RESUMEN
PURPOSE: To evaluate the influence of patients' serum vitamin D levels on muscle strength characteristics and whether it impacts the durability of botulinum toxin (BT) treatment. METHODS: The muscle strength of the frontal and corrugator muscles was evaluated before and after the application of TB with pre- and post-application control measurements, and at weeks 2, 5 and 12. The effect of vitamin D on muscle strength and its interaction with BT were investigated in 20 patients. The muscle contraction force was measured by surface electromyography. RESULTS: The results revealed statistically significant differences between the frontal measurement groups at weeks 2 and 5, as well as for the corrugator in the same weeks and at week 12. Regarding vitamin D, significant differences were observed only in the initial group with vitamin D > 30 ng/mL compared to < 30 ng/mL for the frontal muscles. Patients with higher levels of vitamin D had higher average muscle strength compared to those with lower levels in all evaluations. CONCLUSIONS: It was observed that vitamin D influences muscle strength and the necessary dosage of BT.
Asunto(s)
Electromiografía , Fuerza Muscular , Vitamina D , Humanos , Electromiografía/efectos de los fármacos , Electromiografía/métodos , Fuerza Muscular/efectos de los fármacos , Vitamina D/sangre , Vitamina D/administración & dosificación , Masculino , Femenino , Adulto , Persona de Mediana Edad , Contracción Muscular/efectos de los fármacos , Contracción Muscular/fisiología , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/farmacología , Adulto Joven , Fármacos Neuromusculares/administración & dosificación , Fármacos Neuromusculares/farmacología , Músculos Faciales/efectos de los fármacos , Músculos Faciales/fisiología , Factores de Tiempo , Toxinas Botulínicas/administración & dosificaciónRESUMEN
BACKGROUND: In patients with large ventral hernias, botulinum toxin to external and internal oblique muscles decreases thickness and increases length. We examined the impact of botulinum toxin in the amount of loss of domain according to two ratios and in hernia size. METHODS: Between October 2021 and November 2023, 20 patients with ventral hernias measuring 10 cm or more on the horizontal size underwent the administration of 50 units of botulinum toxin to each external and each internal oblique muscle 4 weeks before their surgery. Incisional hernia volume to peritoneal volume ratio, volume ratio, and hernia size were compared before and 4 weeks after the injection of botulinum toxin. Comparisons between all variables obtained before and after the administration of botulinum toxin were performed using either the paired t-test or the Wilcoxon signed-rank test. Pearson correlation coefficient was used to analyze associations between initial conditions and further changes observed after botulinum toxin injection. RESULTS: We observed a 42% reduction in muscle amplitude, 16% increase in intra-abdominal volume, 28% decrease in herniated volume, decreases of 6% in IHV/PV ratio and of 11% in V ratio, 11% reduction of hernia width, and decrease of 10% in rectangular and elliptical hernia areas. CONCLUSIONS: In patients with large ventral hernias, botulinum toxin is associated with reduction of hernia size and decrease in loss of domain, the latter not being significant when less than 10% of the visceral block is herniated.
Asunto(s)
Pared Abdominal , Toxinas Botulínicas Tipo A , Hernia Ventral , Hernia Incisional , Humanos , Pared Abdominal/cirugía , Músculos Abdominales/cirugía , Toxinas Botulínicas Tipo A/uso terapéutico , Toxinas Botulínicas Tipo A/farmacología , Herniorrafia , Hernia Ventral/tratamiento farmacológico , Hernia Ventral/cirugía , Hernia Incisional/cirugía , Mallas QuirúrgicasRESUMEN
BACKGROUND: It has been reported that botulinum toxin type A (BoNT-A) produces structural changes in masticatory muscles. However, not all histomorphometric parameters affected by BoNT-A parameters have been assessed. This study investigated the histomorphometric changes in the masseter muscle of rats after a single injection of BoNT-A. METHODS: Forty-four adult animals were randomly divided into control group (n = 22) and BoNT-A group (n = 22). Controls received a single dose of 0.14 mL/kg of saline in masseter muscles, and the BoNT-A group received a 7 U/Kg of BoNT-A. The groups received the same volume of injected substances. Animals were sacrificed on 7th (n = 5), 14th (n = 5), 21st (n = 5), 28th (n = 4) and 90th (n = 3) days post-treatment. Histological masseter tissue slides were obtained from hematoxylin-eosin treatment and analyzed in optical microscopy regarding muscle cross-sectional area, amount of connective tissue and quantity and diameter of myocytes. For statistical analysis, generalized linear models were used to compare the data (ANOVA). In all test, the significance level of 5% was set. RESULTS: BoNT-A values of cross-sectional area of the masseter muscle were significantly lower than controls (p < 0.01) throughout the study. Regarding myocytes quantity, BoNT-A subgroups presented higher values than controls (p < 0.0001) since the 14th day until the end of the study; however, the diameter of myocytes was smaller in all BoNT-A subgroups (p < 0.0001) in all assessment points. The amount of connective tissue was higher in BoNT-A subgroups (p < 0.0001) throughout the study. CONCLUSION: A single injection of BoNT-A altered the structure of masseter muscle of rats, regarding its histomorphometric parameters. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Toxinas Botulínicas Tipo A , Ratas , Animales , Toxinas Botulínicas Tipo A/farmacología , Músculo Masetero/patología , Inyecciones IntramuscularesRESUMEN
Improvements in Botulinum toxin type-A (BoNT-A) aesthetic treatments have been jeopardized by the simplistic statement: "BoNT-A treats wrinkles". BoNT-A monotherapy relating to wrinkles is, at least, questionable. The BoNT-A mechanism of action is presynaptic cholinergic nerve terminals blockage, causing paralysis and subsequent muscle atrophy. Understanding the real BoNT-A mechanism of action clarifies misconceptions that impact the way scientific productions on the subject are designed, the way aesthetics treatments are proposed, and how limited the results are when the focus is only on wrinkle softening. We designed a systematic review on BoNT-A and muscle atrophy that could enlighten new approaches for aesthetics purposes. A systematic review, targeting articles investigating BoNT-A injection and its correlation to muscle atrophy in animals or humans, filtered 30 publications released before 15 May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Histologic analysis and histochemistry showed muscle atrophy with fibrosis, necrosis, and an increase in the number of perimysial fat cells in animal and human models; this was also confirmed by imaging studies. A significant muscle balance reduction of 18% to 60% after single or seriated BoNT-A injections were observed in 9 out of 10 animal studies. Genetic alterations related to muscle atrophy were analyzed by five studies and showed how much impact a single BoNT-A injection can cause on a molecular basis. Seriated or single BoNT-A muscle injections can cause real muscle atrophy on a short or long-term basis, in animal models and in humans. Theoretically, muscular architecture reprogramming is a possible new approach in aesthetics.
Asunto(s)
Toxinas Botulínicas Tipo A/efectos adversos , Toxinas Botulínicas Tipo A/farmacología , Músculo Esquelético/efectos de los fármacos , Atrofia Muscular/inducido químicamente , Humanos , Inyecciones IntramuscularesRESUMEN
This systematic review investigated the effectiveness and safety of botulinum toxin type A (BTX-A) for painful temporomandibular disorders. We searched for randomized controlled trials (RCTs) in 10 databases, from inception to February 12, 2019 (MEDLINE, EMBASE, CENTRAL, LILACS, BBO, Web of Science, Scopus, ClinicalTrials.gov, WHO and OpenGrey). We included 12 RCTs that compared BTX-A versus inactive or active interventions. BTX-A was slightly more effective than placebo for pain reduction at 1 month: mean difference -1.74 points (0-10 scale), 95% confidence interval -2.94 to -.54, 3 RCTs, 60 participants, I-square (I2)â¯=â¯0%. However, there were no significant differences at 3 and 6 months. BTX-A was similar to no treatment for pain reduction at 3 and 6 months. BTX-A was more effective than conventional treatment and low-level laser therapy for pain reduction at 1, 6, and 12 months, but less effective than facial manipulation for pain reduction at 3 months. BTX-A was not associated with a significant increase in the risk of adverse events. The quality of the evidence was low, and results are insufficient to support the use of BTX-A for painful temporomandibular disorders. High-quality RCTs are needed to increase confidence in effect estimates. PERSPECTIVE: BTX-A for painful temporomandibular disorders appears to be well tolerated. For pain reduction, BTX-A is slightly more effective than placebo only at 1 month; conventional treatment and low-level laser at 1, 6, and 12 months. Low-quality evidence limits the applicability of these findings and precludes recommendations for practice.
Asunto(s)
Toxinas Botulínicas Tipo A/farmacología , Dolor Facial/tratamiento farmacológico , Fármacos Neuromusculares/farmacología , Trastornos de la Articulación Temporomandibular/tratamiento farmacológico , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/efectos adversos , Humanos , Fármacos Neuromusculares/administración & dosificación , Fármacos Neuromusculares/efectos adversosRESUMEN
Omphalocele is a congenital abdominal wall defect that occurs approximately 1 in 4000-6000 live births. The abdominal-visceral disproportion, large diameter of the defect, volume of liver in the sac along with high incidence of associated anomalies make the surgical management a real challenge. Currently, there are two strategies for managing giant omphaloceles, staged surgical closure and nonoperative delayed closure. The combined treatment with PPP and BoNT/A injection has recently been described in adults. There is strong evidence on safety and efficacy of the use of BoNT/As in other areas of pediatrics and no recent reports of PPP use in children. Also, there are no data available about the combination of both techniques in pediatric population. The purpose of this manuscript is to report a case of a 7-year-old female child that was referred to our institution with a large ventral hernia secondary to omphalocele. We opted for a combined approach with BoNT/A injection and PPP before the definitive surgery. The surgical result was great with midline closure with no tension and no need for prosthetic substitution or component separation needed. To our knowledge, this is the first case report of BoNT/A injection and PPP for large ventral hernias in children. BoNT/A application was safe and the PPP technique was also proved to be applicable on children. We believe that the combination of BoNT/A and PPP presented to be a safe approach with an excellent result, particularly for not needing abdominal wall prosthetic substitution.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Hernia Umbilical/tratamiento farmacológico , Hernia Umbilical/cirugía , Hernia Ventral/tratamiento farmacológico , Hernia Ventral/cirugía , Herniorrafia/métodos , Neumoperitoneo Artificial/métodos , Neumoperitoneo/cirugía , Toxinas Botulínicas Tipo A/farmacología , Niño , Femenino , HumanosRESUMEN
BACKGROUND: The intraglandular application of botulinum neurotoxin type A (BoNT-A) is used in patients with neuromotor disorders to control the escape of saliva. The aim of this study was to analyze the impact of repeated treatment with BoNT-A on the submandibular-sublingual complex of rats. METHODS: A total of 35 Wistar rats were divided into three groups: control group (C), in which animals were not treated; group B, treated with 2.5 U intraglandular injections of BoNT-A (Prosigne® ) and group G, that received bovine gelatine (Prosigne stabilizer). Three applications were performed in intervals of 35 days. Twelve and 35 days after ending the treatment, submandibular-sublingual complex was collected for histological analysis. Immunohistochemical reactions for calponin and specific muscle actin were also performed, besides detection of apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. RESULTS: A decrease in mucosal and serous acini diameter was observed, with increased interstitial space after 12 days of treatment with BoNT-A, which was observed in a lesser degree on the 35th day. At 12 days, immunohistochemical analysis revealed a decrease in myoepithelial cells of serous acini in group B. TUNEL methods evidenced apoptosis in animals from group B. CONCLUSIONS: BoNT-A caused histological and cellular changes in submandibular-sublingual complex, followed by a tendency toward reversal after 35 days. The reversal characteristic of cellular changes in the submandibular-sublingual complex suggests that this BoNT-A formulation may be safely used for sialorrhea treatment.
Asunto(s)
Toxinas Botulínicas Tipo A/farmacología , Glándulas Salivales/efectos de los fármacos , Animales , Apoptosis , Bovinos , Células Epiteliales/efectos de los fármacos , Femenino , Inmunohistoquímica , Ratas , Ratas Wistar , Saliva , Glándulas Salivales/patología , Sialorrea/tratamiento farmacológicoRESUMEN
OBJECTIVES: To compare signs and symptoms of dysphagia in individuals with cervical dystonia (CD) before and after application of botulinum toxin (BTX). METHODS: A prospective study was conducted with 20 patients diagnosed with CD with indications for BTX application. We selected 18 patients who met the study inclusion criteria. All individuals were patients from the Movement Disorders Unit, Department of Neurology, Federal University of São Paulo. BTX was applied in the cervical region at the necessary dose for each individual. To identify signs/complaints of changes in swallowing, we used a specific questionnaire that was completed by patients and/or their companions on the day of BTX injection and repeated 10 to 15 days after BTX injection. RESULTS: Among the 18 study subjects, 15 (83.3%) showed primary and three (16.7%) showed secondary cervical dystonia. The most frequent dystonic movements were rotation (18), tilt (5), forward shift (3), backward shift (7), shoulder elevation (12), shoulder depression (2), and cervical tremor (6). The main complaints reported before BTX application were voice changes in 10 (55.6%), need for adjustment of eating position in 10 (55.6%), coughing and/or choking while eating in nine (50%), and increased eating time in nine (50%) individuals. The main complaints reported after BTX application were coughing and/or choking while eating in 11 (61.1%), voice changes in nine (50%), sensation of food stuck in the throat in eight (44%), and increased eating time in eight (44%) individuals. CONCLUSION: The administration of a swallowing-specific questionnaire to individuals with CD before and after BTX application enabled the identification of possible dysphagia symptoms prior to drug treatment resulting from CD, which are often subsequently interpreted as side effects of the drug treatment. Thus, dysphagia can be managed, and aspiration symptoms can be prevented.
Asunto(s)
Toxinas Botulínicas Tipo A/farmacología , Trastornos de Deglución/diagnóstico , Deglución/efectos de los fármacos , Distonía/congénito , Fármacos Neuromusculares/farmacología , Adolescente , Adulto , Toxinas Botulínicas Tipo A/uso terapéutico , Estudios de Casos y Controles , Trastornos de Deglución/tratamiento farmacológico , Trastornos de Deglución/psicología , Distonía/tratamiento farmacológico , Distonía/psicología , Ingestión de Alimentos/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/uso terapéutico , Percepción , Estudios Prospectivos , Distribución Aleatoria , Autoinforme , Resultado del Tratamiento , Calidad de la Voz , Adulto JovenRESUMEN
BACKGROUND: Masseter muscle function influences mandibular bone homeostasis. As previously reported, bone resorption markers increased in the mouse mandibular condyle two days after masseter paralysis induced with botulinum toxin type A (BoNTA), followed by local bone loss. OBJECTIVE: This study aimed to evaluate the bone quality of both the mandibular condyle and alveolar process in the mandible of adult mice during the early stage of a BoNTA-induced masseter muscle atrophy, using a combined 3D histomorphometrics and shape analysis approach. METHODS: Adult BALB/c mice were divided into an untreated control group and an experimental group; the latter received one single BoNTA injection in the right masseter (BoNTA-right) and saline in the left masseter (Saline-left). 3D bone microstructural changes in the mandibular condyle and alveolar process were determined with high-resolution microtomography. Additionally, landmark-based geometric morphometrics was implemented to assess external shape changes. RESULTS: After 2 weeks, masseter mass was significantly reduced (P-value <0.001). When compared to Saline-left and untreated condyles, BoNTA-right condyles showed significant bone loss (P-value <0.001) and shape changes. No significant bone loss was observed in the alveolar processes of any of the groups (P-value >0.05). CONCLUSION: Condyle bone quality deteriorates at an early stage of BoNTA-induced masseter muscle atrophy, and before the alveolar process is affected. Since the observed bone microstructural changes resemble those in human temporomandibular joint degenerative disorders, the clinical safety of BoNTA intervention in the masticatory apparatus remains to be clarified.
Asunto(s)
Atrofia/patología , Resorción Ósea/patología , Toxinas Botulínicas Tipo A/farmacología , Cóndilo Mandibular/patología , Músculo Masetero/patología , Animales , Atrofia/inducido químicamente , Densidad Ósea/efectos de los fármacos , Resorción Ósea/inducido químicamente , Modelos Animales de Enfermedad , Masculino , Ratones , Ratones Endogámicos BALB CRESUMEN
BACKGROUND: Obesity is a disease that is highly prevalent in Brazil, and the associated comorbidities represent a major global public health challenge. Botulinum toxin type A (BTX-A) is a potent neurotoxin and inhibitor of gastric smooth muscle activity. In theory, BTX-A administration should promote early satiety and weight loss because it delays gastric emptying by inhibiting acetylcholine-mediated peristalsis, which is primarily responsible for gastric motility. Because results in the literature are discrepant, the efficacy of intragastric injections of BTX-A as a primary treatment for obesity remains unknown. The objective of this prospective, double-blind, single-center randomized study was to evaluate the effects of endoscopic ultrasound-guided intragastric BTX-A injections, as a bridge to bariatric surgery, in super-obese patients. METHODS: Thirty-two super-obese patients were randomized to one of two groups: BTX-A, in which 200 units of BTX-A were injected into the gastric antrum and body; and control, in which the same injections were performed with 0.9% saline. Weight, body mass index (BMI), and loss of excess weight were measured monthly over a 6-month period. Gastric emptying scintigraphy was performed before and after the procedure. RESULTS: The patients in both groups showed significant weight loss over the course of the study (p < 0.001). There were no statistically significant differences between the groups regarding weight loss, excess weight, total loss of excess weight, total weight loss, or change in BMI. CONCLUSIONS: Intragastric injection of BTX-A does not appear to be an effective method of achieving preoperative weight loss in super-obese patients.
Asunto(s)
Toxinas Botulínicas Tipo A , Endosonografía/métodos , Obesidad Mórbida , Cuidados Preoperatorios/métodos , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/farmacología , Toxinas Botulínicas Tipo A/uso terapéutico , Vaciamiento Gástrico/efectos de los fármacos , Humanos , Obesidad Mórbida/tratamiento farmacológico , Obesidad Mórbida/cirugía , Pérdida de Peso/efectos de los fármacosRESUMEN
OBJECTIVES: To compare signs and symptoms of dysphagia in individuals with cervical dystonia (CD) before and after application of botulinum toxin (BTX). METHODS: A prospective study was conducted with 20 patients diagnosed with CD with indications for BTX application. We selected 18 patients who met the study inclusion criteria. All individuals were patients from the Movement Disorders Unit, Department of Neurology, Federal University of São Paulo. BTX was applied in the cervical region at the necessary dose for each individual. To identify signs/complaints of changes in swallowing, we used a specific questionnaire that was completed by patients and/or their companions on the day of BTX injection and repeated 10 to 15 days after BTX injection. RESULTS: Among the 18 study subjects, 15 (83.3%) showed primary and three (16.7%) showed secondary cervical dystonia. The most frequent dystonic movements were rotation (18), tilt (5), forward shift (3), backward shift (7), shoulder elevation (12), shoulder depression (2), and cervical tremor (6). The main complaints reported before BTX application were voice changes in 10 (55.6%), need for adjustment of eating position in 10 (55.6%), coughing and/or choking while eating in nine (50%), and increased eating time in nine (50%) individuals. The main complaints reported after BTX application were coughing and/or choking while eating in 11 (61.1%), voice changes in nine (50%), sensation of food stuck in the throat in eight (44%), and increased eating time in eight (44%) individuals. CONCLUSION: The administration of a swallowing-specific questionnaire to individuals with CD before and after BTX application enabled the identification of possible dysphagia symptoms prior to drug treatment resulting from CD, which are often subsequently interpreted as side effects of the drug treatment. Thus, dysphagia can be managed, and aspiration symptoms can be prevented.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Trastornos de Deglución/diagnóstico , Toxinas Botulínicas Tipo A/farmacología , Deglución/efectos de los fármacos , Distonía/congénito , Fármacos Neuromusculares/farmacología , Percepción , Trastornos de Deglución/psicología , Trastornos de Deglución/tratamiento farmacológico , Estudios de Casos y Controles , Estudios Prospectivos , Resultado del Tratamiento , Toxinas Botulínicas Tipo A/uso terapéutico , Distonía/psicología , Distonía/tratamiento farmacológico , Ingestión de Alimentos/psicología , Fármacos Neuromusculares/uso terapéuticoAsunto(s)
Toxinas Botulínicas Tipo A/farmacología , Cicatriz/tratamiento farmacológico , Cara/patología , Fármacos Neuromusculares/farmacología , Cicatrización de Heridas/efectos de los fármacos , Anciano , Biopsia , Toxinas Botulínicas Tipo A/administración & dosificación , Cicatriz/patología , Femenino , Humanos , Persona de Mediana Edad , Fármacos Neuromusculares/administración & dosificación , Envejecimiento de la Piel/efectos de los fármacos , Resultado del TratamientoAsunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Cicatrización de Heridas/efectos de los fármacos , Cicatriz/tratamiento farmacológico , Toxinas Botulínicas Tipo A/farmacología , Cara/patología , Fármacos Neuromusculares/farmacología , Biopsia , Envejecimiento de la Piel/efectos de los fármacos , Cicatriz/patología , Resultado del Tratamiento , Toxinas Botulínicas Tipo A/administración & dosificación , Fármacos Neuromusculares/administración & dosificaciónRESUMEN
Síndrome do choro assimétrico é uma condição congênita secundária à hipoplasia ou ausência do músculo depressor do ângulo da boca. Trata-se de uma condição não tão incomum que pode cursar com assimetria facial ao chorar e sorrir, além de poder estar associadas a outras malformações congênitas. Crianças com essa deformidade podem sofrer dificuldades psicossociais e introversão. O arsenal terapêutico dessa condição já foi estudado e discutido na literatura com ênfase em abordagens cirúrgicas e invasivas. Relatamos aqui um caso de uma criança de 9 anos com essa síndrome, tratada, de forma menos invasiva, com toxina botulínica, com um bom resultado e satisfação.
Asymmetric crying face syndrome is a congenital condition secondary to hypoplasia or absence of the depressor muscle at the mouth angle. It is a common condition that presents with facial asymmetry while crying and smiling and may be associated with other congenital malformations. Children with this deformity may experience psychosocial difficulties and introversion. The therapeutic arsenal of this condition has already been studied and discussed in the literature with an emphasis on surgical and invasive approaches. We report here a case of a 9-year-old child with this syndrome, treated less invasively with botulinum toxin, with good result and satisfaction.
Asunto(s)
Humanos , Femenino , Niño , Historia del Siglo XXI , Anomalías Congénitas , Toxinas Botulínicas Tipo A , Asimetría Facial , Parálisis Facial , Anomalías de la Boca , Anomalías Congénitas/genética , Anomalías Congénitas/rehabilitación , Toxinas Botulínicas Tipo A/efectos adversos , Toxinas Botulínicas Tipo A/efectos de los fármacos , Toxinas Botulínicas Tipo A/farmacología , Asimetría Facial/cirugía , Asimetría Facial/complicaciones , Asimetría Facial/tratamiento farmacológico , Parálisis Facial/cirugía , Parálisis Facial/complicaciones , Parálisis Facial/congénito , Anomalías de la Boca/cirugía , Anomalías de la Boca/diagnóstico , Anomalías de la Boca/rehabilitaciónRESUMEN
BACKGROUND: Masseter muscle paralysis induced by botulinum toxin type A (BoNTA) evokes subchondral bone loss in mandibular heads of adult rats and growing mice after 4 weeks. However, the primary cellular and molecular events leading to altered bone remodeling remain unexplored. Thus, the aim of the current work has been to assess the molecular response that precedes the early microanatomical changes in the masseter muscle and subchondral bone of the mandibular head in adult mice after BoNTA intervention. METHODS: A pre-clinical in vivo study was performed by a single intramuscular injection of 0.2â¯U BoNTA in the right masseter (experimental) of adult BALB/c mice. The contralateral masseter was injected with vehicle (control). Changes in mRNA levels of molecular markers of bone loss or muscle atrophy/regeneration were addressed by qPCR at day 2 or 7, respectively. mRNA levels of receptor activator of nuclear factor-κB ligand (RANKL) was assessed in mandibular heads, whilst mRNA levels of Atrogin-1/MAFbx, MuRF-1 and Myogenin were addressed in masseter muscles. In order to identify the early microanatomical changes at day 14, fiber diameters in transversal sections of masseter muscles were quantified, and histomorphometric analysis was used to determine the bone per tissue area and the trabecular thickness of subchondral bone of the mandibular heads. RESULTS: An increase of up to 4-fold in RANKL mRNA levels were detected in mandibular heads of the BoNTA-injected sides as early as 2 days after intervention. Moreover, a 4-6 fold increase in Atrogin-1/MAFbx and MuRF-1 and an up to 25 fold increase in Myogenin mRNA level were detected in masseter muscles 7 days after BoNTA injections. Masseter muscle mass, as well as individual muscle fiber diameter, were significantly reduced in BoNTA-injected side after 14 days post-intervention. At the same time, in the mandibular heads from the treated side, the subchondral bone loss was evinced by a significant reduction in bone per tissue area (-40%) and trabecular thickness (-55%). CONCLUSIONS: Our results show that masseter muscle paralysis induced by BoNTA leads to significant microanatomical changes by day 14, preceded by molecular changes as early as 2 days in bone, and 7 days in muscle. Therefore, masseter muscle atrophy and subchondral bone loss detected at 14 days are preceded by molecular responses that occur during the first week after BoNTA intervention.
Asunto(s)
Toxinas Botulínicas Tipo A/farmacología , Cóndilo Mandibular/efectos de los fármacos , Cóndilo Mandibular/ultraestructura , Músculo Masetero/efectos de los fármacos , Músculo Masetero/ultraestructura , Fármacos Neuromusculares/farmacología , Animales , Atrofia , Inyecciones Intramusculares , Masculino , Cóndilo Mandibular/metabolismo , Músculo Masetero/metabolismo , Ratones , Ratones Endogámicos BALB C , Proteínas Musculares/biosíntesis , Osteoporosis/patología , Parálisis/inducido químicamente , ARN Mensajero/análisis , ARN Mensajero/biosíntesisRESUMEN
OBJECTIVE: This study aimed to investigate the antinociceptive effects of Botulinum toxin type A (BoNT-A) on persistent inflammatory hypernociception induced by arthritis in the temporomandibular joint (TMJ) of rats. MATERIAL AND METHODS: Wistar rats were induced to persistent inflammatory hypernociception in the left TMJ. Then, animals were treated with intra-TMJ injections of BoNT-A, using doses of 3.5, 7 and 14 U/kg. Saline was used as control group. Behavioral tests were applied to evaluated the effect of BoNT-A in the inflammatory hypernociception. After that, animals were euthanized and samples from peri-articular tissues and trigeminal ganglia were obtained for further analyses. RESULTS: BoNT-A reduced the persistent inflammatory hypernociception induced by arthritis in the TMJ of rats. BoNT-A significantly reduced the peripheral release of the neurotransmitters Substance P and Calcitonin gene related peptide; and the pro-inflammatory cytokine IL-1ß. Otherwise, BoNT-A had no effect in the peripheral release of glutamate and the cytokine TNF-α. CONCLUSION: These results demonstrate that intra-articular injection of BoNT-A reduces the albumin-induced arthritis persistent hypernociception in TMJ of rats by peripheral inhibition of neuropeptides release.
Asunto(s)
Analgésicos/farmacología , Artritis Experimental/tratamiento farmacológico , Toxinas Botulínicas Tipo A/farmacología , Nocicepción/efectos de los fármacos , Articulación Temporomandibular/fisiopatología , Animales , Péptido Relacionado con Gen de Calcitonina/antagonistas & inhibidores , Péptido Relacionado con Gen de Calcitonina/metabolismo , Inyecciones Intraarticulares , Interleucina-1beta/metabolismo , Masculino , Ratas , Ratas Wistar , Sustancia P/antagonistas & inhibidores , Sustancia P/metabolismo , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
BACKGROUND: Cerebral palsy (PCI) is the leading cause of disability in children. Botulinum toxin type A (TBA) is a treatment to improve the function and pattern in the gait, although with a few studies that quantify the improvement. METHODS: Quasi-experimental study was conducted from May 2010 to September 2011, in Integrated Rehabilitation Center, in 36 patients with spastic PCI. Was evaluated: functionality of travel by the scale of Koman, speed of the gait with tone scale of Ashworth and arches of passive mobility, were applied TBA and was sent to 10 sessions of physical therapy, with measurements taken before, the 1st and 4th month. RESULTS: 30 Patients completed the study, between the ages of 2 and 12 years, the majority had improvement in the functionality of the gear, tone, dorsiflexion and abduction of ankles to the motion, which was maintained at 4 months. CONCLUSIONS: Botulinum toxin is an effective treatment to increase the arches of mobility and functionality of the gait of patients with hemiparesis and spastic paraparesis.
Introducción: La parálisis cerebral (PCI) es la principal causa de discapacidad en la infancia. La toxina botulínica tipo A (TBA) es un tratamiento para mejorar la función y patrón en la marcha, aunque con pocos estudios que cuantifiquen la mejoría. Métodos: Se realizó un estudio cuasiexperimental, de mayo de 2010 a septiembre de 2011, en un centro de rehabilitación integral, participaron 36 pacientes con PCI espástica. Se evaluó: funcionalidad de la marcha por la escala de Koman, velocidad de desplazamiento de la marcha, tono con escala de Ashworth y arcos de movilidad pasivas. Se les aplicó TBA y se les envió a 10 sesiones de terapia física, con mediciones antes, al mes 1 y 4. Resultados: 30 pacientes terminaron el estudio, con edades entre 2 y 12 años, la mayoría tuvieron mejoría en la funcionalidad de la marcha, tono, dorsiflexión y abducción de tobillos al mes, que se mantuvo a los 4 meses. Conclusiones: La toxina botulínica es un tratamiento eficaz para aumentar los arcos de movilidad y la funcionalidad de la marcha en los pacientes con hemiparesia y paraparesia espástica.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Parálisis Cerebral/terapia , Fármacos Neuromusculares/uso terapéutico , Modalidades de Fisioterapia , Toxinas Botulínicas Tipo A/farmacología , Niño , Preescolar , Terapia Combinada , Esquema de Medicación , Femenino , Estudios de Seguimiento , Marcha/efectos de los fármacos , Humanos , Masculino , Fármacos Neuromusculares/farmacología , Resultado del TratamientoRESUMEN
PURPOSE:: To evaluate the effect of Botulinum Toxin A in different time of tobacco exposure. METHODS:: 60 male, Wistar rats were divided into two tobacco exposure groups: a 2- month or a 4-month regimen. After this period, these two groups were subdivided as two: saline solution(SS) or botulinum toxin A(Bonta), at the time of the surgery. Seven days before the SS or Bonta injection, the animals were submitted to a random flap (3x10cm). On the seventh postoperative day, all animals were assessed for total flap area, viable area, and the viable/ total area ratio. RESULTS:: This study showed a difference between groups 2-month saline vs. BontA injection (p=0.04); groups 4-month saline vs. BontA injection (p=0.001); groups 2-month saline vs. 4-month BontA (p=0.003), and, between groups 2- month BontA vs. 4-month saline(p=0.03). CONCLUSIONS:: Botulinum Toxin A increased random flap viability in tobacco-exposed rats. Two months of tobacco exposure had the same effect as exposure for four months.
Asunto(s)
Toxinas Botulínicas Tipo A/farmacología , Supervivencia de Injerto/efectos de los fármacos , Fármacos Neuromusculares/farmacología , Colgajos Quirúrgicos , Contaminación por Humo de Tabaco/efectos adversos , Animales , Toxinas Botulínicas Tipo A/administración & dosificación , Diabetes Mellitus Experimental/complicaciones , Inyecciones , Masculino , Fármacos Neuromusculares/administración & dosificación , Distribución Aleatoria , Ratas , Ratas Wistar , Cloruro de Sodio/administración & dosificación , Factores de TiempoRESUMEN
ABSTRACT PURPOSE: To evaluate the effect of Botulinum Toxin A in different time of tobacco exposure. METHODS: 60 male, Wistar rats were divided into two tobacco exposure groups: a 2- month or a 4-month regimen. After this period, these two groups were subdivided as two: saline solution(SS) or botulinum toxin A(Bonta), at the time of the surgery. Seven days before the SS or Bonta injection, the animals were submitted to a random flap (3x10cm). On the seventh postoperative day, all animals were assessed for total flap area, viable area, and the viable/ total area ratio. RESULTS: This study showed a difference between groups 2-month saline vs. BontA injection (p=0.04); groups 4-month saline vs. BontA injection (p=0.001); groups 2-month saline vs. 4-month BontA (p=0.003), and, between groups 2- month BontA vs. 4-month saline(p=0.03). CONCLUSIONS: Botulinum Toxin A increased random flap viability in tobacco-exposed rats. Two months of tobacco exposure had the same effect as exposure for four months.