Bell felcinin viral patojenitesi ve tedavi olarak botulinum toksin tip A kullanımı

Bell'in felci, kraniyal sinir VII'nin iltihaplanmasının ortak adıdır. Kendine özgü genikulat ganglion iltihabı idiyopatiktir ve hemifasiyal felce neden olur. Bu felçten muzdarip olan hastaların semptomları 3 hafta ile 3 ay arasında kaybolabilir. Yüz felci devam eden bazı hastalar için botulinum toksin tip A etkili bir tedavi olabilir. Kas felcinin şiddetine göre botoksun yanı sıra ameliyat, steroid ve antiviral tedavi gibi farklı tedaviler sunulabilir. Bu derleme makalesinin amacı, viral patojenlerin fasiyal sinir iltihabının aktivasyonu ile olası ilişkisine ve Bell felçli hastaların tedavi olarak botoks tip-A'dan nasıl yararlanabileceğine dalmaktır.

Therapeutic applications of botulinum neurotoxins in head and neck disorders

Objective

The aim of this article is to review the mechanism of action, physiological effects, and therapeutic applications of botulinum neurotoxins in the head and neck area.

Study design

An extensive literature search was performed using keywords. The resulting articles were analyzed for relevance in four areas: overview on botulinum neurotoxins, the role of botulinum neurotoxins in the management of salivary secretory disorders, the role of botulinum neurotoxins in the management of facial pain, and the role of botulinum neurotoxins in head and neck movement disorders. Institutional review board approval was not needed due the nature of the study.

Results

Botulinum neurotoxin therapy was demonstrated to be a valuable alternative to conventional medical therapy for many conditions affecting the head and neck area in terms of morbidly, mortality, and patient satisfaction with treatment outcomes.

Conclusion

Botulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.

Use of botulinum toxin in facial paralysis

Facial paralysis triggers aesthetic and functional changes that hold significant physical and psychological repercussions to those suffering from this condition. Botulinum toxin may be used to reduce the facial asymmetry encountered in patients suffering from facial paralysis. The onset of improvement starts usually 15 days after the injection. Patients' satisfaction increases with time, especially after 30 days. Adverse events concerning the perioral area are found but resume as the patients get used to the new dynamics. The use of botulinum toxin is effective in decreasing the hyperkinesis contralateral to facial paralysis. The global aesthetic aspect of the face improves.

Botulinum Toxin in Facial Palsy: An Effective Treatment for Contralateral Hyperkinesis

BACKGROUND

The treatment of facial paralysis aims to recover symmetry in both static and dynamic states, which are seriously affected by the progressive contralateral hyperkinesis. Botulinum toxin may be used to reduce facial asymmetry in patients suffering from facial paralysis.

METHODS

Eighteen patients (12 female and six male patients) with facial palsy and contralateral hyperkinesis were injected with 112.5 units (0.9 ml) of Dysport (botulinum toxin type A) distributed evenly in the muscles of the perioral area. The patients were examined at 14, 28, 42, 56, 90, 150, and 180 days after the injection. Patients evaluated the degree of improvement at each time point. In addition, three evaluators made static (relaxed state) and dynamic (maximum contraction while smiling) assessments using a series of measurements obtained with a digital caliper, and the mean was used as the reference value.

RESULTS

The quantitative analysis demonstrated a significant reduction in hyperkinesis that lasted approximately 180 days. There was a significant or moderate improvement in most of the cases. All of the patients were very satisfied with the treatment. Adverse events were short-lived (mainly during the first 15 days) and related to difficulty in drinking without liquid loss (nine of 18) and difficulty in chewing without food loss (three of 18).

CONCLUSION

Injection of botulinum toxin was effective in reducing muscular hyperkinesis in the hemiface opposite that affected by facial paralysis, with mild and short-term side effects.

Botulinum neurotoxins: fundamentals for the facial plastic surgeon

The most commonly performed nonsurgical cosmetic procedure in the facial plastic surgery armamentarium involves the various commercial preparations of botulinum neurotoxins. These drugs have undergone a transformation from public health scourge to near ubiquitous therapeutic modality across the entire medical spectrum. Herein, the history of botulinum neurotoxins is reviewed, including an exploration of their pharmacology, neuromuscular junction physiology, a description of the commercially available preparations, and the recent research concerning the practicalities of their clinical use.

Alterations in CNS activity induced by botulinum toxin treatment in spasmodic dysphonia: an H215O PET study

Speech-related changes in regional cerebral blood flow (rCBF) were measured using H(2)(15)O positron-emission tomography in 9 adults with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (BTX) injection and 10 age- and gender-matched volunteers without neurological disorders. Scans were acquired at rest and during production of continuous narrative speech and whispered speech. Speech was recorded during scan acquisition for offline quantification of voice breaks, pitch breaks, and percentage aperiodicity to assess correlations between treatment-related changes in rCBF and clinical improvement. Results demonstrated that speech-related responses in heteromodal sensory areas were significantly reduced in persons with ADSD, compared with volunteers, before the administration of BTX. Three to 4 weeks after BTX injection, speech-related responses were significantly augmented in these regions and in left hemisphere motor areas commonly associated with oral-laryngeal motor control. This pattern of responses was most strongly correlated with the objective measures of clinical improvement (decreases in the frequency of voice breaks, pitch breaks, and percentage aperiodicity). These data suggest a pathophysiological model for ADSD in which BTX treatment results in more efficient cortical processing of sensory information, making this information available to motor areas that use it to more effectively regulate laryngeal movements.

The effect of intranasal injection of botulinum toxin A on the symptoms of vasomotor rhinitis

PURPOSE

Vasomotor rhinitis (VMR) is a common disease that is unrelated to allergy, infection, structural abnormalities, and systemic diseases. Patients with VMR usually complain of nasal obstruction accompanied by profuse watery nasal discharge. The exact pathophysiologic mechanisms of VMR are not known. Some studies suggested that it results from an autonomic nervous system dysfunction. No effective long-term treatment modalities exist for the VMR.

MATERIALS AND METHODS

Thirty patients with VMR were randomly and equally divided into 2 groups. The mean age was 38.46 years (range, 18-59 years; 1 men, 14 women) for group 1 and 41.60 (range, 29-62 years; 4 men, 11 women) for group 2. Five patients with VMR were accepted as a control group. Fifteen patients were injected 10 U of botulinum toxin A (BTX-A) (group 1) and patients in group 2 were injected 20 U to inferior and middle turbinates. Control patients were injected with saline solution into the inferior and middle turbinates.

RESULTS

Total symptom scores generally decreased after the first week and increased after the eighth week. The symptoms of patients (nasal obstruction, sneezing, nasal discharge, and nasal itching) were scored from 1 to 5, with 1 as less severe and 5 as most severe. The statistical significance of the results was analyzed using Kruskal-Wallis and Mann-Whitney U test. When total symptom scores of group 1 (10 U BTX-A) were compared with the control group, there was a statistically significant difference regarding symptoms scores at all control weeks. There was also a statistically significant difference for total symptom scores between group 2 and control group, except for the first control week.

CONCLUSION

Intranasal injection of BTX-A is a highly effective, safe, and simple symptomatic treatment modality with a long-lasting effect for patients with VMR. Botulinum toxin A may be a good alternative especially for the treatment of resistant VMR cases.

[Frey's syndrome of the external auditory canal]

Frey's syndrome of the external auditory canal is extremely rare. A 55-year old woman presented with a 6 month history of unilateral gustatory otorrhea. She never complained of hearing impairment, tinnitus, vertigo or otalgia. No trauma or surgical signs were evident near the ear or parotid gland. Examination of the ear showed an intact tympanic membrane without disease. A diagnosis of gustatory sweating syndrome was suggested by the observation of sweat production after chewing and by Minor's starch-iodine test. Symptoms were relieved after tympanic neurectomy. The pathogenesis, differential diagnosis and treatment options are discussed.

Immunologic characterization of spasmodic dysphonia patients who develop resistance to botulinum toxin

The immune status of six spasmodic dysphonia patients who became resistant to botulinum toxin was compared to that of a series of patients who remained responsive. The two groups were similar in terms of age, sex, and cumulative dose of toxin. Five of the resistant patients had a significant titer of anti-botulinum toxin IgG antibodies, as determined by enzyme-linked immunosorbent assay (ELISA). These same five resistant patients had a circulating titer of anti-heavy chain antibodies, but only three of these patients had a circulating titer of anti-light chain antibodies, as determined by Western blotting. By contrast, none of the responsive patients had antibodies against the holotoxin or its two chains. Interestingly, two of the resistant patients also had a low circulating titer of anti-botulinum toxin IgA antibodies. None of the responsive patients was IgA-positive. The cumulative dose of botulinum toxin administered to resistant patients was lower than that customarily associated with emergence of immunity in dystonia patients.