Uses of Botulinum Toxin Injection in Medicine

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 12959

Special Issue Editor


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Guest Editor
Department of Clinical Neurosciences, University of Lausanne, CH-1011 Lausanne, Switzerland
Interests: spasticity; botulinum toxin; neurological rehabilitation; gait

Special Issue Information

Dear Colleagues,

In recent decades, we have seen a growing interest in the use of botulinum toxin (mainly type A) in several domains of medicine. From the first utilizations in strabismus and dystonia, the use has widened to spasticity, lower urinary tract dysfunctions, sialorrhea, and headache. Then, to dermatology and cosmesis, pain, achalasia, as well as several gynecological and urological conditions.

The use of botulinum toxin over the years has been so varied that it has led some authors to call it the new panacea. The main reason for this heterogeneous use is mainly due to its principal effect of no cholinergic transmission but also due to its effect on multiple nerve co-transmitters, along with its ease and safety of use.

However, most of the clinical applications of botulinum toxin have a limited level of evidence and are sometimes only limited to case reports.

This Special Issue welcomes original papers or review articles focusing on the different applications that botulinum toxin has in clinical medicine. We seek papers showing the role of botulinum toxin in diagnosis, treatment and/or health maintenance.

We expect to receive papers on traditional and new utilizations of botulinum toxin in cancer medicine, psychiatry, gastrointestinal conditions, musculoskeletal conditions, gynecology and urology. Generalizing, research on all relevant medical conditions in which the use of botulinum toxin has been shown to have potential is welcome.

Dr. Stefano Carda
Guest Editor

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Keywords

  • botulinum toxin
  • therapeutic use
  • clinical medicine
  • diagnostic use of chemicals
  • internal medicine
  • neurology
  • psychiatry
  • physical and rehabilitation medicine
  • palliative medicine
  • reproductive medicine
  • specialties
  • surgical

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Published Papers (7 papers)

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14 pages, 928 KiB  
Article
Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study
by Pablo Maldonado, Hugo Bessaguet, Cédric Chol, Pascal Giraux, Ludovic Lafaie, Ahmed Adham, Romain David, Thomas Celarier and Etienne Ojardias
Toxins 2024, 16(8), 365; https://doi.org/10.3390/toxins16080365 - 16 Aug 2024
Viewed by 845
Abstract
Acquired deforming hypertonia (ADH) affects the daily care of numerous nursing home residents. The aim of this study was to analyze the practice, aims, and effectiveness of botulinum toxin injections (BTxis) in the treatment of older patients with contractures, an indication for which [...] Read more.
Acquired deforming hypertonia (ADH) affects the daily care of numerous nursing home residents. The aim of this study was to analyze the practice, aims, and effectiveness of botulinum toxin injections (BTxis) in the treatment of older patients with contractures, an indication for which BTxis are still underused. Data were extracted retrospectively from medical records regarding population, contractures, and injections. A prospective analysis was conducted to evaluate treatment goals set by goal attainment scaling (GAS) at T0 and at T1, to evaluate the therapeutic effects. We also recorded the occurrence of side effects, using a telephone questionnaire. This study included 41 patients older than 70 years who had received one or more BTxis for the first time between January 2018 and December 2021. Most of the older people we included lived in an institution (66%), manifested severe dependence, and presented significant morbi-mortality (37% of the patients died in the year after the last injection). The main objectives of these injections were purely comfort, without any functional goals. The GAS scores suggested effectiveness for comfort GAS scores. No complications were recorded. This study highlights the BTxis potential to address the needs of a larger number of older patients with ADH. Full article
(This article belongs to the Special Issue Uses of Botulinum Toxin Injection in Medicine)
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10 pages, 538 KiB  
Article
Enhancing Botulinum Toxin Injection Precision: The Efficacy of a Single Cadaveric Ultrasound Training Intervention for Improved Anatomical Localization
by Camille Heslot, Omar Khan, Alexis Schnitzler, Chloe Haldane, Romain David and Rajiv Reebye
Toxins 2024, 16(7), 304; https://doi.org/10.3390/toxins16070304 - 2 Jul 2024
Viewed by 1075
Abstract
Ultrasound guidance can enhance existing landmark-based injection methods, even through a brief and single exposure during a cadaveric training course. A total of twelve participants were enrolled in this training program, comprising nine physical medicine and rehabilitation specialists, one pediatrician, and two physician [...] Read more.
Ultrasound guidance can enhance existing landmark-based injection methods, even through a brief and single exposure during a cadaveric training course. A total of twelve participants were enrolled in this training program, comprising nine physical medicine and rehabilitation specialists, one pediatrician, and two physician assistants. For each participant, one upper-limb muscle and one lower-limb muscle were randomly chosen from the preselected muscle group. Subsequently, participants were tasked with injecting both of their chosen cadaveric muscles with 1 mL of acrylic paint using a manual needle palpation technique, relying solely on their knowledge of anatomic landmarks. Participants then underwent a personalized, one-to-one ultrasound teaching session, lasting approximately five minutes, conducted by two highly experienced instructors. Following this instructive phase, participants were tasked with a second round of injections, targeting the same two muscles in the lower and upper limbs. However, this time, the injections were performed using anatomical landmarks and ultrasound guidance. To facilitate differentiation from the initial injections, a distinct color of acrylic paint was employed. When employing the anatomical landmark-based approach, the overall success rate for injections was 67%, with 16 out of 24 targeted muscles accurately injected. With the incorporation of ultrasound guidance, the success rate was 92%, precisely targeting 22 out of the 24 muscles under examination. There was an improvement in injection accuracy achievable through the integration of ultrasound guidance, even with minimal training exposure. Our single cadaveric ultra-sound training program contributes valuable insights to the utilization of ultrasound for anatomy training to help optimize the targeting of BoNT-A. Full article
(This article belongs to the Special Issue Uses of Botulinum Toxin Injection in Medicine)
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8 pages, 2678 KiB  
Communication
Mindfulness in Facilitating Pelvic Floor Botulinum Toxin Injection in Women with Chronic Pelvic Pain
by Jacqueline V. Aredo, Hannah K. Tandon, Samin Panahi, Vy T. Phan, Rezvan Ameli, Barbara I. Karp and Pamela Stratton
Toxins 2024, 16(5), 216; https://doi.org/10.3390/toxins16050216 - 9 May 2024
Viewed by 1547
Abstract
Botulinum toxin (BoNT) injection can safely be done as an office-based procedure, but can be painful itself, especially when injecting pelvic floor muscles to treat chronic pelvic pain (CPP). Mindfulness interventions may reduce procedure-associated acute anxiety and pain. We applied mindfulness techniques to [...] Read more.
Botulinum toxin (BoNT) injection can safely be done as an office-based procedure, but can be painful itself, especially when injecting pelvic floor muscles to treat chronic pelvic pain (CPP). Mindfulness interventions may reduce procedure-associated acute anxiety and pain. We applied mindfulness techniques to increase the tolerability of office-based pelvic floor BoNT injections in women with CPP. Women enrolled in a clinical trial of BoNT for endometriosis-associated CPP were offered a brief, guided mindfulness session before and/or after transvaginal injection. Anxiety, pain, and dysphoria were rated on a 0–10 numerical rating scale (NRS) before and after each mindfulness session. Eight women underwent mindfulness sessions. Five participants had a session before and two after the transvaginal injection. One participant had two sessions: one before and one after separate injections. All six women completing a session prior to injection had at least moderate anxiety, which lessened after the mindfulness session (median NRS change: −3.3/10). All three women reporting injection-associated pain experienced less intense pain following the post-injection session (median NRS change: −3/10). Three women experiencing dysphoria improved after the session (median NRS change: −3/10). A brief, guided mindfulness session may lessen acute pain, anxiety, and dysphoria associated with office-based transvaginal BoNT injection. Full article
(This article belongs to the Special Issue Uses of Botulinum Toxin Injection in Medicine)
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14 pages, 859 KiB  
Article
Longitudinal Assessment of Facial Hyperhidrosis Management: Evaluating the Utility and Quality of Life Improvements following Botulinum Toxin Injection
by Catalin Prodan-Barbulescu, Luca Castiglione, Sonia Roxana Burtic, Marius Murariu, Shruta Reddy, Ovidiu Rosca, Felix Bratosin, Camelia Melania Fizedean, Pavel Krupyshev and Ileana Enatescu
Toxins 2024, 16(1), 59; https://doi.org/10.3390/toxins16010059 - 21 Jan 2024
Cited by 1 | Viewed by 1591
Abstract
Facial hyperhidrosis is a debilitating condition that can severely impact the quality of life. This study aimed to assess the long-term utility of Botulinum toxin type A therapy (BTA) for facial hyperhidrosis and its impact on quality of life over a one-year period. [...] Read more.
Facial hyperhidrosis is a debilitating condition that can severely impact the quality of life. This study aimed to assess the long-term utility of Botulinum toxin type A therapy (BTA) for facial hyperhidrosis and its impact on quality of life over a one-year period. Conducted at the Pius Brinzeu Clinical Emergency Hospital in Timisoara, Romania, this longitudinal observational study involved 77 adult patients with primary facial hyperhidrosis. Participants received two sessions of Botulinum toxin injections (50 U IncoBTX-A each) and were evaluated at baseline, 6 months, and 12 months using the Hyperhidrosis Disease Severity Scale (HDSS), WHOQOL-BREF, Dermatology Life Quality Index (DLQI), and a bespoke survey. The study demonstrated significant reductions in HDSS scores from 3.6 ± 0.5 to 1.2 ± 0.8 post-treatment, sustained at 1.3 ± 0.6 at 12 months (p-value < 0.001). DLQI scores markedly decreased from 24.8 ± 4.2 to 6.2 ± 2.1 post-treatment, stabilizing at 6.5 ± 2.5 at 12 months (p-value < 0.001). Sweat production significantly dropped from 0.75 g ± 0.15 to 0.18 g ± 0.07 per 15 min (p-value < 0.001). WHOQOL-BREF scores improved notably in the mental domain from 66.7 ± 6.1 to 70.8 ± 5.2 at 12 months (p-value < 0.001), with physical and social domains also showing significant improvements. Correlation analysis revealed strong negative correlations between DLQI total score and HDSS (rho = −0.72, p-value < 0.001) and sweat production (rho = −0.68, p-value < 0.001). Regression analysis indicated significant predictors for DLQI total score, including HDSS (B Coefficient = −3.8, p-value < 0.001) and sweat production (B Coefficient = −2.2, p-value < 0.001). BTA therapy significantly improved the quality of life in facial hyperhidrosis patients, with lasting effects on symptom severity, sweat production, and quality of life domains. The correlation and regression analyses further substantiated the treatment’s impact on both physical and psychological aspects. These findings advocate Botulinum toxin as a viable long-term treatment for facial hyperhidrosis. Full article
(This article belongs to the Special Issue Uses of Botulinum Toxin Injection in Medicine)
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16 pages, 1740 KiB  
Article
Improvement in Quality-of-Life-Related Outcomes Following Treatment with IncobotulinumtoxinA in Adults with Limb Spasticity: A Pooled Analysis
by Franco Molteni, Jörg Wissel, Klemens Fheodoroff, Michael C. Munin, Atul T. Patel, Michael Althaus, Georg Comes, Andrzej Dekundy, Irena Pulte, Astrid Scheschonka, Matteo Vacchelli and Andrea Santamato
Toxins 2024, 16(1), 19; https://doi.org/10.3390/toxins16010019 - 29 Dec 2023
Viewed by 1861
Abstract
A strong correlation has been reported between patient-reported quality of life (QoL) and the investigator-rated Disability Assessment Scale (DAS) in patients with spasticity. The current analysis evaluates the effect of incobotulinumtoxinA on QoL-related outcomes (limb position abnormality, as well as dressing- and hygiene-related [...] Read more.
A strong correlation has been reported between patient-reported quality of life (QoL) and the investigator-rated Disability Assessment Scale (DAS) in patients with spasticity. The current analysis evaluates the effect of incobotulinumtoxinA on QoL-related outcomes (limb position abnormality, as well as dressing- and hygiene-related disability, measured with the DAS) in adults with upper limb spasticity, using pooled data from six studies. Separate analyses for each DAS domain were performed using data from patients with disabilities for that domain (DAS score ≥1). Results showed that a significantly greater proportion of incobotulinumtoxinA-treated compared with placebo-treated patients achieved a ≥1-point reduction from baseline in each of the DAS domains (improvement) 4 weeks after the first injection. The benefits of incobotulinumtoxinA were observed regardless of the baseline severity of DAS impairment and of the time elapsed since stroke. The effects of incobotulinumtoxinA 4 weeks after injection were maintained or enhanced over multiple injection cycles for all three DAS domains, supporting the use of repeated injection cycles to provide sustained QoL benefit. IncobotulinumtoxinA represents an important treatment option to achieve better QoL-related outcomes for patients with upper limb spasticity, irrespective of the duration of their condition. Full article
(This article belongs to the Special Issue Uses of Botulinum Toxin Injection in Medicine)
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24 pages, 2358 KiB  
Systematic Review
Botulinum Toxin Injections for Psychiatric Disorders: A Systematic Review of the Clinical Trial Landscape
by Ilya Demchenko, Alyssa Swiderski, Helen Liu, Hyejung Jung, Wendy Lou and Venkat Bhat
Toxins 2024, 16(4), 191; https://doi.org/10.3390/toxins16040191 - 15 Apr 2024
Cited by 2 | Viewed by 2863
Abstract
Botulinum toxin type A (BONT-A) has shown promise in improving the mood-related symptoms of psychiatric disorders by targeting muscles linked to the expression of negative emotions. We conducted a systematic review of past and ongoing efficacy trials of BONT-A therapy for psychiatric disorders [...] Read more.
Botulinum toxin type A (BONT-A) has shown promise in improving the mood-related symptoms of psychiatric disorders by targeting muscles linked to the expression of negative emotions. We conducted a systematic review of past and ongoing efficacy trials of BONT-A therapy for psychiatric disorders to identify relevant trends in the field and discuss the refinement of therapeutic techniques. A comprehensive search for published clinical trials using BONT-A injections for psychiatric disorders was performed on 4 May 2023 through OVID databases (MEDLINE, Embase, APA PsycINFO). Unpublished clinical trials were searched through the ClinicalTrials.gov and International Clinical Trial Registry Platform public registries. The risk of bias was assessed using the JBI Critical Appraisal tools for use in systematic reviews. We identified 21 studies (17 published, 4 unpublished clinical trials) involving 471 patients. The studies focused on evaluating the efficacy of BONT-A for major depressive, borderline personality, social anxiety, and bipolar disorders. BONT-A was most commonly injected into the glabellar area, with an average dose ranging between 37.75 U and 44.5 U in published studies and between 32.7 U and 41.3 U in unpublished trials. The results indicated significant symptom reductions across all the studied psychiatric conditions, with mild adverse effects. Thus, BONT-A appears to be safe and well-tolerated for psychiatric disorders of negative affectivity. However, despite the clinical focus, there was a noted shortage of biomarker-related assessments. Future studies should focus on pursuing mechanistic explorations of BONT-A effects at the neurobiological level. Full article
(This article belongs to the Special Issue Uses of Botulinum Toxin Injection in Medicine)
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20 pages, 10428 KiB  
Systematic Review
Botulinum Toxin for Pain Relief in Cancer Patients: A Systematic Review of Randomized Controlled Trials
by Lorenzo Lippi, Alessandro de Sire, Alessio Turco, Martina Ferrillo, Serdar Kesikburun, Alessio Baricich, Stefano Carda and Marco Invernizzi
Toxins 2024, 16(3), 153; https://doi.org/10.3390/toxins16030153 - 15 Mar 2024
Viewed by 2196
Abstract
Cancer pain is one of the most disabling symptoms complained by cancer patients, with a crucial impact on physical and psychological well-being. Botulinum neurotoxins (BoNTs) type A and B have emerged as potential interventions for chronic pain; however, their role in these patients [...] Read more.
Cancer pain is one of the most disabling symptoms complained by cancer patients, with a crucial impact on physical and psychological well-being. Botulinum neurotoxins (BoNTs) type A and B have emerged as potential interventions for chronic pain; however, their role in these patients is still debated. Thus, this systematic review of randomized controlled trials aimed at assessing the effects of BoNT treatment for cancer pain to guide physicians in an evidence-based approach integrating BoNT in cancer care. Out of 5824 records, 10 RCTs satisfied our eligibility criteria and were included in the present work for a total of 413 subjects with several cancer types (breast, head and neck, esophageal, and thoracic/gastric cancers). While some studies demonstrated significant pain reduction and improved quality of life post-BoNT-A injections, outcomes across different cancer types were inconclusive. Additionally, several effects were observed in functioning, dysphagia, salivary outcomes, esophageal strictures, gastric emptying, and expansions. This review emphasizes the need for further standardized research to conclusively establish the efficacy of BoNT in comprehensive cancer pain management. Full article
(This article belongs to the Special Issue Uses of Botulinum Toxin Injection in Medicine)
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