Articoli di riviste: "Botulinum toxin – Therapeutic use"

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Palazón-García, Ramiro, e Ana María Benavente-Valdepeñas. "Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury". International Journal of Molecular Sciences 22, n. 9 (5 maggio 2021): 4886. http://dx.doi.org/10.3390/ijms22094886.

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Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.

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Zbrojkiewicz, Małgorzata, Agata Lebiedowska e Barbara Błońska-Fajfrowska Barbara Błońska-Fajfrowska. "Botulinum toxin in medicine and cosmetology – two hundred years’ history and new perspectives". Postępy Higieny i Medycyny Doświadczalnej 72 (16 aprile 2018): 278–89. http://dx.doi.org/10.5604/01.3001.0011.7617.

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It has been nearly 200 years since the discovery of the botulinum toxin and the strain responsible for its synthesis Clostridium botulinum. Over this period, the knowledge about botulism and the use of botulinum toxin in medicine has been significantly expanded. Currently, eight serotypes of botulinum toxin (A-H) are known and they differ from each other by molecular weight, antigenic structure, immunogenicity, receptors, localization of coding genes and by the duration of the therapeutic effect. American physician Allan B. Scott was the first to demonstrate the use of botulinum toxin for medical purposes. Nowadays, botulinum toxin type A is widely used in medicine. Botulinum toxin injections are not only one of the most popular non-surgical aesthetic-cosmetic procedures, but are also widely used in neurology, ophthalmology and dermatology. The therapeutic potential of botulinum toxin has not been exhausted yet. Currently, many clinical trials are underway to extend the therapeutic indications of botulinum toxin and to improve its safety. Due to the huge development in medicine, botulinum toxin is today not only associated with aesthetic procedures and improvement in appearance, but also with raising the quality of life for people suffering from diseases with excessive muscle contraction and with other neuromuscular disorders.

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Tugnoli, Valeria, Roberto Eleopra, Cesare Montecucco e Domenico De Grandis. "The therapeutic use of botulinum toxin". Expert Opinion on Investigational Drugs 6, n. 10 (ottobre 1997): 1383–94. http://dx.doi.org/10.1517/13543784.6.10.1383.

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Martina, Emanuela, Federico Diotallevi, Giulia Radi, Anna Campanati e Annamaria Offidani. "Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review". Toxins 13, n. 2 (5 febbraio 2021): 120. http://dx.doi.org/10.3390/toxins13020120.

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Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.

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Intiso, Domenico. "Therapeutic Use of Botulinum Toxin in Neurorehabilitation". Journal of Toxicology 2012 (2012): 1–12. http://dx.doi.org/10.1155/2012/802893.

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The botulinum toxins (BTX), type A and type B by blocking vesicle acetylcholine release at neuro-muscular and neuro-secretory junctions can result efficacious therapeutic agents for the treatment of numerous disorders in patients requiring neuro-rehabilitative intervention. Its use for the reduction of focal spasticity following stroke, brain injury, and cerebral palsy is provided. Although the reduction of spasticity is widely demonstrated with BTX type A injection, its impact on the improvement of dexterity and functional outcome remains controversial. The use of BTX for the rehabilitation of children with obstetrical brachial plexus palsy and in treating sialorrhea which can complicate the course of some severe neurological diseases such as amyotrophic lateral sclerosis and Parkinson's disease is also addressed. Adverse events and neutralizing antibodies formation after repeated BTX injections can occur. Since impaired neurological persons can have complex disabling feature, BTX treatment should be viewed as adjunct measure to other rehabilitative strategies that are based on the individual's residual ability and competence and targeted to achieve the best functional recovery. BTX therapy has high cost and transient effect, but its benefits outweigh these disadvantages. Future studies must clarify if this agent alone or adjunctive to other rehabilitative procedures works best on functional outcome.

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TaniosMarrelli, LorenaCury, Daniele MazzucaDominelli, IdibertoJosé ZotarelliFilho, LeandroMoreira Tempest e PatríciaGarani Fernandes. "THERAPEUTIC USE OF BOTULINUM TOXIN IN DENTISTRY". International Journal of Advanced Research 6, n. 10 (30 settembre 2018): 1219–22. http://dx.doi.org/10.21474/ijar01/7926.

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Ghasemi, Majid, Rasul Norouzi, Mehri Salari e Bahador Asadi. "Iatrogenic Botulism After the Therapeutic Use of Botulinum Toxin-A". Clinical Neuropharmacology 35, n. 5 (2012): 254–57. http://dx.doi.org/10.1097/wnf.0b013e31826248b8.

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Erbguth, Frank J. "Historical notes on botulism,Clostridium botulinum, botulinum toxin, and the idea of the therapeutic use of the toxin". Movement Disorders 19, S8 (2004): S2—S6. http://dx.doi.org/10.1002/mds.20003.

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Eleopra, R., O. Rossetto e C. Montecucco. "Non-A/non-B botulinum toxin for therapeutic use". Toxicon 68 (giugno 2013): 73. http://dx.doi.org/10.1016/j.toxicon.2012.07.051.

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Corsalini, Massimo, Francesco Inchingolo, Gianna Dipalma, Angelika Elzbieta Wegierska, Ioannis Alexandros Charitos, Maria Assunta Potenza, Antonio Scarano et al. "Botulinum Neurotoxins (BoNTs) and Their Biological, Pharmacological, and Toxicological Issues: A Scoping Review". Applied Sciences 11, n. 19 (23 settembre 2021): 8849. http://dx.doi.org/10.3390/app11198849.

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Botulinum toxins or neurotoxins (BoNTs) are the most potent neurotoxins known, and are currently extensively studied, not only for their potential lethality, but also for their possible therapeutic and cosmetic uses. Currently, seven types of antigenically distinct toxins are known and characterized, produced by a rod-shaped bacterium, Clostridium botulinum. Human poisoning by botulism (presenting with severe neuromuscular paralytic disease) is usually caused by toxins A, B, E, and F type. Poisoning from contaminated food preparations is the most common cause of noniatrogenic botulism. The spores are highly resistant to heat but are easily destroyed at 80 °C for thirty minutes. Type A and B toxins are resistant to digestion by the enzymes of the gastrointestinal system. After their entry, BoNTs irreversibly bind to cholinergic nerve endings and block the release of acetylcholine from the synapses. In contrast, in wound botulism, the neurotoxin is instead product by the growth of C. botulium in infected tissues. The contamination by BoNT inhalation does not occur by a natural route but it is certainly the most dangerous. It can be caused by the dispersion of the botulinum toxin in the atmosphere in the form of an aerosol and therefore can be deliberately used for bioterrorist purposes (e.g., during CBRN (chemical, biological, radiological, and nuclear) unconventional events). In addition, BoNTs are currently used to treat a variety of diseases or alleviate their symptoms, such as the onabotulinumtoxinA for migraine attacks and for cosmetic use. Indeed, this paper aims to report on updated knowledge of BoNTs, both their toxicological mechanisms and their pharmacological action.

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Sohrabi, Catrin, e Ioannis Goutos. "The use of botulinum toxin in keloid scar management: a literature review". Scars, Burns & Healing 6 (gennaio 2020): 205951312092662. http://dx.doi.org/10.1177/2059513120926628.

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Introduction: Administration of botulinum toxin is an increasingly popular procedure in the medical and aesthetic field. There is emerging evidence that it can influence fibroblast activity and minimise tension around the scar by virtue of muscular chemoimmobilisation. This review aims to explore the current evidence base behind the treatment of keloid scars with botulinum toxin. [Formula: see text] Methods: A detailed literature review was conducted using PubMed Medline, Embase and Web of Science databases. Manuscripts were appraised and classified in accordance with the Joanna Briggs Institute Levels of Evidence by an independent consultant in evidence synthesis. The results of this search are presented in descending order of evidence for botulinum toxin as a primary management agent as well as a secondary adjunct following extralesional keloid excision. Discussion: On the basis of level 1 evidence, botulinum toxin appears to be equivalent to triamcinolone in producing a short-term reduction in keloidal volume, height and vascularity. A number of level 1 and 2 studies also suggest that botulinum toxin may be particularly helpful in alleviating symptoms of keloid associated pain and itch. There are currently limited studies appraising the value of botulinum toxin in the postoperative management of keloid scars. Conclusion: Botulinum toxin may represent a promising agent in the management of keloid scars. However, further research involving large-scale studies with comparative designs and long-term follow-up is warranted to delineate the value of this therapeutic modality in scar management protocols.

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Bayet, Kinz, Luc Chikhani e Anne-Laure Ejeil. "Therapeutic uses and efficacy of botulinum toxin in orofacial medicine". Journal of Oral Medicine and Oral Surgery 24, n. 1 (gennaio 2018): 11–21. http://dx.doi.org/10.1051/mbcb/2017030.

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Introduction: Botulinum toxin, primarily known for its use in cosmetic surgery, is also used for therapeutic purposes in many medical fields. It works as a muscle relaxant and inhibits glandular secretions. In the orofacial sphere, the use of this toxin is proposed in particular for disabling myofascial pain and aberrant salivary disorders. Methodology: A critical analysis of the literature, based on PUBMED data, concerning the orofacial indications of botulinum toxin was carried out. Results: The literature is abundant regarding the therapeutic interest of this toxin for several oral pathologies, but scientific merits vary markedly from one indication to another. Discussion: The musculorelaxant and antisecretory action of this toxin appears to be demonstrated in the case of bruxism, limitation of the mouth opening and in hypersialorrhea. On the other hand, its medical benefit is still not supported by scientific evidence for masseter hypertrophy, tonicity of the levator labii superioris muscles, sialocele fistulae and Frey's syndrome. Conclusion: Additional high-level studies, unbiased, randomized controlled trials, are required to eliminate the uncertainties that persist about the clinical impact of botulinum toxin and to justify the development of recommendations for good practice valid and credible.

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Akhmadeeva, L. R., e Kh P. Derevyanko. "«Off-label» use of botulinic toxin type A preparations in neurological practice". Bulletin of the Russian Military Medical Academy 20, n. 2 (15 dicembre 2018): 195–201. http://dx.doi.org/10.17816/brmma12327.

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The modern view on the application of botulinum toxin type A for the off-label use in neurology and foreign experience analysis are presented. The «off-label» category referred to any prescription of a medication in case of using it for unregistered indications, with product instruction violation or in the presence of contraindications including age restrictions. The sources of information about medicines were the leaflets of manufacturers of medicines and the State Register of Medicines. It is well known that Botulinum toxin type A is a good therapeutic option for treating children with cerebral palsy. Increased efficacy of regularly repeated cycles with Onabotulinumtoxin A in medication-overuse headache patients beyond the first year of treatment. Botulinum toxin type A is effective in the management of sialorrhea. Botulinum toxin type A is a safe and effective treatment for primary axillary hyperhidrosis and produces high levels of patient satisfaction. Facing depression with botulinum toxin: positive effects on mood have been observed in subjects who underwent treatment of glabellar frown lines with botulinum toxin and, in an open case series, depression remitted or improved after such a treatment. Botox injection significantly improved foot dystonia, pain and lower limb functional outcomes in patients with Parkinson’s disease with deep brain stimulation. The paper describes the problems associated with the lack of clinical data about the possibility of using botulinum toxin type A in different conditions, emphasizes the need to organize clinical trials and educational programs for neurologists as well as more active implementation of protocols for the treatment of patients.

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Aminianfar, Mohammad, Siavash Parvardeh e Mohsen Soleimani. "In vitro and in vivo Assessment of Silver Nanoparticles Against Clostridium botulinum Type A Botulinum". Current Drug Discovery Technologies 16, n. 1 (10 aprile 2019): 113–19. http://dx.doi.org/10.2174/1570163815666180403163946.

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Background: Clostridium botulinum causes botulism, a serious paralytic illness that results from the ingestion of a botulinum toxin. Because silver nanoparticle products exhibit strong antimicrobial activity, applications for silver nanoparticles in healthcare have expanded. Therefore, the objective of the current study was to assess a therapeutic strategy for the treatment of botulism toxicity using silver nanoparticles. Methods: A preliminary test was conducted using doses that produce illness in laboratory animals to determine the absolute lethal dose (LD100) of botulinum toxin type A (BoNT/A) in mice. Next, the test animals were divided into six groups containing six mice each. Groups I, II and III were the negative control (botulinum toxin only), positive control-1 (nano-silver only) and positive control-2 (no treatment), respectively. The remaining groups were allocated to the toxin that was supplemented with three nano-silver treatments. Results: The mortality rates of mice caused by BoNT/A significantly reduced in the treatment groups with different doses and injection intervals of nano-silver when compared to the negative control group. BoNT/A toxicity induced by intraperitoneal injection of the toxin of Clostridium botulinum causes rapid death while when coupled with nano-osilver results in delayed death in mice. Conclusion: These results, while open to future improvement, represent a preliminary step towards the satisfactory control of BoNT/A with the use of silver nanoparticles for human protection against this bioterrorism threat. Further study in this area can elucidate the underlying mechanism for detoxifying BoNT/A by silver nanoparticles.

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Smith, A. "Pearls and Pitfalls in the Therapeutic Use of Botulinum Toxin". Seminars in Neurology 24, n. 02 (15 luglio 2004): 165–74. http://dx.doi.org/10.1055/s-2004-830902.

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Ramachandran, Roshni, e Tony L. Yaksh. "Therapeutic use of botulinum toxin in migraine: mechanisms of action". British Journal of Pharmacology 171, n. 18 (28 agosto 2014): 4177–92. http://dx.doi.org/10.1111/bph.12763.

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Piot, Numa, F. Gisou van der Goot e Oksana A. Sergeeva. "Harnessing the Membrane Translocation Properties of AB Toxins for Therapeutic Applications". Toxins 13, n. 1 (6 gennaio 2021): 36. http://dx.doi.org/10.3390/toxins13010036.

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Over the last few decades, proteins and peptides have become increasingly more common as FDA-approved drugs, despite their inefficient delivery due to their inability to cross the plasma membrane. In this context, bacterial two-component systems, termed AB toxins, use various protein-based membrane translocation mechanisms to deliver toxins into cells, and these mechanisms could provide new insights into the development of bio-based drug delivery systems. These toxins have great potential as therapies both because of their intrinsic properties as well as the modular characteristics of both subunits, which make them highly amenable to conjugation with various drug classes. This review focuses on the therapeutical approaches involving the internalization mechanisms of three representative AB toxins: botulinum toxin type A, anthrax toxin, and cholera toxin. We showcase several specific examples of the use of these toxins to develop new therapeutic strategies for numerous diseases and explain what makes these toxins promising tools in the development of drugs and drug delivery systems.

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Wei, Pengxu. "Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction". Toxins 14, n. 5 (30 aprile 2022): 321. http://dx.doi.org/10.3390/toxins14050321.

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Dysphagia associated with upper esophageal sphincter (UES) dysfunction remarkably affects the quality of life of patients. UES injection of botulinum toxin is an effective treatment for dysphagia. In comparison with skeletal muscles of the limb and trunk, the UES is a special therapeutic target of botulinum toxin injection, owing to its several anatomical, physiological, and pathophysiological features. This review focuses on (1) the anatomy and function of the UES and the pathophysiology of UES dysfunction in dysphagia and why the entire UES rather than the cricopharyngeal muscle before/during botulinum toxin injection should be examined and targeted; (2) the therapeutic mechanisms of botulinum toxin for UES dysfunction, including the choice of injection sites, dose, and volume; (3) the strengths and weaknesses of guiding techniques, including electromyography, ultrasound, computed tomography, and balloon catheter dilation for botulinum toxin injection of the UES.

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Rho, Nark-Kyoung, Kwang-Ho Han e Hei-Sung Kim. "An Update on the Cosmetic Use of Botulinum Toxin: The Pattern of Practice among Korean Dermatologists". Toxins 14, n. 5 (4 maggio 2022): 329. http://dx.doi.org/10.3390/toxins14050329.

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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.

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Szwed, Jakub, Monika Szwed, Weronika Szwed e Nadia Miga. "The use of botulinum toxin (BoNT) in urology - review". Journal of Education, Health and Sport 12, n. 8 (24 agosto 2022): 1026–36. http://dx.doi.org/10.12775/jehs.2022.12.08.087.

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Introduction and purpose Botulinum neurotoxin (BoNT) prevents the release of acetylcholine into the synaptic cleft of the neuromuscular junction, which causes flaccid muscle paralysis. A non-obvious specialization that uses botulinum toxin is urology. The aim of this article is to present a literature review regarding the use of botulinum toxin in the treatment of urological diseases. Description of the state of knowledge In the overactive bladder syndrome, with resistance to oral medications, an alternative is botox injections into the bladder wall, which reduce the intensity of urgency and pollakiuria. Treatment of BPH with botulinum toxin injection may be an alternative to surgical and pharmacological treatment. Intra-articular botox injection causes smooth muscle relaxation and gland atrophy through prostate tissue apoptosis. Clinical studies show promising therapeutic effects of using Botox injections in the treatment of intramural cystitis. It reduces the feeling of bladder pain and the worsening of other symptoms. Panunzio et al. Presented a meta-analysis of prospective studies that showed a statistically significant improvement in pain perception after injection of botulinum toxin into the pelvic structures, compared with baseline values for CPPS, in all cohorts evaluated. Summary Urology uses the entire spectrum of botox possibilities, from myocrelation in the bladder hyperresponsiveness syndrome, through neuromodulation and apoptosis induction in benign prostatic hyperplasia, ending with anti-inflammatory and analgesic properties in bladder pain syndrome and chronic pelvic pain syndrome.

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Verginelli, Flavia, Silvia Dari e Silvia Aquilani. "[A case of foodborne botulism in the province of Viterbo]". Clinical Management Issues 10, n. 2 (30 giugno 2016): 27–31. http://dx.doi.org/10.7175/cmi.v10i2.1248.

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A 57 years-old woman with gastrointestinal pain, dysphagia, diplopia, dry mouth, was diagnosed with foodborne botulism caused by Clostridium Botulinum toxin. In this case, a jar of vegetables preserved in oil was identified as the source of the intoxication. Canned peppers were produced at home by the patient according to traditional techniques, deemed appropriate as established use. Despite this, the procedure proved to be a health hazard.The present article follows the diagnostic therapeutic pathway of the patient, highlighting the critical points not only related to the clinic but also to the ministerial procedures for reporting a case of botulism. This case provides an opportunity to emphasize the need for greater awareness about how to prevent and correctly manage the cases of botulism, both by the general population and by physicians who faced a patient with suspected poisoning by Botulinum toxin.[Article in Italian]

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Dalgatova, P. O., M. V. Starkova, M. Yu Vlasova, A. D. Zikiryakhodzhaev, G. S. Alekseeva, I. V. Reshetov, F. N. Usov e K. V. Maksimov. "Use of botulinum toxin type A in reconstructive surgery in patients with breast cancer (literature review)". Medical alphabet, n. 29 (21 novembre 2020): 38–42. http://dx.doi.org/10.33667/2078-5631-2020-29-38-42.

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According to the analyzed literature, the use of botulinum toxin type A is promising as an auxiliary method for simultaneous or delayed breast reconstruction using a subpectoral silicone implant or tissue expander. This method is safe and simple. Relaxation of the large pectoral muscle both intraoperatively and in the postoperative period reduces the intensity of pain, accelerates the rehabilitation of patients. Botulinum toxin therapy prevents the animation and deformation of the reconstructed breast. The effect after injection of botulinum toxin persists for 6-8 months and for a long time there is no need for analgesic therapy. According to the literature, this technique for reconstructive plastic surgery in patients with breast cancer significantly improves the quality of life of patients by reducing pain, preventing deformation and contraction of the large pectoral muscle. Conclusion. The literature analysis evaluates the effectiveness of botulinum toxin preparations for pain after reconstructive plastic surgery on the breast using a subpectoral space. The possibilities of therapeutic use of botulinum toxin preparations as an analgesic are known, but are little used in practice. This direction is promising. Given the small number of literary publications on this subject, it is necessary to conduct further research in this direction.

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Kaynar, A., Y. Parman, A. Poyanl, O. Demirkol, S. H. Birinci, O. Minareci, Y. Alkaner e A. Boyaciyan. "Therapeutic use of botulinum toxin in the treatment of masseter hypertrophy". International Journal of Oral and Maxillofacial Surgery 26 (gennaio 1997): 116. http://dx.doi.org/10.1016/s0901-5027(97)81187-3.

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Gadhia, Kushal, e Damien Walmsley. "The therapeutic use of botulinum toxin in cervical and maxillofacial conditions". Evidence-Based Dentistry 10, n. 2 (giugno 2009): 53. http://dx.doi.org/10.1038/sj.ebd.6400654.

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Berardelli, A., G. Abbruzzese, L. Bertolasi, G. Cantarella, F. Carella, A. Currà, D. De Grandis et al. "Guidelines for the therapeutic use of botulinum toxin in movement disorders". Italian Journal of Neurological Sciences 18, n. 5 (ottobre 1997): 261–69. http://dx.doi.org/10.1007/bf02083302.

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Pagni, C. A., G. Abbruzzese e A. Berardelli. "Guidelines for the therapeutic use of botulinum toxin in movement disorders". Italian Journal of Neurological Sciences 19, n. 3 (giugno 1998): 189–90. http://dx.doi.org/10.1007/bf00831571.

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Anandan, Charenya, e Joseph Jankovic. "Botulinum Toxin in Movement Disorders: An Update". Toxins 13, n. 1 (8 gennaio 2021): 42. http://dx.doi.org/10.3390/toxins13010042.

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Abstract (sommario):

Since its initial approval in 1989 by the US Food and Drug Administration for the treatment of blepharospasm and other facial spasms, botulinum toxin (BoNT) has evolved into a therapeutic modality for a variety of neurological and non-neurological disorders. With respect to neurologic movement disorders, BoNT has been reported to be effective for the treatment of dystonia, bruxism, tremors, tics, myoclonus, restless legs syndrome, tardive dyskinesia, and a variety of symptoms associated with Parkinson’s disease. More recently, research with BoNT has expanded beyond its use as a powerful muscle relaxant and a peripherally active drug to its potential central nervous system applications in the treatment of neurodegenerative disorders. Although BoNT is the most potent biologic toxin, when it is administered by knowledgeable and experienced clinicians, it is one of the safest therapeutic agents in clinical use. The primary aim of this article is to provide an update on recent advances in BoNT research with a focus on novel applications in the treatment of movement disorders. This comprehensive review of the literature provides a critical review of evidence-based clinical trials and highlights recent innovative pilot studies.

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Anandan, Charenya, e Joseph Jankovic. "Botulinum Toxin in Movement Disorders: An Update". Toxins 13, n. 1 (8 gennaio 2021): 42. http://dx.doi.org/10.3390/toxins13010042.

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Abstract (sommario):

Since its initial approval in 1989 by the US Food and Drug Administration for the treatment of blepharospasm and other facial spasms, botulinum toxin (BoNT) has evolved into a therapeutic modality for a variety of neurological and non-neurological disorders. With respect to neurologic movement disorders, BoNT has been reported to be effective for the treatment of dystonia, bruxism, tremors, tics, myoclonus, restless legs syndrome, tardive dyskinesia, and a variety of symptoms associated with Parkinson’s disease. More recently, research with BoNT has expanded beyond its use as a powerful muscle relaxant and a peripherally active drug to its potential central nervous system applications in the treatment of neurodegenerative disorders. Although BoNT is the most potent biologic toxin, when it is administered by knowledgeable and experienced clinicians, it is one of the safest therapeutic agents in clinical use. The primary aim of this article is to provide an update on recent advances in BoNT research with a focus on novel applications in the treatment of movement disorders. This comprehensive review of the literature provides a critical review of evidence-based clinical trials and highlights recent innovative pilot studies.

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Bellows, Steven, e Joseph Jankovic. "Immunogenicity Associated with Botulinum Toxin Treatment". Toxins 11, n. 9 (26 agosto 2019): 491. http://dx.doi.org/10.3390/toxins11090491.

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Botulinum toxin (BoNT) has been used for the treatment of a variety of neurologic, medical and cosmetic conditions. Two serotypes, type A (BoNT-A) and type B (BoNT-B), are currently in clinical use. While considered safe and effective, their use has been rarely complicated by the development of antibodies that reduce or negate their therapeutic effect. The presence of antibodies has been attributed to shorter dosing intervals (and booster injections), higher doses per injection cycle, and higher amounts of antigenic protein. Other factors contributing to the immunogenicity of BoNT include properties of each serotype, such as formulation, manufacturing, and storage of the toxin. Some newer formulations with purified core neurotoxin devoid of accessory proteins may have lower overall immunogenicity. Several assays are available for the detection of antibodies, including both structural assays such as ELISA and mouse-based bioassays, but there is no consistent correlation between these antibodies and clinical response. Prevention and treatment of antibody-associated non-responsiveness is challenging and primarily involves the use of less immunogenic formulations of BoNT, waiting for the spontaneous disappearance of the neutralizing antibody, and switching to an immunologically alternate type of BoNT.

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Serrera-Figallo, Maria-Angeles, Gonzalo Ruiz-de-León-Hernández, Daniel Torres-Lagares, Alejandra Castro-Araya, Omar Torres-Ferrerosa, Esther Hernández-Pacheco e Jose-Luis Gutierrez-Perez. "Use of Botulinum Toxin in Orofacial Clinical Practice". Toxins 12, n. 2 (11 febbraio 2020): 112. http://dx.doi.org/10.3390/toxins12020112.

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Introduction: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine’s release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT’s efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more. Aim: This study’s aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT’s efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies. Materials and methods: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia. Results: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles). Discussion: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.

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HUAMANI, Mary Akemy Uehara, Luciano Artioli MOREIRA, Ney Soares de ARAÚJO, Marcelo Henrique NAPIMOGA, José Luiz Cintra JUNQUEIRA e Milton Edson MIRANDA. "Use of botulinum toxin type a in temporomandibular disorder". RGO - Revista Gaúcha de Odontologia 65, n. 2 (giugno 2017): 151–55. http://dx.doi.org/10.1590/1981-863720170002000093144.

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ABSTRACT Temporomandibular disorder (TMD) may be defined as a set of clinical scenarios involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures. Currently, 40 to 75% of the population has some sign of temporomandibular disorder, mainly pain located in the muscles of mastication in the pre-auricular region. The present clinical case was diagnosed as muscle temporomandibular disorder secondary to parafunction, as well as muscle hyperactivity due to surgical displacement of the left temporal muscle on two occasions, one for placement of aneurysm clips and the other for tumor excision from the supraorbital region on the left side. The patient sought medical and dental attention for 10 years due to constant headaches, tiredness and pain in the cheeks. The patient tried numerous bite-guards and pharmacological therapies to no avail. The American Academy of Orofacial Pain Questionnaire was applied combined with the Criteria for Research and Diagnostics (DRC) and a decision was made to use botulinum toxin type A in the masseter and temporalis muscles. An analog pain scale was applied over 90 days. Three days following the application of botulinum toxin type A, the patient reported a significant improvement with complete resolution of pain (level 0) after 90 days. At 12 weeks from starting treatment, facial muscle physiotherapy was introduced to strengthen the muscles of mastication and the patient remained pain-free, which allowed the preparation and adaptation of a snap-on prosthetic appliance. In conclusion, the use of botulinum toxin in patients with temporomandibular disorder should be considered as a viable therapeutic option.

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Tomeva, Natali, Elitsa Deliverska e Peter Ignatov. "The therapeutic use of botulinum toxin in different oral and maxillofacial conditions". Journal of Medical and Dental Practice 9, n. 2 (11 settembre 2022): 1491–97. http://dx.doi.org/10.18044/medinform.202292.1491.

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Erbguth, F. J. "Historical note on the therapeutic use of botulinum toxin in neurological disorders." Journal of Neurology, Neurosurgery & Psychiatry 60, n. 2 (1 febbraio 1996): 151. http://dx.doi.org/10.1136/jnnp.60.2.151.

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Becker, Werner J. "Botulinum Toxin in the Treatment of Headache". Toxins 12, n. 12 (17 dicembre 2020): 803. http://dx.doi.org/10.3390/toxins12120803.

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Botulinum toxin type A has been used in the treatment of chronic migraine for over a decade and has become established as a well-tolerated option for the preventive therapy of chronic migraine. Ongoing research is gradually shedding light on its mechanism of action in migraine prevention. Given that its mechanism of action is quite different from that of the new monoclonal antibodies directed against calcitonin gene-related peptide (CGRP) or its receptor, it is unlikely to be displaced to any major extent by them. Both will likely remain as important tools for patients with chronic migraine and the clinicians assisting them. New types of botulinum toxin selective for sensory pain neurons may well be discovered or produced by recombinant DNA techniques in the coming decade, and this may greatly enhance its therapeutic usefulness. This review summarizes the evolution of botulinum toxin use in headache management over the past several decades and its role in the preventive treatment of chronic migraine and other headache disorders.

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Mielniczek, Katarzyna. "Botulinum toxin in the treatment of neuralgia and neuropathic pain". Journal of Education, Health and Sport 11, n. 9 (19 settembre 2021): 310–14. http://dx.doi.org/10.12775/jehs.2021.11.09.038.

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Introduction: Botulinum toxin is one of the most powerful neurotoxins currently known, with high affinity to the cholinergic synapse, which sufficiently inhibits the release of acetylcholine. Its use has proved to be effective in the treatment of many diseases of the musculoskeletal system. Although most of the therapeutic effects of botulinum toxin are due to the temporary relaxation of skeletal muscles (caused by inhibition of acetylcholine release), research is ongoing into its effects on the nervous system. Purpose of the work: The aim of the study is to analyze the effectiveness of botulinum toxin in the treatment of neuralgia and neuropathic pain. Method: The relevant samples were accessed by means of an electronic search in the PubMed database. The analysis used reviews and meta-analyzes posted on the platform over the last 10 years. Conclusions: Botulinum toxin has great potential in the treatment of pain. It is multitasking due to its favorable safety profile and long-lasting relief from a single injection compared to other pain medications. The side effects caused by it were assessed to be mild to moderate and included a local skin reaction (swelling), injection site pain, muscle weakness, flu symptoms, nausea and vomiting. Keywords: botulinum toxin; neuropathic pain; pain treatment; neuralgia; BoNT / A

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Popescu, Marius Nicolae, Cristina Beiu, Mădălina Gabriela Iliescu, Mara Mădălina Mihai, Liliana Gabriela Popa, Ana Maria Alexandra Stănescu e Mihai Berteanu. "Botulinum Toxin Use for Modulating Neuroimmune Cutaneous Activity in Psoriasis". Medicina 58, n. 6 (16 giugno 2022): 813. http://dx.doi.org/10.3390/medicina58060813.

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Psoriasis is a complex immune-mediated inflammatory disorder that generates enormous interest within the scientific communities worldwide, with new therapeutic targets being constantly identified and tested. Despite the numerous topical and systemic medications available for the treatment of psoriasis, alternative therapies are still needed for the optimal management of some patients who present with localized, resistant lesions. Novel insights into the contribution of cutaneous neurogenic inflammation in the pathogenesis of psoriasis have yielded exciting new potential roles of nerve-targeting treatments, namely botulinum toxin type A (BoNT-A), for the management of this disease. This paper aims to review the existing literature on knowledge regarding the potential role of BoNT-A in psoriasis treatment, with a focus on its ability to interfere with the immunopathogenetic aspects of psoriatic disease. Furthermore, in our paper, we are also including the first report of psoriatic lesions remission following local BoNT-A injections that were administered for treating upper limb spasticity, in a patient that concomitantly suffered from psoriasis and post-stroke spasticity.

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Mattout, HalaK, Ahmed Tawfik, Omar Alshabrawy e MohamedA Almarakby. "Evaluation of the therapeutic use of botulinum toxin A in the periorbital region". Journal of the Egyptian Ophthalmological Society 108, n. 3 (2015): 110. http://dx.doi.org/10.4103/2090-0686.168680.

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Timmermans, Grégory, Frédérique Depierreux, François Wang, Isabelle Hansen e Pierre Maquet. "Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review". Case Reports in Neurology 11, n. 2 (16 agosto 2019): 244–51. http://dx.doi.org/10.1159/000502350.

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Cosmetic or therapeutic use of botulinum toxin type A (BoNT-A) is usually safe but can rarely cause iatrogenic botulism. Iatrogenic botulism and myasthenia gravis (MG) share similar clinical features, because both BoNT-A and anti-acetylcholine receptorantibodies impair neuromuscular transmission. We report a patient who underwent cosmetic BoNT-A injection and later developed serious local and systemic adverse reactions. The peculiarity of this case is that a latent seropositive MG was eventually discovered, suggesting that both iatrogenic botulism and MG contributed to the clinical picture. This patient is one of the less than 10 reported cases worldwide in whom MG was unmasked by BoNT-A injection. He is the first to be assessed in detail by single-fiber electromyography. This case emphasizes the risk associated with BoNT-A injection in patients with subclinical impairment of neuromuscular transmission and prompts the search for MG in case of exaggerated response.

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Setler, Paulette E. "Therapeutic Use of Botulinum Toxins: Background and History". Clinical Journal of Pain 18, Supplement (novembre 2002): S119—S124. http://dx.doi.org/10.1097/00002508-200211001-00002.

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Honeybrook, Adam, Walter Lee, Julie Woodward e Charles Woodard. "Botulinum Toxin-A and Scar Reduction: A Review". American Journal of Cosmetic Surgery 35, n. 4 (1 giugno 2018): 165–76. http://dx.doi.org/10.1177/0748806818776156.

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Pathologic scars remain a therapeutic enigma. Several therapeutic modalities have been described for the prevention and treatment of hypertrophic and keloid scars, but the optimal management approach has not yet been defined. This article reviews the newly emerging, off-label treatment, botulinum toxin-A (BTXA) for scar reduction. Eight in vitro, 9 in vivo animal, and 23 human clinical studies were deemed relevant to this review. Studies were conducted between 2000 and 2018. Clinical studies were of various methodologic qualities and comprised of 8 blinded randomized control trials, 7 cohort studies, and 7 case series/reports. Across all 23 human clinical studies, 521 patients were recruited, 20 studies were in favor of BTXA to reduce scars, 2 studies had equivocal results, and 1 study showed no benefit. The efficacy of BTXA to reduce scars appears promising and the clinical literature currently favors its use over placebo controls as a safe scar reduction alternative. The efficacy of this modality in comparison with other more widely accepted scar reduction methods is less clear. Further understanding of the molecular mechanism of action of BTXA upon scars and treatment modality cost-effectiveness comparisons remain to be explored. Large-scale randomized control trials of high methodologic quality, using objective measurement scales, must be produced to truly determine the efficacy of this innovative treatment.

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Sager, Cristian, Carol Burek, Victor Durán, Juan Pablo Corbetta, Santiago Weller, Bortagaray Juan e Juan Carlos López. "Pharmacotherapy in Pediatric Neurogenic Bladder Intravesical Botulinum Toxin Type A". ISRN Urology 2012 (7 giugno 2012): 1–6. http://dx.doi.org/10.5402/2012/763159.

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When the neurogenic bladder is refractory to anticholinergics, botulinum toxin type A is used as an alternative. The neurotoxin type A reduces bladder pressure and increases its capacity and wall compliance. Additionally, it contributes to improving urinary continence and quality of life. This novel therapy is ambulatory with a low incidence of adverse effects. Due to its transitory effect, it is necessary to repeat the injections in order to sustain its therapeutic effect. In these review article we talk about Mechanism of Action, Indications, effects, administration and presentations of the Botulinum Neurotoxin Type A in pediatric patients. Also, we make references to controversial issues surrounding its use. A bibliographic search was done selecting articles and revisions from Pubmed. The key words used were botulinum toxin A, neurogenic bladder, and children. The search was limited to patients younger than 18 years of age and reports written in English in the past ten years.

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Watson, Natalie Anne, Benjamin John Miller, Zohaib Siddiqui, Yakubu Karagama e Nicholas Gibbins. "The Therapeutic Use of Botulinum Toxin Injections for Conditions Affecting the Head and Neck". Current Otorhinolaryngology Reports 8, n. 4 (18 agosto 2020): 351–57. http://dx.doi.org/10.1007/s40136-020-00305-7.

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Chung, Tae Mo, Adriana Moro, Ana Paula Coutinho Fonseca, Arquimedes de Moura Ramos, Cristiane Lima Carqueja, Denise Rodriques Xerez, Eduardo Freire de Oliveira et al. "Dispensing profile of botulinum toxin for treating spasticity: Brazilian national data". Acta Fisiátrica 23, n. 1 (7 marzo 2016): 1–6. http://dx.doi.org/10.11606/issn.2317-0190.v23i1a137599.

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The physiatrists specialized in treating spasticity were brought together for a panel discussion about the use of botulinum toxin (BT) in the public system in different states of Brazil. The data analyzed during the discussion of Datasus demonstrate a low-demand profile of the product dispensed by the Unified Health System (SUS), with heterogeneity in the distribution of TB in the Brazilian states. This scenario seems to be set up mainly for lack of a properly planned public policy, such as lack of unification and standardization of distribution centers, the lack or inadequacy of TB compensation proceeding to treatment centers, in a standardized manner by SUS and shortage of trained doctors to do it together with the lack of qualified multidisciplinary rehabilitation centers. The use of botulinum toxin for therapeutic purposes in Brazil began in the 90s, to treat dystonia and spasticity. It is currently employed in different clinical conditions; however, despite growing demand and indications over the years, there are few reports or publications on its use and benefit to patients served by the Unified Health System (SUS). To address this issue, in May 2015, in São Paulo, physiatrists from different states of Brazil met and discussed the relevance of botulinum toxin in treating spasticity.

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Piętka, Aleksandra, Julia Stochel, Martyna Galicka, Ewa A. Dudek, Natalia Szpalerska, Iwona Walecka e Jakub S. Gąsior. "Evaluation of the efficacy of constraint-induced movement therapy combined with botulinum toxin injection in patients with cerebral palsy – a scoping review". Aktualności Neurologiczne 21, n. 3 (20 dicembre 2021): 155–62. http://dx.doi.org/10.15557/an.2021.0020.

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Introduction: Both constraint-induced movement therapy and botulinum toxin injection are well-researched and described therapeutic interventions in the group of patients with cerebral palsy. One of the main symptoms of damage to the central nervous system is excessive muscle tension, which may limit, among many other things, the manipulative and grasping skills of the upper limb. The most appropriate approach in patients with hemiplegia seems to be one that is aimed at enabling and then facilitating the use of the less functional limb. The aim of this study is to evaluate the efficacy of constraint-induced movement therapy combined with botulinum toxin injection in paediatric patients with cerebral palsy. Methods: In order to determine the efficacy of botulinum toxin injection combined with constraint-induced movement therapy, the PubMed medical database was searched using the following keywords: “botulinum toxin” and “constraint-induced movement therapy.” The inclusion criteria were the following: only papers in English and relating to paediatric patients. The literature review was based on the PRISMA Statement guidelines. Results: As a result of the database search, a total of 32 articles were found, of which four met the inclusion criteria. The protocols of all studies varied both in terms of the daily dose of training and the duration of therapy. Discussion: The combination of constraint-induced movement therapy with botulinum toxin injection allows for more frequent and effective use of the directly affected hand in children with cerebral palsy. A longer-lasting constraint-induced movement therapy with a lower intensity brings better results than a shorter-lasting therapy with a higher intensity. A significant improvement was observed for the grip assessment (functional assessment and Quality of Upper Extremity Skills Test – QUEST scale) and in the Goal Attainment Scaling – GAS results.

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Przybylska, Patrycja, Alicja Morawska, Martyna Ortarzewska e Margarita Parvanov. "The use of botulinum toxin injection into the mentalis muscle in aesthetic medicine procedures". Journal of Face Aesthetics 4, n. 1 (30 giugno 2021): 58–64. http://dx.doi.org/10.20883/jofa.44.

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Botulinum toxin, produced by the bacteria Clostridium botulinum, paralyzes muscle contraction by inhibiting the conduction of nerve impulses. Injections of the preparation are widely used as a non-surgical method of improving the face appearance. The mentalis muscles and the surrounding soft tissue are considered key structures in lower facial rejuvenation treatments.The ability to precisely locate the muscle is a challenge for every doctor who performs treatments with the use of neurotoxin and determines therapeutic success. The muscle extends 5–10 mm from the midline and 20–30 mm from the horizontal line joining the mouth, and is present at a depth of 6.7–10.7 mm under the skin. Typically, a single midline injection of 4 to 10 units of onobotulin, incobotulin, parabotulin or 12–30 U of abobotulin is sufficient. Two injections laterally from the center of the chin are allowed, using 4–5 units of the toxin (12–15 U for abobotulin). The aim of the article is to review the use of neurotoxin injection into the mental muscle in aesthetic medicine procedures.

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Sacco, E., M. Paolillo, A. Totaro, F. Pinto, A. Volpe, M. Gardi e P. F. Bassi. "Botulinum toxin in the treatment of overactive bladder". Urologia Journal 75, n. 1 (gennaio 2008): 4–13. http://dx.doi.org/10.1177/039156030807500102.

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Clinical effectiveness of botulinum toxin (BTX) in the treatment of both neurogenic and idiopathic detrusor overactivity has been demonstrated in several studies. However, different protocols and techniques have been used by authors. Methods. Literature review on intradetrusor injection of BTX for detrusor overactivity. Results. The greatest clinical experience reports the use of 200 and 300 U Botox®. Available data suggest that clinical efficacy, duration, and the side effect profile is similar at these doses. Very few data, on the other hand, are available regarding the clinical outcomes using the Dysport® preparation; isolated reports support that efficacy is similar when using a dosing range of 500 to 1000 SU with increased risk of systemic side effects using 1000 SU. A variety of injection volumes was used, demonstrating similar efficacy and tolerability profile. Clinical effect duration extends six to ten months in the majority of studies. Data suggest that a repeated injection scheme proves successful in the vast majority of initial responders. Conclusions. Safety, effectiveness, specificity and reversibility make BTX a new attractive treatment modality for overactive bladder syndrome. However, more experience is needed to standardize the injection protocol with respect to therapeutic outcomes and adverse effects.

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Dhungana, Isha, e Prabin Shrestha. "Role of Botulinum toxin injection in neurological problems: A Short Review". Nepal Journal of Neuroscience 12, n. 1 (9 ottobre 2016): 3–7. http://dx.doi.org/10.3126/njn.v12i1.15918.

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Botulinum Toxin (BoNT), a neurotoxin known for many years for its lethal nature has been in use for many cosmetic purposes for last many years. Its use in many medical problems especially chronic neurological problems has been well established in recent years. BoNT is a useful symptomatic treatment for many neurological disorders, and is emerging as one of the leading modes of treatments in the new subspecialty in neurology called “Interventional neurology.” We have also been using BoNT regularly for therapeutic purposes in different neurological diseases with good success rate for last few years. We think use of BoNT-A needs to be encouraged in our country to provide relief to the patients suffering from many of the chronic disabling neurological problems.Nepal Journal of Neuroscience 12:3-7, 2015

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Ihde, Stefan K. A., e Vitomir S. Konstantinovic. "The therapeutic use of botulinum toxin in cervical and maxillofacial conditions: an evidence-based review". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 104, n. 2 (agosto 2007): e1-e11. http://dx.doi.org/10.1016/j.tripleo.2007.02.004.

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Opoka, Kinga, Magdalena Filip, Elżbieta Mirek, Beata Mazurek e Szymon Pasiut. "The use of combination therapy in the treatment of lower limb spasticity among patients after stroke - a review of literature". Rehabilitacja Medyczna 23, n. 2 (12 marzo 2019): 36–41. http://dx.doi.org/10.5604/01.3001.0013.0875.

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Stroke is not only a medical problem, but also, due to the permanent disability of patients, a significant social issue. Therefore, gait disturbances resulting from lower limb muscle spastici-ty are a common subject of research. The ambiguities in the scientific literature have become justification for the creation of this systematic review, the aim of which is to collect and ana-lyse works describing the efficacy of combination therapy - including Botulinum toxin type A injections and physiotherapy following stroke. The following databases were searched: Pub-Med, EBSCO, Springer Link (date of access: 24 Jan. 2019). It was assumed that analysis will include scientific works published in English from 2000 to date (in accordance with search date). For the entry "combination therapy" (Botulinum toxin injections and physiotherapy), the search was conducted using the following keywords: physical therapy, Botulinum toxin type A, Botox A, lower limb, gait, brain, stroke, hemiparesis. Out of all the elaborate articles, 7 concerning combination therapy were ultimately evaluated. Analysis of the collected works indicates the effectiveness of combination therapy in the area of improving structural parame-ters. Some of the works prove that this type of therapy also improves functional indices and leads to increased activity of patients. We could not collect satisfactory evidence confirming its effectiveness in terms of increasing social participation and improving the quality of life of patients. This review indicates the need to develop specific therapeutic protocols accurately describing both Botulinum toxin injections and physiotherapy - taking the intensity, duration and type of therapy into account. Opoka K., Filip M., Mirek E., Pasiut S. The use of combination therapy in the treatment of lower limb spasticity among patients after stroke − a review of literature. Med Rehabil 2019; 23(2): 36-41. DOI: 10.5604/01.3001.0013.0875 This article is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License CC BY-SA (http://creativecommons.org/licenses/by-sa/4.0/) null

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Rasetti-Escargueil e Popoff. "Antibodies and Vaccines Against Botulinum Toxins: Available Measures and Novel Approaches". Toxins 11, n. 9 (12 settembre 2019): 528. http://dx.doi.org/10.3390/toxins11090528.

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Botulinum neurotoxin (BoNT) is produced by the anaerobic, Gram-positive bacterium Clostridium botulinum. As one of the most poisonous toxins known and a potential bioterrosism agent, BoNT is characterized by a complex mode of action comprising: internalization, translocation and proteolytic cleavage of a substrate, which inhibits synaptic exocytotic transmitter release at neuro-muscular nerve endings leading to peripheral neuroparalysis of the skeletal and autonomic nervous systems. There are seven major serologically distinct toxinotypes (A–G) of BoNT which act on different substrates. Human botulism is generally caused by BoNT/A, B and E. Due to its extreme lethality and potential use as biological weapon, botulism remains a global public health concern. Vaccination against BoNT, although an effective strategy, remains undesirable due to the growing expectation around therapeutic use of BoNTs in various pathological conditions. This review focuses on the current approaches for botulism control by immunotherapy, highlighting the future challenges while the molecular underpinnings among subtypes variants and BoNT sequences found in non-clostridial species remain to be elucidated.

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