hui Chen
- Dr. Chao is with the CHAO Institute of Aesthetic Medicine in Taipei, Taiwan
- Dr. Tseng is with the Milano Aesthetic Clinic in Taipei, Taiwan
- Dr. Yang is with the MED Aesthetic Clinic in Kaohsiung, Taiwan
- Dr. Chen is with the YaSkin Dermatology Clinic in Kaohsiung, Taiwan
- Dr. Hsu is with the Nai Jen Hsu Dermatology Clinic in Tainan, Taiwan
- Dr. Chang is with Liyen's Clinic of Plastic Surgery in Taichung, Taiwan
| | - Nai-Jen Hsu
- Dr. Chao is with the CHAO Institute of Aesthetic Medicine in Taipei, Taiwan
- Dr. Tseng is with the Milano Aesthetic Clinic in Taipei, Taiwan
- Dr. Yang is with the MED Aesthetic Clinic in Kaohsiung, Taiwan
- Dr. Chen is with the YaSkin Dermatology Clinic in Kaohsiung, Taiwan
- Dr. Hsu is with the Nai Jen Hsu Dermatology Clinic in Tainan, Taiwan
- Dr. Chang is with Liyen's Clinic of Plastic Surgery in Taichung, Taiwan
| | - Li-Yen Chang
- Dr. Chao is with the CHAO Institute of Aesthetic Medicine in Taipei, Taiwan
- Dr. Tseng is with the Milano Aesthetic Clinic in Taipei, Taiwan
- Dr. Yang is with the MED Aesthetic Clinic in Kaohsiung, Taiwan
- Dr. Chen is with the YaSkin Dermatology Clinic in Kaohsiung, Taiwan
- Dr. Hsu is with the Nai Jen Hsu Dermatology Clinic in Tainan, Taiwan
- Dr. Chang is with Liyen's Clinic of Plastic Surgery in Taichung, Taiwan
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50
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Morgante F, Bavikatte G, Anwar F, Mohamed B. The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®). Ther Adv Neurol Disord 2019; 12:1756286419888601. [PMID: 31819763 PMCID: PMC6883364 DOI: 10.1177/1756286419888601] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022] Open
Abstract
Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson’s
disease, motor neuron disease, cerebral palsy, and stroke) and is defined as
excessive saliva accumulation leading to unintentional loss of saliva from the
mouth. Sialorrhoea increases the overall burden on the patient and their
caregivers, the impact of which can be both physical and psychosocial.
Treatments for sialorrhoea range from lifestyle and behavioural guidance, to
medications, surgery or radiation. Nonpharmacological interventions include
advice on posture, swallowing control, cough management, dietary changes, eating
and drinking techniques, and behavioural modification; however, these
conservative measures may be ineffective for people with progressive
neurological conditions. The pharmacological treatment of sialorrhoea is
challenging because medications licensed for this purpose are limited, but
treatments can include anticholinergic drugs and botulinum toxins. Surgical
treatment of sialorrhoea is typically reserved as a last resort for patients.
IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US
and UK marketing authorization for the symptomatic treatment of chronic
sialorrhoea due to neurological disorders in adults. In this review, we discuss
and compare the frequency and method of administration, location of treatment
delivery, approximate annual costs and main side effects of botulinum toxin and
different anticholinergic drugs. Management of patients with chronic
neurological conditions requires input from multiple specialist teams and thus a
multidisciplinary team (MDT) approach is considered fundamental to ensure that
care is consistent and tailored to patients’ needs. To ensure that adult
patients with neurological conditions receive the best care and sialorrhoea is
well managed, we suggest a potential clinical care pathway for sialorrhoea with
a MDT approach, which healthcare professionals could aspire to.
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Affiliation(s)
- Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Messina
| | - Ganesh Bavikatte
- Department of Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Fahim Anwar
- Department of Rehabilitation Medicine, Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Biju Mohamed
- Department of Medicine and Gerontology, University Hospital of Wales, Cardiff, UK
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