A型肉毒毒素治疗痉挛型双瘫患儿疗效的表面肌电分析

目的观察A型肉毒毒素(BTX-A)注射治疗痉挛型双瘫前后表面肌电图(sEMG)的变化。方法 50例痉挛型双瘫患儿于小腿三头肌注射BTX-A,治疗前后分别用临床方法和sEMG进行评价。结果 治疗后患儿功能位测试小腿三头肌的肌电积分值降低,测试足背屈角减小。结论 sEMG可以客观评价BTX-A注射后痉挛型双瘫患儿肌张力的变化。     

A型肉毒毒素治疗眼睑面肌痉挛的临床研究

目的观察A型肉毒毒素治疗偏侧面肌痉挛,眼睑痉挛及Meige综合征的疗效。方法对46例偏侧面肌痉挛,7例眼睑痉挛,3例Meige综合征病人进行面部肌肉局部多点注射A型肉毒毒素,评价其疗效。结果46例偏侧面肌痉挛者,完全缓解24例(52%),明显缓解22例(48%);7例眼睑痉挛者,4例完全缓解,3例明显缓解;Meige综合征明显缓解1例,部分缓解2例,总有效率达100%。局部副反应轻微,短暂,无全身反应和过敏反应。结论A型肉毒毒素局部肌肉注射是治疗局限性肌肉痉挛的一种安全,有效,简便,易行的治疗方法。     

腋臭粉联合A型肉毒毒素治疗低龄腋臭的疗效观察

目的 研究自制腋臭粉联合局部注射A型肉毒毒素治疗低龄腋臭患者疗效及安全性。方法 2014年8月到2016年12月因腋臭在我科门诊就诊的低龄腋臭患者共计115例,分为两组：自制腋臭粉联合A型肉毒毒素局部注射治疗（治疗组）64例和单用A型肉毒毒素局部注射治疗（对照组）51例。两组于治疗后2个月、6个月、12个月分别进行随访。观察两组治疗疗效及并发症。结果 治疗后2个月、6个月、12个月总有效率治疗组分别为98.4%、89.1%、51.6%,对照组有效率分别为98.0%、78.4%、17.6%,治疗后2个月两组比较差异无统计学意义（p>0.05）,治疗后6个月、12个月治疗组有效率明显高于对照组,差异有显著性（P<0.05）。结论 腋臭粉联合A型肉毒毒素局部注射可作为暂不宜行手术的低龄腋臭患者的一种有效治疗方法,安全性好、疗效佳,值得临床推广。     

肉毒杆菌毒素A治疗特发性上睑退缩的临床观察

目的　研究经结膜下进针提上睑肌及M櫣ｌｌｅｒ肌注射肉毒杆菌毒素Ａ治疗特发性上睑退缩的临床效果。方法　对 2 2例 ( 2 2眼 )特发性上睑退缩患者 ,应用肉毒杆菌毒素A经上睑上 1 / 3内、外侧结膜进针 ,注射于提上睑肌及M櫣ｌｌｅｒ肌 ,根据上睑退缩程度分别给予 2 5u、 4u、 5u。所有病例追踪观察 8～ 2 8周。观察上睑缘位置 ,效果欠佳者隔 1个月可再次注射。结果　所有病例注射肉毒杆菌毒素A后约 1～ 6d出现麻痹效果 ,1 0d左右达到高峰 ,上睑缘下降 1～ 4mm ,效果持续 4～ 2 0周 ,半年后上睑缘均恢复于发病前生理位置。结论　经结膜下的提上睑肌及M櫣ｌｌｅｒ肌注射肉毒杆菌毒素Ａ是治疗特发性上睑退缩的有效方法。     

Immunological characterization of the subunits of type A botulinum neurotoxin and different components of its associated proteins

Botulinum neurotoxins (BoNTs) constitute a family of seven structurally similar but antigenically distinct proteins produced by different strains of Clostridium botulinum. Type A botulinum neurotoxin (BoNT/A) is produced along with 6 neurotoxin associated proteins (NAPs) including hemagglutinin (Hn-33) through polycistronic expression of a clustered group of genes to form a complex (BoNT/AC). The presence of NAPs enhances the oral toxicity of the neurotoxin significantly. Hn-33 makes up the largest fraction of NAPs in BoNT/AC and strongly protects BoNT/A against proteases of the GI tract. BoNT in its complex form is also used in therapeutic and cosmetic applications to treat several neuromuscular disorders. In this study immunological reactivity of BoNT/A in its purified and complex forms, neurotoxin associated proteins, and Hn-33 have been examined using enzyme-linked immunosorbent assay (ELISA). Antibodies raised against the whole complex reacted 60 times better with the complex and 35 times better with Hn-33 and NAPs compared to the purified neurotoxin suggesting stronger immunogenicity of NAPs over that of purified neurotoxin and a higher potential of BoNT/AC and its associated proteins to induce host immune response. This observation also suggests that Hn-33 and other NAPs could potentially be employed as adjuvants for development of vaccines against botulism and could be a good surrogate for botulinum diagnostics. ELISA binding curves of BoNT/AC and BoNT/A with antibodies raised against BoNT/A indicate that BoNT/A in its purified and complex forms induces equal immunogenic response and a 2.5-fold higher immunogenic response compared to BoNT/A light and heavy chains. We have also discovered a new protein, an intimin analog, present within the complex preparation of BoNT/A which shows dramatically high immunoreactivity.     

Hirschsprung-Associated Enterocolitis at a Referral Institution: A Retrospective Review

BackgroundHirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality amongst patients with Hirschsprung disease (HD); rectal Botulinum toxin (Botox) has been reported a possible prevention strategy. We aimed to evaluate our institution's historic cohort of HD patients, first to determine our incidence of HAEC and second to begin assessing the effect of Botox on HAEC incidence.MethodsPatients with HD seen at our institution between 2005 and 2019 were reviewed. Incidence of HD and frequencies of HAEC and Botox injections were tallied. Associations between initial Botox treatment or transition zone and HAEC incidence were evaluated.ResultsWe reviewed 221 patients; 200 were included for analysis. One hundred thirteen (56.5%) patients underwent primary pull-through at a median age of 24 days (IQR 91). Eighty-seven (43.5%) patients with initial ostomy had their intestinal continuity reestablished at a median of 318 days (IQR 595). Ninety-four (49.5%) experienced at least one episode of HAEC and 62 (66%) experienced multiple episodes of HAEC. Nineteen (9.6%) patients had total colonic HD and had an increased total incidence of HAEC compared to patients without total colonic HD (89% vs 44%, p < 0.001). Six (2.9%) patients received Botox injections at the time of pull-through or ostomy takedown; one experienced an episode of HAEC (versus 50.7% of the patients who were confirmed to have not received Botox injections at their surgery, p = 0.102).ConclusionFurther prospective study on Botox's effect on Hirschsprung-associated enterocolitis is required and is the next step in our investigation.Level of evidenceLevel III.     

Effectiveness of Botulinum Toxin A for Persistent Upper Limb Pain After Breast Cancer Treatment: A Double-Blinded Randomized Controlled Trial

Objective

To investigate the effect of a single botulinum toxin A (BTX-A) infiltration in the pectoralis major muscle in addition to a standard physical therapy program for treatment of persistent upper limb pain in breast cancer survivors.

A型肉毒毒素治疗紧张性头痛的临床研究

目的观察A型肉毒毒素治疗紧张性头痛的临床疗效和不良反应。方法选取31例紧张性头痛患者,应用A型肉毒毒素进行颅周肌肉注射治疗。问卷调查并记录每例紧张性头痛患者治疗前、后3个月紧张性头痛发作情况,比较紧张性头痛发作频率、持续时间、严重程度及使用止痛药物情况,观察不良反应。结果A型肉毒毒素治疗后第1个月,紧张性头痛发作频率、发作持续时间、发作严重程度均较治疗前明显下降(P<0.01),使用止痛药物较治疗前显著减少(P<0.01),疗效至少可维持3个月,且不良反应轻微、短暂。结论A型肉毒毒素颅周肌肉注射治疗紧张性头痛有一定疗效,不良反应轻微、短暂,值得进一步验证。     

Botulinum toxin injections in the management of non-neurogenic overactive bladders in children

Introduction

Non-neurogenic detrusor overactivity in children leads to varying degrees of functional impairments (urinary urgency, pollakiuria, urge incontinence, nocturia). Botulinum toxin has shown its effectiveness in the management of detrusor overactivity in neurological patients.

Objectives

To evaluate the relevance of intravesical Botulinum toxin injections for the treatment of non-neurogenic overactive bladders in children. These pediatric patients were resistant to all the usual therapeutics (e.g. bladder/bowel rehabilitation, anticholinergic drugs, management of diet/hygiene habits and constipation, percutaneous posterior tibial nerve stimulation).

Materials and methods

8 children (mean age: 12.5 years), 5 girls, 3 boys with daytime and/or nighttime incontinence and non-neurogenic detrusor overactivity validated by urodynamic testing. Urodynamic testing was conducted before the injections as well as 6 weeks and 1 year post injections. We used Dysport® 8 Speywood Units/kg injected via cystoscopy into 25 different sites.

Results

We noted improvements without any complaints during bladder voiding for all patients, in 6 patients the overactivity disappeared after 1 injection. Compliance was improved early-on in half the cases and at 1 year for all cases (from 12% to 61%, p = 0.01). Noninhibited contractions decreased constantly in both frequency and intensity. Clinical symptoms improved: mean of 7.75 daytime urinary incontinence episodes (IE) per week before the injection vs. 3 after the procedure (p = 0.04). For nighttime IE the improvement was even more noticeable with 7.38 nighttime IE episodes per week before the injection vs. 2.06 after the procedure (p = 0,02).

Conclusion

Intradetrusor Botulinum toxin injections are a potential therapeutic option for the management of non-neurogenic detrusor overactivity in children resistant to the usual treatments.