scholarly journals Comparison of Two Botulinum Neurotoxin A Injection Patterns with or without the Medial Lower Eyelid in the Treatment of Blepharospasm

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Hui Yang ◽  
Jing Lu ◽  
Xiujuan Zhao ◽  
Xiaohu Ding ◽  
Zhonghao Wang ◽  
...  
Keyword(s):  
Rating Scale ◽  
Botulinum Toxin A ◽  
Lower Eyelid ◽  
Essential Blepharospasm ◽  
Registration Number ◽  
Tear Meniscus Height ◽  
Jankovic Rating Scale ◽  
Breakup Time ◽  
Schirmer I Test ◽  
Lacrimal Drainage

The aim of this study was to evaluate the efficacy of two botulinum toxin A (BoNT-A) injection patterns with or without the medial lower eyelid (MLE) in treating benign essential blepharospasm (BEB) and influencing lacrimal drainage. Two different injection patterns of BoNT-A were randomly applied to 98 eyes of 49 BEB patients: MLE Group received a full injection pattern of 5 sites and non-MLE Group received a MLE waived injection pattern of 4 sites. Tear breakup time (BUT), Schirmer I test, lagophthalmos height, and lower lid tear meniscus height (TMH) were measured and Jankovic Rating Scale (JRS) was surveyed before injection and at 1 week, 1 month, and 3 months after injection. The symptom of BEB was relieved in both groups as suggested by JRS scores at all time points after injection, and MLE Group came up with a better JRS score at 3 months. The increases of Schirmer I test value and TMH in MLE Group were higher than those in non-MLE Group at 1 week after injection. This study shows that the MLE-involved full injection pattern is a better choice for patients with BEB. It has longer-lasting effects in relieving BEB symptoms and better efficacy in reducing lacrimal drainage. Clinical Trials registration number isNCT02327728.

scholarly journals Transconjunctival versus Transcutaneous Injection of Botulinum Toxin into the Lacrimal Gland to Reduce Lacrimal Production: A Randomized Controlled Trial

Toxins ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 77
Author(s):  
Andrew G. Lee ◽  
Shin-Hyo Lee ◽  
Minsu Jang ◽  
Sang Jae Lee ◽  
Hyun Jin Shin
Keyword(s):  
Botulinum Toxin ◽  
Lacrimal Gland ◽  
Botulinum Toxin A ◽  
Controlled Trial ◽  
Clinical Effectiveness ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Delivery Routes ◽  
Tear Meniscus Height

The purpose of this study was to determine and compare the effects between injecting botulinum toxin A (BTX-A) transconjunctivally into the palpebral lobe and transcutaneously into the orbital lobe of the lacrimal gland in patients with epiphora due to lacrimal outflow obstruction. This randomized controlled study included 53 eyes of 31 patients with unilateral or bilateral epiphora. Patients were randomly allocated to receive an injection of BTX-A (3 units) either transconjunctivally (n = 15, 25 eyes) or transcutaneously (n = 16, 28 eyes). For objective assessments, the tear meniscus height and Schirmer’s I test with topical anesthesia were measured at baseline and after 2, 6, 12, and 24 weeks of follow-up. Subjective evaluations were performed using the Munk score. After BTX-A injection, patients in both groups experienced significant objective and subjective reductions in tearing at all follow-up times compared to pre-injection (success rate 86.8%), and the effect lasted for a mean duration of 5.63 months. The two delivery routes showed similar clinical effectiveness for a single injected dose of BTX-A. In conclusion, injecting BTX-A via either a transconjunctival or transcutaneous route helps to reduce normal tear production and results in significant improvements in the symptoms in patients with epiphora.

scholarly journals Successful treatment of lower eyelid epiblepharon by injection of botulinum toxin A in patients under two years of age

2013 ◽  
Vol 5 (2) ◽  
pp. 177-181 ◽  
Author(s):  
CY Chen ◽  
Angel Nava-Castaneda
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Lower Eyelid ◽  
Rank Test ◽  
Orbicularis Muscle

Introduction: Epiblepharon is characterized by a cutaneous horizontal fold adjacent to the lid margin. Some cases showed spontaneous resolution, others required surgical treatment. We propose a medical treatment with botulinum toxin type A (BTX-A). Objective: To provide clinical evidence of the usefulness of botulinum toxin type A (BTX-A) in patients with lower eyelid epiblepharon. Subjects and methods: This was a prospective, non-randomized, nonmasked study. Patients with lower eyelid epiblepharon with corneal eyelash contact were included in the study. The scale proposed by Khwarg & Lee (1997) was used to assess the epiblepharon clinical evaluation. A single dose of 12.5 IU of BTX-A (Dysport ®) was directly injected into the medial pre-tarsal orbicularis muscle region in the lower eyelid. Patients were evaluated before the injection and at 1, 4, 12 and 24 weeks after the injection. We performed descriptive statistics and Wilcoxon Signed Rank Test, comparing prior injection measurements to post injection measurements at the 24th week. A p < 0.05 was considered statistically significant. Each eye was separately analyzed. Results: Fourteen eyes of seven Hispanic patients were treated, five female and two male. The mean age was 8.4 months (4 - 14 months). The height of the skin-fold, the area of the cornea touched by the cilia and the symptoms score improved after the first week of BTX-A injection and remained so until the end of study (p < 0.05). No major complications were noted. Conclusion: The effect of a single 12.5 IU injection of BTX-A (Dysport ®) into the medial orbicularis muscle portion in the lower eyelid epiblepharon patients successfully improves the clinical signs and symptoms. Nepal J Ophthalmol 2013; 5(10): 177-181 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8709

scholarly journals Examining the effects of enhanced provider–patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e015505 ◽  
Author(s):  
Liesbeth M van Vliet ◽  
Sandra van Dulmen ◽  
Bram Thiel ◽  
Gerard W van Deelen ◽  
Stephanie Immerzeel ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Rating Scale ◽  
Controlled Trial ◽  
Clinical Care ◽  
Numeric Rating Scale ◽  
Study Results ◽  
Audio Recordings ◽  
Registration Number ◽  
Randomised Controlled ◽  
Care Ward

IntroductionPlacebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider’s communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients’ outcomes.Methods and analysisUsing a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse–patient interactions.Ethics and disseminationAlthough communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication.Trial registration numberNTR5994; Pre-results.

scholarly journals Botulinum Toxin for Benign Essential Blepharospasm, Hemifacial Spasm and Age-Related Lower Eyelid Entropion

1987 ◽  
Vol 14 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Jean Carruthers ◽  
Harrison A. Stubbs
Keyword(s):  
Botulinum Toxin ◽  
Hemifacial Spasm ◽  
Lower Eyelid ◽  
Essential Blepharospasm ◽  
Age Related

Abstract:Purified botulinum A exotoxin was used in the treatment of forty seven patients with benign essential blepharospasm, 11 patients with hemifacial spasm and 2 patients with age-related entropion. The treatment was effective in all three groups for an average of 3-4 months when symptoms recurred and repeated chemodenervation with toxin was needed. The commonest complication was transient ptosis with an overall frequency of 7.8%. This incidence increased to 11.1% with toxin doses higher than 25 units per orbicularis. The treatment was well accepted by the patients, who were subsequently able to return to pre-blepharospasm lifestyles.

High Versus Low Concentration Botulinum Toxin A for Benign Essential Blepharospasm: Does Dilution Make a Difference?

2009 ◽  
Vol 25 (2) ◽  
pp. 81-84 ◽  
Author(s):  
Michael H. Boyle ◽  
Gerald McGwin ◽  
Courtney E. Flanagan ◽  
Matthew G. Vicinanzo ◽  
John A. Long
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Toxin A ◽  
Low Concentration ◽  
Essential Blepharospasm

scholarly journals Levodopa+carbidopa in X-linked Dystonia Parkinsonism (XDP/DYT3/Lubag): A Randomized, Double-blind, Placebo-controlled Trial

2018 ◽  
Vol 52 (6) ◽  
Author(s):  
Roland Dominic G. Jamora ◽  
Rosalia A. Teleg ◽  
Cynthia P. Cordero ◽  
Rodelyn F. Villareal-Jordan ◽  
Lillian V. Lee ◽  
...  
Keyword(s):  
Rating Scale ◽  
Botulinum Toxin A ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Efficacy Analysis ◽  
Intention To Treat ◽  
Oral Medications ◽  
Significant Difference ◽  
Scale Scores

Objective. X-linked dystonia parkinsonism (XDP) is an adult-onset, progressive and debilitating movement disorder described among Filipino males from Panay Island. The available oral medications have been ineffective. While chemodenervation with botulinum toxin A works and deep brain stimulation surgery is promising, these are not affordable for the vast majority of patients. Thus, we decided to look into the efficacy, safety and tolerability of levodopa+carbidopa (levodopa) versus placebo among patients with XDP. Methods. This was a double blind, randomized, placebo-controlled clinical trial. Patients were randomized to receive levodopa or placebo for 6 months. The dose was increased gradually until 1000 mg levodopa/day is reached or until side effects appear. Results. A total of 86 out of 94 randomized patients (91.5%) were included in the intention-to-treat cohort for the primary efficacy analysis. Nineteen patients (9 in levodopa, 10 in placebo) dropped out or were lost to follow up. There was no significant difference in the baseline and last visit Burke Fahn Marsden Dystonia Rating Scale and the part III of the Unified Parkinson’s Disease Rating Scale scores between levodopa and placebo. The most common adverse events in the levodopa group were increased movements, pain and nausea/ vomiting. Conclusion. While levodopa is safe and well-tolerated, it does not have any effect in alleviating the dystonia or parkinsonism in XDP

scholarly journals Machine Learning for Predicting Individual Severity of Blepharospasm Using Diffusion Tensor Imaging

2021 ◽  
Vol 15 ◽  
Author(s):  
Gang Liu ◽  
Yanan Gao ◽  
Ying Liu ◽  
Yaomin Guo ◽  
Zhicong Yan ◽  
...  
Keyword(s):  
Machine Learning ◽  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Disease Severity ◽  
Rating Scale ◽  
Diffusion Tensor ◽  
Support Vector ◽  
Learning Scheme ◽  
The Individual ◽  
Jankovic Rating Scale

Accumulating diffusion tensor imaging (DTI) evidence suggests that white matter abnormalities evaluated by local diffusion homogeneity (LDH) or fractional anisotropy (FA) occur in patients with blepharospasm (BSP), both of which are significantly correlated with disease severity. However, whether the individual severity of BSP can be identified using these DTI metrics remains unknown. We aimed to investigate whether a combination of machine learning techniques and LDH or FA can accurately identify the individual severity of BSP. Forty-one patients with BSP were assessed using the Jankovic Rating Scale and DTI. The patients were assigned to non-functionally and functionally limited groups according to their Jankovic Rating Scale scores. A machine learning scheme consisting of beam search and support vector machines was designed to identify non-functionally versus functionally limited outcomes, with the input features being LDH or FA in 68 white matter regions. The proposed machine learning scheme with LDH or FA yielded an overall accuracy of 88.67 versus 85.19% in identifying non-functionally limited versus functionally limited outcomes. The scheme also identified a sensitivity of 91.40 versus 85.87% in correctly identifying functionally limited outcomes, a specificity of 83.33 versus 83.67% in accurately identifying non-functionally limited outcomes, and an area under the curve of 93.7 versus 91.3%. These findings suggest that a combination of LDH or FA measurements and a sophisticated machine learning scheme can accurately and reliably identify the individual disease severity in patients with BSP.

scholarly journals Role of Botulinum Toxin in Post-Stroke Spasticity Related Shoulder Pain

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Botulinum Toxin ◽  
Shoulder Pain ◽  
Upper Limb ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Botulinum Toxin A ◽  
Initial Assessment ◽  
Shoulder Abduction ◽  
Post Injection ◽  
Post Stroke

Shoulder pain is a very common complication after stroke, with a reported prevalence varying from 23% to 64%. There are very few treatment options that have been shown to be more effective than placebo for relief of poststroke shoulder pain. One of the factors most frequently associated with shoulder pain is spasticity, especially when the muscles are stretched. Botulinum toxin A (BT-A) is one of the treatments available for the treatment of focal spasticity and its effectiveness in reducing upper limb spasticity in stroke is well documented. In this review, patients with shoulder pain and spasticity after hemiplegia, a single injection of BT-A was associated with a statistically significantly greater reduction in shoulder pain on a numerical rating scale (NRS) from 6/10 at initial assessment; to 1/10 two months post injection. Nine patients (56%) were pain free at 5 and 9 months postinjection. Median Modified Ashworth Scale (MAS) scores for shoulder spasticity in the affected upper limb improved from 3 at the initial assessment to 2, two months post injection and remained as 1+, five and nine months post injection. There was also a significant improvement in median passive shoulder abduction range of motion on the affected upper limb from 80 degrees at the initial assessment to 95 degrees, two months post injection and further improvement to 110 degrees in 9 patients, 5 months post injection. BT-A seems to be effective in managing post- stroke shoulder pain secondary to spasticity.

The good toxin: 10 years of experience with botulinum toxin A in the treatment of benign essential blepharospasm

2020 ◽  
pp. 112067212092563
Author(s):  
Kenneth KH Lai ◽  
Andrew KT Kuk ◽  
Edwin Chan ◽  
Simon TC Ko
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Onset Time ◽  
Surgical Correction ◽  
First Year ◽  
Common Complication ◽  
Toxin A ◽  
Essential Blepharospasm ◽  
Threatening Condition ◽  
Life Threatening

Purpose: To describe the efficacy and safety of botulinum toxin A (Botox) in patients with benign essential blepharospasm. Methods: Retrospective review of operation, injection, and medical records. Results: Information of 29 patients (nine males) was reviewed, and the average age of benign essential blepharospasm onset was 59.1 years. The average number of injections per patient was 14.2 ± 8.2 (5–44) and the average follow-up was 75.8 ± 47.3 months (15–180). The average unit dose was 14.2 ± 8.2 (10–30) ipsilaterally in the patient’s first year and was 21.4 ± 5.0 (12.5–30) ipsilaterally in their last year (p = 0.00458). The average onset time was 3.8 ± 1.9 (1–7) days in a patient’s first year and was 3.6 ± 1.7 (2–7) days in their last year (p = 0.549). The average effective duration was 2.86 ± 1.1 months in a patient’s first year and was 2.53 ± 0.9 in their final year (p = 0.187). The Subjective Spasm Alleviation Scale was 1.72 ± 0.4 at the first year and was 1.79 ± 0.5 in the last year (p = 0.187). Ten (34.5%) patients with eyelid disease had surgical correction. The Subjective Spasm Alleviation Scale was 1.50 ± 0.5 before and was 2.0 ± 0 six months after the operation (p = 0.0268). Post-injection complications were experienced in eight (27.6%) patients. The most common complication was ptosis (n = 7), followed by diplopia (n = 1), dry eye (n = 1), and tearing (n = 1). No life-threatening complication was reported. Conclusion: Botox was a safe and effective treatment in benign essential blepharospasm which required an increased dosage over time. Ptosis was the most common complication and no life-threatening condition was reported. Surgical correction of those with eyelid diseases showed subjective improvement of subsequent Botox treatment.

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