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Toxins
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Neurophysiology of Botulinum Toxins in Clinical Practice
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Neurophysiology of Botulinum Toxins in Clinical Practice

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

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 6005

Special Issue Editor

Prof. Dr. Roberto Eleopra

E-Mail Website
Guest Editor
Neurological Unit 1, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, 20133 Milan, Italy
Interests: movement disorders; neurophysiology; botulinum toxin; deep brain stimulation; MRgFUS

Special Issue Information

Dear Colleagues,

Botulinum neurotoxin (BoNT) is one of the most powerful toxins in nature, and is a polypeptide produced by different serotypes of the bacterium (Clostridium botulinum) that are now well identified. Serotypes A and B are largely used in clinical practice to treat different neurological diseases characterized by neuromuscular hyperactivity, autonomic dysfunction, pain syndrome, and so on.

The electrophysiological effects of BoNT have been investigated in systemic human botulism, where the most commonly used tests include the evaluation of variations in compound muscle action potentials (CMAPs), repetitive nerve stimulation, and single-fiber EMG (SFEMG), However, in clinical practice the role of neurophysiology is still unclear, making it difficult to evaluate the neuromuscular block induced by different BoNT serotypes. Therefore, the role of electrophysiology during therapeutic BoNT injections in clinical practice is controversial.

In the literature, the utility of neurophysiology to evaluate the systemic spread of BTX in peripheral or central nervous systems following local injection has been reported, but how electrophysiology may help to check subtle changes in autonomic and nociceptive terminal endings is not well defined.

The aim of this Special Issue is to review the role of neurophysiology in BoNT poisoning in humans. Preliminarily, the electrophysiological findings in wound botulism will be reviewed . Then, the neurophysiological features of BoNT treatment will be revised for: improving the clinical strategy of BoNT injections; detecting local or systemic effects in the PNS and CNS; quantifying the effect of BoNTs on autonomic or nociceptive fibers; detecting adverse local or distant side effects and evaluating true BoNT-resistant subjects.

Prof. Dr. Roberto Eleopra
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 toxins
  • neurophysiology
  • botulism
  • electrophysiology

Published Papers (2 papers)

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Research

14 pages, 1748 KiB  
Article
Comprehensive Assessment of the Time Course of Biomechanical, Electrophysiological and Neuro-Motor Effects after Botulinum Toxin Injections in Elbow Flexors of Chronic Stroke Survivors with Spastic Hemiplegia: A Cross Sectional Observation Study
by Yen-Ting Chen, Yang Liu, Chuan Zhang, Elaine Magat, Ping Zhou, Yingchun Zhang and Sheng Li
Toxins 2022, 14(2), 104; https://doi.org/10.3390/toxins14020104 - 28 Jan 2022
Cited by 1 | Viewed by 2765
Abstract
Botulinum neurotoxin (BoNT) is commonly used to manage focal spasticity in stroke survivors. This study aimed to a perform comprehensive assessment of the effects of BoNT injection. Twelve stroke subjects with spastic hemiplegia (age: 52.0 ± 10.1 year; 5 females) received 100 units [...] Read more.
Botulinum neurotoxin (BoNT) is commonly used to manage focal spasticity in stroke survivors. This study aimed to a perform comprehensive assessment of the effects of BoNT injection. Twelve stroke subjects with spastic hemiplegia (age: 52.0 ± 10.1 year; 5 females) received 100 units of BoNT to the spastic biceps brachii muscles. Clinical, biomechanical, electrophysiological, and neuro-motor assessments were performed one week (wk) before (pre-injection), 3 weeks (wks) after, and 3 months (mons) after BoNT injection. BoNT injection significantly reduced spasticity, muscle strength, reflex torque, and compound muscle action potential (CMAP) amplitude of spastic elbow flexors (all p < 0.05) during the 3-wks visit, and these values return to the pre-injection level during the 3-mons visit. Furthermore, the degree of reflex torque change was negatively correlated to the amount of non-reflex component of elbow flexor resistance torque. However, voluntary force control and non-reflex resistance torque remained unchanged throughout. Our results revealed parallel changes in clinical, neurophysiological and biomechanical assessment after BoNT injection; BoNT injection would be more effective if hypertonia was mainly mediated by underlying neural mechanisms. BoNT did not affect voluntary force control of spastic muscles. Full article
(This article belongs to the Special Issue Neurophysiology of Botulinum Toxins in Clinical Practice)
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11 pages, 1665 KiB  
Article
Low-Dose Neubotulinum Toxin A versus Low-Dose Abobotulinum Toxin A Injection for the Treatment of Cervical Dystonia: A Multicenter, 48-Week, Prospective, Double-Blinded, Randomized Crossover Design Study
by Subsai Kongsaengdao, Arkhom Arayawithchanont, Kanoksri Samintharapanya, Pichai Rojanapitayakorn, Benchalak Maneeton and Narong Maneeton
Toxins 2021, 13(10), 694; https://doi.org/10.3390/toxins13100694 - 1 Oct 2021
Cited by 1 | Viewed by 2349
Abstract
Various types of botulinum toxin (BoNT) have been studied to treat cervical dystonia (CD). Although high-dose BoNT has proven efficacy, it increases the risk of adverse events. For this reason, this study was planned to identify the non-inferiority efficacy, tolerability, and safety of [...] Read more.
Various types of botulinum toxin (BoNT) have been studied to treat cervical dystonia (CD). Although high-dose BoNT has proven efficacy, it increases the risk of adverse events. For this reason, this study was planned to identify the non-inferiority efficacy, tolerability, and safety of low-dose neubotulinum toxin A (Neu-BoNT-A) versus low-dose abobotulinum toxin A (Abo-BoNT-A) in CD treatment. The 48-week, prospective, randomized, controlled crossover design study of CD treatment, with 50-unit Neu-BoNT-A and 250-unit Abo-BoNT-A injections at 12-week intervals, was conducted over a 24-week treatment period. This study used the following standardized rating scales to assess the efficacy of BoNT: the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS); health-related quality of life (HRQoL); the Cervical Dystonia Impact Profile (CDIP-58); the Short Form 36 health survey questionnaire (SF-36); and, for the depressive symptoms of CD patients, the Center for Epidemiological Studies-Depression Scale (CES-D) and the Patient Health Questionnaire-9 (PHQ-9). Fifty-two CD patients were enrolled from October 2019 to January 2021. The mean scores of the TWSTRS total at the post-treatments in both Neu-BoNT-A and Abo-BoNT-A had a significant reduction from baseline (p = 0.008 and 0.002, respectively). However, the mean changes of the TWSTRS total at the 12- and 24-week treatments between the two treatment groups were not significantly different (p = 0.284 and 0.129, respectively). The mean scores of the HRQoL questionnaires (the CIDP-58 and the SF-36) and the depressive symptoms (the CES-D and the PHQ-9) in both treated groups at the post-treatments did not significantly decrease from baseline and were comparable. Two patients treated with Abo-BoNT-A (250 units) reported cervical tension and benign paroxysmal positional vertigo (BPPV). There were no serious adverse events reported. Though both low-dose BoNT-As were effective at improving clinical symptoms without significant side effects, both treatments did not predict change in quality of life and depression. With the non-inferiority criteria, low-dose Neu-BoNT-A has a similar efficacy, safety, and tolerability to Abo-BoNT-A. Full article
(This article belongs to the Special Issue Neurophysiology of Botulinum Toxins in Clinical Practice)
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