Effect of botulinum toxin in stellate ganglion for craniofacial hyperhidrosis: a case report

Botulinum Toxin for Scalp Conditions: A Systematic Review

BACKGROUND

Many reports have described the use of botulinum toxin (BTX) in the treatment of scalp conditions, but no studies have synthesized these collective findings.

OBJECTIVE

We conducted a systematic review to summarize the scalp conditions for which treatment with BTX has been described.

METHODS

We searched PubMed/MEDLINE and Scopus for articles in English published before November 1, 2022, using the keywords "hair" or "scalp" and BTX-related search terms. Articles that described patients who received injections of BTX for the management of scalp conditions were included.

RESULTS

Twenty-four original articles (12 case reports, 9 clinical trials, and 3 case series) were identified that described 309 patients with a scalp condition treated with BTX. Androgenetic alopecia, craniofacial hyperhidrosis, and scalp hyperseborrhea had the most robust data supporting the clinical efficacy of BTX.

CONCLUSION

The current quality of evidence is highly variable and, for many conditions, limited to small observational studies. Botulinum toxin may be a promising therapeutic option for patients with various scalp conditions, but future studies are needed to better understand its efficacy and safety.

Treatment of stellate ganglion block in diseases: Its role and application prospect

The stellate ganglion (SG), as a type of sympathetic ganglion, consists of the sixth and seventh cervical vertebrae and the first thoracic sympathetic ganglia. SG block (SGB) is a minimally invasive injection that aims to inject low-concentration local anesthetics to induce a broad sympathetic blocking effect near the SG. There have been no changes and progress in the clinical application of SGB since the 1830s due to several potential risks, including hematoma from blood vessel injury, hoarseness from recurrent laryngeal nerve injury, and cardiopulmonary arrest. The feasibility and safety of SGB have greatly improved since the appearance of ultrasound-guided SGB. In recent years, SGB has been widely applied in the field of non-anesthesiology sedation, with significant therapeutic effects on pain, immunological diseases, somnipathy, psychological disorders, arrhythmias, and endocrine diseases. The present study reviews the present application of SGB in clinical practice.

Botox-Enhanced Stellate Ganglion Blockade for the Treatment of Post-traumatic Stress Disorder

Emerging evidence promotes stellate ganglion blocks (SGB) as a treatment for post-traumatic stress disorder (PTSD) in individuals who have not fully responded to conventional therapies. Ongoing research aims to assess the reliability and sustainability of this intervention. A 36-year-old female presented to our clinic complaining of severe and persistent symptoms since childhood, consistent with a diagnosis of PTSD and trauma-induced anxiety. The patient tried traditional psychological therapies and psychotropic medications for multiple years without optimal symptom relief. The patient underwent two sets of bilateral SGB: one set of standard injections performed with 0.5% bupivacaine and one set performed with the addition of botulinum toxin (Botox) injected into the stellate ganglion. After the initial standard bilateral SGB procedures, the patient experienced a significant reduction in PTSD symptoms. Two months later, however, the somatic symptoms of PTSD and trauma-induced anxiety returned, including hypervigilance, nightmares, insomnia, hyperhidrosis, and muscle tension. The patient elected to proceed with a set of Botox-enhanced SGB, and the results demonstrated profound relief as quantified by a drop in PTSD Checklist Version 5 (PCL-5) scores from 57 to 2. At a six-month follow-up since the initial injections, the patient reported significant and sustained relief from her PTSD symptoms. We report that the addition of Botox in a selective blockade of the stellate ganglion reduced our patient's PTSD symptoms to below the PTSD diagnostic threshold for a sustained period while providing additional benefits of reduced anxiety, hyperhidrosis, and pain. We provide a reasonable explanation for our findings.

Ultrasound-guided injection of botulinum toxin type A blocks cardiac sympathetic ganglion to improve cardiac remodeling in a large animal model of chronic myocardial infarction

BACKGROUND

Strategies to improve various cardiovascular diseases by blocking cardiac sympathetic ganglion have been increasingly available currently. Botulinum toxin type A (BTA), a typical neurotoxin, has been shown to block neural transmission in a safe and long-lasting manner.

OBJECTIVE

The aim of the present preclinical study was to assess the efficacy of BTA microinjection to alleviate cardiac remodeling after chronic myocardial infarction (MI) by blocking cardiac sympathetic ganglion in a canine model.

METHODS

Beagles were randomly divided into a control group (saline microinjection with sham surgery), an MI group (saline microinjection with MI), and an MI + BTA group (BTA microinjection with MI). Ultrasound-guided percutaneous BTA or saline injection into the left stellate ganglion (LSG) was performed followed by MI induction via left anterior descending artery occlusion (LADO) or sham surgery. After 30 days, electrocardiography, Doppler echocardiography, LSG function, neural activity, and ventricular electrophysiological detection were performed in all experimental dogs. At the end, LSG and ventricular tissues were collected for further detection.

RESULTS

BTA treatment significantly inhibited LSG function and neural activity and improved heart rate variability. Additionally, BTA application alleviated ventricular remodeling, ameliorated cardiac function, and prevented ventricular arrhythmias after 30-day chronic LADO-induced MI.

CONCLUSION

Ultrasound-guided percutaneous microinjection of BTA can block cardiac sympathetic ganglion to improve cardiac remodeling in a large animal model of chronic LADO-induced MI. Ultrasound-guided BTA microinjection has potential for clinical application as a novel cardiac sympathetic ganglion blockade strategy for MI.

Outcome Using Either Intradermal Botox Injection or Endoscopic Thoracic Sympathectomy for Patients with Primary Palmar Hyperhidrosis: A Comparative Study

Hyperhidrosis, or excessive sweating, negatively impacts patients both physically and psychologically. It may be primary or secondary: the primary form is a benign condition, with its growing prevalence reaching 5% recently. Its medical treatments are transitory. Objectives: Comparison of the outcomes of patients with primary palmar hyperhidrosis (PPH) after intradermal Botox injection (IBI) versus endoscopic thoracic sympathectomy (ETS). Methods: Forty patients were randomly divided into two equal groups. Patients in the IBI group received an intradermal injection of a botulinum toxin A. Patients in the EST group received endoscopic electrocautery of the sympathetic chain. The patients were evaluated biweekly for 12 weeks, and patient satisfaction by outcome was evaluated using a 4-point satisfaction score. Results: At 12 weeks, 60% of the IBI group patients had maintained an improvement. Meanwhile, 40% of the patients were improved compared to pre-intervention scores, despite deterioration after remarkable improvement. On the other hand, 80% of ETS group patients maintained their Hyperhidrosis Disease Severity Scale (HDSS) up until the end of follow-up. Patient satisfaction scores were significantly higher for the IBI group compared to the ETS group. Conclusions: Intradermal Botox injection is a simple, safe, non-invasive, and effective therapeutic modality for PPH and achieved higher patient satisfaction compared to ETS.