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Toxins
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Clinical Application of Botulinum Toxin
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Clinical Application of Botulinum Toxin

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: closed (31 August 2022) | Viewed by 45889

Special Issue Editor

Prof. Dr. Markus Naumann

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Guest Editor
Department of Neurology and Clinical Neurophysiology, Academic Hospital, Klinikum Augsburg, Augsburg 86156, Germany
Interests: movement disorders; botulinum toxin; autonomic disorders; neurophysiology; neuroimaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Botulinum toxin has been approved for many disorders, including movement disorders, autonomic disorders (i.e., secretory, bladder), pain, and ophthalmologic uses. Among movement disorders, it has revolutionized the treatment of focal spasticity of upper and lower limbs, focal dystonias, and some other rare conditions. In spasticity and dystonia, the mode of action of botulinum toxin is complex and is not only based on a blockage of acetylcholine release at the neuromuscular junction, leading to muscle weakness. Due to its effect on muscle spindles, it exerts an additional effect on different pathways to the central nervous system, thereby markedly contributing to beneficial clinical effects. There is increasing evidence that treatment outcomes can be optimized using guided injection techniques.

The focus of this Special Issue of Toxins will be on botulinum toxin treatment of movement disorders, in all its aspects: Treatment outcomes in focal spasticity, dystonias, tremors, and other movement disorders; effects of different serotypes; dosing and side effects; antigenicity; evidence-based medicine; guided injection techniques (ultrasound, EMG, stimulation, imaging); sensorimotor aspects of mode of action; and others.

Prof. Dr. Markus Naumann
Guest Editor

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Keywords

  • botulinum toxin
  • spasticity
  • dystonia
  • mode of action
  • guidance
  • outcome
  • clinic therapy

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Published Papers (8 papers)

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Research

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12 pages, 3443 KiB  
Article
An Update on the Cosmetic Use of Botulinum Toxin: The Pattern of Practice among Korean Dermatologists
by Nark-Kyoung Rho, Kwang-Ho Han and Hei-Sung Kim
Toxins 2022, 14(5), 329; https://doi.org/10.3390/toxins14050329 - 4 May 2022
Cited by 7 | Viewed by 5605
Abstract
The efficacy and safety of botulinum toxin injection have made it a popular aesthetic procedure worldwide. A cross-sectional survey was performed in order to determine the pattern of type A botulinum toxin injections in cosmetic practice, for which an 18-item questionnaire was distributed [...] Read more.
The efficacy and safety of botulinum toxin injection have made it a popular aesthetic procedure worldwide. A cross-sectional survey was performed in order to determine the pattern of type A botulinum toxin injections in cosmetic practice, for which an 18-item questionnaire was distributed to dermatologists. A total of 469 Korean board-certified dermatologists participated in the survey, with the following results: the main candidates for type A botulinum toxin injection were individuals in their 40–50 years (46.1%), followed by those in their 20–30 years (33.4%), and people over 60 years of age (20.5%). Overall, the upper face (the glabella, forehead, and crow’s line, in decreasing order) was the most favored area of injection (51%). In contrast, body contouring (i.e., shoulder, calf) and treatment for benign masseter hypertrophy were significantly more popular in the 20–30 years age group than their older counterparts. For wrinkle effacement, the most preferred dilution was 100 units/2.5 mL with isotonic sodium chloride injection (51.2%), and the most often used interval was six months (43.6%). About half (46.3%) of the dermatologists reported the experience of clinical cases which were suspicious of botulinum toxin resistance. Despite this, regarding the choice of the product, type A botulinum toxin products with greater cost-effectiveness were favored over products with a lower risk of antibody formation. Other than its cosmetic usage, botulinum toxin is applied for a variety of skin conditions. Further studies are suggested in order to identify the practice pattern of type A botulinum toxin for therapeutic uses in dermatology, such as hyperhidrosis and rosacea. Full article
(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)
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11 pages, 1516 KiB  
Article
Ultra-Long-Term Therapy of Benign Essential Blepharospasm with Botulinumtoxin A—30 Years of Experience in a Tertiary Care Center
by Bettina Wabbels, Rolf Fimmers and Peter Roggenkämper
Toxins 2022, 14(2), 120; https://doi.org/10.3390/toxins14020120 - 7 Feb 2022
Cited by 4 | Viewed by 2286
Abstract
Aim of this study was to investigate the long-term results of botulinum toxin A (BoNT-A) injections for the treatment of benign essential blepharospasm (BEB) and to report our experience with (ultra-)long-term treatment with onabotulinumtoxin-A. We conducted a retrospective cross-sectional analysis at a university [...] Read more.
Aim of this study was to investigate the long-term results of botulinum toxin A (BoNT-A) injections for the treatment of benign essential blepharospasm (BEB) and to report our experience with (ultra-)long-term treatment with onabotulinumtoxin-A. We conducted a retrospective cross-sectional analysis at a university hospital. Patients with BEB and BoNT-A treatment were assigned to the Total Blepharospasm Group, patients with ≥21 onabotulinumtoxin-A injections to the Ona Long-Term Group. The Total Blepharospasm Group (n = 1940) included 33,933 BoNT-A injections. The age of patients at symptom onset was (mean ± SD) 58.0 ± 13.1 years, and 70.4% were female. The Ona long-term group (n = 234) included 10,632 onabotulinumtoxin-A injections. In this group, patients received 45.4 ± 22.9 injections with a mean dose of 22.2 IU ± 0.5. The duration of treatment was 12.6 ± 5.4 years, ranging from 2.9 to 30.0 years. The effect–duration–dose quotient did not change during long-term treatment. The observed side effects were comparable in type and frequency to other studies, even with the (ultra-)long treatment with onabotulinumtoxin-A. Our results, based on one of the largest patient populations and a treatment duration of up to 30 years, impressively demonstrate that onabotulinumtoxin-A is a safe and effective therapy for essential blepharospasm, even in the ultra-long term. Full article
(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)
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9 pages, 1122 KiB  
Article
Intramuscular Neural Arborization of the Latissimus Dorsi Muscle: Application of Botulinum Neurotoxin Injection in Flap Reconstruction
by Kyu-Ho Yi, Hyung-Jin Lee, Kyle K. Seo and Hee-Jin Kim
Toxins 2022, 14(2), 107; https://doi.org/10.3390/toxins14020107 - 30 Jan 2022
Cited by 17 | Viewed by 3751
Abstract
Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler’s method [...] Read more.
Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler’s method was performed on the latissimus dorsi muscles in 16 specimens. Intramuscular nerve arborization was noted under the landmark of the medial side surgical neck of the humerus to the line crossing the spinous process of T5 and the middle of the iliac crest. The latissimus dorsi muscles were divided into medial, middle, and lateral segments with 10 transverse divisions to give 10 sections (each 10%). Intramuscular nerve arborization of the latissimus dorsi muscle was the largest from the medial and lateral part of the muscle ranging from 40 to 60%, middle part from 30 to 60% and medial, middle and lateral part from 70 to 90%. The nerve entry points were at the medial and lateral part with 20–40% regarding the medial side of surgical neck of the humerus to the line crossing spinous process of T5 to the middle of iliac crest. These outcomes propose that an injection of BoNT into the latissimus dorsi muscles should be administered into specific zones. Full article
(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)
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Review

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22 pages, 2714 KiB  
Review
Botulinum Neurotoxin Therapy in the Clinical Management of Laryngeal Dystonia
by Winnie Yeung, Amanda L. Richards and Daniel Novakovic
Toxins 2022, 14(12), 844; https://doi.org/10.3390/toxins14120844 - 1 Dec 2022
Cited by 1 | Viewed by 5310
Abstract
Laryngeal dystonia (LD), or spasmodic dysphonia (SD), is a chronic, task-specific, focal movement disorder affecting the larynx. It interferes primarily with the essential functions of phonation and speech. LD affects patients’ ability to communicate effectively and significantly diminishes their quality of life. Botulinum [...] Read more.
Laryngeal dystonia (LD), or spasmodic dysphonia (SD), is a chronic, task-specific, focal movement disorder affecting the larynx. It interferes primarily with the essential functions of phonation and speech. LD affects patients’ ability to communicate effectively and significantly diminishes their quality of life. Botulinum neurotoxin was first used as a therapeutic agent in the treatment of LD four decades ago and remains the standard of care for the treatment of LD. This article provides an overview of the clinical application of botulinum neurotoxin in the management of LD, focusing on the classification for this disorder, its pathophysiology, clinical assessment and diagnosis, the role of laryngeal electromyography and a summary of therapeutic injection techniques, including a comprehensive description of various procedural approaches, recommendations for injection sites and dosage considerations. Full article
(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)
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10 pages, 300 KiB  
Review
Voice Tremor and Botulinum Neurotoxin Therapy: A Contemporary Review
by David P. Newland, Daniel Novakovic and Amanda L. Richards
Toxins 2022, 14(11), 773; https://doi.org/10.3390/toxins14110773 - 9 Nov 2022
Cited by 5 | Viewed by 2133
Abstract
Voice tremor is a common, yet debilitating symptom for patients suffering from a number of tremor-associated disorders. The key to targeting effective treatments for voice tremor requires a fundamental understanding of the pathophysiology that underpins the tremor mechanism and accurate identification of the [...] Read more.
Voice tremor is a common, yet debilitating symptom for patients suffering from a number of tremor-associated disorders. The key to targeting effective treatments for voice tremor requires a fundamental understanding of the pathophysiology that underpins the tremor mechanism and accurate identification of the disease in affected patients. An updated review of the literature detailing the current understanding of voice tremor (with or without essential tremor), its accurate diagnosis and targeted treatment options was conducted, with a specific focus on the role of botulinum neurotoxin. Judicious patient selection, following detailed characterisation of voice tremor qualities, is essential to optimising treatment outcomes for botulinum neurotoxin therapy, as well as other targeted therapies. Further focused investigation is required to characterise the response to targeted treatment in voice tremor patients and to guide the development of innovative treatment options. Full article
(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)
10 pages, 859 KiB  
Review
Treatment of Depression with Botulinum Toxin
by Marc Axel Wollmer, Michelle Magid, Tillmann H. C. Kruger and Eric Finzi
Toxins 2022, 14(6), 383; https://doi.org/10.3390/toxins14060383 - 31 May 2022
Cited by 14 | Viewed by 10746
Abstract
Injection of botulinum toxin (BoNT) into the glabellar region of the face is a novel therapeutic approach in the treatment of depression. This treatment method has several advantages, including few side effects and a long-lasting, depot-like effect. Here we review the clinical and [...] Read more.
Injection of botulinum toxin (BoNT) into the glabellar region of the face is a novel therapeutic approach in the treatment of depression. This treatment method has several advantages, including few side effects and a long-lasting, depot-like effect. Here we review the clinical and experimental evidence for the antidepressant effect of BoNT injections as well as the theoretical background and possible mechanisms of action. Moreover, we provide practical instructions for the safe and effective application of BoNT in the treatment of depression. Finally, we describe the current status of the clinical development of BoNT as an antidepressant and give an outlook on its potential future role in the management of mental disorders. Full article
(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)
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8 pages, 1994 KiB  
Review
Anatomical Proposal for Botulinum Neurotoxin Injection for Glabellar Frown Lines
by Kyu-Ho Yi, Ji-Hyun Lee, Hye-Won Hu and Hee-Jin Kim
Toxins 2022, 14(4), 268; https://doi.org/10.3390/toxins14040268 - 10 Apr 2022
Cited by 34 | Viewed by 9525
Abstract
Botulinum neurotoxin injection for treating glabellar frown lines is a commonly used method; however, side effects, such as ptosis and samurai eyebrow, have been reported due to a lack of comprehensive anatomical knowledge. The anatomical factors important for the injection of the botulinum [...] Read more.
Botulinum neurotoxin injection for treating glabellar frown lines is a commonly used method; however, side effects, such as ptosis and samurai eyebrow, have been reported due to a lack of comprehensive anatomical knowledge. The anatomical factors important for the injection of the botulinum neurotoxin into the corrugator supercilii muscle has been reviewed in this study. Current understanding on the localization of the botulinum neurotoxin injection point from newer anatomy examination was evaluated. We observed that for the glabellar-frown-line-related muscles, the injection point could be more accurately demarcated. We propose the injection method and the best possible injection sites for the corrugator supercilii muscle. We propose the optimal injection sites using external anatomical landmarks for the frequently injected muscles of the face to accelerate effective glabellar frown line removal. Moreover, these instructions would support a more accurate procedure without adverse events. Full article
(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)
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17 pages, 303 KiB  
Review
Lantox—The Chinese Botulinum Toxin Drug—Complete English Bibliography and Comprehensive Formalised Literature Review
by Dirk Dressler, Lizhen Pan, Junhui Su, Fei Teng and Lingjing Jin
Toxins 2021, 13(6), 370; https://doi.org/10.3390/toxins13060370 - 22 May 2021
Cited by 10 | Viewed by 4761
Abstract
In 1997, lanbotulinumtoxinA (LAN) was introduced in China. It is now available in Asia, Latin America and Eastern Europe under various brand names including Hengli®, Lantox®, Prosigne®, Lanzox®, Redux®, Liftox®, HBTX-A [...] Read more.
In 1997, lanbotulinumtoxinA (LAN) was introduced in China. It is now available in Asia, Latin America and Eastern Europe under various brand names including Hengli®, Lantox®, Prosigne®, Lanzox®, Redux®, Liftox®, HBTX-A and CBTX-A. The literature on LAN is mostly published in Chinese language, restricting its international accessibility. We, therefore, wanted to generate a complete English bibliography of all LAN publications and then use it for a comprehensive formalised literature review. Altogether, 379 LAN publications (322 in Chinese and 57 in English) were retrieved from PubMed and Science and Technology Paper Citation Database. Indications covered are motor (257), glandular (16), pain (32) and aesthetics (48). Topics are neurological (250), aesthetic (48), paediatric (38), ophthalmological (18), urological (9), methodological (6), gastroenterological (5), ear, nose and throat (4) and surgical (1). Seventy-one publications are randomised controlled trials, forty-one publications are interventional studies and observational studies, fifteen publications are case studies, eighteen publications are reviews, and two publications are guidelines. LAN publications cover all relevant topics of BT therapy throughout a period of more than 20 years. This constitutes a publication basis resembling those of other BT drugs. None of the LAN publications presents data contradictory to those generated with other BT type-A drugs. LAN seems to have a similar efficacy and safety features when compared to onabotulinumtoxinA using a 1:1 LAN– onabotulinumtoxinA conversion ratio. Large controlled multicentre studies will become necessary for LAN’s registrations in Europe and North America. Full article
(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)
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