An open study of botulinum-A toxin treatment of trigeminal neuralgia.
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Afferent Pathways↗
Biomedical subjects
G Kranz
Publications and source records attributed to G Kranz.
Botulinum toxin in the treatment of rare head and neck pain syndromes: a systematic review of the literature.
BACKGROUND: Botulinum neurotoxin (BoNT) is used to treat various neurological disorders associated with pathologically increased muscle tone. Botulinum toxin inhibits the release of the neurotransmitter acetylcholine at the neuromuscular junction thereby inhibiting striatal muscle contractions. Besides the reduction in muscle tone BoNT tends to reduce pain in pain syndromes associated with muscle spasm. In addition, BoNT has been proposed as an analgesic, suggesting alternative non-cholinergic mechanisms of action.Surprisingly, BoNT was reported as a potential treatment for tension-type headache and migraine-both primary headache syndromes without an apparent muscular component-however, varying responses to BoNT have been found, overall without sufficient evidence for a general treatment. In this systematic review we set out to clarify the efficacy and safety of BoNT in the treatment of rare head and neck pain syndromes (e. g. cervicogenic headache, chronic paroxysmal hemicrania, cluster headache, trigeminal neuralgia, temporomandibular disorders, cervical dystonia and whiplash injuries). OBJECTIVES: To assess the analgesic efficacy and safety of botulinum toxins versus other medicines, placebo or no treatment in rare head and neck pain syndromes. SEARCH STRATEGY: We searched the bibliographic databases MEDLINE, EMBASE and PASCAL Biomed to May 2003. We also reviewed the reference lists from identified articles including reviews and meta-analyses of treatment studies. Furthermore we searched booklets of scientific congresses in the field of neurology for potentially relevant studies. Additional reports were identified from the reference list of the retrieved papers, and by contacting experts in the field. SELECTION CRITERIA: Randomized controlled trials (RCTs) with any dose of BoNT for rare head and neck pain syndromes, describing subjective pain assessment as either the primary or a secondary outcome, were included in this review. DATA COLLECTION AND ANALYSIS: All trials were quality scored and two independent reviewers extracted data. Results were compared for differences, and discrepancies were resolved by discussion. MAIN RESULTS: Fourteen RCTs of BoNT in cervical dystonia were included in this review. All except one showed significant pain relief following BoNT treatment compared to placebo. Studies providing dichotomous outcome data were pooled using the Peto method. The overall effect was found to be highly significant (OR 4.795 [95% CI 5.551-6.473]). For cervicogenic headache, two RCTs-one positive study and one negative study-were included. Two studies addressing chronic neck pain were included in this review. Both studies did not reveal significant effects. Furthermore, one small trial (N = 15 patients) focussing BoNT in temporomandibular disorders was included,without demonstrating significant effectiveness but a high proportion of patients lost to follow-up and a high rate of adverse effects. For the use of BoNT in cluster headache, chronic paroxysmal hemicrania and trigeminal neuralgia no RCTs were identified. Adverse effects (AEs) were found to be mild to moderate and dose-dependent. They were summarized where possible, irrespective of the formulation used and condition treated (OR = 5.066 [95% CI 2.770-9.265], number-needed-to-harm (NNH) = 5.5 [range 4.4-17]). REVIEWERS' CONCLUSIONS: There is convincing evidence for the effectiveness of BoNT in the treatment of pain associated with cervical dystonia. Due to the frequent adverse effects predominantly observed with higher doses, the trade off in risk and benefit should be carefully considered in each case. For all other rare head and neck pain syndromes we found no RCTs (cluster headache, chronic paroxysmal hemicrania, trigeminal neuralgia) and only a few small sized trials (cervicogenic headache, chronic neck pain, temporomandibular disorders). We were therefore unable to draw any definite conclusions.
Anti-Dyskinesia Agents↗
Treatment of focal hyperhidrosis with botulinum toxin type A: long-term follow-up in 61 patients.
BACKGROUND: The blocking action of botulinum toxin type A (BTX-A) on cholinergically innervated sweat glands has been used successfully to treat patients with focal hyperhidrosis. OBJECTIVES: To investigate the long-term efficacy and safety of intradermal injections of BTX-A. METHODS: We performed an open-label study in 61 patients treated over a period of 3 years for axillary or palmar hyperhidrosis. A total dose of 400 mU BTX-A (Dysport) was injected into both axillae or 460 mU BTX-A (Dysport) into both palms. The injections were repeated after relapse. Objective quantification of sweat production was performed using digitized ninhydrin-stained sheets. RESULTS: Four weeks after BTX-A treatment the median reduction in sweat production was 71% compared with baseline (P < 0.001) in the axillary group and 42% (P = 0.005) in the palmar group. Subjective assessment of sweat production by the patients using a visual analogue scale (0, no sweating; 100, the most severe sweating) showed a significant reduction in both the axillary (P < 0.001) and palmar groups (P < 0.001). Secondary disturbances due to focal hyperhidrosis interfering with daily activities were markedly improved in both groups. The median time interval between the sets of injections was 34 weeks for axillary hyperhidrosis and 25 weeks for palmar hyperhidrosis. The treatment of palmar hyperhidrosis was complicated by transient but not disabling weakness of the small hand muscles in nine of 21 patients. CONCLUSIONS: Repeated intradermal injections of BTX-A in patients with axillary and palmar hyperhidrosis are as effective as first treatments.
Adult↗
[Botulinum toxin in the treatment of focal hyperhidrosis].
INTRODUCTION: Botulinum A toxin (BTX-A) acts primarily at peripheral cholinergic synapses, inhibiting the release of acetylcholine. Initially it has been used to block the neuromuscular junction in focal dystonic and spastic syndromes. Recently there has been suggestions for potential clinical indications in non-muscular diseases where cholinergic terminals play a role. GUSTATORY SWEATING: In 1995 physicians reported a long-lasting anhidrotic effect of intracutaneous BTX-A injections in patients suffering from gustatory sweating (Frey's syndrome). Consequently, a number of clinical studies demonstrated good efficacy of intradermal injections of botulinumtoxin in patients with focal hyperhidrosis. FOCAL HYPERHIDROSIS OF THE PALMS AND AXILLAE: Focal hyperhidrosis is usually confined to the palms and axillae. Excessive sweating may be a social handicap and an occupational hazard. The management of focal hyperhidrosis remains controversial. Topical antiperspirants are only effective in very mild cases. Iontophoresis with tap water or anticholinergic drugs is messy and time consuming with only short-lived effect. Sympathectomy, the cornerstone of surgical management, is usually effective in palmar hyperhidrosis. Complications of this technique include surgical risks, postoperative and cosmetic problems and compensatory hyperhidrosis. AXILLARY HYPERHIDROSIS: Several studies confirmed that intracutaneous injections of botulinum toxin are useful in the majority of patients with axillary hyperhidrosis resistant to conventional treatment. In axillary hyperhidrosis total doses are ranging from 200-400 mU Dysport or from 80 to 130 mU Botox to reach a good clinical response. Injections are usually well tolerated and no serious side-effects have been observed. The mean duration of anhidrotic effect ranges between 3 and 9 weeks. PALMAR HYPERHIDROSIS: The use of botulinumtoxin in patients with palmar hyperhidrosis is rather difficult. The therapeutic window is smaller because injections are complicated by transient weakness of the small hand-muscles. Furthermore the injections at the palms are painful which can be overcomed by application of local anaesthetics or the blockade of the ulnar and median nerves. The duration of anhidrotic effect ranges from 20 to 50 weeks. CONCLUSION: Intracutaneous injections of botulinum-toxin should be offered to patients with focal hyperhidrosis of the palms and axillae causing serious social, psychologic and occupational problems, resistant to other conventional treatment options.
Axilla↗
Kidney function during common carotid artery occlusion in anaesthetized cats: influence of vagotomy, constant ventilation, blood pressure stabilization, and carotid body chemoreceptor inactivation.
The reactions of kidney function elicited by bilateral common carotid artery occlusion were studied in six groups of chloralosed cats in which the Nn. vagi, the breathing reaction, the increase of the mean systemic arterial blood pressure, and the carotid body chemoreceptors were excluded successively. Carotid occlusion in the control animals caused a rise of the mean systemic arterial blood pressure, hyperventilation, and an increase in renal sodium and water excretion, resulting from an inhibition of tubular reabsorption. Bilateral cervical vagotomy, relaxation and constant artificial ventilation only slightly modified this renal response. Inactivation of the carotid body chemoreceptors in vagotomized and constantly ventilated cats attenuated the natriuresis due to carotid occlusion regardless of the behaviour of the renal perfusion pressure. On the other hand, keeping the mean arterial blood pressure during carotid occlusion constant by the bleeding technique also reduced the natriuretic reaction. Cats with both inactivated carotid body chemoreceptors and constant renal perfusion pressure exhibited an antinatriuretic reaction during carotid clamping. From these data it is concluded that in narcotized cats the natriuretic response during carotid occlusion is the result of both a stimulation of the carotid body chemoreceptors and the rise of the renal perfusion pressure. In contrast, in dogs this so-called carotid-sinus-polyuria seems to be induced solely by the increase of the systemic arterial blood pressure. The findings additionally indicated that the arterial chemoreceptors may be involved in the physiological daily control of renal sodium excretion already at normal arterial oxygen tension under sea-level conditions.
Anesthesia↗
[Microbiological degradation of glucosinolates in defatted rapeseed meal].
During the degradation of thioglucosides in defatted rape seed meal (RES) microorganisms were found, whose ability to degrade glucosinolates (GSL) and vinyl thio-oxazolidone (VTO) was not known so far. The isolated microorganisms are two strains of bacteria of the species Bacillus cereus and the yeast Trichosporon cutaneum. The degradation of GSL and VTO in the cultural broths by the Bacillus cereus strains was the more complete the more other Gram-negative bacteria from RES were additionally present. Drinking tests with Wistar rats showed that here is a relation between the watersoluble and mainly bitter toxin substances of rape and their influence on the increase of the animals body weight.
Animals↗
Hydrocortisone (cortisol) concentration and penetration gradient.
Hydrocortisone (Cortisol) was incorporated into four different ointments at four concentrations (0.1% 0.3%, 1%, and 3%) and the amounts of the drug penetrating from these preparations into the different layers of excised skin were investigated. The effect of removing the horny layer on the penetration was also determined. Below a level of 1% ointments with intact horny layer and 0.3% with removed layer, a change in the ointment concentration alters the tissue concentration in the ratio 1:1. Above this level doubling of the concentration in the ointments causes an increase of tissue concentrations of only 20-50%. The removal of the horny layer increases the dermal concentrations 100 fold at each ointment concentration. Furthermore, a vasoconstriction test was performed with the different ointments. An increase in the concentrations above the 1% level failed to increase the effect on the vascular system of the skin. The in vitro and in vivo results are discussed with respect to the consequences on affected skin and the therapeutic efficacy of steroid preparations of different concentrations.
Administration, Topical↗
Some characteristics of optokinetic eye-movement patterns: a comparative study.
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Adaptation, Physiological↗