Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C1762617 (weakness)
 37,932 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied the clinical effectiveness of botulinum toxin type A for spasmodic torticollis and that for facial spasm by multicenter, non-blinded study. The freeze-dried crystalline botulinum toxin type A (AGN 191622; Allergan Inc., Irvine, CA) was injected into the hyperactive muscles and the clinical course was followed for 22 weeks. Repeated injections were done, if necessary, with an interval of 4 weeks. The toxin was highly effective in both disorders. In spasmodic torticollis, clinical severity improved in 38 (63.3%) and the global improvement was seen in 39 (65.0%) out of 60 patients. Subjective improvement was seen in 56 (93.3%). In facial spasm, 52 (92.9%) out of 56 patients improved after the treatment. Unfavorable reactions, mainly consisting of neck muscle weakness and dysphagia in torticollis and facial weakness in facial spasm, were mostly due to the excessive action of the toxin. They were usually mild and transient. No patients discontinued the trial because of side effects. Botulinum toxin injection is a very useful and safe method for the symptomatic treatment of spasmodic torticollis and facial spasm.
 ...
PMID:[The clinical usefulness of botulinum toxin type A for spasmodic torticollis and facial spasm]. 754 19

Injection of botulinum toxin type A has been the treatment of choice for spasmodic torticollis for several years. Although previous reports demonstrate its effectiveness and safety, the treatment strategy has been empirical. The present study, using the freeze-dried crystalline botulinum toxin type A (AGN 191622; Allergan Inc., Irvine, CA), aimed to compare the efficacy among three treatment groups divided into low, medium and high dosage levels. Fifty-one patients who entered the study were grouped into low-dose (60 units/session), medium-dose (120 units/session) and high-dose (240 units/session) groups. Two patients (one in low-dose group and the other in high-dose group) were excluded from the assessment of efficacy because they dropped out in the early phase of the study. One experienced worsening of an existing psychosis and the other developed an acute respiratory infection. Injection sites were decided individually by palpation. If the clinical response was not satisfactory four weeks after an injection, the patient was re-injected with the same dose of toxin. The follow-up period was 14 weeks from the initial injection. The results showed that the high-dose group improved more than the other groups in the parameters of severity of symptoms and subjective benefit (p = 0.000). Also, fewer injections were required in the high-dose group to achieve substantial clinical benefit. Although the mean reduction in Tsui's score was not statistically significant among the groups, the "marked improvement" was seen more frequently in the high-dose group (p = 0.033). Unfavorable adverse effects including excessive weakness and dysphasia were always mild and transient.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Dose-response relationship in the treatment of cervical dystonia with botulinum toxin type A (AGN 191622)--a phase II study]. 754 34

Twenty-five patients with hand tremor of 2+ (moderate) to 4+ (severe) on the tremor severity rating scale were randomized to receive either 50 U of botulinum toxin (BTX) type A (Allergan, Irvine, CA) or placebo injections into the wrist flexors and extensors of the dominant limb. If patients failed to respond to the initial injection, they were eligible to receive another injection of 100 U 4 weeks later. Rest, postural, and kinetic tremors were evaluated at 2- to 4-week intervals over a 16-week study period using tremor severity rating scales, accelerometry, and assessments of improvement and disability. A significant improvement (p < 0.05) was observed on the tremor severity rating scale 4 weeks after injection in patients treated with BTX as compared with placebo, and this effect was maintained for the duration of the study. Four weeks after injection, 75% of BTX-treated patients vs. 27% of placebo-treated patients (p < 0.05) reported mild to moderate improvement (peak effect rating > or = 2). There were no significant improvements in functional rating scales, although trends were observed for some items. Postural accelerometry measurements showed a > or = 30% reduction in amplitude in nine of 12 BTX-treated subjects and in one of nine placebo-treated subjects (p < 0.05). Although all patients treated with BTX reported some degree of finger weakness, no severe, irreversible, or unexpected adverse events occurred. Chemodenervation with BTX may significantly ameliorate essential hand tremor in patients who fail to improve with conventional pharmacologic therapy.
 ...
PMID:A randomized, double-blind, placebo-controlled study to evaluate botulinum toxin type A in essential hand tremor. 872 40

Focal palmar hyperhidrosis can be effectively abolished by intradermal injections with botulinum toxin. Muscle weakness of finger grip has been reported as a reversible side-effect of this new treatment. The objective of this work was to measure muscular side-effects after treatment of palmar hyperhidrosis with botulinum toxin. As botulinum toxin has been used in the treatment of pain, we studied whether the toxin might influence afferent thin-fibre function by measuring temperature perception thresholds. Thirty-seven patients treated with botulinum toxin (Botox, Allergan Pharmaceuticals, Irvine, CA, USA) showed a decrease in compound muscle action potential (CMAP) for both abductor pollicis brevis (APB) and abductor digiti minimi (ADM) compared with pre-injection values on average by 64 and 36%, respectively, at 3 weeks which returned nearly to normal at 37 weeks. Muscle power for both finger abduction and finger opposition decreased to a lesser extent. Repetitive nerve stimulation and single fibre electromyography (EMG) showed a disturbed neuromuscular transmission. Thus, despite careful technique with small doses of botulinum toxin injected intradermally, the toxin diffuses to underlying muscles. With regard to the present results, one should be careful in using higher doses of Botox than 0.8 mU/cm(2) in the palmar skin above intrinsic muscles. No influence on thin-fibre function was seen.
 ...
PMID:Side-effects of intradermal injections of botulinum A toxin in the treatment of palmar hyperhidrosis: a neurophysiological study. 1155 8

Idiopathic cervical dystonia (ICD) is the most common adult-onset focal dystonia. It is characterised by relatively sustained, involuntary contractions of neck muscles. Injections of botulinum toxin (BTX)-A are safe and effective for the treatment of ICD, and have substantially improved its treatment. BTX-A is manufactured by Allergan Pharmaceuticals in the US and Ireland, and is distributed as Botox. In Europe, BTX-A is manufactured and distributed by Ipsen Pharmaceuticals as Dysport. Success rates for BTX-A injections for ICD ranges 64-90%, with 76-93% of injected patients experiencing pain reduction. Side effects are generally mild and include dysphagia and neck weakness.
 ...
PMID:Botulinum toxin A for the treatment of cervical dystonia. 1533 Jul 38

Patients with spinal cord injury or multiple sclerosis are often troubled by urinary incontinence due to detrusor (bladder muscle) overactivity. For patients who use intermittent self-catheterisation, empirical treatments for urinary incontinence include: optimisation of catheterisation; anticholinergic drugs; and, in some cases, surgery. The indications of botulinum toxin type A (Botox, Allergan) in France have been extended to cover this situation when anticholinergic drugs are ineffective. Clinical evaluation is based on 2 double-blind randomised placebo-controlled trials in a total of 691 patients who had an average of about 32 episodes of urinary incontinence per week.These trials tested the efficacy of a total dose of 300 or 200 units of botulinum toxin type A. Six weeks after toxin injection into the bladder wall, about 40% of patients had no further episodes of incontinence, compared to 10% of patients who received placebo injections. The median duration of the effect was 42 to 48 weeks after a dose of 200 units (13 to 18 weeks with placebo). It remains to be shown whether botulinum toxin has any long-term benefits in terms of complications (hospitalisation, urinary tract infections, etc.). The main adverse effects of botulinum toxin injections in these patients were urinary tract infections (51% versus 36% with placebo) and urinary retention (18% versus 3%). Both differences were statistically significant, and these events were most frequent in patients who had not yet started to self-catheterise (mainly patients with multiple sclerosis). Cases of autonomic hyperreflexia with favourable outcome were also reported. Botulinum toxin type A has been marketed since the 1990s in other indications. It has been linked to life-threatening adverse effects on tissues at a distance from the injection site, following its diffusion throughout the body. Muscle weakness, asthenia and constipation have been reported. A negative effect on the course of multiple sclerosis cannot be ruled out. Botulinum toxin type A injection into the bladder wall necessitates cystoscopy, an invasive and very inconvenient procedure that requires antibiotic prophylaxis and sometimes anaesthesia. Cystoscopy also carries a risk of punctures and tears, etc. In practice, existing treatment options are unsatisfactory for patients in whom anticholinergic drugs fail to control urinary incontinence due to neurogenic detrusor overactivity. Botulinum toxin type A temporarily prevents incontinence for a few months in about one-third of patients, but it is difficult to administer. In experienced hands, it may be beneficial for patients with very troublesome incontinence who self-catheterise.
 ...
PMID:Botulinum toxin type A and neurogenic urinary incontinence: sometimes beneficial, if used safely. 2336 77