Low dose botulinum toxin in spasmodic torticollis.

Botulinum toxin has been successfully used to treat spasmodic torticollis. The optimum dosage is not clear and the recommended doses in the United Kingdom are 20-25 ng. We have used much lower doses (average 13 ng) without loss of efficacy and accompanied by a reduction in side effects. We treated 12 patients (eight women and four men) with a mean duration of torticollis of 4 years. Eleven of the 12 patients (91%) showed an improvement in total scores for pain and degree of head movement. The benefits appeared a week after treatment and lasted for 3 months. Side effects were minimal and transient. Our experience suggests low doses of the toxin may be equally efficacious.     

Applications of the botulinum A toxin

The botulinum A toxin inhibits the release of acethylcoline from the vesicles of presynaptic neuronal end plates. Its effect is a transient pharmacological neurectomy. The toxin is used more and more widespreadingly. It selectively inhibits certain muscles or groups of muscles. Its use is of outstanding importance in the treatment of blepharospasm, a disease possibly causing transient functional blindness. This blindness develops randomly, with undetermined duration, therefore it may even threaten the life of the patient. There is no alternative treatment. In ophthalmology, the toxin is used in the therapy of strabismus and nystagmus, as well as replacing entropion operations. Most often its use is suggested in the treatment of focal dystonies, dysphonia, tremor palatinus, dysphagia, spasm of the oesophagus sphincter muscle, nasal hypersecretion, hemifacial spasm, headaches, focal hyperhydrosis, proctalgia fugax, diabetic gastroparesis and difficulties in urination. In the past few years, the toxin has been used for esthetic reasons as well. By relaxing the muscles causing wrinkles, non-permanent result may be reached with its use. The botulinum A toxin does not have general side effects. As local side effects, haematomas and unwanted, transient paresis of the neighboring muscles can be mentioned.     

The use of botulinum toxin in otorhinolaryngology

In recent years, the use of botulinum toxin has become more popular for the treatment of a wide variety of diseases in the head and neck. It offers the possibility of non-invasive treatment of conditions whose aetiology lies in neuromuscular dyskinesis.     

The use of botulinum toxin in ophthalmology

As the diversity of clinical applications for the botulinum neurotoxin continues to grow, exciting developments are occurring in its use around the eye, where indeed its benefits were first recognized. These include use to treat strabismus, eyelid disorders and a number of other ocular conditions.     

Thermal sensitivity of Clostridium botulinum type C toxin

A sterile suspension containing 950 mouse LD50 per ml of type C botulinum toxin was exposed for various periods to different temperatures. The time required for the 99% (hundred-fold) reduction of toxicity was more than 5 years at -70 degrees C or -20 degrees C, 6 months at +5 degrees C, 3 weeks at +20 degrees C, 2 weeks at +28 degrees C, 2 days at +37 degrees C, 9 h at +42 degrees C, less than 30 min at +56 degrees C, less than 20 min at +60 degrees C, and below 5 min at +80 degrees C. The results suggest that Clostridium botulinum type C toxin, if produced in an ecosystem of the mild climatic zone, might persist there over the winter season and cause the intoxication of vertebrates next early spring in the absence of further microbial toxigenesis.     

医源性肉毒毒素中毒2例报告

肉毒毒素是目前毒性最强的蛋白质类神经毒素,近年来越来越多应用于医学美容行业。本文报道2例医源性肉毒毒素中毒病例的临床表现及救治过程,并对医源性肉毒中毒救治的注意事项进行分析。     

Costs and consequences of botulinum toxin type A use

This study was a retrospective survey of the management of a cohort of children with cerebral palsy at Seepark Hospital, Germany, who did (cases; n=107) and did not (controls; n=107) receive botulinum toxin injections. Data on healthcare resource use and clinical outcomes over 12 months were collected from the date cases received their first injection and from the date controls were first admitted into hospital. Botulinum toxin use led to an 85% reduction in the number of children requiring surgery. Additionally, controls used significantly more healthcare resources than cases, particularly hospital bed days (69.2±34.1 vs. 27.5±27.9 days; p <0.0001). The total cost of managing cases and controls was €16,700 and €33,800, respectively. In conclusion, use of botulinum toxin released resources for alternative use during the first year following treatment, without any loss of clinical improvement. However, it is unknown how botulinum toxin affected the need for surgery and associated outcomes in subsequent years.     

膀胱逼尿肌A型肉毒毒素注射的围手术期护理体会

目的总结膀胱逼尿肌A型肉毒毒素注射的围手术期护理体会,提出临床护理的针对性建议。方法为22例拟接受膀胱逼尿肌A型肉毒毒素注射的膀胱逼尿肌反射亢进患者提供全面的围手术期护理,深入观察,及时发现并合理解决临床存在的护理问题。结果及时的心理辅导及完善的护理明显改善了患者的消极心理,增强信心,术后恢复良好,症状改善明显。结论通过针对性的围手术期护理,接受膀胱逼尿肌A型肉毒毒素注射的患者能获得满意的治疗和护理,效果明显。     

The use of botulinum toxin in head and neck disorders

Not only can botulinum toxin be used for cervical and laryngeal dystonia but in this article its use and complications in the management of oromandibular dystonia, Frey's syndrome, crocodile tears and drooling is described.     

C型肉毒梭菌毒素面团毒饵现场灭家鼠效果研究

本文首次报告用C型肉毒梭菌毒素灭家鼠效果研究。1991年12月至翌年4月,在济南市郊区农村,用该毒素液体制剂进行了8次灭家鼠效果试验。毒饵中除含量为0.02%和0.04%的2组试验的灭效较低外,含量为0.1～0.5%的6组试验灭效为84.52～99.12%。作者认为,C型肉毒梭菌毒素是一种具有良好发展前景的灭鼠药,可大面积推广应用。     

Movement,visceral and autonomic disorders: use of botulinum toxin

This article reviews the development of botulinum toxin treatment, how it works, the range of conditions it can treat and the benefits and side effects. It sets out how it is used in practice in specialist units.