Botulinum toxin therapy for neurologic disorders

Botulinum toxin type A, the most potent biologic neurotoxin known, enjoys a curious role as an increasingly used therapeutic agent. Its ability to produce chemical denervation in muscle makes it an intriguing option for treating focal dystonias and other neurologic disorders in which traditional therapies are of limited benefit. In this article, Drs Tim and Massey describe the therapeutic effectiveness of botulinum toxin in various disorders.     

Botulinum toxin therapy for myofascial pain disorders

Myofascial pain disorder can originate from various muscles in the body. Numerous therapeutic approaches have been used to treat myofascial pain syndrome with varying success. Botulinum toxin neurolysis may become an important treatment regimen because it sustains relaxation of muscles. There is a growing body of clinical evidence for the efficacy of botulinum toxin in the treatment of painful myofascial conditions. The conditions that have been investigated include chronic low back pain, chronic cervical-associated headache, myofascial pain, myofascial pain syndrome and pain from chronic muscle spasm, and refractory myofascial pain. One of these studies was an open-label, exploratory pilot study into the cervicothoracic and lumbosacral regions using a novel injection technique.     

Botulinum toxin therapy for cervical dystonia

Botulinum toxin revolutionized the treatment of cervical dystonia. In contrast to systemically active medications, the effect of botulinum toxin results from selective administration to weaken muscles involved in the dystonic posturing of the head. This article reviews the pathophysiologic basis of symptoms in cervical dystonia and how botulinum toxin alleviates them. Other therapeutic options are reviewed for comparison. This article discusses strategies for maximizing the clinical benefit of botulinum toxin in this disorder and reviews muscle selection and identification with electromyography.     

Botulinum toxin in specific pain therapy

Botulinum toxin has been used for therapeutic purposes in medicine for more than 20 years. Its effective use now covers more than 50 conditions in a wide variety of areas. Its medicinal use was initially based on its blockade of neuromuscular and neurosecretory transfers. Its use for conditions in the field of specific pain therapy is currently authorized in Germany for spastic torticollis, blepharospasm, hemifacial spasm, spastic equine gait in cases of idiopathic cerebral paresis, and spasticity of the arm following stroke.New publications suggest that it can usefully be employed for numerous other painful conditions.The modes of action known today are not confined to the blockade of cholinergic innervation.Indeed, there is also evidence that therapeutic effects are mediated through a normalization of muscle spindle activity, retrograde intake into the CNS with modulation of the central neuropeptide function, inhibition of sterile neurogenic inflammation, and normalization of endplate dysfunction. In view of the methodological peculiarities of studies in the field of pain therapy, such as injection techniques, injection sites, blind study techniques, dosage etc., the scientific evidence for its use in a wide variety of pain syndromes is still patchy in many areas.For this reason the use of botulinum toxin for these syndromes is only justified after full use has been made of standard therapeutic methods and evaluation in specialized centers.The possibility of considering botulinum toxin in specific pain therapy contexts is a new option for patients and doctors.However, its use calls for detailed knowledge of functional neuroanatomy and extensive practical experience and expertise.     

Botulinum toxin in the management of bowel and bladder function in spinal cord injury and other neurologic disorders

Botulinum toxin inhibits release of acetylcholine and other neurotransmitters. It has been used successfully to treat pain and abnormal skeletal and smooth muscle activity in patients. This article discusses its use in patients with bladder and bowel disorders.     

Botulinum toxin

Botulinum toxin is regarded as the most lethal substance known. It is estimated that the human LD50 for inhalation botulism is 1 to 3 nanograms of toxin/kilogram body mass. Although only three cases of inhalational botulism have been described, an understanding of the pathophysiology of food-borne outbreaks, wound botulism, and infant botulism, and their therapies, enables the medical community to plan treatment in the event of an aerosol release of botulinum toxin. Antitoxin, vaccine, and F(ab')2 immune fragment therapies are discussed as adjuncts to supportive therapy.     

Botulinum toxin for spasmodic dysphonia

Botulinum toxin is the accepted method of managing SD and has given most patients with adductor SD the ability to develop satisfactory vocal function. Results have been less satisfactory in abductor SD. Management is accomplished best with a team approach. The physiatrist with experience in EMG and botulinum toxin usage can be a prominent member of this team.     

Botulinum toxin for blepharospasm: challenges for rehabilitation nurses.

Blepharospasm is a chronic, progressive, involuntary spasmodic closure of the eyelids associated with abnormal facial and oromandibular movements. It is a neurologic disorder whose cause is unknown and whose pathophysiology is poorly understood. Without appropriate treatment, it can result in functional blindness and other disabilities. In the last decade, botulinum toxin has been found to be effective therapy for most individuals. The drug, which is given by local injection, has a denervation effect. It relieves symptoms for several months, allowing patients to resume their former lifestyles between treatments. This new therapy modality challenges rehabilitation nurses to bridge the gap between disabled persons in the community and this new technology. Casefinding, referrals, and patient education are among the interventions that can help meet this challenge. The major purpose of this article is to inform rehabilitation nurses about how to recognize the symptoms of neurologic blepharospasm and how to intervene to prevent disabilities that could result.     

Botulinum toxin type A for the treatment of urinary tract dysfunction in neurological disorders

Botulinum toxin type A injections represent an important therapeutic option for patients with neurogenic urinary dysfunction in whom conservative treatment has not been effective. The nurse's role in ensuring that these patients receive appropriate assessment and treatment is discussed.     

Botulinum toxin: a case study.

A variety of therapeutic options exist for the treatment of achalasia. This case study explores these options and follows an individual's experiences as he undergoes these treatments from a barium swallow to botulinum toxin injection.     

Botulinum toxin a for vulvodynia: a case report.

Vulvodynia is a poorly understood chronic pain condition, and patients who are refractory to standard therapies often pose a therapeutic dilemma. Current treatment modalities include antidepressants, anticonvulsants, biofeedback, pelvic floor physical therapy, and surgery; however, the options are limited for patients who fail to respond to these treatments. We present a case of refractory vulvodynia with severe dyspareunia successfully managed with a novel therapeutic approach combining botulinum toxin A and surgery. PERSPECTIVE: The authors present a case of refractory vulvodynia that was successfully managed with a novel approach that combined botulinum toxin A and surgery.