Toxins

Research

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))

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14 pages, 2891 KiB

Open AccessArticle

Can Botulinum Toxin Type E Serve as a Novel Therapeutic Target for Managing Chronic Orofacial Pain?

by Sung-Koog Jung, Yu-Mi Kim, Min-Jeong Jo, Jo-Young Son, Jin-Sook Ju, Min-Kyoung Park, Min-Kyung Lee, Jae-Young Kim, Jeong-Sun Nam and Dong-Kuk Ahn

Toxins 2025, 17(3), 130; https://doi.org/10.3390/toxins17030130 - 10 Mar 2025

Viewed by 620

Abstract

The existing literature offers limited experimental evidence on the role of botulinum neurotoxin type E (BoNT-E) in pain transmission. The present study investigated the antinociceptive effects of subcutaneously administered BoNT-E in chronic orofacial pain conditions. This study used orofacial formalin-induced pronociceptive behavior and [...] Read more.

The existing literature offers limited experimental evidence on the role of botulinum neurotoxin type E (BoNT-E) in pain transmission. The present study investigated the antinociceptive effects of subcutaneously administered BoNT-E in chronic orofacial pain conditions. This study used orofacial formalin-induced pronociceptive behavior and complete Freund’s adjuvant (CFA)-induced thermal hyperalgesia as inflammatory pain models in male Sprague Dawley rats. A neuropathic pain model was also developed by causing an injury to the inferior alveolar nerve. Subcutaneously administered BoNT-E (6, 10 units/kg) significantly reduced nociceptive behavior during the second phase of the formalin test compared to that of the vehicle treatment. These doses similarly alleviated thermal hypersensitivity in the CFA-treated rats. Moreover, BoNT-E (6, 10 units/kg) markedly attenuated mechanical allodynia in rats with an inferior alveolar nerve injury. At a dose of 10 units/kg, BoNT-E produced antinociceptive effects that became evident 8 h post-injection and persisted for 48 h. Notably, BoNT-E (10 units/kg) significantly reduced the number of c-fos-immunostained neurons in the trigeminal subnucleus caudalis of rats with an inferior alveolar nerve injury. In comparison, intraperitoneally administered gabapentin (30, 100 mg/kg) demonstrated significant mechanical anti-allodynic effects but exhibited lower analgesic efficacy than that of BoNT-E. These findings highlight the potential of BoNT-E as a therapeutic agent for chronic pain management. Full article

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

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18 pages, 18199 KiB

Open AccessArticle

Comparison of Neural Recovery Effects of Botulinum Toxin Based on Administration Timing in Sciatic Nerve-Injured Rats

by Minsu Seo, Seokjoon Hwang, Tae Heon Lee and Kiyeun Nam

Toxins 2024, 16(9), 387; https://doi.org/10.3390/toxins16090387 - 5 Sep 2024

Viewed by 1418

Abstract

This study aimed to assess the effects of the timing of administering botulinum neurotoxin A (BoNT/A) on nerve regeneration in rats. Sixty 6-week-old rats with a sciatic nerve injury were randomly divided into four groups: the immediately treated (IT) group (BoNT/A injection administered [...] Read more.

This study aimed to assess the effects of the timing of administering botulinum neurotoxin A (BoNT/A) on nerve regeneration in rats. Sixty 6-week-old rats with a sciatic nerve injury were randomly divided into four groups: the immediately treated (IT) group (BoNT/A injection administered immediately post-injury), the delay-treated (DT) group (BoNT/A injection administered one week post-injury), the control group (saline administered one week post-injury), and the sham group (only skin and muscle incisions made). Nerve regeneration was assessed 3, 6, and 9 weeks post-injury using various techniques. The levels of glial fibrillary acid protein (GFAP), astroglial calcium-binding protein S100β (S100β), growth-associated protein 43 (GAP43), neurofilament 200 (NF200), and brain-derived neurotrophic factor (BDNF) in the IT and DT groups were higher. ELISA revealed the highest levels of these proteins in the IT group, followed by the DT and control groups. Toluidine blue staining revealed that the average area and myelin thickness were higher in the IT group. Electrophysiological studies revealed that the CMAP in the IT group was significantly higher than that in the control group, with the DT group exhibiting significant differences starting from week 8. The findings of the sciatic functional index analysis mirrored these results. Thus, administering BoNT/A injections immediately after a nerve injury is most effective for neural recovery. However, injections administered one week post-injury also significantly enhanced recovery. BoNT/A should be administered promptly after nerve damage; however, its administration during the non-acute phase is also beneficial. Full article

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

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Review

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15 pages, 1288 KiB

Open AccessReview

Botulinum Toxin for the Treatment of Raynaud’s Conditions of the Hand: Clinical Practice Updates and Future Directions

by Patrick O’Donohoe, Jake McDonnell, Justin Wormald, Lylas Aljohmani, Kevin Cronin, Laura Durcan, Oran Kennedy and Roisin Dolan

Toxins 2024, 16(11), 472; https://doi.org/10.3390/toxins16110472 - 1 Nov 2024

Viewed by 1766

Abstract

Raynaud’s conditions of the hand, referred to commonly as Raynaud’s phenomenon, both primary and secondary, represents a spectrum of disorders affecting the digits, characterised by recurrent episodes of vasospasm that result in a triad of symptoms: pain, pallor, and cyanosis. Various therapies, ranging [...] Read more.

Raynaud’s conditions of the hand, referred to commonly as Raynaud’s phenomenon, both primary and secondary, represents a spectrum of disorders affecting the digits, characterised by recurrent episodes of vasospasm that result in a triad of symptoms: pain, pallor, and cyanosis. Various therapies, ranging from conservative hand therapy techniques to surgical sympathectomy, have been explored with inconsistent results. Recently, the local administration of botulinum toxin type-A (BTX-A) has re-emerged as a treatment option for this condition. This review delves into the mechanistic pathways of BTX-A therapy, optimal dosing concentrations, administration techniques, and its safety profile. A critical analysis of published studies to date demonstrates varied clinical efficacy of BTX-A in Raynaud’s conditions based on patient-reported outcome measures and objective measures of outcomes assessment. Thus, in order to accurately assess the clinical effectiveness of BTX-A in future robust studies, this review emphasises the importance of streamlining patient selection to minimise heterogeneity in disease severity, optimising recruitment to ensure adequate statistical power, and establishing sensitive outcome measures to monitor response and discern treatment efficacy. Additionally, addressing concerns such as minimising antibody resistance, extending the duration of treatment effects on tissues, and exploring new modalities to assess hand perfusion will be focal points for future research and BTX-A drug development. Full article

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

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11 pages, 1767 KiB

Open AccessReview

Botulinum Toxin Treatment of Psoriasis—A Comprehensive Review

by Ali Ghaseminejad-Bandpey, Shahroo Etemadmoghadam and Bahman Jabbari

Toxins 2024, 16(10), 449; https://doi.org/10.3390/toxins16100449 - 18 Oct 2024

Cited by 1 | Viewed by 1816

Abstract

A literature search on the subject of botulinum toxin treatment in psoriasis found 15 relevant articles, 11 on human subjects and 4 on animal studies. Of the human data, eight were clinical trials and three were single case reports. Seven out of eight [...] Read more.

A literature search on the subject of botulinum toxin treatment in psoriasis found 15 relevant articles, 11 on human subjects and 4 on animal studies. Of the human data, eight were clinical trials and three were single case reports. Seven out of eight clinical trials, all open-label, reported improvement in psoriasis following intradermal or subcutaneous botulinum toxin injections. One double-blind, placebo-controlled study, which used a smaller dose than the open-label studies, did not note a healing effect. Animal studies have shown that injection of botulinum toxins in the skin heals psoriatic skin lesions and can reduce the level of interleukins (ILs) and cytokines as well as inflammatory cells in psoriatic plaques. There is a need for controlled, blinded studies conducted in larger numbers of patients with doses that have shown promise in open-label studies. Full article

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

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15 pages, 2730 KiB

Open AccessReview

Ultrasound-Guided Botulinum Toxin-A Injections into the Masseter Muscle for Both Medical and Aesthetic Purposes

by Marius Nicolae Popescu, Cristina Beiu, Carmen Andrada Iliescu, Andreea Racoviță, Mihai Berteanu, Mădălina Gabriela Iliescu, Ana Maria Alexandra Stănescu, Diana Sabina Radaschin and Liliana Gabriela Popa

Toxins 2024, 16(10), 413; https://doi.org/10.3390/toxins16100413 - 24 Sep 2024

Cited by 6 | Viewed by 3824

Abstract

With the increasing use of Botulinum toxin type A (BoNT-A) injections in the masseter muscles for both medical and aesthetic purposes, there is a constant need to continually enhance the efficacy of these treatments and reduce the risk of potential adverse events. This [...] Read more.

With the increasing use of Botulinum toxin type A (BoNT-A) injections in the masseter muscles for both medical and aesthetic purposes, there is a constant need to continually enhance the efficacy of these treatments and reduce the risk of potential adverse events. This review provides an in-depth analysis of the masseter muscle’s anatomical structure and essential landmarks and emphasizes the advantages of ultrasound (US) guidance in improving the precision of BoNT-A injections compared to conventional blind methods. The review is supplemented with comprehensive figures, including graphics, clinical images, and ultrasound visuals, to support the discussion. Potential complications such as paradoxical bulging, inadvertent injections into the risorius muscle or parotid gland, facial paralysis, and the risk of bone resorption are examined. Future research should aim at refining injection techniques and assessing the long-term effects of repeated treatments to ensure optimal patient care and safety. Full article

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

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Other

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19 pages, 1146 KiB

Open AccessSystematic Review

Botulinum Toxin in the Treatment of Hair and Scalp Disorders: Current Evidence and Clinical Applications

by Sofia M. Perez, Sarah A. AlSalman, Betty Nguyen and Antonella Tosti

Toxins 2025, 17(4), 163; https://doi.org/10.3390/toxins17040163 - 25 Mar 2025

Viewed by 960

Abstract

Botulinum toxin (BoNT) is well-recognized throughout dermatology for its cosmetic indications and growing therapeutic value. Recent studies have trialed BoNT in the treatment of hair and scalp disorders, many of which lack long-term effective treatments and significantly impact quality of life. In this [...] Read more.

Botulinum toxin (BoNT) is well-recognized throughout dermatology for its cosmetic indications and growing therapeutic value. Recent studies have trialed BoNT in the treatment of hair and scalp disorders, many of which lack long-term effective treatments and significantly impact quality of life. In this review, we summarize the current clinical literature on this topic to comprehensively evaluate the efficacy, safety, and clinical value of BoNT in treating hair and scalp conditions. A literature search on PubMed/MEDLINE and Scopus identified 40 articles reporting the use of 25–200 units of BoNT-A or B in 689 patients with hair loss (79.5%), scalp seborrheic dermatitis/hyperseborrhea (10%), craniofacial hyperhidrosis (9%), folliculitis decalvans/dissecting folliculitis (0.86%), scalp pain (0.43%), or linear scleroderma (0.29%). Most studies on BoNT therapy for androgenetic alopecia (AGA) reported mild or non-significant hair growth; however, considerable variability in outcome measures complicates the ability to draw definitive conclusions or justify the use of BoNT over established AGA therapies. BoNT-A and B showed consistent efficacy in treating craniofacial hyperhidrosis with minimal side effects. Additional scalp conditions may benefit from BoNT therapy, but the evidence is limited, and larger, controlled studies are needed to better understand BoNT’s clinical value in these conditions. Full article

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

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10 pages, 1878 KiB

Open AccessBrief Report

Botulinum Toxin and Deep Brain Stimulation in Dystonia

by Julia Carvalhinho Carlos de Souza, Ananda Carolina Moraes Falcone, Renata Montes Garcia Barbosa, Miriam Carvalho Soares, Renato P. Munhoz, Marina Farah, Tamine Capato, Sara Carvalho Barbosa Casagrande, Marcela Ferreira Cordellini, Gabriel de Castro Micheli, João Carlos Papaterra Limongi, Egberto Reis Barbosa, Clarice Listik and Rubens Gisbert Cury

Toxins 2024, 16(6), 282; https://doi.org/10.3390/toxins16060282 - 20 Jun 2024

Cited by 2 | Viewed by 1807

Abstract

Deep Brain Stimulation (DBS) is a recognized treatment for different dystonia subtypes and has been approved by the Food and Drug Administration (FDA) since 2003. The European Federation of Neurological Societies (EFNS) and the International Parkinson and Movement Disorders Society (MDS) recommend DBS [...] Read more.

Deep Brain Stimulation (DBS) is a recognized treatment for different dystonia subtypes and has been approved by the Food and Drug Administration (FDA) since 2003. The European Federation of Neurological Societies (EFNS) and the International Parkinson and Movement Disorders Society (MDS) recommend DBS for dystonia after failure of botulinum toxin (BoNT) and other oral medications for dystonia treatment. In addition, several long-term studies have demonstrated the continuous efficacy of DBS on motor and quality of life (QoL) scores. However, there are only a few reports comparing the overall impact of surgical treatment in BoNT protocols (e.g., dosage and number of selected muscles before and after surgery). This retrospective multicenter chart-review study analyzed botulinum toxin total dosage and dosage per muscle in 23 dystonic patients before and after DBS surgery. The study’s primary outcome was to analyze whether there was a reduction in BoNT dosage after DBS surgery. The mean BoNT dosages difference between baseline and post-surgery was 293.4 units for 6 months, 292.6 units for 12 months, and 295.2 units at the last visit. The median total dose of BoNT in the preoperative period was 800 units (N = 23). At the last visit, the median was 700 units (p = 0.05). This represents a 12.5% reduction in BoNT median dosage. In conclusion, despite the limitations of this retrospective study, there was a significant reduction in BoNT doses after DBS surgery in patients with generalized dystonia. Full article

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

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