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

Dystonias can be classified by etiology (idiopathic or symptomatic), by age of onset (childhood, adolescence or adult), and by anatomical involvement (focal, segmental or generalized). Cervical dystonia (torticollis) is one of the most common focal dystonias. We describe our experience in the treatment of 15 consecutive cervical dystonia patients by chemodenervation with botulinum A toxin (BOTOX), with significant improvement being objectively measured. Botox is accepted as a safe and efficacious modality for the treatment of cervical dystonia.
 ...
PMID:Treatment of cervical dystonia (torticollis) in adults with botulinum A toxin. 151 80

We prospectively evaluated the frequency, severity, and radiologic features of swallowing abnormalities following Botox treatment of spasmodic torticollis. We performed both clinical and radiologic evaluations of swallowing before and following Botox in 18 consecutive cervical dystonia patients receiving their first Botox treatment. Before Botox, 11% of the patients had clinical symptoms of dysphagia and 22% had radiologic signs of a peristaltic abnormality. After Botox, the signs and symptoms of dysphagia in these patients did not change, but an additional 33% developed new dysphagic symptoms and 50% of the patients developed new peristaltic abnormalities by radiologic studies. Complaints of swallowing difficulty were always associated with abnormal radiologic findings. Neither the total Botox dose nor Botox into particular muscles differed between those with dysphagia and those without.
 ...
PMID:Dysphagia after botulinum toxin injections for spasmodic torticollis: clinical and radiologic findings. 162 Mar 39

The "off" painful dystonia (OPD), usually concerning the feet, is a type of abnormal involuntary movement, induced by the chronic use of levodopa. It is mostly observed in the advanced stage of Parkinson's disease (PD), particularly in the early morning, in the evening, and late at night. Indeed, some patients have experienced OPD also during "on" periods when dystonic posture of the foot alternates with dyskinesia. The pain probably is due to sustained muscle contraction, which causes prolonged muscle spasm, as in primary dystonia or torticollis. Dopaminergic drugs like bromocriptine, pergolide, and especially apomorphine (s.c. infusions, or bolus), can dramatically improve the OPD. Anticholinergics baclofen and lithium are alos used in the management of OPD with some benefit. On the other hand, clinical experience shows that in many cases, these therapeutic procedures are not always enough to produce the expected results. Thirty PD patients (22 men and eight women) with OPD of the foot were treated with botulinum toxin (Botox, Btx) using electromyograms to guide injections. Dystonia was evaluated using a quantitative rating scale. The selection of the muscles for Btx treatment was carried out on the basis of foot posture. We injected Btx into tibialis posterior, tibialis anterior, gastrocnemius, flexor digitorum longus, and extensores hallucis longus with a median dose 40 IU for each muscle, distributed in two sites. In all patients, the pain improved within 10 days, whereas in 21 patients, the pain disappeared completely for 4 months (range, 3-7 months); a concomitant improvement in intensity of the dystonic spasm was also observed. No side effects were reported. Seven patients with associated "on" foot dystonia described an improvement of foot posture on walking. In conclusion, in this uncontrolled study, the use of Btx in OPD seemed a promising tool to improve pain linked to foot dystonia; however, because of the well-known underlying dopaminergic defect in OPD, the Btx therapy should be considered only if the dopaminergic treatment established for the management of OPD has failed.
 ...
PMID:"Off" painful dystonia in Parkinson's disease treated with botulinum toxin. 765 52

Local injections of botulinum toxin is a well-accepted treatment for focal dystonias, hemifacial spasms and strabismus. Its use by skilled neurologists has been reported to be safe and effective. We report our experience with botulinum toxin injections in 108 patients with various central nervous system disorders. Botox was effective in upper face dystonia (86% improvement), spastic dysphonia (92% improvement), platysma muscle spasms and spasmodic torticollis (range of movement 61%, pain and tension 90%). It was also very effective in a few patients with apraxia of eyelid opening, parkinsonian jaw tremor, teeth clenching, palatal myoclonus and adductor leg spasticity. No serious side effects were recorded. Botulinum toxin is a useful symptomatic treatment for many neurological disorders, and one of the leading mode of treatments in the new subspecialty in neurology called "Interventional neurology."
 ...
PMID:Interventional neurology: botulinum toxin as a potent symptomatic treatment in neurology. 798 70

Botulinum toxin, the most potent of the neurotoxins, produces paralysis by blocking presynaptic release of the neurotransmitter (acetylcholine) at the neuromuscular junction, with reversible chemical denervation of the muscle fibre, thereby inducing partial paralysis and atrophy. Because chemical denervation is reversible, botulinum toxin has temporary effects, the muscle being progressively reinnervated by nerve sproutings. Type A botulinum toxin (Bix-A) is available under two dosage forms: Botox and Dysport. Although the initial clinical indication was strabismus, subsequent studies have demonstrated the efficacy of Btx-A, mainly in dystonia, hemifacial spasm and spasticity. However, botulinum toxin has been successfully used in various other clinical indications. In regard to spasticity associated with cerebral palsy, Btx-A is a promising treatment requiring a multidisciplinary approach. Btx-A injections lead to effective reduction of muscle hyperactivity with minor side-effects. They are painless, even though electromyographic guidance may be required for the injection of deep muscles. However, the production of antibodies to Btx-A may compromise the effect of long-term treatment.
 ...
PMID:[Mechanism of action, clinical indication and results of treatment of botulinum toxin]. 897 11

Injection of botulinum toxin (BT) into affected neck muscles gives symptomatic relief to patients with cervical dystonia by causing a presynaptic block of acetylcholine release. In a retrospective study of 19 patients, we used the turns-amplitude analysis of the EMG interference pattern for the evaluation of electrophysiological changes as a function of time after BT treatment. EMG was performed immediately before and during injection, and muscles showing abnormally increased activity (> 100 turns/s at rest) were given botulinum toxin A (Oculinum (= Botox)) 40-120 units. A second EMG was done 6-30 weeks later. At attempted rest, the sternocleidomastoid muscle contralateral to the involuntary head rotation showed the most pronounced changes, possibly due to relatively large doses of BT, and the EMG changes were related to the time after BT treatment. Six weeks after treatment the muscle showed decreased turns/s, mean amplitude and ratio (turns/amplitude) at rest. At 30 weeks, turns and mean amplitude reached values as before treatment, while ratio was increased to 175% of the pre-treatment value. This pattern may reflect a reversible and random loss of muscles fibres, due to presynaptic denervation. At maximal voluntary contractions, no correlation was seen between time after BT treatment and quantitative EMG.
 ...
PMID:Quantitative electromyographical changes in cervical dystonia after treatment with botulinum toxin. 955 44

Botulinum toxin (BTX) has become a safe and effective therapeutic tool in the treatment of a variety of neurological disorders, especially dystonias. One major disadvantage, however, is the high cost of a single injection of BTX. In this study of 835 patients, we calculated the cost of treatment with BTX serotype A (BTX-A) for different dystonias and hemifacial spasm. The annual expenditure per patient for BTX-A injections in this cohort totalled (mean +/- standard deviation) 1030 Deutschmarks (DM) [1996 values] +/- DM610 [$US570 +/- $US340; 230 +/- 130 pounds sterling (Pound)] for blepharospasm (n = 158), DM1450 +/- DM1520 ($US800 +/- $US830; 310 Pounds +/- 280 Pounds) for craniocervical dystonia (n = 148), and DM1480 +/- DM780 ($US810 +/- $US430; 330 Pounds +/- 180 Pounds) for oromandibular dystonia (n = 16), while the treatment of cervical dystonia consumed DM4590 +/- DM2060 ($US2520 +/- $US1130; 960 Pounds +/- 420 Pounds) [n = 362] per patient. In order to alleviate symptoms in patients with hemifacial spasm (n = 151), DM510 +/- DM270 ($US280 +/- $US150; 110 Pounds +/- 60 Pounds) had to be spent annually. The expenses for surgical therapy for cervical dystonia were DM10,120 +/- DM1900 (n = 54). No major differences concerning expenditure could be found in this study between the 2 available preparations of BTX. However, there appeared to be a lower rate of adverse effects with the Botox formulation, compared with the Dysport formulation, of BTX-A (this difference was statistically significant, i.e. p < 0.001). Although the cost of an individual injection is high, other cost factors also substantially contribute to the societal costs of adult-onset dystonias. Some of these costs may be attenuated with the use of BTX. The subjective and objective relief of these socially devastating and sometimes painful conditions rewards the expenditure associated with the use of BTX-A.
 ...
PMID:Costs of treating dystonias and hemifacial spasm with botulinum toxin A. 1017 81

The effect of botulinum toxin (BT) upon the human body has so far been measured by using clinical scales monitoring its overall therapeutic effect upon the disorders treated. Clinical scales, however, usually lack sensitivity, are rarely validated and are integrating a number of uncontrollable parameters. After validation of the methodology in a group of 10 controls, we investigated the BT-induced amplitude reduction of the maximal voluntary electromyographic activity (M-EMG amplitude reduction) of the sternocleidomastoid muscle in a group of 34 patients with cervical dystonia undergoing regular BT therapy with Botox (Allergan, Irvine, Calif., USA; n = 16) or Dysport (Ipsen, Maidenhead, UK; n = 18). With Botox doses of 20 mouse units the M-EMG amplitude reduction was 80% (SD = 3.9%, n = 4), with 40 it was 84% (SD = 10.8%, n = 4), with 60 it was 85% (SD = 2.6%, n = 2) and with 80 it was 91% (SD = 5.8%, n = 6). With Dysport doses of 100 mouse units the M-EMG amplitude reduction was 70% (SD = 7.6%, n = 4), with 200 it was 85% (SD = 10.4%, n = 5), with 300 it was 83% (SD = 9.2%, n = 3), with 400 it was 78% (SD = 6.7%, n = 3) and with 500 it was 91% (SD = 5.8%, n = 5). The methodology presented can measure M-EMG amplitude reductions with a precision of about 10%. Dose-efficacy relationships can be used for dose optimisation, evaluation of BT therapy failure and comparison of different preparations and types of BT.
 ...
PMID:Electromyographic quantification of the paralysing effect of botulinum toxin in the sternocleidomastoid muscle. 1079 96

Eyelid dystonia represents a form of idiopathic torsion dystonia, and it is considered as a rare disorder. Although botulinum toxin injections into the eyelids and eyebrows are considered by many neurologists as the treatment of choice for this, its cost limit its use in our community. A study was conducted at the King Hussein Medical Center between January 1995 and January 1998 using 1-2 ml of 0.5% xylocaine added to 99.5% ethanol in one-tenth of the volume of xylocaine, made injectable into the eyelids and eyebrows muscles in patients with blepharospasm. The treatment was aimed at reducing muscle spindle afferent activity. Twenty-one patients were given this modality of treatment in at least 8-12 separate sessions, with two weeks elapsing between any two sessions. Mild to moderate improvement was observed in 47.6% of our patients. The average latency from the time of the injection to the onset of improvement was 30-60 min and the average duration of improvement was 5-7 days. The commonest encountered side-effect was bruising at the site of injection that resolved spontaneously in less than 5 days. It is obvious that the usefulness of this treatment is limited by the substantially shorter duration of benefit, thus it cannot be considered as an alternative to Botox treatment. It may be useful to investigate whether a higher alcohol concentration is more effective.
 ...
PMID:Alcohol with xylocaine for treatment of eyelid dystonia. 1080 44

Spasmodic torticollis or cervical dystonia is the commonest focal dystonia. Botulinum toxin-A (BTX-A) was first used in its treatment in 1985. We are reporting our experience of treating 17 patients of cervical dystonia with 29 treatment sessions of BTX-A. The patients consisted of 13 men and four women with a mean age of 44.17 +/- 16.25 years who had tried medical therapy earlier. All patients had a combination of two or more abnormal postures of neck. Both Botox and Dysport were used as per availability. The mean dose of BTX-A in splenius capitus was 283.3 +/- 59.86 U of Dysport and 61.3 +/- 5.16 U of Botox and in sternocleidomastoid it was 210 +/- 53.47 U of Dysport and 46 +/- 18.97 U for Botox. After BTX-A injection, the response was observed after a mean of 9.7 +/- 5.7 days and the mean duration of effect was 15.56 +/- 7.13 weeks. Significant improvement of dystonia (global rating > or = 2) was seen after 25 of 29 treatment sessions (86%) and of pain was seen after four of five patients. Only three treatment sessions were followed by complications (10.4%) of these two had mild dysphagia and one had mild "flu-like" syndrome. We conclude BTX-A is safe and effective treatment of cervical dystonia.
 ...
PMID:Botulinum toxin A--injection for cervical dystonia. 1099 17


1 2 3 4 5 6 Next >>