Toxins

18 pages, 4890 KiB

Open AccessArticle

Is There a Correlation Between Masticatory Muscle Thickness and Pain After Botulinum Toxin Injections in Myogenic TMD Patients?: A Pilot Study

by Hye-Ji Park, Hee-Jin Kim and Sung Ok Hong

Toxins 2025, 17(5), 220; https://doi.org/10.3390/toxins17050220 - 28 Apr 2025

Viewed by 148

Abstract

Botulinum toxin type A (BoNT-A), a potent neurotoxin, is increasingly used to treat myogenic temporomandibular disorders (TMDs); however, the interplay between muscle atrophy and pain relief remains incompletely understood. This pilot study investigated how masseter and temporalis muscle thickness and pain intensity change [...] Read more.

Botulinum toxin type A (BoNT-A), a potent neurotoxin, is increasingly used to treat myogenic temporomandibular disorders (TMDs); however, the interplay between muscle atrophy and pain relief remains incompletely understood. This pilot study investigated how masseter and temporalis muscle thickness and pain intensity change over 12 weeks following BoNT-A injections in 15 patients (mean age 51.42 years) with myogenic TMD. Muscle thickness was measured via ultrasonography across multiple anatomical positions under both clenching and resting conditions at baseline and at 2, 4, 8, and 12 weeks post-injection. Significant thinning of both muscles occurred within 2 weeks, lasting until 12 weeks, but became less pronounced after the first month. Pain intensity showed parallel decreases, most notably early on, but these reductions were not consistently statistically significant. Correlation analyses revealed no strong persistent association between muscle thickness and pain except for a moderately positive correlation in the anterior temporalis at two weeks (r = 0.61, p = 0.04). BoNT-A induces rapid masticatory muscle atrophy and modest pain relief; however, these outcomes do not coincide. Pain relief was observed earlier than the full development of muscle atrophy and should be considered during TMD pain management. Full article

(This article belongs to the Special Issue Botulinum Toxin Therapy for Diseases in the Oral and Maxillofacial Regions)

► Show Figures

Figure 1

21 pages, 1231 KiB

Open AccessReview

Detection of Mycotoxins in Cereal Grains and Nuts Using Machine Learning Integrated Hyperspectral Imaging: A Review

by Md. Ahasan Kabir, Ivan Lee, Chandra B. Singh, Gayatri Mishra, Brajesh Kumar Panda and Sang-Heon Lee

Toxins 2025, 17(5), 219; https://doi.org/10.3390/toxins17050219 - 27 Apr 2025

Viewed by 173

Abstract

Cereal grains and nuts are the world’s most produced food and the economic backbone of many countries. Food safety in these commodities is crucial, as they are highly susceptible to mold growth and mycotoxin contamination in warm, humid environments. This review explores hyperspectral [...] Read more.

Cereal grains and nuts are the world’s most produced food and the economic backbone of many countries. Food safety in these commodities is crucial, as they are highly susceptible to mold growth and mycotoxin contamination in warm, humid environments. This review explores hyperspectral imaging (HSI) integrated with machine learning (ML) algorithms as a promising approach for detecting and quantifying mycotoxins in cereal grains and nuts. This study aims to (1) critically evaluate current non-destructive techniques for processing these foods and the applications of ML in identifying mycotoxins through HSI, and (2) highlight challenges and potential future research directions to enhance the reliability and efficiency of these detection systems. The ML algorithms showed effectiveness in classifying and quantifying mycotoxins in grains and nuts, with HSI systems increasingly adopted in industrial settings. Mycotoxins exhibit heightened sensitivity to specific spectral bands within HSI, facilitating accurate detection. Additionally, selecting only relevant spectral features reduces ML model complexity and enhances reliability in the detection process. This review contributes to a deeper understanding of the integration of HSI and ML for food safety applications in cereal grains and nuts. By identifying current challenges and future research directions, it provides valuable insights for advancing non-destructive mycotoxin detection methods in the food industry using HSI. Full article

(This article belongs to the Special Issue Mycotoxins in Food and Feeds: Human Health and Animal Nutrition)

► Show Figures

Figure 1

10 pages, 5505 KiB

Open AccessArticle

TM9SF2 Maintains Golgi Integrity and Regulates Ricin-Induced Cytotoxicity

by Yue Meng, Hongzhi Wan, Xinyu Wang, Lina Zhang, Ruozheng Xin, Lingyu Li, Yuhui Wang, Chengwang Xu, Hui Peng, Lu Sun, Bo Wang and Xiaotao Duan

Toxins 2025, 17(5), 218; https://doi.org/10.3390/toxins17050218 - 26 Apr 2025

Viewed by 119

Abstract

TM9SF2 belongs to a family of highly conserved nonaspanin proteins, and has been frequently identified as one of the important host factors for a plethora of lethal pathogens and toxins in previous genome-wide screening studies. We reported herein a novel molecular mechanism of [...] Read more.

TM9SF2 belongs to a family of highly conserved nonaspanin proteins, and has been frequently identified as one of the important host factors for a plethora of lethal pathogens and toxins in previous genome-wide screening studies. We reported herein a novel molecular mechanism of TM9SF2 in mediating the cytotoxicity of ricin, a type II ribosome-inactivating protein. We first showed that TM9SF2 displays a non-redundant requirement for ricin-induced cytotoxicity within the nonaspanin family. Then we found that genetic interference of TM9SF2 substantially affects/remodels intracellular cholesterol trafficking, which results in abnormal cholesterol accumulation in Golgi compartments and causes severe Golgi fragmentation. The disruption of Golgi integrity and network impedes the retrograde transport of ricin and thus attenuates ricin-induced cytotoxicity. We further verified this mechanism by pharmacological manipulation of cholesterol metabolism (e.g., by using A939572 and avasimibe, etc.), which well restores the integrity of the Golgi apparatus and reverses the ricin-resistant phenotype induced by TM9SF2 knockdown. Our finding provides new mechanistic insights into the pathology and toxicology of ricin and could potentially be applied to other ribosome-inactivating toxins. Full article

► Show Figures

Figure 1

19 pages, 17036 KiB

Open AccessArticle

The Uremic Toxins Inorganic Phosphate, Indoxylsulphate, p-Cresylsulphate, and TMAO Induce the Generation of Sulphated Glycosaminoglycans in Aortic Tissue and Vascular Cells via pAKT Signaling: A Missing Link in the “Gut–Matrix Axis”

by Christian Freise, Susanne Metzkow, Andreas Zappe, Monika Ebert, Nicola Stolzenburg, Julia Hahndorf, Jörg Schnorr, Kevin Pagel and Matthias Taupitz

Toxins 2025, 17(5), 217; https://doi.org/10.3390/toxins17050217 - 25 Apr 2025

Viewed by 83

Abstract

Gut-derived uremic toxins (UTs) contribute to cardiovascular disorders like atherosclerosis and cardiomyopathy in patients with chronic kidney disease (CKD), causing increased cardiovascular morbidity and mortality. The intermediate steps between higher concentrations of gut-derived UTs and organ damage caused by UTs are still insufficiently [...] Read more.

Gut-derived uremic toxins (UTs) contribute to cardiovascular disorders like atherosclerosis and cardiomyopathy in patients with chronic kidney disease (CKD), causing increased cardiovascular morbidity and mortality. The intermediate steps between higher concentrations of gut-derived UTs and organ damage caused by UTs are still insufficiently understood. Glycosaminoglycans (GAGs) as components of the extracellular matrix are known to interact with various ligands such as growth factors or receptors, thereby influencing (patho)physiological processes. We previously found that the UT inorganic phosphate (Pi) induces the synthesis and sulphation of the GAGs heparan sulphate and chondroitin sulphate in the rat vascular smooth muscle cell (VSMC) line A7r5 and in the human endothelial cell (EC) line EA.Hy926. The aim of this study was to investigate if other organic UTs modulate GAGs in vascular cells as well. We treated ex vivo cultures of rat aortic rings as well as primary rat VSMCs and human ECs with the UTs Pi, indoxylsulphate (IS), p-cresylsulphate (pCS), trimethylamine N-oxide (TMAO), and urea, and analyzed the samples by histological staining, qPCR, western blot, HPLC, and colorimetric assays. The UT treatment of aortic rings and cells increased contents of sulphated GAGs and hyaluronic acid. UT-treated cells contained higher amounts of 4S- and 6S-sulphated GAGs compared to controls. This was accompanied by altered expressions of genes and proteins relevant for GAG metabolism. Mechanistically, the effects of the UTs on GAGs involve the activation of the PI3K/Akt pathway and of the transcription factor NF-κB. In conclusion, the UT-induced remodeling of the cardiovascular matrix by upregulation of sulphated GAGs and hyaluronic acid in aortic tissue and vascular cells might be a missing link between gut-derived UT and pathophysiological alterations in the cardiovascular system in the sense of a gut–matrix axis. Full article

► Show Figures

Figure 1

13 pages, 1288 KiB

Open AccessArticle

Single-Dose IncobotulinumtoxinA in the Treatment of Early-Stage Knee Osteoarthritis: Results from a Preliminary Single-Arm Clinical Trial

by Sofia Durán-Hernández, Norma E. Herrera-González, Nayar Durán-Hernández, Martha Carnalla, Manuel de Jesús Castillejos-López and Citlaltepetl Salinas-Lara

Toxins 2025, 17(5), 216; https://doi.org/10.3390/toxins17050216 - 25 Apr 2025

Viewed by 168

Abstract

Osteoarthritis (OA) is the most prevalent rheumatologic disease and a leading cause of years lived with disability worldwide. There are no disease-modifying drugs available to treat it. This study aimed to evaluate the effect of a single dose of 100U botulinum neurotoxin-A (BoNT-A) [...] Read more.

Osteoarthritis (OA) is the most prevalent rheumatologic disease and a leading cause of years lived with disability worldwide. There are no disease-modifying drugs available to treat it. This study aimed to evaluate the effect of a single dose of 100U botulinum neurotoxin-A (BoNT-A) in patients with early knee OA. We designed a single-arm preliminary clinical trial in patients diagnosed with knee OA (KOA) grades I and II. 45 Patients received a single dose of 100U IncobotulinumtoxinA in the retro-patellar bursa and received nutritional and physical rehabilitation indications. Patients were evaluated at baseline and at days 5, 30, 60, and 90 after injection. The primary outcome was the reduction in pain using the visual analog scale (VAS). Knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We assessed secondary adverse effects and measured muscular strength in every consultation. Descriptive endpoint summaries and a generalized linear random-effect model were used to evaluate changes in each follow-up time compared to baseline. IncobotulinumtoxinA treatment significantly (p < 0.001) reduced pain in all treated patients at day 90 compared to day 0. Patients showed a significant reduction in total WOMAC score (p < 0.001), from a mean baseline of 44.6 (95% CI; 41.4, 47.8) to 4.4 at day 90 (95% CI; 0.2, 0.3). Our results show that IncobotulinumtoxinA applied in the retro-patellar bursa is a safe and effective treatment for pain in patients with early-stage KOA, offering a potential alternative for symptomatic control in KOA. Full article

(This article belongs to the Collection Botulinum Toxins on Human Pain)

► Show Figures

Figure 1

16 pages, 2089 KiB

Open AccessReview

Decoding Mycoplasma Nucleases: Biological Functions and Pathogenesis

by Xinchao Yi, Ying Huang, Xinru Li, Hao Xu, Chang Liu, Chao Li, Qianrui Zeng, Haodang Luo, Zufeng Ye, Jun He and Xiaoxing You

Toxins 2025, 17(5), 215; https://doi.org/10.3390/toxins17050215 - 24 Apr 2025

Viewed by 116

Abstract

Nucleases are critical metabolic enzymes expressed by mycoplasmas to acquire nucleic acid precursors from the host for their parasitic existence. Certain nucleases, either membrane-bound or secreted, not only contribute to the growth of mycoplasmas but also serve as key virulence factors due to [...] Read more.

Nucleases are critical metabolic enzymes expressed by mycoplasmas to acquire nucleic acid precursors from the host for their parasitic existence. Certain nucleases, either membrane-bound or secreted, not only contribute to the growth of mycoplasmas but also serve as key virulence factors due to their unique spatial structures and physiological activity. The pathogenesis includes, but is not limited to, degradation of host DNA and RNA, leading to disruptions of nucleic acid metabolism and the induction of host cell apoptosis; degradation of neutrophil extracellular traps (NETs), allowing escape from neutrophil-mediated killing; and upregulation of inflammatory molecules to modulate the immune response of the host. Understanding the biological functions of nucleases is essential for gaining deeper insights into the virulence and immune evasion strategies of mycoplasmas, which can inform the development of novel approaches for the prevention, diagnosis, and treatment of mycoplasma infections. Full article

► Show Figures

Figure 1

18 pages, 1955 KiB

Open AccessArticle

Evaluation of Untargeted Metabolomic and Mycotoxin Profiles in Corn Silage and High-Moisture Corn

by Marco Lapris, Valentina Novara, Mattia Masseroni, Michela Errico, Gabriele Rocchetti and Antonio Gallo

Toxins 2025, 17(5), 214; https://doi.org/10.3390/toxins17050214 - 24 Apr 2025

Viewed by 113

Abstract

Corn silage (CS) and high-moisture corn (HMC) represent fundamental ingredients in ruminant diets; however, their chemical complexity and susceptibility to mycotoxin contamination pose challenges for feed safety and quality assessment. This study applied an innovative approach combining untargeted metabolomics and mycotoxin profiling through [...] Read more.

Corn silage (CS) and high-moisture corn (HMC) represent fundamental ingredients in ruminant diets; however, their chemical complexity and susceptibility to mycotoxin contamination pose challenges for feed safety and quality assessment. This study applied an innovative approach combining untargeted metabolomics and mycotoxin profiling through ultra-high-performance liquid chromatography–high-resolution mass spectrometry (UHPLC-HRMS) to characterize the chemical profiles of CS (n = 19) and HMC (n = 13) samples collected from four farms in northern Italy over a period of two years. Fumonisin B1 (FB1) emerged as the most prevalent mycotoxin, with contamination levels significantly higher in HMC than CS, though all the detected levels complied with European Union (EU) guidance limits. Untargeted metabolomics distinguished CS and HMC based on their metabolic signatures: polyamines, amino acids, peptides, and phenolic acids typified CS, while HMC was primarily characterized by flavonoids and mycotoxins. Geographical origin significantly influenced both mycotoxin patterns and metabolite profiles, while the sampling season showed no significant impact. This study highlights the complementary value of metabolomics and mycotoxin screening to assess feed quality, identify biomarkers, and unravel the link between fungal contamination and biochemical composition, offering a robust strategy to support feed safety management in livestock production. Full article

(This article belongs to the Special Issue Mycotoxin Contaminants in Feed: Current Status and What Should We Do?)

► Show Figures

Figure 1

15 pages, 6359 KiB

Open AccessArticle

An Elastase Inhibitor ShSPI from Centipede Attenuates Bleomycin-Induced Pulmonary Fibrosis

by Xi Lian, Bin Liu, Dan Li, Xinyao Wang, Chengbo Long, Xing Feng, Qiong Liao and Mingqiang Rong

Toxins 2025, 17(5), 213; https://doi.org/10.3390/toxins17050213 - 24 Apr 2025

Viewed by 82

Abstract

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by the fibrotic thickening of the alveolar walls, resulting in compromised gas exchange, restricted ventilation, and respiratory failure. It has been indicated that elastase inhibitors reduced the severity of IPF by neutralizing excessive [...] Read more.

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by the fibrotic thickening of the alveolar walls, resulting in compromised gas exchange, restricted ventilation, and respiratory failure. It has been indicated that elastase inhibitors reduced the severity of IPF by neutralizing excessive elastase levels in the lungs. ShSPI is an elastase inhibitor derived from centipede toxin. The present study evaluates the therapeutic effects of ShSPI in a bleomycin-induced idiopathic pulmonary fibrosis model. According to the results, ShSPI markedly reduced the weight loss, showing the improvement of health status in bleomycin-induced mice. Its robust antifibrotic effects were evidenced by the mitigation of alveolar structural damage, reduction in inflammatory cell infiltration, inhibition of collagen deposition, and suppression of fibrotic nodule formation. ShSPI effectively attenuated inflammatory responses by downregulating pro-inflammatory factors (IL-6, IL-1β, and MCP-1) and upregulating the anti-inflammatory factor interleukin-10 (IL-10). After delivered via inhalation, ShSPI exhibited favorable pharmacokinetic properties. It could be detected at 8 h at doses of 1 mg/kg and achieved maximum plasma concentrations (Cmax) of 188.00 ± 64.40 ng/mL in vivo. At high doses (160 mg/kg), ShSPI maintained a strong safety profile, with no detectable toxicity observed. This feature shows the therapeutic potential of ShSPI in the treatment of idiopathic pulmonary fibrosis and provides valuable evidence for its development as a novel peptide-based therapy. Full article

(This article belongs to the Special Issue Animals Venom in Drug Discovery: A Valuable Therapeutic Tool)

► Show Figures

Figure 1

22 pages, 2661 KiB

Open AccessArticle

The Efficacy of a Novel Water-Soluble Anti-Mycotoxin Solution in Improving Broiler Chicken Performance Under Mycotoxin Challenge

by Sayantani Sihi Arora, Anusuya Debnath, Amrita Kumar Dhara, Sudipto Haldar, Raquel Codina Moreno and Insaf Riahi

Toxins 2025, 17(5), 212; https://doi.org/10.3390/toxins17050212 - 23 Apr 2025

Viewed by 295

Abstract

Mycotoxins like aflatoxins (AFs), fumonisins (FBs), and ochratoxin A (OTA) pose serious health risks to humans and animals. Fruit pomace extracts, rich in natural nutrients and bioactive compounds, have the potential to enhance animal health and mitigate mycotoxin toxicity. This study evaluated a [...] Read more.

Mycotoxins like aflatoxins (AFs), fumonisins (FBs), and ochratoxin A (OTA) pose serious health risks to humans and animals. Fruit pomace extracts, rich in natural nutrients and bioactive compounds, have the potential to enhance animal health and mitigate mycotoxin toxicity. This study evaluated a novel liquid anti-mycotoxin solution (LAS), a combination of grape and olive pomace extract administered to broiler chickens through drinking water (2 L:1000 L) for 1–42 days under a natural multi-mycotoxin challenge. The 42-day trial with 288 one-day-old male Ross 308AP95 chicks included four experimental groups: a negative control (NC); NC+LAS; a positive control (PC) group fed a diet containing 80 μg/kg AFs, 1600 μg/kg FBs, and 50 μg/kg OTA; and PC+LAS. The growth performance, oxidative defense genes (liver), and stress biomarkers (blood) were analyzed. Mycotoxin exposure negatively affected body weight (BW), the feed conversion ratio (FCR), and the oxidative defense mechanism. LAS supplementation improved BW and the FCR, reduced Nrf-2 expression, and enhanced mycotoxin detoxification via lower EPHX1 expression. Though the LAS did not fully restore performance to NC levels, it significantly mitigated mycotoxin-induced damage. This study concluded that the LAS is a promising solution to improve broiler resilience against moderate to high mycotoxin exposure. Full article

► Show Figures

Graphical abstract

20 pages, 1936 KiB

Open AccessReview

Intravesical Onabotulinum Toxin A Injection Paradigms for Idiopathic Overactive Bladder: A Scoping Review of Clinical Outcomes, Techniques, and Implications for Practice and Future Research

by Ekene Enemchukwu, Hodan Mohamud, Shada Sinclair, Victoria Harbour, Raveen Syan, Michael Kennelly and Susanna Gunamany

Toxins 2025, 17(5), 211; https://doi.org/10.3390/toxins17050211 - 23 Apr 2025

Viewed by 152

Abstract

Introduction and Objectives: Onabotulinum toxin A (BTXA) is an effective treatment for refractory idiopathic overactive bladder (iOAB). Given the wide spectrum of patient factors and combination of symptoms, a tailored approach to management is needed. This scoping review assesses injection paradigms for iOAB. [...] Read more.

Introduction and Objectives: Onabotulinum toxin A (BTXA) is an effective treatment for refractory idiopathic overactive bladder (iOAB). Given the wide spectrum of patient factors and combination of symptoms, a tailored approach to management is needed. This scoping review assesses injection paradigms for iOAB. Prior studies have established the safety and efficacy of BTXA injections, and this review focuses on exploring variations in injection techniques that may inform more tailored approaches and support future research toward optimizing patient outcomes. Methods: We conducted a systematic literature search. Inclusion criteria included full-text English language and primary research studies assessing outcomes in adults undergoing BTXA for iOAB. Findings are summarized using narrative synthesis. Results: Forty-three articles were identified. Key findings include fewer injections (1–10 vs. 20–40) maintains efficacy while reducing procedure time, discomfort, and retreatment hesitancy. Durability appears to be lower with suburothelial and bladder base injections and higher with detrusor and bladder body injections, though these may carry an increased risk of urinary retention requiring clean intermittent catheterization. Trigone inclusion appears safe and effective without increased vesicoureteral reflux risk. Conclusions: Study heterogeneity and inconsistent reporting limit strong conclusions. Included injection paradigms demonstrated efficacy, high tolerability, symptom relief, and quality-of-life improvements with few adverse events. Further research is needed to refine optimal injection strategies to enhance patient comfort, maximize efficacy, and minimize adverse events. Future studies should ensure comprehensive data collection to clarify these associations. Full article

(This article belongs to the Special Issue Botulinum Toxin for Urinary Tract Disease: After a Decade from Approval)

► Show Figures

Figure 1

19 pages, 1929 KiB

Open AccessArticle

Molecular Diversity and Isoform Evolution in Tityus obscurus Venom: Insights from Proteomic Analysis

by Kemellyn Cristina Panchera, Lais Campelo Mendes, Ana Leonor Abrahão Nencioni, Daniel Carvalho Pimenta and Emídio Beraldo-Neto

Toxins 2025, 17(5), 210; https://doi.org/10.3390/toxins17050210 - 23 Apr 2025

Viewed by 168

Abstract

Over millions of years of evolution, natural selection has driven the specialization of predatory and defensive mechanisms in various animal species through the development of poisons and venoms. These venoms contain highly specific and selective molecules for several different targets according to the [...] Read more.

Over millions of years of evolution, natural selection has driven the specialization of predatory and defensive mechanisms in various animal species through the development of poisons and venoms. These venoms contain highly specific and selective molecules for several different targets according to the habitat and behavior of each species. In this work, we performed a comprehensive proteomic analysis of Tityus obscurus venom, identifying 45 proteins, including 8 toxins targeting K⁺ channels, 22 targeting Na⁺ channels, and 15 other venom components. Our study reveals seven novel isoforms of ion channel-targeting peptides characterized by amino acid substitutions which may influence their bioactivity and pharmacological properties. These findings contribute to our understanding of venom molecular diversity and evolution, providing new insights into peptide structure–function relationships. Considering the biomedical relevance of ion channel-modulating toxins, our work expands the repertoire of potential candidates for future drug development, particularly in the context of neuropharmacology and ion channel disorders. Full article

(This article belongs to the Special Issue New Insights into Structure and Function of Arthropod Toxins and Other Toxins: Tribute to Professor Hervé Rochat)

► Show Figures

Figure 1

14 pages, 3649 KiB

Open AccessArticle

Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients

by Antonio Déniz, Pedro Saavedra, Isabel Marrero, Samuel Barrera, Raúl Domínguez, Raúl Mendoza and Jorge Rodríguez

Toxins 2025, 17(5), 209; https://doi.org/10.3390/toxins17050209 - 22 Apr 2025

Viewed by 210

Abstract

Spasticity is a common complication in patients with neurological disorders, increasing disability and hampering quality of life. Combined treatment with focused shock waves (fESWT) and botulinum toxin (BoNT-A) has been shown to increase the effectiveness and duration of the effect of BoNT-A on [...] Read more.

Spasticity is a common complication in patients with neurological disorders, increasing disability and hampering quality of life. Combined treatment with focused shock waves (fESWT) and botulinum toxin (BoNT-A) has been shown to increase the effectiveness and duration of the effect of BoNT-A on spasticity in patients with brain injuries. We studied the effectiveness of the combination of unfocused shock waves (uESWT) and BoNT-A on spasticity. This prospective study with systematic randomization included 24 patients with brain injury, a small sample size due to clinical limitations, and spasticity was measured using the Ashworth scale (AS) for those with lower limb involvement; gait speed was assessed using the 10-m gait test (10MWT). To judge patient satisfaction with treatment, we used the Consumer Reports Effectiveness Scale-4 (CRES-4). Both uESWT and fESWT with BoNT-A resulted in a 3-point improvement in the median spasticity score, which was maintained from week 2 to week 26, and a statistically significant reduction in the 10MWT was observed. Furthermore, the proportion of patients who were very satisfied with the treatment was higher with uESWT (91%) than with fESWT (69.2%). To the authors’ knowledge, this is the first study to evaluate the added benefit of concurrent and combined treatment with uESWT and BoNT-A injections to improve spasticity in patients with stroke or multiple sclerosis and show higher patient satisfaction with the treatment. Full article

(This article belongs to the Special Issue Botulinum Toxins: New Uses in the Treatment of Diseases (2nd Edition))

► Show Figures

Figure 1

Journal Menu

Journal Browser

Toxins, Volume 17, Issue 5 (May 2025) – 12 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI