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Special Issue "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)

Special Issue Editor

Guest Editor
Prof. Dr. Andrea Santamato

Physical Medicine and Rehabilitation Section, Riuniti Hospital, University of Foggia, Italy
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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

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Keywords

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

Published Papers (3 papers)

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Research

Open AccessArticle
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
Received: 11 March 2019 / Revised: 2 April 2019 / Accepted: 4 April 2019 / Published: 8 April 2019
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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)
Open AccessArticle
Efficacy of Early Endoscopic Intervention for Restoring Normal Swallowing Function in Patients with Lateral Medullary Infarction
Received: 4 January 2019 / Revised: 11 February 2019 / Accepted: 19 February 2019 / Published: 4 March 2019
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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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Figure 1

Open AccessArticle
AbobotulinumtoxinA: A New Therapy for Hip Osteoarthritis. A Prospective Randomized Double-Blind Multicenter Study
Toxins 2018, 10(11), 448; https://doi.org/10.3390/toxins10110448
Received: 13 October 2018 / Revised: 25 October 2018 / Accepted: 26 October 2018 / Published: 31 October 2018
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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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