Therapeutic Uses of Botulinum Toxin (eBook)

Preface 6
Acknowledgments 7
Contents 8
Contributors 9
History and Mechanism of Action 11
INTRODUCTION 11
MEDICAL COMMUNITY GETS INVOLVED 11
DISCOVERY OF THE BACTERIUM 13
BOTULINUM TOXIN STUDIED 13
NORMAL NEUROMUSCULAR JUNCTION 14
BOTULINUM TOXIN MECHANISM OF ACTION 14
REFERENCES 15
Spasticity 16
INTRODUCTION 16
PATHOPHYSIOLOGY 16
RISK FACTORS 18
HISTORY/CLINICAL EXAMINATION 18
DIAGNOSTIC EVALUATION 19
DIFFERENTIAL DIAGNOSIS 19
TREATMENT APPROACH 20
BTX Injection 23
CONCLUSION 26
REFERENCES 26
Radiation Fibrosis Syndrome 28
INTRODUCTION 28
PATHOPHYSIOLOGY 28
RISK FACTORS 33
HISTORY 34
CLINICAL EXAMINATION 36
DIAGNOSTIC EVALUATION 36
DIFFERENTIAL DIAGNOSIS 37
TREATMENT APPROACH 38
CONCLUSION 45
REFERENCES 45
Low Back Pain 48
INTRODUCTION 48
RISK FACTORS 48
Occupational Factors 48
Patient-Related Factors 49
Anthropomorphic Factors 49
Psychosocial Factors 49
ETIOLOGY OF BACK PAIN 49
Primary Spinal Causes of LBP 49
Secondary Causes of LBP 53
Referred Causes for Back Pain 54
DIAGNOSTIC APPROACH 54
History 54
Physical Exam 56
Imaging 61
Treatment 62
CONCLUSION 67
REFERENCES 67
Piriformis Syndrome 69
INTRODUCTION 69
HISTORY OF PS 69
EPIDEMIOLOGY 70
DIAGNOSIS 71
DOES PS EXIST? 73
PATHOGENETIC MECHANISM 74
NONOPERATIVE MANAGEMENT 74
OUR METHOD OF INJECTION 76
CLINICAL EXPERIENCE 79
REFERENCES 81
Plantar Fasciitis 83
DEFINITION AND ANATOMY 83
BIOMECHANICAL FACTORS AND PATHOPHYSIOLOGY 83
EPIDEMIOLOGY AND RISK FACTORS 84
DIFFERENTIAL DIAGNOSIS 85
HISTORY AND PHYSICAL EXAMINATION 85
DIAGNOSIS 85
TREATMENT 86
BOTULINUM TOXIN TYPE A INJECTION PROCEDURE (FIGS. 9–11) 92
ACKNOWLEDGMENTS 97
REFERENCES 97
Headache 98
INTRODUCTION 98
BACKGROUND 98
EPIDEMIOLOGY/SYMPTOMATOLOGY Migraine Headache 99
Tension-Type Headache 100
PATHOPHYSIOLOGY Migraine Headache 101
Tension Headache 102
CLINICAL DIAGNOSIS History 102
Physical Examination 103
Diagnostic Evaluation 104
TREATMENT APPROACH Migraine 104
Tension-Type Headaches 106
How BoNT Fits In 106
RISKS AND HAZARDS 110
Eyelid Ptosis (Blepharoptosis) 110
Brow Ptosis 111
Diplopia 111
Minor Sequelae 111
POST-INJECTION MANAGEMENT 111
FREQUENCY OF INJECTIONS 112
SUCCESS WITH BoNT 112
CONCLUSIONS 112
REFERENCES 113
SUGGESTED FURTHER READING 115
Spasmodic Dysphonia 116
INTRODUCTION 116
BACKGROUND 116
EPIDEMIOLOGY/SYMPTOMATOLOGY 117
PATHOPHYSIOLOGY 118
CLINICAL DIAGNOSIS 119
ANATOMICAL LANDMARKS 120
TREATMENT APPROACH BTX: Rationale for Use 121
Technical Aspects 121
Risks and Hazards 125
Frequency of Administration 126
Success With BTX 126
CONCLUSIONS 127
REFERENCES 127
Sialorrhea and Frey’s Syndrome 129
INTRODUCTION 129
SIALORRHEA 129
Epidemiology/Symptomatology 131
Clinical Diagnosis 132
Treatment Approach 133
Conclusion 136
GUSTATORY SWEATING 136
Epidemiology and Symptomatology 137
Clinical Diagnosis 137
Treatment Approach 138
Conclusion 139
REFERENCES 140
Cosmetic Applications 142
INTRODUCTION 142
PHARMACOLOGY 142
DILUTION AND DOSING 142
CONTRAINDICATIONS 143
ADVERSE EVENTS 143
PATIENT EVALUATION 143
GENERAL INJECTION GUIDELINES 143
CLINICAL APPLICATIONS Glabellar Frown Lines 144
Horizontal Forehead Lines 147
Crow’s Feet 150
“Bunny” Lines 152
Perioral Lines 153
Mental Crease and Dimpled Chin 153
Mouth Frown 154
Platysmal Bands 154
Horizontal Neck Lines 154
SUMMARY 155
REFERENCES 155
Hyperhydrosis 157
INTRODUCTION 157
DIAGNOSIS 159
TREATMENT ALGORITHM 160
BTX INJECTION PROCEDURE 162
Axilla 162
Palms 165
Soles 167
CONCLUSION 168
REFERENCES 168
SUGGESTED FURTHER READING 170
Urological Applications 171
INTRODUCTION 171
DIAGNOSIS AND EVALUATION OF LUT DYSFUNCTION 172
History and Physical Examination 173
Validated Questionnaires and Voiding Diary 174
The Pad Test 174
Routine Urological Assessment 174
Urodynamics 175
Cystourethroscopy 175
CLINICAL APPLICATION OF BTX IN THE TREATMENT OF LUT DYSFUNCTION Detrusor – Sphincter Dyssynergia and Related Disorders 175
Neurogenic and Idiopathic Detrusor Overactivity 178
Sensory Disorders/Interstitial Cystitis/Pelvic Pain Disorders 181
Benign Prostatic Hypertrophy 183
BTX-B in the Treatment of Urological Disorders 184
CLINICAL ISSUES RELATED TO BTX INJECTION Injection Duration 186
Treatment Onset 187
Repeat Injection 187
Side Effects 188
PROTOCOL FOR BTX INJECTION 189
Injection Dose 189
Injection Volume 190
Injection Distribution 190
Bladder Injection Technique 192
Urethral Injection Technique 192
CONCLUSION 194
REFERENCES 194
Gastrointestinal Applications 198
INTRODUCTION 198
BTX-A FOR THE TREATMENT OF GASTROPARESIS 198
TREATMENT OF ACHALASIA WITH BTX-A 200
BTX-A FOR THE TREATMENT OF ANAL FISSURE 204
CONCLUSION 207
REFERENCES 208
Blepharospasm 211
INTRODUCTION 211
CLINICAL FINDINGS 211
TERMINOLOGY 211
DIFFERENTIAL DIAGNOSIS 212
PATHOGENESIS 212
TREATMENT 213
Botulinum Toxin Type A 213
Oral Medications 215
Surgery 220
CONCLUSION 221
REFERENCES 221
Economics, Immunity, and Future Directions 224
INTRODUCTION 224
ECONOMIC CONSIDERATIONS 224
THE DEVELOPING ROLE OF BTX 226
CONCLUSION 227
REFERENCES 228
Index 230