One collective case of type A foodborne botulism in Corsica

Foodborne botulism is rare in 21st century Western Europe. The purpose of this report is to describe a collective case of type A botulism caused by ingestion of artisanal-produced food (canned green beans and/or salted roast pork). Five of the seven persons who shared the meal presented signs of severe intoxication leading to the fatal respiratory failure in one 18-year-old girl. Three patients required mechanical ventilation for durations ranging from 37 to 78 days and developed severe infectious, respiratory and/or psychiatric complications. In 4 out of the 5 patients, trivalent antitoxin was administered between days 2 and 7 but did not avoid the need for long-term intubation/mechanical ventilation. Treatment with 3,4-diaminopyridine was ineffective in the 26-year-old man who required long-term breathing assistance. This case of collective foodborne botulism illustrates the potential severity of this hazard.     

Isolation of Toxins from Buthus Occitanus Sp. Scorpion and Their Action on Excitability of Myelinated Nerve

A series of short neurotoxins (molecular weight 3500-5000 D) was isolated from Vietnamese scorpion B. occitanus sp. All these toxins blocked generation of action potentials (this effect depended on their molecular weight), but did not change conduction velocity and excitation threshold of the nerve.     

Treatment of headache with botulinum toxin administration

Botulinum toxin has been increasingly applied to the treatment of a wide variety of neurological disorders. Its application to headache disorders, and specifically those classified as migraine or tension-type, followed the observation of its effectiveness in decreasing pain. Studies that have primarily used botulinum toxin type A, but with varying dose regimens and sites of administration, have since observed its beneficial effects and in those subjects, headaches have lessened in their frequency or severity. However, questions that have primarily concerned dose and sites of administration have since arisen and clear guidelines for botulinum toxin use in headache disorders have yet to be developed.     

Botulinum toxin type A management of spasticity in the context of orthopaedic surgery for children with spastic cerebral palsy

Cerebral palsy is the most common cause of physical disability affecting children in developed countries. Although cerebral palsy is, by definition, a 'static encephalopathy' the associated musculoskeletal pathology is progressive and current definitions are therefore somewhat inadequate. Understanding the stages of the musculoskeletal pathology is fundamental to understanding current management strategies, including spasticity management, strengthening programmes and deformity correction by orthopaedic surgery. In this review, a number of new management strategies are described, in which spasticity management by intramuscular injections of botulinum toxin type A and deformity correction, by orthopaedic surgery, are combined.     

A型肉毒毒素注射治疗腋窝多汗症或伴腋臭症

目的 探讨A型肉毒毒素(botulinum toxin-A,BTX-A)注射治疗腋窝多汗症或伴腋臭症及单纯液臭的疗效.方法 采用BTX-A每侧腋窝注射50 U治疗,注射选点25个,间距1.5 cm,每点注射2.5 U.结果 共治疗特发性局限性腋窝多汗症或伴腋臭患者42例,其中单纯腋窝多汗症24例全部有效.腋窝多汗症伴有腋臭10例,其中注射后多汗症治疗全部有效,腋臭治疗有效者只有1例.单纯腋臭8例,碘淀粉试验阴性,注射后只有1例显效,无效7例.结论 BTX-A治疗腋窝多汗症有效,副作用轻微、一过性.BTX-A治疗多汗症所伴有的腋臭疗效欠佳,对单纯的腋臭治疗基本无效.     

Intra-articular Botulinum Toxin Type A: A new approach to treat arthritis joint pain

There is a growing need for novel treatments of refractory arthritis joint pain as the aging population is expanding with many patients who are unable to undergo joint replacement surgery. We are studying the efficacy and safety of intra-articular injection of Botulinum Toxin Type A (IA-BoNT/A) into joints with arthritis pain. In several small open label studies, initial effects for IA-BoNT/A were encouraging because two thirds of the patients had more than 50% reduction in joint pain severity that was associated with a significant improvement in function. Importantly no serious adverse effects of IA-BoN/A were noted. Based on these initial results, we have completed two pilot randomized controlled trials in painful shoulder joints and painful knee joints. In the shoulder study, IA-BoNT/A produced a significant decrease in shoulder pain severity at one month (6.8-4.4 on VAS, p = .002) that was also significantly better than the non-significant change after IA-Saline placebo (1.6 unit difference favoring IA-BoNT/A, p = .014). In the knee study IA-BoNT/A produced a significant 48% decrease in McGill Total Pain Score at one month (p = .01 1) that was still significant at 3 mo after injection (p = .002). There was a strong placebo response in one third of those but the decrease in pain severity was not significant. We are currently conducting a RCT of IA-BoNT/A for painful prosthetic knee joints. Based on these initial studies of IA-BoNT/A we have gone ‘back to the bench’ to standardize a menu of pain behaviors for mice with acute inflammatory arthritis pain and chronic inflammatory arthritis pain. IA-BoNT/A significantly reduced arthritis joint tenderness (evoked pain score) in acute and chronic inflammatory arthritis and normalized impaired spontaneous wheel running in mice with chronic inflammatory arthritis but not in those with acute inflammatory arthritis. With these models of arthritis and pain behavior methods we will be able to screen potential intra-articular analgesics, define dose response curves and injection schedule, and study the relationships of articular pain and loss of function.     

The in vivo rat muscle force model is a reliable and clinically relevant test of consistency among botulinum toxin preparations.

To ensure safety and predictable clinical efficacy, the biological activity of type A botulinum toxin (BoNT-A) preparations must remain consistent. Several methods have been employed to assess consistency but lack clinical applicability and/or are associated with animal welfare concerns. Here, we describe a novel in vivo rat muscle force model for evaluating the biological activity of formulated BoNT-A product (Dysport((R))) prepared from bulk toxin batches manufactured at different facilities. Toxin activity was assessed by measuring muscle force generation over time in the triceps surae muscles in the rat hind leg. Animals received 0.1ml gelatine phosphate buffer (negative vehicle control) or 0.1 or 1.0 LD(50) units of BoNT-A in phosphate buffer. Batch equivalence and consistency were confirmed by the lack of significant differences in muscle force generation and duration of effect between each test batch and the reference preparation tested in the same series of experiments. The reduction in muscle force generation was dose-related and reproducible for all active treatment groups. At appropriate dose levels, the rat muscle force model is a reliable tool for measuring biological activity in bulk toxin batches used to formulate clinical product and demonstrates the consistency of batches manufactured over many years.     

A dose–response relationship research on botulinum toxin type A local intramuscular injections of lower extremity spasticity in children with cerebral palsy

Objectives To observe the dose–response relationship of intramuscular injections of botulinum toxin A (BTX-A) in the spastic cerebral palsy. Methods One hundred fifty cases (age between 2 and 12 years) were randomly divided into three groups. The patients were injected with different dose of BTX-A. The movement function was evaluated with modified Ashworth scale (MAS) and physician's rating scale (PRS) at entry and 1 month after injection. The analyses were conducted with one-way analysis of variance and χ ² test. Results The evaluation of MAS and PRS revealed a significant increase of movement function. No statistically significant differences of the side effects among three groups could be demonstrated. Conclusions The study suggested that the movement function was more significantly improved with relatively higher dose of BTX-A, which was safe and effective.     

肉毒杆菌毒素注射在面部美容中的应用效果

探究临床面部美容中注射肉毒杆菌毒素的应用价值。方法 选择2022年5月-2023年2月滕州 市中心人民医院收治的90例面部美容患者为研究对象，经随机抽签法分为对照组和观察组，每组45例。对 照组采用微针导入富血小板血浆治疗，观察组在对照组基础上注射肉毒杆菌毒素，比较两组临床疗效、皮 肤状态、不良反应发生情况以及美容满意度。结果 观察组总有效率为95.56%，高于对照组的80.00%，差异 有统计学意义（P＜0.05）；观察组治疗后滋润度与弹性度评分高于对照组，油脂和斑纹评分低于对照组， 差异有统计学意义（P ＜0.05）；两组不良反应发生率比较，差异无统计学意义（P ＞0.05）；观察组美容 满意度为93.33%，高于对照组的77.78%（P ＜0.05）。结论 临床面部美容患者给予注射肉毒杆菌毒素，能 够有效提高美容效果，改善其皮肤滋润、弹性、油脂以及斑纹等皮肤状态，不良反应少，具有较高的患者 满意度。     

The long-term efficacy and safety of botulinum toxin in refractory chronic tension-type headache

The objective of this study was to investigate the long-term efficacy and safety of botulinum toxin type-A (BoNT-A) for refractory chronic tension-type headache (CTTH). An open-label, prospective study was carried out in the Department of Neurology of Kirikkale University on 28 patients (8 males, 20 females), mean age 35.6 years, diagnosed with moderate/severe CTTH refractory to preventive medications. Each patient received BoNT-A injections once in pericranial muscles. Efficacy and safety data were analysed for 28 refractory CTTH patients who were receiving concomitant headache prophylactic medications at baseline and during the study. The main outcome parameters were reduction of headache frequency and intensity over 1 year. Both parameters were significantly decreased (p<0.05) by the end of the study. Sixty-four percent of patients reported complete headache relief at the final visit, compared to 7% CTTH persisted. BoNT-A also resulted in significant reductions in analgesic consumption (p<0.05). Adverse effects were transient and local. BoNT-A was found to be an effective and safe treatment for refractory CTTH patients with concomitant headache prophylactic medications, resulting in significant reductions in headache frequency, intensity and analgesic consumption which persisted up to 1 year.