Botulinum toxin,a protein exotoxin secreted by Clostridium botulinum,binds to peripheral nerve terminals,inhibits acetylcholine release,and leads to flaccid muscle paralysis.[1]Botox(onabotulinum toxin A)was approved ...Botulinum toxin,a protein exotoxin secreted by Clostridium botulinum,binds to peripheral nerve terminals,inhibits acetylcholine release,and leads to flaccid muscle paralysis.[1]Botox(onabotulinum toxin A)was approved by the Food and Drug Administration(FDA)for cosmetic and therapeutic indications in 2002,and its global use has increased substantially.[2]However,some unlicensed botulinum toxin products may cause iatrogenic botulism.[3]Early diagnosis remains challenging owing to non-specific clinical features and the lack of diagnostic biomarkers,often delaying the timely administration of antitoxin.[4]This study reviewed recent cases of botulism in our center and summarized their clinical presentations,symptoms,and outcomes.展开更多
BACKGROUND The previous studies have primarily focused on the influence of botulinum toxin A(BoNT-A)injection on emotions during the period of peak motor symptom improvement in blepharospasm patients,based on facial f...BACKGROUND The previous studies have primarily focused on the influence of botulinum toxin A(BoNT-A)injection on emotions during the period of peak motor symptom improvement in blepharospasm patients,based on facial feedback hypothesis.AIM To evaluate the sustained anxiolytic and antidepressant effects of BoNT-A in blepharospasm patients beyond motor symptom control.METHODS We recruited benign essential blepharospasm patients with BoNT-A treatment and collected their data to compare scale scores of Jankovic Rating Scale,Blepharospasm Disability Index,Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Hamilton Anxiety Scale and Hamilton Depression Scale between pretreatment(baseline)and pre-reinjection(treatment),to further assess the effects of repeated treatments with BoNT by using sub-group analyses in the certain special states.RESULTS A total of 21 eligible blepharospasm patients were with the mean age of 58.4 years and a male-to-female ratio of 1:6.Significantly decreases in the subscale scores of SDS and SAS,including SDS well-being index,decreased capacity and hard to decide,SAS inability to sit still and headache were showed at post-a single BoNT-A injection when scale scores of Jankovic Rating Scale and Blepharospasm Disability Index were matched between baseline and posttreatment.With each additional BoNT-A injection,the odds ratio of patients with the moderate depressive symptoms decreased by 92.6%.Moreover,BoNT treatment remained a decrease in the subscale scores of SDS and SAS in patients with repeated injections.CONCLUSION This study is to demonstrate that repeated BoNT-A injection have a long-lasting relief for anxiety and depressive symptoms in blepharospasm even after its motor symptom-modulating effects have diminished.展开更多
BACKGROUND Botulinum neurotoxin(BoNT)is widely recognized as an effective therapeutic agent for managing various neurological disorders,characterized by motor impairments and neuromuscular deficits.BoNT works by modul...BACKGROUND Botulinum neurotoxin(BoNT)is widely recognized as an effective therapeutic agent for managing various neurological disorders,characterized by motor impairments and neuromuscular deficits.BoNT works by modulating the release of acetylcholine at the neuromuscular junction.Recently,BoNT has been shown to enhance spatial memory and attenuate anxiety in experimental aging animals.While neurogenesis in the hippocampus contributes to cognitive properties,BoNT treatment could potentially influence the regulation of adult neurogenesis.As aging-associated microglial activation impairs neurogenesis,the anti-inflammatory properties of BoNT could be associated with the modulation of microglial activity,thereby enhancing cognitive function.AIM To investigate the neurogenic and microglial modulatory properties of BoNT in the hippocampus of aging experimental mice.METHODS Experimental aging mice were administered BoNT and after four weeks,the animals were sacrificed.The brains were subjected to cryosections followed by immunohistochemical analysis to quantify doublecortin(DCX)-positive immature neurons,bromodeoxyuridine(BrdU)-neuronal nuclei(NeuN)double positive newly matured neurons and ionized calcium-binding adapter molecule 1(Iba1)-positive microglia in the hippocampal dentate gyrus.In parallel,an additional set of animals was used to evaluate BoNT-mediated alterations in key inflammatory markers such as cyclooxygenase(COX)-2,and nitric oxide(NO)in hippocampal tissues.RESULTS The results revealed a significant increase in the number of DCX-positive immature neurons and BrdU-NeuN positive differentiated neurons in the hippocampus of the BoNT-treated group compared to the control.This enhancement in neurogenesis was accompanied by a marked reduction in the activated form of microglial cells,coupled with decreased mRNA expression of COX-2 and reduced NO levels in the hippocampus of BoNT-treated animals.CONCLUSION This study validates the proneurogenic and anti-neuroinflammatory properties of BoNT,which may underlie its procognitive effects.Hence,BoNT could be a promising therapeutic agent for treating various neurocognitive disorders.展开更多
BACKGROUND Botulinum toxin(BoNT)is a bacterial poison that acts by blocking the release of acetylcholine-containing vesicles at the neuromuscular junction.Notably,a mild amount of BoNT is known to exert therapeutic be...BACKGROUND Botulinum toxin(BoNT)is a bacterial poison that acts by blocking the release of acetylcholine-containing vesicles at the neuromuscular junction.Notably,a mild amount of BoNT is known to exert therapeutic benefits against various diseases,including migraine,movement disorders,anxiety and neurocognitive deficits.BoNT treatment appears to increase platelet count in circulation.Therefore,BoNT treatment may be associated with the regulation of blood coagulation upon haemorrhagic events.However,the effects of BoNT on the degree of bleeding and clotting events have not yet been determined.AIM To investigate the effect of BoNT on the bleeding parameters and blood coagulation events in experimental mice.METHODS A group of 7-8-month-old mice was intramuscularly injected with a mild single dose of BoNT.After a month of BoNT injection,animals were subjected to tail bleeding assay,assessment of clotting time,and degree of platelet aggregation in comparison with the control group.RESULTS Results revealed that BoNT injection significantly reduced blood loss and bleeding time in experimental aging mice upon tail tip transection.Moreover,the blood samples collected from the BoNT-treated mice showed enhanced platelet aggregation and intense formation of the fibrin clot compared to the control.This study indicates a putative therapeutic value of BoNT in mitigating bleeding episodes,possibly through its platelet-enhancing property.CONCLUSION BoNT treatment effectively facilitates blood coagulation.Upon further validation,this approach can be translated to treat traumatic blood vessel injuries,haemorrhagic diseases,and bleeding complications associated with surgical procedures.展开更多
Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both s...Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both studies share the goal of evaluating the efficacy and safety of BoNT-A in this context,they reached very different conclusions.The study by Shaher et al.demonstrated significant improvements in ejaculatory latency,indicating that BoNT-A injections may be a helpful treatment for PE.展开更多
Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in thi...Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.展开更多
Orofacial muscle hypertonicity,characterized by excessive muscle tension in the facial and masticatory regions,can lead to significant functional impairment and aesthetic concerns.Botulinum toxin type A(BoNT-A),widely...Orofacial muscle hypertonicity,characterized by excessive muscle tension in the facial and masticatory regions,can lead to significant functional impairment and aesthetic concerns.Botulinum toxin type A(BoNT-A),widely known for its cosmetic applications,has emerged as a valuable therapeutic tool in dentistry and maxillofacial medicine.This review explores the pharmacological mechanisms,anatomical considerations,and clinical applications of BoNT-A in the treatment of functional disorders such as bruxism,masseter hypertrophy,temporomandibular joint dysfunction,and facial asymmetry.Emphasis is placed on precision-guided injection techniques,region-specific dosing trends,and formulation-specific performance.Adverse effects,although generally mild and self-limiting,are preventable through anatomical expertise and individualized protocols.Preliminary clinical observations and recent East Asian data suggest variations in the response patterns and optimal dosing strategies.This review also highlights the current gaps,including the need for long-term safety data,standardized training for dental practitioners,and comparative evaluations with non-pharmacological therapies.BoNT-A is a minimally invasive interdisciplinary approach for restoring oral function and facial harmony,supporting its integration into modern dental practice.展开更多
Background:Androgenetic alopecia(AGA)is a common hair loss disorder that significantly affects patient’s quality of life.Botulinum toxin(BoNT)has emerged as a potential treatment;however,its effectiveness and underly...Background:Androgenetic alopecia(AGA)is a common hair loss disorder that significantly affects patient’s quality of life.Botulinum toxin(BoNT)has emerged as a potential treatment;however,its effectiveness and underlying mechanisms remain unclear.This systematic review aimed to synthesize the existing evidence on BoNT for AGA,analyze its mechanisms,evaluate its efficacy,and explore its potential for precision therapy.Methods:A PubMed search was conducted for studies published between 2020 and 2025.A total of 25 studies,including 11 clinical trials and 7 reviews,were included.The studies were analyzed for BoNT mechanisms in AGA,treatment regimens,efficacy,outcomes,cost-effectiveness,and safety profiles.Results:Experimental evidence suggests that BoNT reduces transforming growth factor-βin dermal papilla cells,a key pathological pathway in AGA.Other hypothetical mechanisms,such as scalp muscle relaxation improving microcirculation or inhibiting androgen conversion require further validation.In clinical trials,most studies used 30-150 U of BoNT via intramuscular(six studies)or intradermal(three studies)injections,with 1-3 sessions and up to 6 months of follow-up.Early open-label trials reported response rates of 70%-79%,but recent high-quality randomized controlled trials(RCTs)showed no significant improvement in hair density compared to placebo.Combination therapy with finasteride or minoxidil enhanced treatment outcomes,though large-scale evidence is lacking.BoNT was less cost-effective than first-line therapies such as minoxidil,with session costs approximately 37 times higher.Intramuscular injection appeared more effective than intradermal injection,possibly due to scalp muscle relaxation and vascular decompression.BoNT generally had a mild safety profile.Conclusion:Currently,BoNT lacks robust evidence to replace traditional treatments for AGA.Future research should focus on establishing standardized dosing protocols,conducting large-scale,long-term RCTs,and integrating molecular biomarkers to improve understanding and optimize the clinical use of BoNT in AGA management.展开更多
AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at Fir...AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People’s Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study.Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality.Further stratification was performed according to preoperative deviation angles[>35 prism diopters(PD)vs≤35 PD]and age(≥18 years adult group vs<18 years adolescent group).The baseline patient characteristics were collected,deviation angles at multiple timepoints before and after treatment were measured,and stereopsis test results were documented.Through comparative analysis of therapeutic outcomes across subgroups,we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included.At the final follow-up,both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001).Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05).For patients with deviations>35 PD,surgery yielded significantly better outcomes than injection therapy in postoperative angle,success rate,and stereopsis recovery(P<0.05).Similarly,in patients aged≥18 years,surgical treatment was superior to injections in reducing strabismus angle,improving success rates,and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE.Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy,particularly in patients with deviations>35 PD and those aged≥18 years.For patients with angles≤35 PD or under 18 years,BTXA injection remains a viable treatment option.展开更多
Background:Recently,microbotulinum,a new technique that involves injecting botulinum toxin type A(BoNTA)microdroplets into superficial cutaneous tissue,has gained popularity.The precise distribution of BoNTA in the ta...Background:Recently,microbotulinum,a new technique that involves injecting botulinum toxin type A(BoNTA)microdroplets into superficial cutaneous tissue,has gained popularity.The precise distribution of BoNTA in the targeted area profoundly affects outcomes.Many factors may influence the effective area of BoNTA in the dermis.This study aimed to determine the dermal distribution properties of BoNTA to guide microbotulinum injection.Methods:Ten healthy males aged 18–65 years without BoNTA treatment in the previous year were recruited to receive intradermal injections in the chest and back.Ultrasound was used to ensure the intradermal delivery of injections and measure the dermal thickness.The minor iodine starch test was performed at baseline and 3 days,7 days,21 days,1 month,and 2 months after treatment.Results:All participants received intradermal injections.The dermis was thinner on the chest(thickness,0.20±0.03 cm)than on the back(thickness,0.39±0.07 cm)(P<0.05).An injection in the thicker dermis had a significantly smaller effective area at every follow-up visit.The drug concentration did not affect the effective area except at 3 days after treatment.Injection speed did not influence the effective area at any follow-up visits.Conclusion:An injection in a thicker dermis leads to a smaller effective area for intradermal injections.When the BoNTA dose is the same,the drug concentration and injection speed do not matter.展开更多
The present study was designed to examine the therapeutic effects of Botulinum neurotoxin A(BoNT/A)on depression-like behaviors in mice and to explore the potential mechanisms.These results revealed that a single faci...The present study was designed to examine the therapeutic effects of Botulinum neurotoxin A(BoNT/A)on depression-like behaviors in mice and to explore the potential mechanisms.These results revealed that a single facial injection of BoNT/A induced a rapid and prolonged improvement of depression-like behaviors in naive and space-restriction-stressed(SRS)mice,reflected by a decreased duration of immobility in behavioral despair tests.BoNT/A significantly increased the 5-hydroxytryptamine(5-HT)levels in several brain regions,including the hippocampus and hypothalamus,in SRS mice.BoNT/A increased the expression of the N-methyl-Daspartate receptor subunits NR1 and NR2 B in the hippocampus,which were significantly decreased in SRS mice.Furthermore,BoNT/A significantly increased the expression of brain-derived neurotrophic factor(BDNF)in the hippocampus,hypothalamus,prefrontal cortex,and amygdala,which were decreased in SRS mice.Finally,BoNT/A transiently increased the levels of phosphorylated extracellular signal-regulated kinase(p-ERK)and cAMPresponse element binding protein(p-CREB),which were suppressed in the hippocampus of SRS mice.Collectively,these results demonstrated that BoNT/A treatment has antidepressant-like activity in mice,and this is associated with increased 5-HT levels and the activation of BDNF/ERK/CREB pathways in the hippocampus,supporting further investigation of BoNT/A therapy in depression.展开更多
Botulinum toxin A （BTXA） has been used in several clinical trials to treat excessive glandular secretion; however, the precise mechanism of its action on the secretory function of salivary gland has not been fully e...Botulinum toxin A （BTXA） has been used in several clinical trials to treat excessive glandular secretion; however, the precise mechanism of its action on the secretory function of salivary gland has not been fully elucidated. In this study, we aimed to investigate the effect of BTXA on secretion of submandibular gland in rabbits and to identify its mechanism of action on the secretory function of salivary gland. At 12 weeks after injection with 5 units of BTXA, we found a significant decrease in the saliva flow from submandibular glands, while the salivary amylase concentration increased. Morphological analysis revealed reduction in the size of acinar cells with intracellular accumulation of secretory granules that coalesced to form a large ovoid structure. Expression of M3-muscarinic acetylcholine receptor （M3 receptor） and aquaporin-5 （AQP5） mRNA decreased after BTXA treatment, and distribution of AQP5 in the apical membrane was reduced at 1, 2 and 4 weeks after BTXA injection. Furthermore, BTXA injection was found to induce apoptosis of acini. These results indicate that BTXA decreases the fluid secretion of submandibular glands and increases the concentration of amylase in saliva. Decreased expression of M3 receptor and AQP5, inhibition of AQP5 translocation, and cell apoptosis might involve in BTXA-reduced fluid secretion of submandibular lands.展开更多
No recommended guidelines currently exist for the therapeutic concentration or dose of botulinum toxin type A （BTXA） injected into the muscle to treat limb spasticity. Therefore, in this randomized controlled trial,...No recommended guidelines currently exist for the therapeutic concentration or dose of botulinum toxin type A （BTXA） injected into the muscle to treat limb spasticity. Therefore, in this randomized controlled trial, we explored the safety and efficacy of two concentrations and two doses of BTXA in the treatment of spastic toot after stroke to optimize this treatment in these patients. Eligible patients （n = 104） were randomized into four groups. The triceps surae and tibialis posterior on the affected side were injected with BTXA at one of two doses （200 U or 400 U） and two concentrations （50 U/mL or 100 U/mL）. 2he following assessments were conducted before as well as 4 days and 1, 2, 4, and 12 weeks after treatment： spasticity, assessed using the modified Ashworth scale; basic functional mobility, assessed using a timed up and go test; pace, assessed using a 10-meter timed walking test; and the ability to walk, assessed using Holden＇s graded scale and a visual analog scale. The reported results are based on the 89 patients that completed the study. We found significant differences for the two doses and concentrations of BTXA to improve the ability of patients to walk independently, with the high-dose/low-concentration combination providing the best effect. Onset and duration of the ameliorating effects of BTXA were 4-7 days and 12 weeks, respectively. Thus, BTXA effectively treated foot spasms after stroke at an optimal dose of 400 U and concentration of 50 U/mL.展开更多
BACKGROUND A large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective surgery.Persistent obstructive symptoms may result in faecal stasis that can develop into...BACKGROUND A large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective surgery.Persistent obstructive symptoms may result in faecal stasis that can develop into Hirschsprung-associated enterocolitis,a potential life-threatening condition.Important treatment to improve faecal passage is internal anal sphincter relaxation using botulinum toxin injections.AIM To give an overview of all empirical evidence on the effectiveness of botulinum toxin injections in patients with Hirschsprung disease.METHODS A systematic review and meta-analysis was done by searching PubMed,EMBASE and the Cochrane Library,using entry terms related to:(1)Hirschsprung disease;and(2)Botulinum toxin injections.14 studies representing 278 patients met eligibility criteria.Data that were extracted were proportion of patients with improvement of obstructive symptoms or less enterocolitis after injection,proportion of patients with adverse effects and data on type botulinum toxin,mean dose,average age at first injection and patients with associated syndromes.Random-effects meta-analysis was used to aggregate effects and random-effects meta-regression was used to test for possible confounding factors.RESULTS Botulinum toxin injections are effective in treating obstructive symptoms in on average 66%of patients[event rate(ER)=0.66,P=0.004,I2=49.5,n=278 patients].Type of botulinum toxin,average dose,average age at first injections and proportion of patients with associated syndromes were not predictive for this effect.Mean 7 duration of improvement after one botulinum toxin injections was 6.4 mo and patients needed on average 2.6 procedures.There was a significant higher response rate within one month after botulinum toxin injections compared to more than one month after Botulinum toxin injections(ER=0.79,vs ER=0.46,Q=19.37,P<0.001).Botulinum toxin injections were not effective in treating enterocolitis(ER 0.58,P=0.65,I2=71.0,n=52 patients).There were adverse effects in on average 17%of patients(ER=0.17,P<0.001,I2=52.1,n=187 patients),varying from temporary incontinence to mild anal pain.CONCLUSION Findings from this systematic review and meta-analysis indicate that botulinum toxin injections are effective in treating obstructive symptoms and that adverse effects were present,but mild and temporary.展开更多
The effect of botulinum toxin type A injection on voluntary grip control was examined in a 53-year-old female,who sustained a hemorrhagic right middle cerebral artery stroke 3 years previously,which resulted in finger...The effect of botulinum toxin type A injection on voluntary grip control was examined in a 53-year-old female,who sustained a hemorrhagic right middle cerebral artery stroke 3 years previously,which resulted in finger flexor spasticity and residual weak finger/wrist extension.The patient received 50 units of botulinum toxin type A injection each to the motor points(2 sites/muscle)of the left flexor digitorum superficialis and flexor digitorum profundus,respectively.Botulinum toxin injection led to weakness and tone reduction in the spastic finger flexors,but improved grip release time in grip initiation/release reaction time tasks.Improved release time was accompanied by shortened extensor electromyography activity,and improved release time likely correlated with blocked co-contraction of finger flexors during voluntary finger extension.This case report demonstrated that botulinum toxin injection improved voluntary motor control of the hand in a chronic stroke patient with residual finger extension.展开更多
AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases inclu...AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases including: Pub Med/MEDLINE, and Cochrane Central Register of Control ed Trials, also an internet-based search using "Google Scholar" service was conducted. Both comparative and observational studies were included. We excluded irrelevant articles, editorials, case reports, reviews, and meta-analyses. The studies that followed the patients less than 6 mo were excluded. Variables collected were demographic data of the patients, technique of BTX-A injection and number of sessions, short-term and longterm clinical improvement, post-injection changes in electromyography(EMG), defecography, manometry, and balloon expulsion test, and complications recorded after BTX-A injection.RESULTS: Seven studies comprising 189 patients were included in the review. The median age of the patients was 41.2 years and female-to-male ratio was 1.3:1. The median dose of BTX-A injected per procedure was 100 IU(range, 20-100 IU). Lateral injection was done in five trails and combined lateral and posterior injections in two trials. Three studies used endorectal ultrasonographyguided technique, one study used EMG-guided technique,whereas the remaining three studies used manual palpation with the index finger. The median percentage of patients who reported initial improvement of symptoms was 77.4%(range 37.5%-86.7%), this percentage declined to a median of 46%(range 25%-100%) at 4 mo after injection of BTX-A. Rates of improvement evaluated by balloon expulsion test, EMG, and defecography ranged between(37.5%-80%),(54%-86.7%), and(25%-86.6%), respectively. Fourteen(7.4%) patients developed complications after injection of BTX-A. Complication rates across the studies ranged from 0% to 22.6%. CONCLUSION: Initial satisfactory improvement of symptoms after BTX-A injection remarkably deteriorated after 3 mo of the procedure. However, repeated injection may provide better sustained results with no additional morbidities. Further analysis of more patients is necessary to conclude the safety of BTX-A for the treatment of anismus.展开更多
Objective To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disord...Objective To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disorders such as sia-lorrhea and hyperhidrosis. Methods A retrospective study of BTX-B injections in treatment of 58 patients with various neurological disorders was performed. The mean follow-up time was 0.9 ± 0.8 years. Results of the first and last treatment of patients with at least 3 injection sessions were compared. Results The response of 58 patients to a total of 157 BTX-B treatment sessions was analyzed. Of the 157 treatment sessions, 120 sessions (76.4%) resulted in moderate or marked improvement while 17 sessions (10.8%) had no response. The clinical benefits after BTX-B treatment lasted an average of 14 weeks. Of the 41 patients with at least 3 injection ses-sions (mean 10 ± 8.6), most patients needed increased dosage upon the last session compared to the first session. Nineteen patients (32.8%) with 27 sessions (17.2%) reported adverse effects with BTX-B treatment. Conclusions Though most patients require increased dosage to maintain effective response after repeated injections, BTX-B is an effective and safe treatment drug for a variety of movement disorders, as well as drooling and hyperhidrosis.展开更多
AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed af...AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate.CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.展开更多
AIM: To investigate the effects of micro-injection of botulinum toxin A(BTXA) on acute acquired comitant esotropia(AACE). METHODS: A total of 33 AACE patients who underwent BTXA micro-injection at Renmin Hospital of W...AIM: To investigate the effects of micro-injection of botulinum toxin A(BTXA) on acute acquired comitant esotropia(AACE). METHODS: A total of 33 AACE patients who underwent BTXA micro-injection at Renmin Hospital of Wuhan University from September 1^(st), 2019 to July 1^(st), 2021 were retrospective analyzed. Esotropia, eye alignment, stereopsis, and complications were examined at baseline(except complications), 1wk, 1, 3, and 6mo after injection. RESULTS: The average angle of deviation before injection was(+20.24±6.80)^(Δ) at near and(+24.76±6.43)^(Δ) at distance, while(+5.15±5.85)^(Δ) at near and(+7.30±6.17)^(Δ) at distance 6mo after treatment(P<0.05). Six months after injection, the stereopsis of patients had improved. The number of patients having no stereopsis(>800 seconds of arc) decreased from 11 to 3. The number of patients having peripheral stereopsis(300-800 seconds of arc), macular stereopsis(70-200 seconds of arc) and central concave stereopsis(≤60 seconds of arc) increased from 10 to 11, 10 to 12, and 2 to 7, respectively. At the follow-ups at 1wk, 1, 3, and 6mo after injection, success rates were 96.97%, 96.97%, 93.94% and 87.88%, respectively. One week after injection, two patients(6.07%) showed subconjunctival hemorrhage;three patients(9.09%) showed limited eye movement and one patient(3.03%) showed mild vertical strabismus. All the symptoms disappeared by the final follow-up.CONCLUSION: Micro-injection of BTXA can reduce diplopia and improve binocular vision function of AACE patients. Furthermore, the operation is relatively safe with few complications, making it an ideal treatment modality for AACE.展开更多
Background and objective:Botulinum toxin type A(BoNT/A)is a metalloprotease that blocks synaptic transmission via the cleavage of a synaptosomal-associated protein of 25 kDa(SNAP-25).It has gained widespread use as a ...Background and objective:Botulinum toxin type A(BoNT/A)is a metalloprotease that blocks synaptic transmission via the cleavage of a synaptosomal-associated protein of 25 kDa(SNAP-25).It has gained widespread use as a treatment for cerebral palsy and skeletal muscle hypertrophy.In China,Chinese botulinum toxin type A(CBTX-A),a type of BoNT/A,is in widespread clinical use.However,the changes in the morphological and biochemical properties of treated muscles and in remote muscles from the CBTX-A injection site are relatively unknown.Therefore,we investigated the changes in histomorphology and myosin heavy chain(MyHC)isoform composition and distribution in rat gastrocnemius muscles after intramuscular injection of CBTX-A.Methods:The weakness of the injected muscles was assessed periodically to identify their functional deficiency.Muscle slices were stained with hematoxylin-eosin(HE)and adenosine triphosphatase(ATPase).MyHC isoform composition was analyzed by sodium dodecyl sulfatepolyacrylamide gel electrophoresis(SDS-PAGE)to uncover changes in morphological and biochemical properties.Results:Our findings demonstrate that following injection of CBTX-A 5 U into rat gastrocnemius muscles,shifts in MyHC isoform composition emerged on the third day after injection and peaked in the fourth week.The composition remained distinctly different from that of the control group after the twelfth week.More specifically,there was a decrease in the proportion of the type IIb isoform and an increase in the proportions of type IIx,type IIa,and type I isoforms.Conclusions:Data revealed that CBTX-A led to a shift in MyHC composition towards slower isoforms and that the MyHC composition remained far from normal six months after a single injection.However,no noticeable remote muscle weakness was induced.展开更多
文摘Botulinum toxin,a protein exotoxin secreted by Clostridium botulinum,binds to peripheral nerve terminals,inhibits acetylcholine release,and leads to flaccid muscle paralysis.[1]Botox(onabotulinum toxin A)was approved by the Food and Drug Administration(FDA)for cosmetic and therapeutic indications in 2002,and its global use has increased substantially.[2]However,some unlicensed botulinum toxin products may cause iatrogenic botulism.[3]Early diagnosis remains challenging owing to non-specific clinical features and the lack of diagnostic biomarkers,often delaying the timely administration of antitoxin.[4]This study reviewed recent cases of botulism in our center and summarized their clinical presentations,symptoms,and outcomes.
基金Supported by the Special Funds of Jiangsu Provincial Key Research and Development Projects,No.BE2019612Scientific Research Project Cooperated by Lanzhou Biotechnology Development Co.,Ltd.+3 种基金the Key R&D Program of Jiangsu Science and Technology Project,No.BE2022049 and No.BE2022049-1National Natural Science Foundation of China,No.82171249Nanjing Rehabilitation Medicine Center ProjectJiangsu Provincial Health Commission Special Fund for Aging and Health.
文摘BACKGROUND The previous studies have primarily focused on the influence of botulinum toxin A(BoNT-A)injection on emotions during the period of peak motor symptom improvement in blepharospasm patients,based on facial feedback hypothesis.AIM To evaluate the sustained anxiolytic and antidepressant effects of BoNT-A in blepharospasm patients beyond motor symptom control.METHODS We recruited benign essential blepharospasm patients with BoNT-A treatment and collected their data to compare scale scores of Jankovic Rating Scale,Blepharospasm Disability Index,Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Hamilton Anxiety Scale and Hamilton Depression Scale between pretreatment(baseline)and pre-reinjection(treatment),to further assess the effects of repeated treatments with BoNT by using sub-group analyses in the certain special states.RESULTS A total of 21 eligible blepharospasm patients were with the mean age of 58.4 years and a male-to-female ratio of 1:6.Significantly decreases in the subscale scores of SDS and SAS,including SDS well-being index,decreased capacity and hard to decide,SAS inability to sit still and headache were showed at post-a single BoNT-A injection when scale scores of Jankovic Rating Scale and Blepharospasm Disability Index were matched between baseline and posttreatment.With each additional BoNT-A injection,the odds ratio of patients with the moderate depressive symptoms decreased by 92.6%.Moreover,BoNT treatment remained a decrease in the subscale scores of SDS and SAS in patients with repeated injections.CONCLUSION This study is to demonstrate that repeated BoNT-A injection have a long-lasting relief for anxiety and depressive symptoms in blepharospasm even after its motor symptom-modulating effects have diminished.
基金Supported by the Science and Engineering Research Board(SERB),No.SERB-EEQ/2016/000639RUSA 2.0,Biological Sciences,Bharathidasan University,No.TN RUSA:311/RUSA(2.0)/2018 dt.December 2,2020+1 种基金the University Grants Commission,Faculty Recharge Programme(UGC-FRP),New Delhi,IndiaCouncil of Scientific and Industrial Research-Senior Research Fellowship(CSIRSRF)-Direct,No.09/0475(23353)/2025-EMR-I.
文摘BACKGROUND Botulinum neurotoxin(BoNT)is widely recognized as an effective therapeutic agent for managing various neurological disorders,characterized by motor impairments and neuromuscular deficits.BoNT works by modulating the release of acetylcholine at the neuromuscular junction.Recently,BoNT has been shown to enhance spatial memory and attenuate anxiety in experimental aging animals.While neurogenesis in the hippocampus contributes to cognitive properties,BoNT treatment could potentially influence the regulation of adult neurogenesis.As aging-associated microglial activation impairs neurogenesis,the anti-inflammatory properties of BoNT could be associated with the modulation of microglial activity,thereby enhancing cognitive function.AIM To investigate the neurogenic and microglial modulatory properties of BoNT in the hippocampus of aging experimental mice.METHODS Experimental aging mice were administered BoNT and after four weeks,the animals were sacrificed.The brains were subjected to cryosections followed by immunohistochemical analysis to quantify doublecortin(DCX)-positive immature neurons,bromodeoxyuridine(BrdU)-neuronal nuclei(NeuN)double positive newly matured neurons and ionized calcium-binding adapter molecule 1(Iba1)-positive microglia in the hippocampal dentate gyrus.In parallel,an additional set of animals was used to evaluate BoNT-mediated alterations in key inflammatory markers such as cyclooxygenase(COX)-2,and nitric oxide(NO)in hippocampal tissues.RESULTS The results revealed a significant increase in the number of DCX-positive immature neurons and BrdU-NeuN positive differentiated neurons in the hippocampus of the BoNT-treated group compared to the control.This enhancement in neurogenesis was accompanied by a marked reduction in the activated form of microglial cells,coupled with decreased mRNA expression of COX-2 and reduced NO levels in the hippocampus of BoNT-treated animals.CONCLUSION This study validates the proneurogenic and anti-neuroinflammatory properties of BoNT,which may underlie its procognitive effects.Hence,BoNT could be a promising therapeutic agent for treating various neurocognitive disorders.
基金Supported by The Science and Engineering Research Board,No.SERB-EEQ/2016/000639The University Grants Commission-Faculty Recharge Programme(UGC-FRP),No.F4-5(97)/2014+2 种基金Rashtriya Uchchatar Shiksha Abhiyan(RUSA)2.0,Biological Sciences,Bharathidasan University,No.TN RUSA:311/RUSA(2.0)/2018Infrastructure of the Department of Animal Science,Bharathidasan University,UGC-SAP-DRS and DST-FISTand CSIR-SRF Direct,No.09/0475(23353)/2025-EMR-I.
文摘BACKGROUND Botulinum toxin(BoNT)is a bacterial poison that acts by blocking the release of acetylcholine-containing vesicles at the neuromuscular junction.Notably,a mild amount of BoNT is known to exert therapeutic benefits against various diseases,including migraine,movement disorders,anxiety and neurocognitive deficits.BoNT treatment appears to increase platelet count in circulation.Therefore,BoNT treatment may be associated with the regulation of blood coagulation upon haemorrhagic events.However,the effects of BoNT on the degree of bleeding and clotting events have not yet been determined.AIM To investigate the effect of BoNT on the bleeding parameters and blood coagulation events in experimental mice.METHODS A group of 7-8-month-old mice was intramuscularly injected with a mild single dose of BoNT.After a month of BoNT injection,animals were subjected to tail bleeding assay,assessment of clotting time,and degree of platelet aggregation in comparison with the control group.RESULTS Results revealed that BoNT injection significantly reduced blood loss and bleeding time in experimental aging mice upon tail tip transection.Moreover,the blood samples collected from the BoNT-treated mice showed enhanced platelet aggregation and intense formation of the fibrin clot compared to the control.This study indicates a putative therapeutic value of BoNT in mitigating bleeding episodes,possibly through its platelet-enhancing property.CONCLUSION BoNT treatment effectively facilitates blood coagulation.Upon further validation,this approach can be translated to treat traumatic blood vessel injuries,haemorrhagic diseases,and bleeding complications associated with surgical procedures.
文摘Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both studies share the goal of evaluating the efficacy and safety of BoNT-A in this context,they reached very different conclusions.The study by Shaher et al.demonstrated significant improvements in ejaculatory latency,indicating that BoNT-A injections may be a helpful treatment for PE.
文摘Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.
文摘Orofacial muscle hypertonicity,characterized by excessive muscle tension in the facial and masticatory regions,can lead to significant functional impairment and aesthetic concerns.Botulinum toxin type A(BoNT-A),widely known for its cosmetic applications,has emerged as a valuable therapeutic tool in dentistry and maxillofacial medicine.This review explores the pharmacological mechanisms,anatomical considerations,and clinical applications of BoNT-A in the treatment of functional disorders such as bruxism,masseter hypertrophy,temporomandibular joint dysfunction,and facial asymmetry.Emphasis is placed on precision-guided injection techniques,region-specific dosing trends,and formulation-specific performance.Adverse effects,although generally mild and self-limiting,are preventable through anatomical expertise and individualized protocols.Preliminary clinical observations and recent East Asian data suggest variations in the response patterns and optimal dosing strategies.This review also highlights the current gaps,including the need for long-term safety data,standardized training for dental practitioners,and comparative evaluations with non-pharmacological therapies.BoNT-A is a minimally invasive interdisciplinary approach for restoring oral function and facial harmony,supporting its integration into modern dental practice.
文摘Background:Androgenetic alopecia(AGA)is a common hair loss disorder that significantly affects patient’s quality of life.Botulinum toxin(BoNT)has emerged as a potential treatment;however,its effectiveness and underlying mechanisms remain unclear.This systematic review aimed to synthesize the existing evidence on BoNT for AGA,analyze its mechanisms,evaluate its efficacy,and explore its potential for precision therapy.Methods:A PubMed search was conducted for studies published between 2020 and 2025.A total of 25 studies,including 11 clinical trials and 7 reviews,were included.The studies were analyzed for BoNT mechanisms in AGA,treatment regimens,efficacy,outcomes,cost-effectiveness,and safety profiles.Results:Experimental evidence suggests that BoNT reduces transforming growth factor-βin dermal papilla cells,a key pathological pathway in AGA.Other hypothetical mechanisms,such as scalp muscle relaxation improving microcirculation or inhibiting androgen conversion require further validation.In clinical trials,most studies used 30-150 U of BoNT via intramuscular(six studies)or intradermal(three studies)injections,with 1-3 sessions and up to 6 months of follow-up.Early open-label trials reported response rates of 70%-79%,but recent high-quality randomized controlled trials(RCTs)showed no significant improvement in hair density compared to placebo.Combination therapy with finasteride or minoxidil enhanced treatment outcomes,though large-scale evidence is lacking.BoNT was less cost-effective than first-line therapies such as minoxidil,with session costs approximately 37 times higher.Intramuscular injection appeared more effective than intradermal injection,possibly due to scalp muscle relaxation and vascular decompression.BoNT generally had a mild safety profile.Conclusion:Currently,BoNT lacks robust evidence to replace traditional treatments for AGA.Future research should focus on establishing standardized dosing protocols,conducting large-scale,long-term RCTs,and integrating molecular biomarkers to improve understanding and optimize the clinical use of BoNT in AGA management.
文摘AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People’s Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study.Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality.Further stratification was performed according to preoperative deviation angles[>35 prism diopters(PD)vs≤35 PD]and age(≥18 years adult group vs<18 years adolescent group).The baseline patient characteristics were collected,deviation angles at multiple timepoints before and after treatment were measured,and stereopsis test results were documented.Through comparative analysis of therapeutic outcomes across subgroups,we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included.At the final follow-up,both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001).Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05).For patients with deviations>35 PD,surgery yielded significantly better outcomes than injection therapy in postoperative angle,success rate,and stereopsis recovery(P<0.05).Similarly,in patients aged≥18 years,surgical treatment was superior to injections in reducing strabismus angle,improving success rates,and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE.Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy,particularly in patients with deviations>35 PD and those aged≥18 years.For patients with angles≤35 PD or under 18 years,BTXA injection remains a viable treatment option.
基金supported by the National High Level Hospital Clinical Research Funding(grant nos.2022-PUMCH-B-041,2022-PUMCH-A-210,and 2022-PUMCH-C-025).
文摘Background:Recently,microbotulinum,a new technique that involves injecting botulinum toxin type A(BoNTA)microdroplets into superficial cutaneous tissue,has gained popularity.The precise distribution of BoNTA in the targeted area profoundly affects outcomes.Many factors may influence the effective area of BoNTA in the dermis.This study aimed to determine the dermal distribution properties of BoNTA to guide microbotulinum injection.Methods:Ten healthy males aged 18–65 years without BoNTA treatment in the previous year were recruited to receive intradermal injections in the chest and back.Ultrasound was used to ensure the intradermal delivery of injections and measure the dermal thickness.The minor iodine starch test was performed at baseline and 3 days,7 days,21 days,1 month,and 2 months after treatment.Results:All participants received intradermal injections.The dermis was thinner on the chest(thickness,0.20±0.03 cm)than on the back(thickness,0.39±0.07 cm)(P<0.05).An injection in the thicker dermis had a significantly smaller effective area at every follow-up visit.The drug concentration did not affect the effective area except at 3 days after treatment.Injection speed did not influence the effective area at any follow-up visits.Conclusion:An injection in a thicker dermis leads to a smaller effective area for intradermal injections.When the BoNTA dose is the same,the drug concentration and injection speed do not matter.
基金supported by grants from the National Natural Science Foundation of China (81870874, 31371179, 81300968, and 81671270)the Natural Science Foundation of Jiangsu Province, China (BK20170004, 2015-JY-029, and BK20140372)+4 种基金Jiangsu Key Laboratory of Neuropsychiatric Diseases (BM2013003)the Second Affiliated Hospital of Soochow University Preponderant Clinic Discipline Group Project Funding (XKQ2015002)the Postgraduate Research and Practice Innovation Program of Jiangsu Province, China (KYCX17-2000)Suzhou Science and Technology For People’s Livelihood (SYS201706)the Postgraduate Research and Practice Innovation Program of Jiangsu Province, China (KYCX17_2034)
文摘The present study was designed to examine the therapeutic effects of Botulinum neurotoxin A(BoNT/A)on depression-like behaviors in mice and to explore the potential mechanisms.These results revealed that a single facial injection of BoNT/A induced a rapid and prolonged improvement of depression-like behaviors in naive and space-restriction-stressed(SRS)mice,reflected by a decreased duration of immobility in behavioral despair tests.BoNT/A significantly increased the 5-hydroxytryptamine(5-HT)levels in several brain regions,including the hippocampus and hypothalamus,in SRS mice.BoNT/A increased the expression of the N-methyl-Daspartate receptor subunits NR1 and NR2 B in the hippocampus,which were significantly decreased in SRS mice.Furthermore,BoNT/A significantly increased the expression of brain-derived neurotrophic factor(BDNF)in the hippocampus,hypothalamus,prefrontal cortex,and amygdala,which were decreased in SRS mice.Finally,BoNT/A transiently increased the levels of phosphorylated extracellular signal-regulated kinase(p-ERK)and cAMPresponse element binding protein(p-CREB),which were suppressed in the hippocampus of SRS mice.Collectively,these results demonstrated that BoNT/A treatment has antidepressant-like activity in mice,and this is associated with increased 5-HT levels and the activation of BDNF/ERK/CREB pathways in the hippocampus,supporting further investigation of BoNT/A therapy in depression.
基金grants from the National Natural Science Foundation of China （Nos. 30973336 and 81100762）.
文摘Botulinum toxin A （BTXA） has been used in several clinical trials to treat excessive glandular secretion; however, the precise mechanism of its action on the secretory function of salivary gland has not been fully elucidated. In this study, we aimed to investigate the effect of BTXA on secretion of submandibular gland in rabbits and to identify its mechanism of action on the secretory function of salivary gland. At 12 weeks after injection with 5 units of BTXA, we found a significant decrease in the saliva flow from submandibular glands, while the salivary amylase concentration increased. Morphological analysis revealed reduction in the size of acinar cells with intracellular accumulation of secretory granules that coalesced to form a large ovoid structure. Expression of M3-muscarinic acetylcholine receptor （M3 receptor） and aquaporin-5 （AQP5） mRNA decreased after BTXA treatment, and distribution of AQP5 in the apical membrane was reduced at 1, 2 and 4 weeks after BTXA injection. Furthermore, BTXA injection was found to induce apoptosis of acini. These results indicate that BTXA decreases the fluid secretion of submandibular glands and increases the concentration of amylase in saliva. Decreased expression of M3 receptor and AQP5, inhibition of AQP5 translocation, and cell apoptosis might involve in BTXA-reduced fluid secretion of submandibular lands.
基金supported by a grant from the Shandong Science and Technology Development Plan Project in China,No.2012YD18031
文摘No recommended guidelines currently exist for the therapeutic concentration or dose of botulinum toxin type A （BTXA） injected into the muscle to treat limb spasticity. Therefore, in this randomized controlled trial, we explored the safety and efficacy of two concentrations and two doses of BTXA in the treatment of spastic toot after stroke to optimize this treatment in these patients. Eligible patients （n = 104） were randomized into four groups. The triceps surae and tibialis posterior on the affected side were injected with BTXA at one of two doses （200 U or 400 U） and two concentrations （50 U/mL or 100 U/mL）. 2he following assessments were conducted before as well as 4 days and 1, 2, 4, and 12 weeks after treatment： spasticity, assessed using the modified Ashworth scale; basic functional mobility, assessed using a timed up and go test; pace, assessed using a 10-meter timed walking test; and the ability to walk, assessed using Holden＇s graded scale and a visual analog scale. The reported results are based on the 89 patients that completed the study. We found significant differences for the two doses and concentrations of BTXA to improve the ability of patients to walk independently, with the high-dose/low-concentration combination providing the best effect. Onset and duration of the ameliorating effects of BTXA were 4-7 days and 12 weeks, respectively. Thus, BTXA effectively treated foot spasms after stroke at an optimal dose of 400 U and concentration of 50 U/mL.
文摘BACKGROUND A large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective surgery.Persistent obstructive symptoms may result in faecal stasis that can develop into Hirschsprung-associated enterocolitis,a potential life-threatening condition.Important treatment to improve faecal passage is internal anal sphincter relaxation using botulinum toxin injections.AIM To give an overview of all empirical evidence on the effectiveness of botulinum toxin injections in patients with Hirschsprung disease.METHODS A systematic review and meta-analysis was done by searching PubMed,EMBASE and the Cochrane Library,using entry terms related to:(1)Hirschsprung disease;and(2)Botulinum toxin injections.14 studies representing 278 patients met eligibility criteria.Data that were extracted were proportion of patients with improvement of obstructive symptoms or less enterocolitis after injection,proportion of patients with adverse effects and data on type botulinum toxin,mean dose,average age at first injection and patients with associated syndromes.Random-effects meta-analysis was used to aggregate effects and random-effects meta-regression was used to test for possible confounding factors.RESULTS Botulinum toxin injections are effective in treating obstructive symptoms in on average 66%of patients[event rate(ER)=0.66,P=0.004,I2=49.5,n=278 patients].Type of botulinum toxin,average dose,average age at first injections and proportion of patients with associated syndromes were not predictive for this effect.Mean 7 duration of improvement after one botulinum toxin injections was 6.4 mo and patients needed on average 2.6 procedures.There was a significant higher response rate within one month after botulinum toxin injections compared to more than one month after Botulinum toxin injections(ER=0.79,vs ER=0.46,Q=19.37,P<0.001).Botulinum toxin injections were not effective in treating enterocolitis(ER 0.58,P=0.65,I2=71.0,n=52 patients).There were adverse effects in on average 17%of patients(ER=0.17,P<0.001,I2=52.1,n=187 patients),varying from temporary incontinence to mild anal pain.CONCLUSION Findings from this systematic review and meta-analysis indicate that botulinum toxin injections are effective in treating obstructive symptoms and that adverse effects were present,but mild and temporary.
基金supported in part by NIH grants(NIH/NINDS R01NS060774NIH/NICHD/NCMRR R24 HD050821-08)under subcontract with the Rehabilitation Insti-tute of Chicago
文摘The effect of botulinum toxin type A injection on voluntary grip control was examined in a 53-year-old female,who sustained a hemorrhagic right middle cerebral artery stroke 3 years previously,which resulted in finger flexor spasticity and residual weak finger/wrist extension.The patient received 50 units of botulinum toxin type A injection each to the motor points(2 sites/muscle)of the left flexor digitorum superficialis and flexor digitorum profundus,respectively.Botulinum toxin injection led to weakness and tone reduction in the spastic finger flexors,but improved grip release time in grip initiation/release reaction time tasks.Improved release time was accompanied by shortened extensor electromyography activity,and improved release time likely correlated with blocked co-contraction of finger flexors during voluntary finger extension.This case report demonstrated that botulinum toxin injection improved voluntary motor control of the hand in a chronic stroke patient with residual finger extension.
文摘AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases including: Pub Med/MEDLINE, and Cochrane Central Register of Control ed Trials, also an internet-based search using "Google Scholar" service was conducted. Both comparative and observational studies were included. We excluded irrelevant articles, editorials, case reports, reviews, and meta-analyses. The studies that followed the patients less than 6 mo were excluded. Variables collected were demographic data of the patients, technique of BTX-A injection and number of sessions, short-term and longterm clinical improvement, post-injection changes in electromyography(EMG), defecography, manometry, and balloon expulsion test, and complications recorded after BTX-A injection.RESULTS: Seven studies comprising 189 patients were included in the review. The median age of the patients was 41.2 years and female-to-male ratio was 1.3:1. The median dose of BTX-A injected per procedure was 100 IU(range, 20-100 IU). Lateral injection was done in five trails and combined lateral and posterior injections in two trials. Three studies used endorectal ultrasonographyguided technique, one study used EMG-guided technique,whereas the remaining three studies used manual palpation with the index finger. The median percentage of patients who reported initial improvement of symptoms was 77.4%(range 37.5%-86.7%), this percentage declined to a median of 46%(range 25%-100%) at 4 mo after injection of BTX-A. Rates of improvement evaluated by balloon expulsion test, EMG, and defecography ranged between(37.5%-80%),(54%-86.7%), and(25%-86.6%), respectively. Fourteen(7.4%) patients developed complications after injection of BTX-A. Complication rates across the studies ranged from 0% to 22.6%. CONCLUSION: Initial satisfactory improvement of symptoms after BTX-A injection remarkably deteriorated after 3 mo of the procedure. However, repeated injection may provide better sustained results with no additional morbidities. Further analysis of more patients is necessary to conclude the safety of BTX-A for the treatment of anismus.
文摘Objective To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disorders such as sia-lorrhea and hyperhidrosis. Methods A retrospective study of BTX-B injections in treatment of 58 patients with various neurological disorders was performed. The mean follow-up time was 0.9 ± 0.8 years. Results of the first and last treatment of patients with at least 3 injection sessions were compared. Results The response of 58 patients to a total of 157 BTX-B treatment sessions was analyzed. Of the 157 treatment sessions, 120 sessions (76.4%) resulted in moderate or marked improvement while 17 sessions (10.8%) had no response. The clinical benefits after BTX-B treatment lasted an average of 14 weeks. Of the 41 patients with at least 3 injection ses-sions (mean 10 ± 8.6), most patients needed increased dosage upon the last session compared to the first session. Nineteen patients (32.8%) with 27 sessions (17.2%) reported adverse effects with BTX-B treatment. Conclusions Though most patients require increased dosage to maintain effective response after repeated injections, BTX-B is an effective and safe treatment drug for a variety of movement disorders, as well as drooling and hyperhidrosis.
文摘AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate.CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.
基金Supported by the Central Guided Local Science and Technology Development (No.2019ZYYD058)。
文摘AIM: To investigate the effects of micro-injection of botulinum toxin A(BTXA) on acute acquired comitant esotropia(AACE). METHODS: A total of 33 AACE patients who underwent BTXA micro-injection at Renmin Hospital of Wuhan University from September 1^(st), 2019 to July 1^(st), 2021 were retrospective analyzed. Esotropia, eye alignment, stereopsis, and complications were examined at baseline(except complications), 1wk, 1, 3, and 6mo after injection. RESULTS: The average angle of deviation before injection was(+20.24±6.80)^(Δ) at near and(+24.76±6.43)^(Δ) at distance, while(+5.15±5.85)^(Δ) at near and(+7.30±6.17)^(Δ) at distance 6mo after treatment(P<0.05). Six months after injection, the stereopsis of patients had improved. The number of patients having no stereopsis(>800 seconds of arc) decreased from 11 to 3. The number of patients having peripheral stereopsis(300-800 seconds of arc), macular stereopsis(70-200 seconds of arc) and central concave stereopsis(≤60 seconds of arc) increased from 10 to 11, 10 to 12, and 2 to 7, respectively. At the follow-ups at 1wk, 1, 3, and 6mo after injection, success rates were 96.97%, 96.97%, 93.94% and 87.88%, respectively. One week after injection, two patients(6.07%) showed subconjunctival hemorrhage;three patients(9.09%) showed limited eye movement and one patient(3.03%) showed mild vertical strabismus. All the symptoms disappeared by the final follow-up.CONCLUSION: Micro-injection of BTXA can reduce diplopia and improve binocular vision function of AACE patients. Furthermore, the operation is relatively safe with few complications, making it an ideal treatment modality for AACE.
基金Project (No.491030-w10011) supported by the Zhejiang Provincial Natural Science Foundation of China
文摘Background and objective:Botulinum toxin type A(BoNT/A)is a metalloprotease that blocks synaptic transmission via the cleavage of a synaptosomal-associated protein of 25 kDa(SNAP-25).It has gained widespread use as a treatment for cerebral palsy and skeletal muscle hypertrophy.In China,Chinese botulinum toxin type A(CBTX-A),a type of BoNT/A,is in widespread clinical use.However,the changes in the morphological and biochemical properties of treated muscles and in remote muscles from the CBTX-A injection site are relatively unknown.Therefore,we investigated the changes in histomorphology and myosin heavy chain(MyHC)isoform composition and distribution in rat gastrocnemius muscles after intramuscular injection of CBTX-A.Methods:The weakness of the injected muscles was assessed periodically to identify their functional deficiency.Muscle slices were stained with hematoxylin-eosin(HE)and adenosine triphosphatase(ATPase).MyHC isoform composition was analyzed by sodium dodecyl sulfatepolyacrylamide gel electrophoresis(SDS-PAGE)to uncover changes in morphological and biochemical properties.Results:Our findings demonstrate that following injection of CBTX-A 5 U into rat gastrocnemius muscles,shifts in MyHC isoform composition emerged on the third day after injection and peaked in the fourth week.The composition remained distinctly different from that of the control group after the twelfth week.More specifically,there was a decrease in the proportion of the type IIb isoform and an increase in the proportions of type IIx,type IIa,and type I isoforms.Conclusions:Data revealed that CBTX-A led to a shift in MyHC composition towards slower isoforms and that the MyHC composition remained far from normal six months after a single injection.However,no noticeable remote muscle weakness was induced.
