Therapy with Botulinum Toxin

Therapy with Botulinum Toxin......Page 1
SERIES INTRODUCTION......Page 8
FOREWORD......Page 9
PREFACE......Page 12
CONTENTS......Page 14
CONTRIBUTORS.......Page 18
HISTORICAL PERSPECTIVE......Page 24
BASIC SCIENCE......Page 28
Introduction......Page 29
Neurotoxin Origin and Structure......Page 30
Binding......Page 31
Intracellular Poisoning......Page 32
Potency........Page 33
Biochemistry......Page 34
Future Directions......Page 35
References......Page 36
Introduction......Page 40
Primary (Covalent) Structure......Page 41
The Zinc-Binding Site of the Neurotoxin......Page 44
Secondary Structures......Page 45
Tertiary and Quaternary Structures......Page 46
Functional Domains......Page 47
Potential Use of Different Neurotoxin Serotypes and Chimeric Neurotoxins......Page 49
Crystalline Type A Toxin.......Page 50
Comments on the Optical Properties......Page 51
Electrophoretic Analysis and Criteria for Testing Purity......Page 52
Toxin Complex and Crystalline Toxin A, History and Current Status......Page 53
Detoxification of Crystalline Type A Toxin and pH......Page 56
Toxicity Assays......Page 58
Looking Ahead.......Page 59
References......Page 60
Introduction......Page 65
Developments Leading to the Use of Botulinum Toxin Type A.......Page 66
Use of Types of Botulinum Toxin Other than Type A......Page 69
Assay Procedures for Biological Standardization and Control......Page 70
Discussion......Page 71
References......Page 72
Background and Rationale......Page 74
Sequence Alignments......Page 76
Hydropathic Analyses......Page 77
Hydrophobic Moment Analysis......Page 78
Discussion.......Page 80
References......Page 82
Background......Page 85
Data Analysis......Page 86
Botulinum Toxin Translocation.......Page 87
Captopril......Page 89
References......Page 91
Introduction......Page 93
Toxin......Page 94
Mode of Action......Page 96
Comparative Muscle Paralytic Efficacy......Page 98
Comparative Toxicity Data......Page 100
Clinical Uses of Botulinum Toxin Type B.......Page 103
References......Page 104
Toxin Production......Page 108
Step 5: SP-Sephadex Chromatography......Page 109
Preparation of Final Product......Page 110
Properties of Final Product......Page 111
References......Page 113
Immunogenicity of Bacterial Protein Toxins......Page 114
Preparation of Botulinum Toxoids......Page 115
Immunization of Humans with Botulinum Toxoids......Page 116
Enzyme-Linked Immunosorbent Assay......Page 118
Standard Antitoxins......Page 119
Determining Test Dilution for Each Toxin......Page 120
Example of 50% End Point Calculations According to the Reed and Muench Method......Page 121
Results of Immune Assessment of Patients......Page 123
Results of Continued Evaluation of Patients by the Smith-Kettlewell Institute......Page 124
Discussion......Page 125
Summary......Page 126
References.......Page 127
Background......Page 129
Subclinical Effects Associated with Botulinum Toxin Injection......Page 134
Antibodies.......Page 135
Implications of Subclinical Effects of Botulinum Toxin......Page 136
References......Page 137
Introduction......Page 139
Biochemistry and Cellular Physiology......Page 140
Acetylcholine Nicotinic Receptor Density and Distribution in Response to Denervation......Page 141
Muscle Fiber Morphometric Studies and Histochemistry after Injection......Page 143
Motor Nerve Terminal Morphology Following Botulinum Toxin Type A Injection......Page 147
Normal Human Orbicularis Oculi Terminal Motor Axons......Page 149
Alteration of End Plate Size and Arrangement......Page 150
Dual Axonal Innervation of Individual Muscle Fibers......Page 152
The Maintenance of Altered Neuromuscular Interactions Following Botulinum Toxin Injection......Page 153
Strabismus......Page 156
Blepharospasm and Meige Syndrome......Page 157
Histologic Innervation Zone Analysis of Human Orbicularis Oculi......Page 158
Adult-Onset Spasmodic Torticollis.......Page 159
A Depiction of the Diffusion Denervation Field in a Patient......Page 163
Histologic Determination of the Denervation Field and Botulinum Toxin Activity at Therapeutic Doses......Page 164
Case Report......Page 171
Summary......Page 173
References......Page 174
Introduction......Page 178
Controls......Page 179
Changing Location......Page 180
Discussion......Page 184
References......Page 188
DYSTONIA......Page 190
Phenomenology of Dystonic Movements......Page 191
Variants from Classical Torsion Dystonia......Page 193
Classification by Distribution.......Page 194
Classification By Etiology and Genetics of Dystonia......Page 195
Pathophysiology and Pathoanatomy......Page 200
Treatment......Page 202
References......Page 203
Symptomatology......Page 208
Management......Page 210
Methods of Treatment.......Page 211
Results......Page 212
References......Page 213
Acute Local Effects of Botulinum Toxin......Page 216
Diplopia......Page 219
Entropion and Ectropion.......Page 220
Rare Local Effects of Botulinum Toxin for Blepharospasm......Page 221
Chronic Local Effects of Botulinum Toxin for Blepharospasm......Page 222
Chronic Distant Effects of Botulinum Toxin for Blepharospasm......Page 223
References.......Page 224
The Spectrum of Dystonic Head Movements......Page 227
Morning Benefit......Page 229
Other Neurological Deficits......Page 230
Symptomatic Cervical Dystonia......Page 231
Other Hyperkinetic Movement Disorders......Page 232
Examination of the Patient with Cervical Dystonia......Page 233
Cervical Dystonia Rating Scales......Page 235
The Columbia Torticollis Rating Scale......Page 236
The Tsui Rating Scale......Page 237
Jankovic's Rating Scales.......Page 239
The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)......Page 240
Instrumental Methods......Page 242
Quality-of-Life Assessment......Page 243
Appendix A: The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)......Page 244
Appendix B: TWSTRS—Videotape Protocol......Page 248
References......Page 249
Anatomy of the Major Neck Muscles......Page 254
Central Control......Page 262
Motoneurons of the Cervical Musculature......Page 263
Background......Page 264
Results......Page 265
Discussion......Page 268
Acknowledgments.......Page 269
References......Page 270
Electromyographic Studies......Page 272
Exteroceptive Reflexes......Page 274
Vestibular Reflexes.......Page 275
Blink Reflex Recovery Curves......Page 276
H-Reflex Recovery Curve and Reciprocal Inhibition of the H-reflex......Page 277
References......Page 278
Selection of Muscles......Page 281
Injection Techniques......Page 282
Types of Toxin and Doses to Be Injected......Page 286
Risks and Side Effects.......Page 288
Primary and Secondary Nonresponders......Page 290
References......Page 291
Introduction......Page 293
Methods.......Page 294
Rating Scales......Page 295
Outcome......Page 296
Statistics......Page 298
Discussion......Page 299
References.......Page 301
Identifying Patterns of Muscle Involvement with Electromyography......Page 302
Targeting Botulinum Toxin Injection into Muscle with Electromyography......Page 303
Electromyography-Assisted Botulinum Toxin Injections for Cervical Dystonia......Page 304
Technique of Electromyography-Assisted Injection......Page 306
References......Page 309
Introduction......Page 312
Botulinum Toxin Treatment of Writer's Cramp......Page 313
Efficacy of Injection......Page 315
Musician's Cramp......Page 317
References.......Page 318
Introduction......Page 320
General Concerns......Page 322
Determination of Botulinum Toxin Doses......Page 324
Injection Technique......Page 328
The Question of Electromyography.......Page 329
Treatment Outcome......Page 330
Dystonic Tremor......Page 331
Concluding Remarks......Page 332
References.......Page 333
Patient Population......Page 336
Methods......Page 337
Side Effects and Adverse Reactions.......Page 338
References......Page 340
HEMIFACIAL SPASM......Page 342
Clinical Characteristics.......Page 343
Differential Diagnosis......Page 347
Therapy......Page 349
Botulinum Toxin Type A......Page 350
Conclusion......Page 361
References......Page 362
Indications and Contraindications for Treatment with Botulinum Toxin Type A......Page 365
Procedure for Treating Hemifacial Spasm with Botulinum Toxin Type A.......Page 366
Treatment Results......Page 367
Exposure Keratitis......Page 369
Conclusion......Page 370
References......Page 371
Introduction......Page 373
Patients with Hemifacial Spasm......Page 374
Botulinum Toxin Injections......Page 375
Discussion......Page 376
References......Page 378
STRABISMUS.......Page 381
Indications and Contraindications......Page 382
Results......Page 383
Directions for Future Research......Page 386
References.......Page 387
Introduction......Page 388
Extraocular Muscle Physiology and Kinetics......Page 391
Miotic Therapy......Page 392
Occlusion for Amblyopia......Page 393
Principles of Surgical Treatment of Strabismus.......Page 394
References......Page 396
Clinical Trials.......Page 398
Rationale for Treatment......Page 399
Clinical Trials......Page 401
Summary......Page 403
References......Page 404
SPEECH AND VOICE DISORDERS.......Page 406
What is Speech?......Page 407
Symptoms and Signs......Page 409
General Speech Motor Examination.......Page 411
Clinical Syndromes......Page 416
Spasmodic Dysphonia......Page 417
Dysfluency......Page 421
References......Page 425
Introduction......Page 431
Acoustic Analysis......Page 432
Aerodynamic Measures......Page 434
Videoendoscopy.......Page 435
Summary......Page 437
References......Page 438
Introduction......Page 439
Technical Considerations.......Page 440
Results......Page 441
Acknowledgments......Page 443
References......Page 444
Movement Abnormalities......Page 446
Patient Selection for Treatment: Differential Diagnosis......Page 447
Percutaneous Injection Technique......Page 448
Unilateral Injections: Doses.......Page 449
Duration of Benefit......Page 450
Side Effects......Page 451
Repeated Treatment......Page 452
Treatment Failures......Page 455
Future Directions......Page 456
References......Page 457
Clinical Characteristics......Page 460
Current Experience with Botulinum Toxin for Abductor Laryngeal Dystonia......Page 461
Results.......Page 463
Conclusions......Page 467
References......Page 468
Selection of Indirect Laryngoscopic Peroral Approach.......Page 469
Technique......Page 470
Outcomes......Page 471
References......Page 472
Introduction......Page 474
Rationale for Unilateral Injection......Page 475
Method of Injection......Page 476
Doses......Page 477
Response to Unilateral Injections—Assessment of Response.......Page 479
Variations in Response to Injection......Page 482
Conclusions......Page 485
References......Page 486
Background on Stuttering......Page 488
Background on Vocal Tremor......Page 490
Botulinum Toxin Injections in Adductor Spasmodic Dysphonia, Stuttering, and Vocal Fold Tremor......Page 491
Discussion......Page 494
References......Page 495
MISCELLANEOUS DISORDERS......Page 498
Clinical Characteristics and Differential Diagnosis of Tremors......Page 499
Treatment of Tremors.......Page 501
Treatment of Tremors with Botulinum Toxin......Page 503
References......Page 507
Clinical Characteristics of Tics and Tourette's Syndrome......Page 509
Treatment of Tics and Tourette's Syndrome.......Page 511
References......Page 514
Introduction......Page 517
Rationale for use of Botulinum Toxin in Cerebral Palsy.......Page 518
Alternative Management and Perspective......Page 519
Dosage and Toxin Preparation.......Page 520
Evaluation......Page 521
Open Drug Trial......Page 522
Double-Blind Placebo-Controlled Feasibility Trial.......Page 524
References......Page 527
Spasticity.......Page 529
Monitoring Efficacy......Page 530
Monitoring Safety......Page 531
Injections......Page 532
Results.......Page 533
Discussion of Results......Page 534
Study in Post-Stroke Spasticity......Page 535
Study in Cerebral Palsy......Page 536
Safety.......Page 537
References......Page 538
Anatomy and Physiology of Micturition......Page 540
Use of Botulinum Toxin......Page 542
Method of Injection......Page 544
References......Page 545
Regulation of Gastrointestinal Motility*......Page 548
Botulinum Toxin and the Enteric Nervous System......Page 551
In Vivo Effects of Botulinum Toxin on the Lower Esophageal Sphincter.......Page 552
Achalasia......Page 553
Conclusions......Page 556
References......Page 558
Introduction......Page 561
Injections......Page 563
Results.......Page 564
References......Page 568
Clinical and Pathophysiologic Background of the Disease......Page 570
The Differential Diagnosis of Palatal Tremor.......Page 573
Proposed Therapies for the Click......Page 574
Botulinum Toxin Treatment of the Click......Page 575
References......Page 578
Introduction......Page 580
Other Muscles......Page 581
Results......Page 582
The Treatment of Acquired Facial Lines......Page 586
Discussion.......Page 589
How Effective Is It?......Page 590
What Complications Occur?......Page 595
What Facial Lines can be Treated?......Page 596
References......Page 597
A......Page 600
C......Page 601
D......Page 602
F......Page 603
H......Page 604
L.......Page 605
N......Page 606
P......Page 607
S.......Page 608
T......Page 609
U......Page 610
Z......Page 611
ABOUT THE EDITORS.......Page 612