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De la Torre Canales G, Câmara-Souza MB, Ernberg M, Al-Moraissi EA, Grigoriadis A, Poluha RL, Christidis M, Jasim H, Lövgren A, Christidis N. Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews. Drugs 2024; 84:779-809. [PMID: 38900335 PMCID: PMC11289222 DOI: 10.1007/s40265-024-02048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. METHOD An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. RESULTS In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. CONCLUSION The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.
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Affiliation(s)
- Giancarlo De la Torre Canales
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil
| | | | - Malin Ernberg
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Anastasios Grigoriadis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
| | | | - Maria Christidis
- The Institute of Health Sciences, The Swedish Red Cross University, SE-141 21, Huddinge, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-14183, Huddinge, Sweden
| | - Hajer Jasim
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
- Public Dental Services, Department of Orofacial Pain and Jaw Function, Folktandvården Stockholms län AB, Eastmaninstitutet, SE-102 31, Stockholm, Sweden
| | - Anna Lövgren
- Clinical Oral Physiology, Department of Odontology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Nikolaos Christidis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden.
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Maci M, Fanelli C, Lorusso M, Ferrara D, Caroprese M, Laurenziello M, Tepedino M, Ciavarella D. Botulinum Toxin Type A and Hyaluronic Acid Dermal Fillers in Dentistry: A Systematic Review of Clinical Application and Indications. J Clin Med Res 2024; 16:273-283. [PMID: 39027812 PMCID: PMC11254312 DOI: 10.14740/jocmr5202] [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: 05/13/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background Botulinum toxin type A (BoNT-A) and hyaluronic acid (HA) dermal fillers are increasingly utilized in dentistry for therapeutic and aesthetic purposes. However, a comprehensive synthesis of their clinical applications and indications in dentistry is lacking. This systematic review aimed to analyze the clinical application and indications of BoNT-A and HA dermal fillers in dentistry, providing insights into their efficacy, safety profiles, and limitations. Methods A systematic search was conducted in PubMed/MEDLINE databases to identify relevant studies published between 2018 and 2024. Medical Subject Headings (MeSH) terms and keywords related to BoNT-A, HA dermal fillers, dentistry, clinical applications, and indications were used. Study selection criteria included randomized controlled trials (RCTs) and non-RCTs involving human participants of any age group. Data extraction and synthesis followed established guidelines, focusing on study characteristics, participant demographics, intervention details, outcome measures, and key findings related to BoNT-A and HA dermal fillers' clinical application in dentistry. Results Systematic searches across electronic databases and grey literature identified 857 records, with an additional 73 from hand searches. After screening titles and abstracts, 542 records were excluded, leaving 374 full-text publications for evaluation. Ultimately, 12 RCTs and 13 non-RCTs were included. The systematic review encompassed diverse geographic locations: Brazil, Italy, Spain, Syria, India, Egypt, Korea, and the Netherlands, involving samples sizes ranging from 14 to 143 participants. The review synthesized findings on HA's efficacy in various areas, including bone repair, gingivitis management, temporomandibular joint disorders, postoperative swelling reduction, periodontal defect treatment, chin and check projection and lips augmentation. BoNT-A exhibited promising efficacy in managing orofacial pain conditions, gummy smile treatment and neuromodulation of the lower third muscles. Safety profiles varied among studies, with some reporting minimal adverse effects while others noted dose-related concerns. Conclusion BoNT-A and HA dermal fillers offer a wide array of clinical applications in dentistry, ranging from therapeutic interventions to aesthetic enhancements. Despite promising efficacy, careful consideration and monitoring of safety outcomes are essential when integrating these interventions into clinical practice. Further research addressing methodological limitations and safety concerns is warranted to optimize their utilization and improve patient care in dentistry.
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Affiliation(s)
- Marta Maci
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Carlotta Fanelli
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Mauro Lorusso
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Donatella Ferrara
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Marino Caroprese
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
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Tilki HE. Some reasons for frowning upon the effects of botulinum toxin injections in facial muscles. Clin Neurophysiol Pract 2023; 8:174-176. [PMID: 37681119 PMCID: PMC10480585 DOI: 10.1016/j.cnp.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Hacer Erdem Tilki
- Ondokuz Mayıs University, Medical Faculty, Departments of Neurology and Clinical Neurophysiology, Samsun, Turkey
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Chandra S, Suresh NL, Afsharipour B, Rymer WZ, Holobar A. Anomalies of motor unit amplitude and territory after botulinum toxin injection. J Neural Eng 2022; 19. [PMID: 35671714 DOI: 10.1088/1741-2552/ac7666] [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] [Received: 12/01/2021] [Accepted: 06/07/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Botulinum toxin (BT) induced cholinergic denervation of hyperactive motor units is a clinically accepted and extensively practiced way of managing focal spasticity after stroke. The denervation potentially initiates a temporary reorganization of the motor unit (MU) structure by inducing the emergence of a large number of newly innervated muscle fibers. In this study, we quantify the effect of the BT on motor unit action potential (MUAP) amplitudes and on the motor unit territory areas (MUTA) as seen on the surface of the skin over the biceps brachii (BB) muscle. APPROACH We have used a 128 channel high-density electromyography (HDsEMG) grid on the spastic and contralateral BB muscle and recorded the myoelectric activity along with the contraction force during isometric contraction of elbow muscles. We have decomposed the recorded EMG signal into individual MU potentials and estimated the MUAP amplitudes and territory areas before and two weeks after a BT injection. MAIN RESULT We found that there were significantly larger median (47±9%) MUAP amplitudes as well as reduction of MUTA (20±2%) two weeks after the injection compared to the respective pre-injection recording. SIGNIFICANCE The observed covariation of the amplitude and the territory area indicates that the large amplitude MUs that appeared after the BT injection have a relatively smaller territory area. We discuss the potential contributing factors to these changes subsequent to the injection in the context of the investigated subject cohort.
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Affiliation(s)
- Sourav Chandra
- Shirley Ryan Ability Lab, Arms and Hands Laboratory, Northwestern University, 355 East Erie street,, Chicago, Illinois, 60611, UNITED STATES
| | - Nina L Suresh
- Shirley Ryan Ability Lab, Northwestern University, 355 East Erie street, Arms and Hands Laboratory, Chicago, Illinois, 60611, UNITED STATES
| | - Babak Afsharipour
- University of Alberta, 116 St & 85 Ave,, Edmonton, Alberta, T6G 2R3, CANADA
| | - William Zev Rymer
- Shirley Ryan Ability Lab, Northwestern University Medical School, 355 East Erie street, Arms and Hands Laboratory, Chicago, IL 60611, USA, Chicago, Illinois, 60611, UNITED STATES
| | - Ales Holobar
- Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, Maribor, 2000, SLOVENIA
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Providing Optimal Rejuvenation to the Jawline and Perioral Area Using Neuromodulators and Hyaluronic Acid Dermal Fillers. Plast Surg Nurs 2021; 41:225-231. [PMID: 34871290 DOI: 10.1097/psn.0000000000000409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Including the jawline in aesthetic assessment has become increasingly popular when using both surgical and nonsurgical techniques. Facial aging processes include bone resorption, fat pad atrophy, and a breakdown of the quality of collagen and elastin in the skin. To provide optimal treatment of the jawline using nonsurgical techniques, it is important to consider all of these aspects before planning treatment. Men and women have different facial aging processes and ideal facial ratios that must be respected. The objective of this article is to discuss the use of botulinum toxin A and hyaluronic acid filler injectable treatments, deoxycholic acid injectable treatments, and cryolipolysis treatments and explain how these treatments can be utilized for optimal rejuvenation of the jawline and perioral area.
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Providing Optimal Rejuvenation to the Jawline and Perioral Area Using Neuromodulators and Hyaluronic Acid Dermal Fillers. Plast Surg Nurs 2021; 41:98-104. [PMID: 34033635 DOI: 10.1097/psn.0000000000000372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Including the jawline in aesthetic assessment has become increasingly popular when using both surgical and nonsurgical techniques. Facial aging processes include bone resorption, fat pad atrophy, and a breakdown of the quality of collagen and elastin in the skin. To provide optimal treatment of the jawline using nonsurgical techniques, it is important to consider all of these aspects before planning treatment. Men and women have different facial aging processes and ideal facial ratios that must be respected. The objective of this article is to discuss the use of botulinum toxin A and hyaluronic acid filler injectable treatments, deoxycholic acid injectable treatments, and cryolipolysis treatments and explain how these treatments can be utilized for optimal rejuvenation of the jawline and perioral area.
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Li YH, Yang J, Zheng Z, Hu DH, Wang ZD. Botulinum toxin type A attenuates hypertrophic scar formation via the inhibition of TGF-β1/Smad and ERK pathways. J Cosmet Dermatol 2020; 20:1374-1380. [PMID: 33185943 DOI: 10.1111/jocd.13842] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypertrophic scar is a common complication in would healing process, and how to effectively prevent and treat it has been a hot and difficult research issue. Previous studies have showed that botulinum toxin type A (BTA) has effects on the prevention and treatment of hypertrophic scar, but little is known about the specific mechanisms. OBJECTIVE This study aimed to explore the potential mechanisms of BTA on the inhibition of hypertrophic scar formation. METHODS Hypertrophic scar-derived human fibroblasts were cultured and then treated with transforming growth factor-β1 (TGF-β1) and various concentrations of BTA. Cell proliferation and viability were measured by CellTiter 96® AQueous One Solution Cell Proliferation Assay and trypan blue staining, respectively. The total amount of collagen was examined using Sirius red staining. Collagen I and Collagen III in the culture supernatant were evaluated by enzyme-linked immunosorbent assay. Reverse transcription-quantitative polymerase chain reaction and Western blot analysis were performed to detect the transcription and translation levels. RESULTS Our results revealed that BTA decreased the proliferation of hypertrophic scar-derived human fibroblasts. The mRNA and protein expression levels of alpha-smooth muscle actin, collagen I, and collagen III induced by TGF-β1 were inhibited by BTA in a dose-dependent manner. BTA also inhibited the phosphorylation of Smad2/3 and ERK. CONCLUSION BTA decreased the proliferation of fibroblasts and prevented overdeposition of ECM through the inhibition of the TGF-β1/Smad and ERK pathways. The findings of this study provide new scientific reference for the prevention and treatment of hypertrophic scar.
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Affiliation(s)
- Yue-Hua Li
- Department of Geriatric Digestive Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiaomei Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhao Zheng
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Da-Hai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhi-Dong Wang
- Department of Geriatric Digestive Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Kula E, Tanridag T, Kahraman Koytak P, Uluc K. Reference jitter values for the sternocleidomastoid muscle with concentric needle electrodes. Muscle Nerve 2020; 63:116-119. [PMID: 33067804 DOI: 10.1002/mus.27094] [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: 05/22/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to establish reference jitter values for the voluntary activated sternocleidomastoid (SCM) muscle using a concentric needle electrode (CNE). METHODS The study included 39 healthy participants (20 female and 19 male) aged 18-77 y. Jitter was expressed as the mean consecutive difference (MCD) of 80-100 consecutive discharges. Filters were set at 1 and 10 kHz. The mean MCDs for all participants were pooled, and the mean value +2.5 SD was accepted as the upper limit for the mean MCD. The upper limit for individual MCD was calculated using +2.5 SD of the upper 10th percentile MCD for individual participants. RESULTS Mean age of the participants was 45 ± 14.5 y. Mean MCD was 16.20 ± 2.23 μs (range: 12-21 μs), and the upper limit of normal for mean MCD was 21.8 μs. The mean value for 823 individual jitters was 23.3 ± 4.61 μs (range: 6.6-36.9 μs), and the upper limit of normal for each individual jitter was 34.6 μs. CONCLUSIONS The present findings indicate that upper normal limit for mean MCD is 22 μs and for individual data it is 35 μs.
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Affiliation(s)
- Ezgi Kula
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulin Tanridag
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Kayihan Uluc
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
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Ågren M, Sahin C, Pettersson M. The effect of botulinum toxin injections on bruxism: A systematic review. J Oral Rehabil 2019; 47:395-402. [PMID: 31769044 DOI: 10.1111/joor.12914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To systematize evidence on the efficacy of botulinum toxin type A (BTA) in the treatment of bruxism measured through bite force or electromyography (EMG) at the masseter muscle. METHOD Identification of relevant articles through databases PubMed, Web of Science, SCOPUS, Ovid and EBSCO and manual search were performed for sources from review articles. Studies scoring less than 3 on the Jadad Scale were excluded. RESULTS Four articles were included after an exclusion of 333 articles. 3 articles measured EMG and 1 bite force. 1 article did not record a significant drop of activity, 1 article recorded reduction midway and at final endpoint. 2 articles recorded initial reduction, but a non significant difference at later follow up. CONCLUSION The available research is inconclusive and does not show enough evidence that bruxism can be treated with BTA injections. However, promising results have been shown in individual studies and further research in this area is needed.
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Affiliation(s)
- Martin Ågren
- Prosthodontic specialist clinic, Region Västerbotten, Umeå, Sweden
| | - Christofer Sahin
- Department of Dermatology and Venerology, Linköping university hospital and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mattias Pettersson
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
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Carcamo CR. Dysarthria Associated with Lumbar Sympathetic Block Using Botulinum Toxin. PAIN MEDICINE 2019; 20:1634-1635. [PMID: 30753626 DOI: 10.1093/pm/pnz007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cesar R Carcamo
- Chronic Pain Unit, Mutual de Seguridad Hospital, Santiago, Chile; Faculty of Medicine CAS UDD, Universidad del Desarrollo, Santiago, Chile
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Ravina K, Strickland BA, Rennert RC, Carey JN, Russin JJ. Role of botulinum neurotoxin-A in cerebral revascularization graft vasospasm prevention: current state of knowledge. Neurosurg Focus 2019; 46:E13. [PMID: 30717063 DOI: 10.3171/2018.11.focus18514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 11/07/2018] [Indexed: 11/06/2022]
Abstract
Graft stenosis and occlusion remain formidable complications in cerebral revascularization procedures, which can lead to significant morbidity and mortality. Graft vasospasm can result in early postoperative graft stenosis and occlusion and is believed to be at least partially mediated through adrenergic pathways. Despite various published treatment protocols, there is no single effective spasmolytic agent. Multiple factors, including anatomical and physiological variability in revascularization conduits, patient age, and comorbidities, have been associated with graft vasospasm pathogenesis and response to spasmolytics. The ideal spasmolytic agent thus likely needs to target multiple pathways to exert a generalizable therapeutic effect. Botulinum toxin (BTX)-A is a powerful neurotoxin widely used in clinical practice for the treatment of a variety of spastic conditions. Although its commonly described paradigm of cholinergic neural transmission blockade has been widely accepted, evidence for other mechanisms of action including inhibition of adrenergic transmission have been described in animal studies. Recently, the first pilot study demonstrating clinical use of BTX-A for cerebral revascularization graft spasm prevention has been reported. In this review, the mechanistic basis and potential future clinical role of BTX-A in graft vasospasm prevention is discussed.
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Affiliation(s)
| | | | - Robert C Rennert
- 4Department of Neurosurgery, University of California, San Diego, California
| | - Joseph N Carey
- 3Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles; and
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Segura-Aguilar J, Tizabi Y. Botulinum Neurotoxin, an Example of Successful Translational Research. CLINICAL PHARMACOLOGY AND TRANSLATIONAL MEDICINE 2018; 2:125-126. [PMID: 30801056 PMCID: PMC6384007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Juan Segura-Aguilar
- Molecular & Clinical Pharmacology, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington, DC 20059, USA
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