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Yang Y, Zhang T, Liu L, Shan L, Hu X, Yang L, Gao F, Xiaoli W, Li H. Efficacy and safety of botulinum toxin for treating motor dysfunction in patients with Parkinson's disease: a systematic review and meta-analysis. BMJ Open 2023; 13:e060274. [PMID: 37328181 PMCID: PMC10277107 DOI: 10.1136/bmjopen-2021-060274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/26/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of botulinum toxin (BTX) for motor dysfunction in Parkinson's disease (PD). DESIGN Systematic review and meta-analysis. DATA SOURCES Searches of PubMed, EMBASE and the Cochrane Library, from database inception to 20 October 2022. ELIGIBILITY CRITERIA Studies reported in English with adult PD patients treated with BTX. DATA EXTRACTION AND SYNTHESIS Primary outcomes were United Parkinson's Disease Rate Scale Section (UPDRS) III (or its items) and Visual Analogue Scale (VAS). Secondary outcomes were UPDRS-II (or its items), Freezing of Gait Questionnaire (FOG-Q), Timed Up and Go test (TUG) and treatment-related adverse events (TRAEs). Mean difference (MD) or standardised MD (SMD) before and after treatment with 95% CIs were used for continuous variables and risk ratios (RRs) with 95% CIs was used for TRAEs. RESULTS Six randomised controlled trials (RCTs) and six non-RCTs (case series) were included (ntotal=224 participants, nRCT=165). No significant difference was found in pooled results of UPDRS-III (available in four RCTs and two non-RCTs, SMD=-0.19, 95% CI -0.98 to 0.60), UPDRS-II (four RCTs and one non-RCT, SMD=-0.55, 95% CI -1.22 to 0.13), FOG-Q (one RCT and one non-RCT, SMD=0.53, 95% CI -1.93 to 2.98) or the risk of TRAEs (five RCTs, RR 0.87, 95% CI 0.37 to 2.01). Significant decreases were found in pooled VAS score (three RCTs and five non-RCTs, MD=-2.14, 95% CI -3.05 to -1.23) and TUG (MD=-2.06, 95% CI -2.91 to -1.20) after BTX treatment. CONCLUSIONS BTX may not be associated with motor symptoms alleviation, although it benefits pain alleviation and functional mobility improvement.
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Affiliation(s)
- Yuqi Yang
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Tong Zhang
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Lixu Liu
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Lei Shan
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Xueyan Hu
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Lingyu Yang
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Fei Gao
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Wu Xiaoli
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Hanzhi Li
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
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Zhu K, Ha M, Finkelstein ER, Chaudry S, Hricz N, Ngaage LM, Rasko Y. The Surgical Management of Migraines and Chronic Headaches: A Cross-sectional Review of American Insurance Coverage. Ann Plast Surg 2023; 90:592-597. [PMID: 37311314 DOI: 10.1097/sap.0000000000003563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Migraine headache can be an extremely debilitating condition, with pharmacotherapy for prophylaxis or treatment of acute symptoms being unsuccessful in a large proportion of patients. Surgical management of migraine has recently gained popularity as an alternative to pharmacotherapy for severe disease. However, the novel nature of these procedures may lead to variable insurance coverage, limiting access to care. METHODS A cross-sectional analysis of 101 US insurance companies was conducted. Companies were chosen based on greatest market share and enrollment per state. A Web-based search or phone call identified whether each company had a publicly available policy on nonsurgical or surgical management of migraine or headache. For companies with an available policy, coverage was categorized into covered, covered on a case-by-case basis, or never covered, with criteria required for coverage collected and categorized. RESULTS Of the 101 evaluated insurers, significantly fewer companies had a policy on surgical treatment for migraine or headache (n = 52 [52%]) compared with nonsurgical treatment (n = 78 [78%]) (P < 0.001). For companies with a policy, the most frequently covered nonsurgical treatments were biofeedback (n = 23 [92%]) and botulism toxin injections (n = 61 [88%]). Headaches were an approved indication for occipital nerve stimulation in 4% (n = 2) of company policies and nerve decompression in 2% (n = 1) of policies. Migraines were never offered preauthorized coverage for surgical procedures. CONCLUSION Approximately half of US insurance companies have a publicly available policy on surgical management of migraine or headache. Surgical treatment was seldom covered for the indication of headache and would never receive preauthorized coverage for migraine. Lack of coverage may create challenges in accessing surgical treatment. Additional prospective, controlled studies are necessary to further support the efficacy of surgical treatment.
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Affiliation(s)
- Kevin Zhu
- From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Michael Ha
- From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Emily R Finkelstein
- Division of Plastic and Reconstructive Surgery, University of Miami, Miami, FL
| | - Salman Chaudry
- Department of General Surgery, Anne Arundel Medical Center, Annapolis
| | - Nicholas Hricz
- From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | | | - Yvonne Rasko
- From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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Dhanasekara CS, Payberah D, Chyu JY, Shen CL, Kahathuduwa CN. The effectiveness of botulinum toxin for chronic tension-type headache prophylaxis: A systematic review and meta-analysis. Cephalalgia 2023; 43:3331024221150231. [PMID: 36786349 DOI: 10.1177/03331024221150231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND A systematic and meta-analysis was conducted to examine the evidence of the effects of botulinum toxin A on chronic tension-type headache. METHODS Cochrane, Embase, Ovid, ProQuest, PubMed, Scopus, Web-of-Science databases, and ClinicallTrials.gov registry were systematically searched for studies examining the effects of botulinum toxin A on tension-type headaches. The records were screened by two independent reviewers using pre-determined eligibility criteria. DerSimonian Liard random-effects meta-analyses were performed using the 'meta' package (5.2-0) in R (4.2.0). Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's Tool RoB 2 and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Clinical significance was determined using pre-defined minimal clinically important differences. RESULTS Eleven controlled trials were included (390 botulinum toxin A, 297 controls). Botulinum toxin A was associated with significant improvements in standardized headache intensity (-0.502 standard deviations [-0.945, -0.058]), headache frequency (-2.830 days/month [-4.082, -1.578]), daily headache duration (-0.965 [-1.860, -0.069]) and the frequency of acute pain medication use (-2.200 days/month [-3.485, -0.915]) vs controls. Botulinum toxin A-associated improvements exceeded minimal clinically important differences for headache intensity, frequency, and acute pain medication use. A 79% (28%, 150%) greater response rate was observed for botulinum toxin A vs controls in improving chronic tension-type headache. Treatment of eight chronic tension-type headache patients was sufficient to elicit a therapeutic response in one patient. CONCLUSIONS Corroborating the current mechanistic evidence, our meta-analysis supports the utility of botulinum toxin A for managing chronic tension-type headaches. However, due to limitations in the quality of evidence, adequately-powered high-quality controlled trials examining the effects of Botulinum toxin A on chronic tension-type headache are warranted. REGISTRATION Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020178616).
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Affiliation(s)
- Chathurika S Dhanasekara
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Daniel Payberah
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Joanna Y Chyu
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Chwan-Li Shen
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chanaka N Kahathuduwa
- Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Application areas and effects of aquatic therapy WATSU - A survey among practitioners. Complement Ther Clin Pract 2021; 46:101513. [PMID: 34844068 DOI: 10.1016/j.ctcp.2021.101513] [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: 08/14/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION WATSU (WaterShiatsu) is a treatment administered in warm water. The present study investigated if and how frequently scientifically studied application areas and effects of WATSU occur in practice, whether similar effectiveness of WATSU is observed in trials and practice, and whether practitioners can contribute additional application areas and effects of WATSU. METHODS Application areas and effects of WATSU reported in a recent systematic review were extracted verbatim to be assessed in a worldwide multilingual cross section online survey, generating quantitative and qualitative data. A pre-test and retest were conducted to ensure quality and evaluate the questionnaire's psychometric properties. RESULTS Answers of 191 respondents were processed. All proposed 26 application areas and 20 effects were confirmed, each with relatively high ratings of observed effectiveness of WATSU. WATSU was frequently applied in healthy individuals (including during pregnancy), and individuals in various pain- (e.g., low back pain, neck pain, myofascial pain, fibromyalgia) and stress-related (e.g., stress, depression, sleep disorders, fatigue, anxiety disorders) conditions. Frequently confirmed effects were physical relaxation, relief of physical tension, pain relief, increased mobility and flexibility, improved quality of life, spiritual experiences, and increased psychological health. Respondents contributed 73 additional application areas and effects (both, mental and physical) of WATSU. CONCLUSIONS Application areas and effects of WATSU are consistently employed practically and scientifically. Respondents' ratings of effectiveness of WATSU match tentative research efforts. WATSU is cautiously recommended for the use in pain- and stress-related conditions. Short- and long-term effectiveness of WATSU need to be evaluated in high level intervention studies.
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Roland SB, Pripp AH, Msomphora MR, Kvarstein G. The efficacy of botulinum toxin A treatment for tension-type or cervicogenic headache: a systematic review and meta-analysis of randomized, placebo-controlled trials. Scand J Pain 2021; 21:635-652. [PMID: 34090319 DOI: 10.1515/sjpain-2021-0038] [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: 02/19/2021] [Accepted: 05/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The pathogeneses of chronic tension-type headache (CTTH) and cervicogenic headache (CEH) are not well established. Peripheral activation or sensitization of myofascial nociceptors is suggested as a potential mechanism and injections of botulinum toxin (BONTA) have thus been used in the treatment for both headache conditions. BONTA inhibits the release of acetylcholine at the neuromuscular junction and inhibits contraction of skeletal muscles. If the pain is precipitated by increased tone in cervical muscles, local injections of BONTA could represent a prophylactic measure. However, the treatment is still controversial, and a thorough assessment of the current evidence is required. This review aims to assess the evidence of BONTA injection as a prophylactic treatment for CTTH and CEH by reviewing and examining the quality of placebo-controlled, randomized trials. METHODS Data sources: we searched in the following databases: PubMed (including Medline), Embase, Cochrane Central register of Controlled Trials, Cinahl, Amed, SCOPUS and Google Scholar including other repository sources. Both MeSH and free keywords were used in conducting the systematic search in the databases. The search covered publications from the root of the databases to November 2020. STUDY ELIGIBILITY CRITERIA The review included RCTs, comparing single treatment of BONTA with placebo on patients with CTTH or CEH above 18 years of age, by measuring pain severity/relief or headache frequency. DATA EXTRACTION The following data were extracted: year of publication, country, setting, trial design, number of participants, injection procedure, BONTA dosages, and clinical outcome measures. STUDY APPRAISAL To assess validity and quality, and risk of bias, the Oxford Pain Validity Scale, Modified Jadad Scale, last version of Cochrane Collaboration's tool for assessing risk of bias (RoB 2), and the CONSORT 2010 Checklist were used. The trials were assessed, and quality scored independently by two of the reviewers. A quantitative synthesis and meta-analyses of headache frequency and intensity were performed. RESULTS We extracted 16 trials, 12 on prophylactic BONTA treatment for CTTH and four on CEH. Of these 12 trials (8 on CTTH and 4 on CEH) were included in the quantitative synthesis. A majority of the trials found no significant difference on the primary outcome measure when BONTA treatment was compared with placebo. Three "positive" trials, reporting significant difference in favor of BONTA treatment, but two of these were hampered by low validity and quality scores and high risk of bias. CONCLUSIONS There is no clear clinical evidence supporting prophylactic treatment with BONTA for CTTH or CEH.
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Affiliation(s)
- Sissel Breivold Roland
- Department of Orthopedics, Finnmark Hospital Trust, Hammerfest, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Pain Clinic, Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Mbachi Ruth Msomphora
- Research and Publishing Support, Department of Library services, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunnvald Kvarstein
- Pain Clinic, Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Botulinum Toxin for Headache: a Comprehensive Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Straube A, Förderreuther S, Eren OE. [Tension type headaches : Quo vadis?]. Schmerz 2020; 34:464-475. [PMID: 32926240 DOI: 10.1007/s00482-020-00495-5] [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: 04/28/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
Episodic tension type headache is considered to be the most prevalent primary headache. If tension type headache occurs on more than 15 days per month for at least 3 consecutive months, it is classified as chronic tension type headache. In recent years, it has become obvious that it is difficult to distinguish between episodic tension type headache and a moderate migraine attack and also between chronic tension type headache and chronic migraine. In the paper, we discuss how the differential diagnosis can be more specific and which therapy is supported by the literature. In addition, we discuss differences and similarities of tension type headache and migraine and a possible similar pathophysiology of both (convergence hypothesis).
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Affiliation(s)
- Andreas Straube
- Klinik für Neurologie, Oberbayerisches Kopfschmerzzentrum, Klinikum Großhadern, Ludwig-Maximilians-Universität, 81377, München, Deutschland.
| | - Stefanie Förderreuther
- Klinik für Neurologie, Oberbayerisches Kopfschmerzzentrum, Klinikum Großhadern, Ludwig-Maximilians-Universität, 81377, München, Deutschland
| | - Ozan Emre Eren
- Klinik für Neurologie, Oberbayerisches Kopfschmerzzentrum, Klinikum Großhadern, Ludwig-Maximilians-Universität, 81377, München, Deutschland
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Dawson A, Dawson J, Ernberg M. The effect of botulinum toxin A on patients with persistent idiopathic dentoalveolar pain-A systematic review. J Oral Rehabil 2020; 47:1184-1191. [PMID: 32640063 DOI: 10.1111/joor.13053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/01/2020] [Accepted: 06/30/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND It has been suggested that botulinum toxin A (BONT-A) is a safe and effective treatment in relieving pain in patients with persistent idiopathic dentoalveolar pain (PIDP). OBJECTIVES This study aimed to systematically evaluate all the available studies investigating the pain-relieving effects of BONT-A in patients with PIDP. METHODS A systematic search with specific search terms was made in PubMed, Web of Science and Scopus. Two authors screened titles and abstracts and selected eligible studies for inclusion in the systematic review. The quality of the studies was evaluated by the 12 items Quality Assessment Tool for Observational studies (Pre-Post) Studies with No Control Group, and the level of evidence was assessed according to GRADE. RESULTS Three observational studies of 3695 identified were included (445 overlapping studies; 3247 excluded studies). All studies were uncontrolled observational studies investigating the pain-relieving effect of BONT-A in patients with PIDP. The included studies had a fair quality (moderate risk of bias) and insufficient level of evidence. The pain reducing effect by BONT-A injections was in average 50% or more in two studies, in one study 3 out of 4 patients became almost pain free. CONCLUSIONS This systematic review shows that presently the level of scientific evidence is insufficient to evaluate the pain-relieving effect of BONT-A injections in patients with PIDP. There are indications that BONT-A injections could be a possible management option for patients with PIDP that seems to be safe and with few adverse events. There is a need for well-designed placebo-controlled, double-blind RCTs.
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Affiliation(s)
- Andreas Dawson
- Centre for Oral Rehabilitation, Östergötland County Council, Linköping, Sweden.,Faculty of Odontology, Malmö University, Malmö, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Jenny Dawson
- Centre for Oral Rehabilitation, Östergötland County Council, Linköping, Sweden
| | - Malin Ernberg
- Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.,Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
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Kwon HJ, Yang HM, Won SY. Intramuscular innervation patterns of the splenius capitis and splenius cervicis and their clinical implications for botulinum toxin injections. Clin Anat 2020; 33:1138-1143. [PMID: 31894602 DOI: 10.1002/ca.23553] [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: 11/28/2019] [Revised: 12/26/2019] [Accepted: 12/28/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The purpose of this study was to clearly characterize the intramuscular nerve distributions of the splenius capitis and splenius cervicis muscles that are both responsible for the onset of a chronic tension type headache and to use this information to identify the effective botulinum toxin (BoNT) injection sites. MATERIALS AND METHODS Ten splenius capitis and splenius cervicis specimens were subjected to Sihler's staining to reveal intramuscular nerve arborization patterns and determined the optimal location for BoNT injection. RESULTS Nerve distribution patterns in the splenius capitis were identified as nerve pathways that travel down toward the origin point and others that travel up toward the insertion point. This neuromuscular innervation from the central (50%) point was distributed evenly in these two directions. The neural pathways of splenius cervicis traveled vertically from the insertion point to the origin point. If the length from the muscle origin point to the insertion point is normalized to 100%, motor neurons innervate the muscle from around the 30% to the 70% point. CONCLUSIONS The safest and most-effective BoNT injection sites for the splenius capitis and splenius cervicis were found at around the 50% point and the 30% to the 70% point, respectively.
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Affiliation(s)
- Hyun-Jin Kwon
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea.,Surgical Anatomy Education Centre at the Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Yoon Won
- Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea
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Di Stadio A, Dipietro L, Gambacorta V, Cristi MC, Faralli M, Della Volpe A, Ricci G. Can the Jankovic-assessment be used as an alternative to electromyography? A cross-sectional study on facial dystonia patients treated with Botulinum toxin. Am J Otolaryngol 2019; 40:102278. [PMID: 31477366 DOI: 10.1016/j.amjoto.2019.102278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aims to quantitatively compare the Jankovic assessment (JA) with electromyography (EMG)-based measures for assessing changes in facial movements in patients with facial dystonia. MATERIALS AND METHODS Thirteen patients (five males and eight females) affected with different forms of facial dystonia (hemifacial spasm and synkinesis) participated in this study. All patients were treated with Botulinum Toxin (BTX) and evaluated with the JA scale and EMG-based measures, including motor unit potentials (MUP) latency and presence of polyphasic potentials before and after BTX injection. Correlation between the JA scores and the EMG-based measures was calculated. Statistical analysis was performed with the Pearson test. RESULTS Correlation between the JA scores and the EMG-based measures was found to be statistically significant, both before and after treatment with BTX. CONCLUSION AND RELEVANCE JA scores significantly correlated with more objective EMG-based measures, suggesting that the JA scale can be used to assess facial movement changes, for example elicited by a treatment such as BTX injection. Thus, in facial dystonia patients, the JA scale may be used for evaluating treatment outcomes as a valid and low-cost alternative to EMG.
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Affiliation(s)
| | | | | | | | - Mario Faralli
- Silvestrini Hospital, Otolaryngology Department, Perugia, Italy
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Freund B, Rao A. Efficacy of Botulinum Toxin in Tension‐Type Headaches: A Systematic Review of the Literature. Pain Pract 2019; 19:541-551. [DOI: 10.1111/papr.12773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/21/2019] [Accepted: 02/03/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Brin Freund
- The Department of Neurology Johns Hopkins Hospital Baltimore Maryland U.S.A
| | - Aruna Rao
- The Department of Neurology Johns Hopkins Hospital Baltimore Maryland U.S.A
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