Conclusion

The etiologies and pathophysiological mechanisms of spasticity are varied and affect a wide array of patients. Although Botox has relatively few approved indications, its use has expanded over the past decade to include the treatment of spasticity, which has proven to be of great benefit in patients with disabling focal muscle overactivity. Appropriate patients must be chosen and functional goals must be clearly outlined and discussed with the patient and caregiver. Once defined, Botox may...

Botulinum Toxin Type A Injection Procedure Figs 911

Over the last several years, botulinum toxin type A (BTX-A) has been increasingly used in the treatment of various medical conditions. Increasing literature supports the role of BTX-A in the treatment of chronic pain syndromes. Blockade of acetylcholine release from the presynaptic membrane plays an important role in relief of muscles spasms and myofascial pain syndromes. However, some animal models suggest alternative mechanisms for the analgesic Fig. 9. Identify tender lesions on the sole of...

Clinical Experience

We first used the electrodiagnostic techniques outlined here when standard diagnostic means turned up nothing in patients with severe sciatica. In 1992, after accumulating 34 patients, and following their generally successful surgical course, we published a small article in the Archives of Physical Medicine and Rehabilitation. Possibly because of the preponderant emphasis on intramedullary causes of sciatica, the study was heralded in the New York Times, and expounded in the lay press fairly...

Pathogenesis

Blepharospasm is thought to be a defect in neurological circuit activity (9). The circuit has an afferent sensory limb, a central control center, and an efferent motor limb. A defect at any point in the circuit can precipitate blepharospasm. Multiple factors can initiate the afferent limb of the cycle. These include such stimuli as corneal or eyelid irritation, pain, light, emotional stresses, or other factors (12). The afferent stimuli are transmitted to the central control center. Although...

Medical Community Gets Involved

Finally, the Medical Faculty at the University of T bingen was asked for advice. The first answer came from Wilhelm Gottfried von Ploucqet (1744-1814), who disputed that prussic acid could be the toxic agent in sausages, suspecting a zoonic, possibly organic poison(2). In a second statement, one of the prominent medical professors at the University of T bingen, Johann Heinrich Ferdinand Autenrieth (1772-1835), asked the government to collect the reports of general practitioners and health...

Btxa For The Treatment Of Gastroparesis

Under normal conditions, gastric emptying is a highly regulated process reflecting the integration of propulsive forces generated by proximal fundic tone and distal antral contractions against the resistance of the pyloric sphincter. The motor control of the stomach is dependent on the coordination of neurogenic modulators (central, autonomic, and enteric nervous systems), myogenic control mechanisms (interstitial cells of Cajal), and chemical modulators (excitatory and inhibitory...

Loren M Fishman Alena Polesin and Steven Sampson Introduction

Piriformis syndrome (PS) is the reversible compression of the sciatic nerve by the piriformis muscle. It may cause deep and severe pain in the buttock, hip, and sciatica, with radiation into the thigh, leg, foot, and toes. Like carpal tunnel or pronator syndromes, it may cause damage to the peripheral nerve through excessive pressure (1). In PS, piriformis muscular tension presses the sciatic nerve anteriorly and inferiorly against the sharp tendinous edges of other muscles, such as the...

Pathophysiology

Radiation therapy uses high-energy radiation to kill proliferating tumor cells with relative sparing of the surrounding normal cells, which are typically less active. Two main types of radiation are external beam radiation and internal radiation, also known as brachytherapy. A variety of new dose-sculpting techniques for delivering radiation have been developed. From Therapeutic Uses of Botulinum Toxin Edited by G. Cooper Humana Press Inc., Totowa, NJ Fig. 1. Radiation fibrosis syndrome...

Treatment Approach

The effective treatment of migraine headache involves implementing an abortive therapy for the acute attack (acute therapy), as well as developing a rational strategy to prevent or minimize future migraine episodes (preventative therapy ref. 32). Acute therapy aims to rapidly and effectively lessen the severity of the acute migraine and restore patient comfort and function. The goals of preventative therapy are to reduce the severity, frequency, and duration of future episodes. In addition,...

Epidemiology And Risk Factors

Plantar fasciitis is the most common cause of chronic heel pain observed in up to 10 of the general population. A survey among professional team physicians and trainers in 1995 found plantar fasciitis to be among the top five causes of foot and ankle injuries in professional athletes (6). Another study estimated that about one million patient visits per year are for plantar fasciitis (7). It mainly occurs in middle-aged females and male runners younger than 20 years old, although all ages can...

Anatomical Landmarks

The larynx is a specialized upper airway organ designed to permit phonation and respiration as well as protect the lower airways from swallowed food and foreign bodies. It rests atop the upper trachea in the anterior neck, measuring approximately 5 cm in vertical dimension. The laryngeal skeleton consists of nine major cartilages joined by membranes and ligaments. Inferiorly, the cricoid cartilage forms a complete ring, with its posterior lamina being much thicker and taller than the anterior...

Clinical Applications

Contraction of the muscles in the glabellar complex (corrugator supercilii, procerus, and depressor supercilii) causes vertical frown lines. Treatment of this area is the most common site for BTX-A injection and the only FDA-approved cosmetic indication for BTX-A. Twenty to 35 U of BTX-A are placed using a five-point injection method (14-17). The authors typically start with the lower amount because our experience demonstrates that this effectively reduces muscle activity. Higher doses are used...

References

Laryngeal dystonia a series with botulinum toxin therapy. Ann Otol Rhinol Laryngol 1991 100 85-89. 2. Marsden CD, Sheehy MP. Spastic dysphonia, Meige disease and torsion dystonia. Neurology 1982 32 1202-1203. 3. Stacy M, Jankovic J. Differential diagnosis and treatment of childhood dystonia. Pediatr Ann 1993 22 353-358. 4. Jankovic J. Movement disorders. In Goetz CG, ed. Textbook of Clinical Neurology, 2nd ed. Philadelphia Saunders 2003, pp. 725-727. 5. Heaver L. Spastic...

Sialorrhea

BTX can reduce excessive or uncontrolled salivation (sialorrhea) and ptyalism (drooling) via autonomic denervation rather than muscular denervation. By impairing acetylcholine release in the neural junction, parasympathetic activity can be prevented. Localized injection of BTX is specific and regional. This ability to target secretary glands is a significant advantage over oral medications that are used to control salivation, such as glycopyrrolate and scopolamine, which produce systemic...

Botulinum Toxin Studied

The first major result of BTX studies occurred in the 1950s, when Dr. Vernon Brooks discovered that BTX type A (BTX-A), when injected into a hyperactive muscle, blocked the release of acetylcholine from motor nerve endings, thus inducing a temporary paralysis of the targeted muscle (3). Dr. Brooks' breakthrough sparked new interest in BTX as a potentially significant therapeutic agent. In the 1960s and 1970s, Dr. Alan B. Scott of the Smith-Kettlewell Eye Research Foundation tested BTX-A in...

Low Back Pain

Rebecca Brown, Avniel Klein, Alex Visco, and Joseph E. Herrera INTRODUCTION Low back pain (LBP) is the most common musculoskeletal complaint in the general population. It is one of the major reasons patients seek medical evaluation (1), second only to upper respiratory illness (2,3). Approximately 50 to 90 of the adult population will suffer from pain related to their back during their lifetime (4,5). Each year, 15 to 45 of adults suffer LBP, and 1 out of 20 people present to the hospital with...

Nonoperative Management

Myocutaneous Sacral Flap

Physical therapy that consists of stretching of the piriformis muscle, using a combination of manual maneuvers and ultrasound treatments, has been a mainstay of the conservative therapeutic approach (10-14,24,25). Five percent of the time, leg-length discrepancies appear, which are treated with in-shoe lifts and pelvic work. In our clinic, we have developed a treatment protocol that is correlated with 60 to 90 improvement, depending on the injection technique that accompanies it (see Table 2)....

Epidemiology

Because an estimated 80 million Americans suffer from low back pain and sciatica annually, any sizeable percentage of that group suffering from PS would be significant. One reason the syndrome is underdiagnosed is that MRI, myelogram, CT, and other imaging studies are very unlikely to turn up real evidence of PS (7-9). Rather, it is a functional syndrome, in which only certain positions and pressures will bring out the pain, paresthesias, and weakness that come with it. Therefore, traditional...

Btxa For The Treatment Of Anal Fissure

An anal fissure is a break in the epithelial lining (anoderm) of the anal canal. Often, the term anal ulcer is used for patients with a chronic (> 1 month) anal fissure. A mature ulcer is associated with a sentinel pile (skin tag) and a hypertrophied papilla. A primary anal fissure is one that has no obvious underlying cause. As per Goligher's rule, 90 of anal fissures occur in the midline posteriorly, 10 occur anteriorly, and 1 are both anterior and posterior (41). The most common initiating...

Diagnosis And Evaluation Of Lut Dysfunction

Botulinum Toxin Injection Anal Sphincter

As discussed previously, clinical experience has been reported using BTX in the treatment of a wide range of urological disorders. A basic discussion of the pathophysiology underlying each disorder, and the rationale for BTX injection as a treatment modality, is given in the following sections. In general, these disorders are classified under the broad category of LUT dysfunction. This section provides a brief overview of the diagnosis and evaluation of patients with LUT dysfunction. In the...

Gustatory Sweating

The term hyperhidrosis is used to describe excessive sweating beyond that which is needed to thermoregulate the body. Focal hyperhidrosis affects localized areas such as the palms, soles of the feet, axilla, trunk, and face. Gustatory sweating is a type of focal hyperhidrosis that results in facial sweating with meals. This can occur from aberrant regeneration after parotid gland surgery, sympathectomy, facial trauma, or infection. This section focuses on the role of BTX injection for the...

Our Method Of Injection

Pyriformis Injection

We inject Botox or Myobloc under EMG guidance, selecting four points in the muscle that should reach different myoneural junctions see Fig. 5 . Each site receives either 75 U of Botox or 3125 U of Myobloc, adding up to 300 U of Botox or 12,500 of Myobloc. We use a 75- or 80-mm monopolar Teflon-coated 23 gauge injectible monopolar needle e.g., of the type made by Chalgren Enterprises see Figs. 5 and 6 . We palpate the buttock for the most tender spot, then judge by the greater trochanter and the...