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Toxins
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Botulinum Toxin: The Role in Neuro-Rehabilitation
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Botulinum Toxin: The Role in Neuro-Rehabilitation

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

Deadline for manuscript submissions: closed (30 April 2019) | Viewed by 15790

Special Issue Editor

Prof. Dr. Andrea Santamato

E-Mail Website
Guest Editor
Physical Medicine and Rehabilitation, Spasticity and Movement Disorder Unit, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
Interests: spasticity; botulinum neurotoxin; neurological rehabilitation; robotics for neurological rehabilitation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Current best practice in neuro-rehabilitation aims to increase the residual motor upper and lower limb function impeded by the muscles hyperactivity or movement disorders reducing abnormal posture, pain and spastic dystonic movements, in order to increase a functional recovery through rehabilitation treatments.

Botulinum toxin represents the gold standard therapy not only for positive muscles symptoms (i.e. focal spasticity, focal dystonias, spasms or muscle painful contractures) related to stroke, brain and spinal cord injuries, but also for autonomic disorders (i.e., secretory, bladder), with many label and off-label indications.

Moreover, several researches have shown a double action of botulinum toxin, not only at motor endplates, but also at the central level after peripheral intervention.

There is increasing evidence that the best choice of dosage, as well as the selection of correct muscles, the time of re-injection and correct techniques depend on the clinicians’ experience, due to a lack of approved guides. However, it is important, before each botulinum toxin treatment, to have an adequate goal for the treatment considering a patient-centered approach.

The focus of this Special Issue of Toxins will be on botulinum toxin in neuro-rehabilitation. I invite you to submit original research articles and reviews about label and off label indications, as well as the different effects related to doses, injection techniques, outcome measures, sensorimotor changes, post injections treatments, cost-effectiveness analyses, both in adults and in children affected by central and peripheral nervous system lesions.

Prof. Dr. Andrea Santamato
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Toxins is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Botulinum toxin type A
  • Spasticity
  • Dystonia
  • Neuro-rehabilitation
  • Injection techniques
  • Doses
  • Stroke
  • Brain and spinal cord injuries

Published Papers (4 papers)

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Research

11 pages, 1248 KiB  
Article
Association of Long-Term Treatment by Botulinum Neurotoxins and Occupational Therapy with Subjective Physical Status in Patients with Post-Stroke Hemiplegia
by Toyohiro Hamaguchi, Masahiro Abo, Kai Murata, Mari Kenmoku, Izumi Yoshizawa, Atsushi Ishikawa, Makoto Suzuki, Naoki Nakaya and Kensuke Taguchi
Toxins 2019, 11(8), 453; https://doi.org/10.3390/toxins11080453 - 2 Aug 2019
Cited by 2 | Viewed by 4253
Abstract
The short-term effects of botulinum toxin type A (BoNT-A) treatment in stroke patients with upper extremity are well established. This study examined the association between the recovery of motor function of the upper extremity with subjective physical symptoms in outpatients receiving long-term BoNT-A [...] Read more.
The short-term effects of botulinum toxin type A (BoNT-A) treatment in stroke patients with upper extremity are well established. This study examined the association between the recovery of motor function of the upper extremity with subjective physical symptoms in outpatients receiving long-term BoNT-A and occupational therapy following stroke. We also investigated the expectations of patients who elected to continue treatment. Forty-seven patients (23 men and 24 women) aged 61 years received BoNT-A treatment more than 20 times. The subjective physical status was analyzed by using the visual analogue scale score through an eight-item questionnaire. Recovery of motor function in the upper extremity was detected by calculating the change (delta) in Fugl–Mayer Assessment (FMA), and ordinal logistic modeling analysis was used to determine the association between the delta-FMA score and the subjective level of agreement for each item. When the ordinal logistic modeling fit was statistically significant, results were interpreted as having logistic probability. The logistic curves discriminating one point (strongly disagree) from five points (strongly agree) were fit in a stepwise fashion. This study suggests that patients receiving long-term BoNT-A treatment and occupational therapy experienced an increased upper extremity mitigation and decreased insomnia after injection, regardless of the recovery of motor function. Full article
(This article belongs to the Special Issue Botulinum Toxin: The Role in Neuro-Rehabilitation)
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11 pages, 279 KiB  
Article
Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial
by Nicoletta Cinone, Sara Letizia, Luigi Santoro, Salvatore Facciorusso, Raffaella Armiento, Alessandro Picelli, Maurizio Ranieri and Andrea Santamato
Toxins 2019, 11(4), 210; https://doi.org/10.3390/toxins11040210 - 8 Apr 2019
Cited by 13 | Viewed by 4531
Abstract
Botulinum toxin A (BoNT-A) has been shown effective for poststroke lower limb spasticity. Following injections, a wide range of multidisciplinary approach has been previously provided. The purpose of this pilot, single-blind, randomized controlled trial was to determine whether BoNT-A combined with a regime [...] Read more.
Botulinum toxin A (BoNT-A) has been shown effective for poststroke lower limb spasticity. Following injections, a wide range of multidisciplinary approach has been previously provided. The purpose of this pilot, single-blind, randomized controlled trial was to determine whether BoNT-A combined with a regime of a four-week ankle isokinetic treatment has a positive effect on function and spasticity, compared with BoNT-A alone. Secondly, the validity of the use of an isokinetic dynamometer to measure the stretch reflex at the ankle joint and residual strength has been investigated. Twenty-five chronic stroke patients were randomized to receive combined treatment (n = 12; experimental group) or BoNT-A alone (n = 13; control group). Outcome measures were based on the International Classification of Functioning, Disability and Health. An isokinetic dynamometer was also used for stretch reflex and strength assessment. Patients were evaluated at baseline (t0), after five (t1) and eight weeks after the injection (t2). The experimental group reported significantly greater improvements on lower limb spasticity, especially after eight weeks from baseline. Gait speed (10-m walk test) and walking capacity (6-min walking test) revealed statistically significantly better improvement in the experimental than in control group. Peak resistive ankle torque during growing angular velocities showed a significant reduction at the higher velocities after BoNT-A injections in the experimental group. Peak dorsiflexor torque was significantly increased in the experimental group and peak plantarflexor torque was significantly decreased in control group. Alternative rehabilitation strategies that combine BoNT-A and an intense ankle isokinetic treatment are effective in reducing tone and improving residual strength and motor function in patients with chronic hemiparesis. Full article
(This article belongs to the Special Issue Botulinum Toxin: The Role in Neuro-Rehabilitation)
8 pages, 842 KiB  
Article
Efficacy of Early Endoscopic Intervention for Restoring Normal Swallowing Function in Patients with Lateral Medullary Infarction
by Sun Hyung Kang, Ju Seok Kim, Jong Seok Joo, Hyuk Soo Eun, Eaum Seok Lee, Hee Seok Moon, Seok Hyun Kim, Jae Kyu Sung, Byung Seok Lee, Hyun Yong Jeong, Yeongwook Kim, Min Kyun Sohn and Sungju Jee
Toxins 2019, 11(3), 144; https://doi.org/10.3390/toxins11030144 - 4 Mar 2019
Cited by 4 | Viewed by 3446
Abstract
Dysphagia is considered to be a significant barrier for recovery after lateral medullary infarction (LMI). However, there is still no gold standard treatment for dysphagia. The aim of this study was to explore an effect of an early treatment options for swallowing dysfunction [...] Read more.
Dysphagia is considered to be a significant barrier for recovery after lateral medullary infarction (LMI). However, there is still no gold standard treatment for dysphagia. The aim of this study was to explore an effect of an early treatment options for swallowing dysfunction after acute LMI. Medical records of acute LMI patients who had been admitted to the department of rehabilitation medicine from January 2014 to December 2017 were reviewed retrospectively. We compared the clinical efficacy of conventional dysphagia rehabilitation to early endoscopic intervention using either botulinum toxin injection into cricopharyngeal muscle or endoscopic balloon dilatation of the muscle. Outcomes, such as duration of parental feeding, albumin level at diet transition to enteral feeding, and complications, were analyzed. A total of 18 patients with LMI were included. While eight patients (8/9, 88.89%) in the endoscopic group were capable of orally ingesting their diet after intervention, the conversion from tube feeding to an oral diet was possible in only five patients (5/9, 55.56%) of the conventional group during hospitalization. However, the difference between the two groups was not significant (p-value ≤ 0.147, chi-square test). Only the final dietary level at the time of discharge was higher level in endoscopic group. The conversion interval from tube feeding to oral diet was also comparable between groups. There was no re-conversion from the oral diet to tube feeding in patients of either group during the median follow-up period of 20 months. Early endoscopic intervention may be a better option for dysphagia with LMI, compared to conventional dysphagia rehabilitation. However, a larger and prospective trial may be needed to confirm our observations. Full article
(This article belongs to the Special Issue Botulinum Toxin: The Role in Neuro-Rehabilitation)
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10 pages, 661 KiB  
Article
AbobotulinumtoxinA: A New Therapy for Hip Osteoarthritis. A Prospective Randomized Double-Blind Multicenter Study
by Roberto Eleopra, Sara Rinaldo, Christian Lettieri, Andrea Santamato, Paolo Bortolotti, Carmelo Lentino, Carmine Tamborino, Araldo Causero and Grazia Devigili
Toxins 2018, 10(11), 448; https://doi.org/10.3390/toxins10110448 - 31 Oct 2018
Cited by 6 | Viewed by 3004
Abstract
Hip Osteoarthritis (OA) causes pain and disability. Here we evaluate abobotulinumtoxinA (Dysport®) (AboBoNT-A) injections versus placebo as a novel treatment option to improve hip range of motion, pain and quality of life. This prospective randomized double-blind multicenter study (EudraCT # 2012-004890-25) [...] Read more.
Hip Osteoarthritis (OA) causes pain and disability. Here we evaluate abobotulinumtoxinA (Dysport®) (AboBoNT-A) injections versus placebo as a novel treatment option to improve hip range of motion, pain and quality of life. This prospective randomized double-blind multicenter study (EudraCT # 2012-004890-25) recruited 46 outpatients with hip OA who were randomized 2:1 to the Treatment Group (TG; 31 subjects), or the Placebo Group (PG; 15 subjects). The TG received 400 U of AboBoNT-A injected into the adductor muscles, and the PG received placebo solution. The primary endpoints were the difference in Harris Hip Score (HHS) and Visual Analogic Scale for pain (VAS) at Week 4 between groups (TG vs. PG). Secondary endpoints were the change from baseline in HHS, VAS pain, Medical Research Council scale for muscle strength (MRC) and Short Form scale (SF-36) scores. In TG at Week 4, the HHS and VAS score were significantly improved compared to PG, and pairwise assessments showed significant improvements in HSS and VAS pain at each time point compared to baseline for TG. No significant changes were observed in MRC and SF-36 over time, though SF-36 showed a positive trend. There were no significant differences from baseline in the PG. No adverse events were detected in either treatment group. AboBoNT-A injections in hip OA improve range of motion and pain without any significant side effects. Full article
(This article belongs to the Special Issue Botulinum Toxin: The Role in Neuro-Rehabilitation)
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