Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013421 (dystonia)
 8,418 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Local injections with Botulinum toxin A (BtxA) are safe and effective in the treatment of focal dystonia. In cervical dystonia and blepharospasm, BtxA injections have become the treatment of choice. However, good results have also been reported with oromandibular dystonia, spasmodic dysphonia and writer's cramp. In cervical dystonia, muscles for injection are selected by clinical presentation or in complex forms with EMG guidance. Several studies have shown that 500 units Dysport are safe and effective in the treatment of cervical dystonia. In blepharospasm, injections are performed in the periorbital part of the orbicularis oculi muscle with good results for 12-14 weeks. The most frequently employed starting dose is 120 units Dysport per eye, divided in three periorbital injection sites. In case of levator inhibition, the pretarsal part of the orbicularis oculi muscle should be injected in a lower dose. EMG guidance is not necessary. By contrast, BtxA treatment of spasmodic dysphonia and writer's cramp require EMG-guided injections in order to avoid side-effects. Dose recommendations for the various types of dystonia are given in the text. In up to 5% of patients with dystonia, the development of neutralising antibodies is reported following repetitive injections with BtxA. Patients with antibodies had a shorter interval between injections, more "boosters", a higher dose per 3-month interval, and a higher total dose injected. In case of neutralizing antibodies against the A toxin, the treatment with Botulinum toxin B (Neurobloc) is a possible alternative.
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PMID:[Treatment of focal dystonia with botulinum toxin A]. 1550 45

Since its introduction in the late 1970s for the treatment of strabismus and blepharospasm, botulinum toxin (BoNT) has been increasingly used in the interventional treatment of several other disorders characterized by excessive or inappropriate muscle contractions. The use of this pluripotential agent has extended to a plethora of conditions including: focal dystonia; spasticity; inappropriate contraction in most sphincters of the body such as those associated with spasmodic dysphonia, esophageal achalasia, chronic anal fissure, and vaginismus; eye movement disorders; other hyperkinetic disorders including tics and tremors; autonomic disorders such as hyperhidrosis; genitourinary disorders such as overactive and neurogenic bladder, non-bacterial prostatitis and benign prostatic hyperplasia; and aesthetically undesirable hyperfunctional facial lines. In addition, BoNT is being investigated for the control of the pain, and for the management of tension or migraine headaches and myofascial pain syndrome. BoNT injections have several advantages over drugs and surgical therapies in the management of intractable or chronic disease. Systemic pharmacologic effects are rare; permanent destruction of tissue does not occur. Graded degrees of relaxation may be achieved by varying the dose injected; most adverse effects are transient. Finally, patient acceptance is high. In this paper, clinical experience over the last years with BoNT in urological impaired patients will be illustrated. Moreover, this paper presents current data on the use of BoNT to treat pelvic floor disorders.
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PMID:Management of bladder, prostatic and pelvic floor disorders with botulinum neurotoxin. 1572 17

We report on the case of a 69-year-old woman with Parkinson's disease and long-standing history of spasmodic dysphonia that reversed during an episode of transient global amnesia (TGA). To our knowledge, this phenomenon has not been reported before. We suggest possible mechanisms by which the pathophysiology of dystonia could reverse during TGA.
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PMID:Normalization of voice in spasmodic dysphonia during transient global amnesia. 1595 30

The cause of spasmodic dysphonia, a dystonic disorder of the larynx, remains unclear. Recently, TAFII250, TATA-box binding protein associated factor, was suggested to be involved in dystonia parkinsonism. There is a possibility that TAFII250 is involved in spasmodic dysphonia, but little information is available about the expression of TAFII250 in the laryngeal nervous system. In this study, we investigated the localization of TAFII250 protein in the rat laryngeal nervous system by immunohistochemistry. TAFII250-immunoreactivity was detected in the nodose ganglion and superior cervical ganglion. In these nuclei, TAFII250 was localized in the nucleus of NeuroTrace-positive neurons but not in GFAP-positive glial cells. No positive cells were detected in the motor and parasympathetic nervous system. TAFII250-immunoreactivity was sustained between 3 and 7 days after vagotomy, but at 14 days expression was down-regulated in the distal part of the nodose ganglion. These findings suggest that TAFII250 plays an important role in the laryngeal innervation of the sensory and sympathetic nervous systems.
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PMID:Immunohistochemical study of TAFII250 in the rat laryngeal nervous system. 1613 84

Botulinum neurotoxin type B (BT, BT-B) has been used as NeuroBloc/MyoBloc since 1999 for treatment of cervical dystonia, hyperhidrosis, spastic conditions, cerebral palsy, hemifacial spasm, bladder dysfunction, spasmodic dysphonia, sialorrhoea, anal fissures, piriformis syndrome, various pain conditions and cosmetic applications. Generally, its therapeutic effects are comparable to BT type A (BT-A). The adverse effect profiles of BT-B and BT-A, however, differ considerably. BT-B has been found to produce more regional as well as systemic anticholinergic adverse effects, such as dryness of mouth, accommodation difficulties, conjunctival irritation, reduced sweating, dysphagia, heartburn, constipation, bladder voiding difficulties and dryness of nasal mucosa. In BT-B the relationship between autonomic and motor effects known from BT-A is substantially shifted towards autonomic effects. BT-B, therefore, should be used carefully in patients with autonomic disorders and in patients with concomitant anticholinergic therapy. If NeuroBloc/MyoBloc is used to treat cervical dystonia patients with antibody-induced failure of BT-A therapy, 86% of those will develop complete secondary therapy failure after five applications. If NeuroBloc/MyoBloc used to treat cervical dystonia patients without prior exposure to BT, 44% of those will develop complete secondary therapy failure after nine applications. NeuroBloc/MyoBloc, therefore, is associated with substantial antigenicity problems originating from a particular low specific biological potency. Systemic anticholinergic adverse effects and high antigenicity limits the clinical use of NeuroBloc/MyoBloc considerably.
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PMID:Clinical use of non-A botulinum toxins: botulinum toxin type B. 1678 8

Spasmodic dysphonia is a focal form of laryngeal dystonia that causes unintended contractions of vocal folds with speech interruptions and affecting the voice quality. There are adductor (82%), abductor (36%), mixed (1%) types and reported by Blitzer--respiratory adductor type with paradoxical vocal fold movement and stidor. As an example of diagnostic and therapeutic difficulties in spasmodic dysphonia and its multidisciplinary approach with needed cooperation of many specialists we presented patient with adductor spasmodic dysphonia. In stroboscopic evaluation there were observed glottic overclosure and hyperaduction in supraglotic stuctures (sphincteric). During diagnostic procedures there was made acoustic analysis by digital spectrograph (by KAY Elmetrics Company). IV degree of hoarsness and voice breaks were observed in sonogram. In multidimentional analysis there were deviations of the frequency, amplitude, noise, tremor and voice break parameters. Treatment included regular speech therapy, relaxation- and psychotherapy. The results of treatment were very instable because every stress-related problem released symptoms. Botulinum toxin injections into thyro-arytenoid muscle which had made before our hospitalisation were also not succeeding. Because of lack of etiologic factor and plenty diseases that can mimic spasmodic dysphonia, close communication between many specialists is needed.
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PMID:[Therapeutic difficulties in spasmodic dysphonia--case report]. 1687 62

Laryngeal dystonia or spasmodic dysphonia is characterized by involuntary and inappropriate spasms of vocal muscles, having the adductor type as the most common one. It is characterized by strain-strangled voice with pitch breaks. Diagnosis is made by means of videolaryngostroboscopic exam. The treatment of choice is done with botulinum toxin directly injected in the muscles responsible for the mismatched movement. The aim of this study is to report on an adductor- type dysphonia patient and to discuss the advantages and observations about this treatment reported in the literature.
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PMID:Laryngeal dystonia: case report and treatment with botulinum toxin. 1711 83

We investigated whether structural white matter abnormalities, in the form of disruption of axonal coherence and integrity as measured with diffusion tensor imaging (DTI), constitute an underlying pathological mechanism of idiopathic dystonia (ID), independent of genotype status. We studied seven subjects with ID: all had cervical dystonia as their main symptom (one patient also had spasmodic dysphonia and two patients had concurrent generalized dystonia, both DYT1-negative). We compared DTI MR images of patients with 10 controls, evaluating differences in mean diffusivity (MD) and fractional anisotropy (FA). ID was associated with increased FA values in the thalamus and adjacent white matter, and in the white matter underlying the middle frontal gyrus. ID was also associated with increase in MD in adjacent white matter to the pallidum and putamen bilaterally, left caudate, and in subcortical hemispheric regions, including the postcentral gyrus. Abnormal FA and MD in patients with ID indicate that abnormal axonal coherence and integrity contribute to the pathophysiology of dystonia. These findings suggest that ID is not only a functional disorder, but also associated with structural brain changes. Impaired connectivity and disrupted flow of information may contribute to the impairment of motor planning and regulation in dystonia.
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PMID:Structural white matter abnormalities in patients with idiopathic dystonia. 1723 Apr 63

Laryngeal dystonia (spasmodic dysphonia) is a movement disorder characterised by involuntary contractions of the laryngeal muscles involved in vocalisation. The introduction of botulinum toxin (BTX) in the treatment of laryngeal dystonia had a major clinical impact due to the striking improvement of symptoms. In general, BTX can be delivered by percutaneous injection or by the transoral route. The subcutaneous method is simple, but the effects of the transoral injection, applied through a curved device or by use of a flexible nasolaryngoscope with a working channel and visual control, might be more effective. However, for various reasons the transoral route does not work in every patient. We report our experiences using these different techniques for the monitoring of patients and their treatment with botulinum toxin in laryngeal movement disorders.
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PMID:[The treatment of laryngeal movement disorders with botulinum toxin: part 2: experience and considerations]. 1743 66

Laryngeal dystonia (spasmodic dysphonia) is a movement disorder characterised by involuntary contractions of the laryngeal muscles involved in vocalisation. The introduction of botulinum toxin (BTX) in the treatment of laryngeal dystonia had a major clinical impact due to the striking improvement of symptoms. Most patients with severe types of spasmodic dysphonia are treated with injections of botulinum toxin type A. For patients with a resistance against type A toxin there is a new hypercleaned type A toxin or type B available. Research on type F toxin is also underway. In this article, the history of botulinum toxin, its therapeutic activity and possibilities for its use are described.
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PMID:[Treatment of laryngeal movement disorders with botulinum toxins: part 1: History and mode of action]. 1743 67


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