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Toxins
Special Issues
Application of Botulinum Toxin in Clinical Medicine
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Application of Botulinum Toxin in Clinical Medicine

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

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 24707

Special Issue Editor

Prof. Dr. Seong Taek Kim

E-Mail Website
Guest Editor
Department of Orofacial Pain & Oral Medicine, Yonsei University College of dentistry, Seoul 03722, Korea
Interests: botulinum toxin; anatomy; off-label use; aesthetic; pain; movement disorders

Special Issue Information

Dear Colleagues,

Over the past 25 years, botulinum toxin has emerged as an important clinical tool in the management of a diverse array of medical and aesthetic conditions, including spasticity, focal dystonias, chronic migraine headaches, overactive bladder, and facial wrinkles. The common thread underlying all of these conditions is that their symptoms are dependent on heightened efferent drive and excessive neurotransmitter and/ or neuropeptide release from motor or sensory neurons.

However, recent basic/clinical knowledge has been lacking in the clinical use of botulinum toxins diversely, despite many off-label uses for them.

This Special Issue includes the basic knowledge and clinical experiences of off-label use of botulinum toxin injection.

Prof. Dr. Seong Taek Kim
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Toxins is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • botulinum toxin
  • anatomy
  • off-label use
  • aesthetic
  • pain
  • movement disorders

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Published Papers (6 papers)

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Research

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10 pages, 743 KiB  
Article
Clinical and Neurophysiological Effects of Botulinum Neurotoxin Type A in Chronic Migraine
by Mariarosaria Valente, Christian Lettieri, Valentina Russo, Francesco Janes and Gian Luigi Gigli
Toxins 2021, 13(6), 392; https://doi.org/10.3390/toxins13060392 - 29 May 2021
Cited by 8 | Viewed by 3105
Abstract
Chronic pain syndromes present a subversion of both functional and structural nociceptive networks. We used transcranial magnetic stimulation (TMS) to evaluate changes in cortical excitability and plasticity in patients with chronic migraine (CM) treated with botulinum neurotoxin type A (BoNT/A). We enrolled 11 [...] Read more.
Chronic pain syndromes present a subversion of both functional and structural nociceptive networks. We used transcranial magnetic stimulation (TMS) to evaluate changes in cortical excitability and plasticity in patients with chronic migraine (CM) treated with botulinum neurotoxin type A (BoNT/A). We enrolled 11 patients with episodic migraine (EM) and 11 affected by CM. Baseline characteristics for both groups were recorded using single- and paired-pulse TMS protocols. The same TMS protocol was repeated in CM patients after four cycles of BoNT/A completed in one year. At baseline, compared with EM patients, patients with CM had a lower threshold in both hemispheres (right hemisphere: 46% ± 7.8 vs. 52% ± 4.28, p = 0.03; left hemisphere: 52% ± 4.28 vs. 53.54% ± 6.58, p = 0.02). In EM, paired-pulse stimulation elicited a physiologically shaped response, whereas in CM, physiological intracortical inhibition (ICI) between 1 and 3 ms intervals was absent at baseline. On the contrary, increasing intracortical facilitation (ICF) was observed for all interstimulus intervals (ISIs). In CM, cortical excitability was partially reduced after BoNT/A treatment, along with a significant decrease observed in MIDAS score (from 20.7 to 9.8; p = 0.008). The lower motor threshold in CM reflects a higher cortical hyperexcitability. The lack of physiological ICI in CM could indicate sensitisation of the trigeminovascular system. Although reduced, this type of response is still observable after treatment, despite a marked clinical improvement. Our study suggests a long-term alteration of cortical plasticity due to chronic pain. Full article
(This article belongs to the Special Issue Application of Botulinum Toxin in Clinical Medicine)
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11 pages, 968 KiB  
Article
Nonlinear Changes in Botulinum Toxin Treatment of Task-Specific Dystonia during Long-Term Treatment
by André Lee, Jabreel Al-Sarea and Eckart Altenmüller
Toxins 2021, 13(6), 371; https://doi.org/10.3390/toxins13060371 - 22 May 2021
Cited by 4 | Viewed by 2230
Abstract
Botulinum toxin (BoTX) is the standard treatment for task-specific dystonias (TSDs) such as musician’s dystonia (MD). Our aim was to assess the long-term changes in BoTX treatment in a highly homogeneous and, to our knowledge, largest group of MD patients with respect to [...] Read more.
Botulinum toxin (BoTX) is the standard treatment for task-specific dystonias (TSDs) such as musician’s dystonia (MD). Our aim was to assess the long-term changes in BoTX treatment in a highly homogeneous and, to our knowledge, largest group of MD patients with respect to the following parameters: (1) absolute and (2) relative BoTX dosage, (3) number of treated muscles, and (4) inter-injection interval. We retrospectively assessed a treatment period of 20 years in 233 patients, who had received a cumulative dose of 68,540 MU of BoTX in 1819 treatment sessions, performed by two neurologists. Nonlinear correlation was used to analyze changes in the parameters over the course of repeated treatments. Post-hoc we applied a median-split to classify two subgroups (high-BoTX, low-BoTX) depending on the total amount of BoTX needed during treatment. Across all patients, we found a decrease of dosage for the first approximately 25 treatments with an increase afterwards. The number of muscles and inter-injection intervals increased with time with a discrete decrease of inter-injection intervals after about 35 treatments. Subgroup differences were observed in the amount of BoTX and inter-injection intervals, with continuously increasing inter-injection intervals and decreasing BoTX dosage in the low-BTX group. Both groups showed a continuously increasing number of injected muscles. In summary, we found nonlinear changes of BoTX dosage and inter-injection intervals and a continuously increasing number of injected muscles with treatment duration in TSD-patients. Furthermore, we, for the first time, identified two subgroups with distinct differences. Increasing inter-injection intervals and decreasing BoTX dosages in the low-BoTX group indicated improvement of symptoms with continued treatment. Continually increasing BoTX dosages with unchanged inter-injection intervals in the high-BoTX group indicated deterioration. Full article
(This article belongs to the Special Issue Application of Botulinum Toxin in Clinical Medicine)
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6 pages, 639 KiB  
Article
Botulinum Toxin Type-A (Botulax®) Treatment in Patients with Intractable Chronic Occipital Neuralgia: A Pilot Study
by Hyeyun Kim, Bongjin Jang and Seong-Taek Kim
Toxins 2021, 13(5), 332; https://doi.org/10.3390/toxins13050332 - 4 May 2021
Cited by 5 | Viewed by 6573
Abstract
Intractable chronic occipital neuralgia (ON) is an uncommon type of headache often experienced by patients in outpatient neurological clinics. Among patients unresponsive to oral neuralgia medications, needling or injections with several drugs were suggested alternatives for treating chronic ON. This study aimed to [...] Read more.
Intractable chronic occipital neuralgia (ON) is an uncommon type of headache often experienced by patients in outpatient neurological clinics. Among patients unresponsive to oral neuralgia medications, needling or injections with several drugs were suggested alternatives for treating chronic ON. This study aimed to determine the effectiveness and safety of botulinum toxin type-A (BTX-A) injection treatments, where eight patients with unilateral chronic ON received BTX-A injections at the pain sites. The pain relief effect was observed 2 weeks after receiving the injections, gradually showing improvements up to 12 weeks after injection. There were no adverse events or changes from baseline in serologic studies and vital signs in any of the participants. The treatment’s pain-relieving effects were confirmed through regular, 12-week follow-ups, confirming the safety and effectiveness of BTX-A on chronic ON and suggesting that this method is an effective, novel alternative option for chronic ON treatment. Full article
(This article belongs to the Special Issue Application of Botulinum Toxin in Clinical Medicine)
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10 pages, 1724 KiB  
Article
Ultrasonographic Considerations for Safe and Efficient Botulinum Neurotoxin Injection in Masseteric Hypertrophy
by Hyung-Jin Lee, Su-Jin Jung, Seong-Taek Kim and Hee-Jin Kim
Toxins 2021, 13(1), 28; https://doi.org/10.3390/toxins13010028 - 4 Jan 2021
Cited by 14 | Viewed by 3626
Abstract
There are still concerns about masseteric bulging due to a lack of knowledge about the internal architecture of the masseter muscle. Further investigations are therefore required of the most-effective botulinum neurotoxin (BoNT) injection points and strategies for managing masseteric bulging. The purpose of [...] Read more.
There are still concerns about masseteric bulging due to a lack of knowledge about the internal architecture of the masseter muscle. Further investigations are therefore required of the most-effective botulinum neurotoxin (BoNT) injection points and strategies for managing masseteric bulging. The purpose of this study was to identify safer and more effective botulinum neurotoxin injection points and strategies by using ultrasonography to determine the structural patterns of the deep inferior tendon. We also measured the precise depths and locations of the deep inferior tendon of the masseter muscle. Thirty-two healthy volunteers participated in this study, and ultrasonography was used to scan the masseter muscle both longitudinally and transversely. Three structural patterns of the deep inferior tendon were identified: in type A, the deep inferior tendon covered the anterior two-thirds of the masseter muscle (21.8%); in type B, the deep inferior tendon covered the posterior two-thirds of the masseter muscle (9.4%); and in type C, the deep inferior tendon covered most of the inferior part of the masseter muscle (68.8%). Depending on the ultrasonography scanning site, the depth from the skin surface to the mandible in the masseteric region ranged from 15 to 25 mm. The deep inferior tendon was typically located 2 to 5 mm deep from the mandible. Ultrasonography can be used to observe the internal structure of the masseter muscle including the deep inferior tendon in individual patients. This will help to reduce the side effects of masseteric bulging when applying retrograde or dual-plane injection methods depending on the structural pattern of the deep inferior tendon. Full article
(This article belongs to the Special Issue Application of Botulinum Toxin in Clinical Medicine)
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9 pages, 1047 KiB  
Article
Effect of Botulinum Toxin Injection on Asymmetric Lower Face with Chin Deviation
by Dongwook Kim, Ju-Hyun Park, Vittorio Favero, James Mah, Young-Soo Jung and Seong Taek Kim
Toxins 2020, 12(7), 456; https://doi.org/10.3390/toxins12070456 - 17 Jul 2020
Cited by 5 | Viewed by 3275
Abstract
The purpose of this study was to compare the efficacy of botulinum toxin (BoNT) in masseter muscle reduction depending on the amount of chin deviation. Exploring distinctive effects of BoNT relative to the characteristics of facial asymmetry will aid in planning and predicting [...] Read more.
The purpose of this study was to compare the efficacy of botulinum toxin (BoNT) in masseter muscle reduction depending on the amount of chin deviation. Exploring distinctive effects of BoNT relative to the characteristics of facial asymmetry will aid in planning and predicting treatment outcomes. Sixteen adult volunteers were classified into two groups according to the degree of menton deviation observed in posteroanterior cephalograms. Eight had a menton deviation of 3 mm or more and the other eight had less than 3 mm. A total of 25 Units of BoNT was injected into the unilateral masseter muscle of the prominent side for each participant. Changes in the volume and bulkiest height of the lower face on each side were measured with a 3D laser scan at four time points: before and 4, 8, and 12 weeks after the injection. Two-way mixed ANOVA was employed for analyses. The volume and bulkiest height of the injected side decreased over time in both types of asymmetry, with significant differences at each time point. The reductions in the volume and bulkiest height were significantly greater in subjects without chin deviation. The reductions in the volume and bulkiest height of the lower face using BoNT are more effective for subjects without chin deviation. Full article
(This article belongs to the Special Issue Application of Botulinum Toxin in Clinical Medicine)
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Review

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16 pages, 1315 KiB  
Review
Use of AbobotulinumtoxinA for Cosmetic Treatments in the Neck, and Middle and Lower Areas of the Face: A Systematic Review
by Hassan Galadari, Ibrahim Galadari, Riekie Smit, Inna Prygova and Alessio Redaelli
Toxins 2021, 13(2), 169; https://doi.org/10.3390/toxins13020169 - 22 Feb 2021
Cited by 17 | Viewed by 4988
Abstract
AbobotulinumtoxinA (aboBoNT-A) has been used for various cosmetic purposes, including minimization of moderate to severe lines, or other cosmetic indications, in the face and neck. We carried out a systematic review to identify all relevant evidence on the treatment approaches and outcomes of [...] Read more.
AbobotulinumtoxinA (aboBoNT-A) has been used for various cosmetic purposes, including minimization of moderate to severe lines, or other cosmetic indications, in the face and neck. We carried out a systematic review to identify all relevant evidence on the treatment approaches and outcomes of aboBoNT-A as a cosmetic treatment of the middle and lower areas of the face, and the neck. Embase, MEDLINE, Cochrane Library, congress proceedings and review bibliographies were searched for relevant studies. Identified articles were screened against pre-specified eligibility criteria. Of 560 unique articles identified, 10 were included for data extraction (three observational studies, 1 randomized controlled trial [with two articles] and five non-randomized trials). The articles provided data on gummy/asymmetric smile (2), marionette lines (5), masseter muscle volume (2), nasal wrinkles (2), perioral wrinkles (3) and the platysma muscle (4). All articles reporting on efficacy of aboBoNT-A demonstrated positive results, including reduction of wrinkles (5), reduction of masseter muscle (2) and degree of gummy smile (1) compared with before treatment. No serious adverse events were reported and patient satisfaction was high. In conclusion, positive findings support further research of aboBoNT-A for the middle and lower areas of the face, and in the neck, which are largely unapproved indications. Full article
(This article belongs to the Special Issue Application of Botulinum Toxin in Clinical Medicine)
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