Botulinum toxin type A

Bose-Einstein condensation, 17 352 Bosons, 17 352 Boswellic acids, 24 557 Botox (Clostridium botulinum toxin type A), 2 816 Bottle centrifuge operation, 5 528-529 theory of performance, 5 507-508 Bottle polymerizatioi, 20 376 Bottles... 

Botulinum toxin from Clostridium botulinum is the most potent poison known. The lethal dose in an adult is approx. 3x10 mg. The toxin blocks exo-cytosis of ACh in motor (and also parasympathetic) nerve endings. Death is caused by paralysis of respiratory muscles. Injected intramuscularly at minuscule dosage, botulinum toxin type A is used to treat blepharospasm, strabismus, achalasia of the lower esophageal sphincter, and spastic aphonia. 

Powder for injection (vacuum-dried) 100 units of vacuum-dried Clostridium botulinum toxin type A neurotoxin complex- (Rx)... 

Reconstitute with 0.9% sterile, nonpreserved saline (100 units in 2.5 mL saline) prior to IM injection. The resulting formulation will be 4 units/0.1 mL and a total treatment dose of 20 units in 0.5 mL. The duration of activity of botulinum toxin type A for glabellar lines is approximately 3 to 4 months. Injection intervals should be no more frequent than every 3 months and should be performed using the lowest effective dose. The safety and efficacy of more frequent dosing have not been clinically evaluated more frequent dosing is not recommended. 

Primary axillary hyperhidrosis (Botox only) The recommended dose is 50 units per axilla. Define the hyperhidrotic area to be injected using standard staining techniques (eg. Minor s Iodine-Starch Test). Botulinum toxin type A is reconstituted with 0.9% nonpreserved sterile saline (100 units/4 mL). Using a 30-gauge needle, 50 units of botulinum toxin type A (2 mL) is injected intradermally in 0.1 to 0.2 mL aliquots to each axilla evenly distributed in multiple sites (10 to 15) approximately 1 to 2 cm apart. 

Blepharospasm (Botox only) For blepharospasm, reconstituted botulinum toxin type A is injected using a sterile, 27- to 30-gauge needle without electromyographic guidance. The initial recommended dose is 1.25 to 2.5 units (0.05 to 0.1 mL volume at... 

Strabismus (Botox only) The volume of botulinum toxin type A injected for treatment of strabismus should be between 0.05 to 0.15 mL per muscle. 

Doses The initial listed doses of the reconstituted botulinum toxin type A typically create paralysis of injected muscles beginning 1 to 2 days after injection and increasing in intensity during the first week. The paralysis lasts for 2 to 6 weeks and gradually resolves over a similar time period. Overcorrections lasting over 6 months have been rare. Approximately one half of patients will require subsequent doses because of inadequate paralytic response of the muscle to the initial dose, or mechanical factors such as large deviations or restrictions, or the lack of binocular motor fusion to stabilize the alignment. 

Cardiovascular events There have been rare reports following administration of botulinum toxin type A for other indications of adverse events involving the cardiovascular system, including arrhythmia and Ml, some with fatal outcomes. Some of these patients had risk factors including pre-existing cardiovascular disease. 

Lactation It is not known whether this drug is excreted in breast milk. Exercise caution when botulinum toxin type A is administered to a nursing woman. 

Safe and effective use Safe and effective use of botulinum toxin type A depends upon proper storage of the product, selection of the correct dose, and proper reconstitution and administration techniques. Physicians administering botulinum toxin type A must understand the relevant neuromuscular or orbital anatomy of the area involved and any alterations to the anatomy caused by prior surgical procedures. An understanding of standard electromyographic techniques is also required for treatment of strabismus and may be useful for the treatment of CD. 

Retrobulbar hemorrhages During the administration of botulinum toxin type A for the treatment of strabismus, retrobulbar hemorrhages sufficient to compromise retinal circulation have occurred from needle penetrations into the orbit. It is recommended that appropriate instruments to decompress the orbit be accessible. Ocular (globe) penetrations by needles have also occurred. An ophthalmoscope to diagnose this condition should be available. Inducing paralysis in 1 or more extraocular P.788... 

Administration Inject botulinum toxin type A (cosmetic) no more frequently than every 3 months and perform using the lowest effective dose. 

Injection site Use caution when botulinum toxin type A treatment is used in the presence of inflammation at the proposed injection site(s) or when excessive weakness or atrophy is present in the target muscle(s). 

Immunogenicity Treatment with botulinum toxin type A may result in the formation of antibodies that may reduce the effectiveness of subsequent treatments with botulinum toxin type A for glabellar lines or other indications. 

The results from some studies suggest that botulinum toxin type A injections at more frequent intervals or at higher doses may lead to greater incidence of antibody formation. The potential for antibody formation may be minimized by injecting with... 

The effect of administering different botulinum neurotoxin serotypes at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin. Aminoglycosides Cautiously perform coadministration of botulinum toxin type A and aminoglycosides or other agents interfering with neuromuscular transmission (eg, curare-like nondepolarizing blockers, lincosamides, polymyxins, quinidine, magnesium sulfate, anticholinesterases, succinylcholine chloride) because the effect of the toxin may be potentiated. 

In general, adverse events occur within the first week following injection of botulinum toxin type A and, while generally transient, may have a duration of several months. CD. Adverse reactions in at least 3% of patients include dysphagia, upper respiratory infection, neck pain, headache, dyspnea, increased cough, flu syndrome, back pain, rhinitis, dizziness, hypertonia, injection site soreness, asthenia, oral dryness, speech disorder, fever, nausea, and drowsiness. 

Primary axillary hyperhidrosis Adverse events (in at least 3% of patients) included injection site pain and hemorrhage, nonaxillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety. Blepharospasm The most frequently reported treatment-related adverse reactions were ptosis (20.8%), superficial punctate keratitis (6.3%), and eye dryness (6.3%). Strabismus Extraocular muscles adjacent to the injection site can be affected, causing ptosis, vertical deviation, spatial disorientation, double vision, or past-pointing, especially with higher doses of botulinum toxin type A. 

Botulinum Toxin Type A (Botox, Botox Cosmetic, Myobloc, Dysport)... 

Neuromuscular paralytic agents botulinum toxin type A... 

Nolan KW, Cole LL, Liptak GS Use of botulinum toxin type A in children with cerebral palsy. Phys Ther 2006 86 573. [PMID 16579673]... 

Aoki KR. Pharmacology and immunology of botulinum toxin type A. Clin Dermatol. 2003 21 476-480. 

Bakheit AM, Fedorova NV, Skoromets AA, et al. The beneficial antispasticity effect of botulinum toxin type A is maintained after repeated treatment cycles. J Neurol Neurosurg Psychiatry. 2004 75 1558-1561. 

Costa J, Borges A, Espirito-Santo C, et al. Botulinum toxin type A versus botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev. 2005 CD004314. 

Gordon MF, Brashear A, Elovic E, et al. Repeated dosing of botulinum toxin type A for upper limb spasticity following stroke. Neurology. 2004 63 1971-1973. 

Sarioglu B, Serdaroglu G, Tutuncuoglu S, Ozer EA. The use of botulinum toxin type A treatment in children with spasticity. Pediatr Neurol. 2003 29 299-301. 

This chapter deals with botulinum toxin type A (BOTOX) in the treatment of strabismus, blepharospasm, and related disorders. Botulinum toxin type A (BOTOX) has been used to treat strabismus, blepharospasm, Meige s syndrome, and spasmodic torticollis. By preventing acetylcholine release at me neuromuscular junction, botulinum toxin A usually causes a temporary paralysis of the locally injected muscles. The variability in duration of paralysis may be related to me rate of developing antibodies to me toxin, upregulation of nicotinic cholinergic postsynaptic receptors, and aberrant regeneration of motor nerve fibers at me neuromuscular junction. Complications related to this toxin include double vision (diplopia) and lid droop (ptosis). 

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