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Cervical dystonia is a neurological movement disorder causing abnormal posture of the head. It may be accompanied by involuntary movements which are sometimes tremulous. The condition has marked effects on patients' self-image, and adversely affects quality of life, social relationships and employment. Botulinum neurotoxin (BoNT) is the treatment of choice for CD and its efficacy and safety have been extensively studied in clinical trials. However, current guidelines do not provide enough practical information for physicians who wish to use this valuable treatment in a real-life setting. In addition, patients and physicians may have different perceptions of what successful treatment outcomes should be. Consequently, an international group of expert neurologists, experienced in BoNT treatment, met to review the literature and pool their extensive clinical experience to give practical guidance about treatment of CD with BoNT. Eight topic headings were considered: the place of BoNT within CD treatment options ; patient perspectives and desires for treatment ; assessment and goal setting ; starting treatment with BoNT-A ; follow- up sessions ; management of side effects ; management of non- response ; switching between different BoNT products. One rapporteur took responsibility for summarising the current literature for each topic, while the consensus statements were developed by the entire expert group. These statements are presented here along with a discussion of the background information.

Teh data confirm that BTX-A therapy is able to induce significant amelioration os several aspects of HRQL in CD patients

Our study, for the first time indicated that depression and disability have significant relationship in CD. The data confirm that BTX-A treatment is able to induce significant amelioration of several aspects of HRQL in CD patients.

Botulinum toxin type - A (BTX -A)is used today in migraine headache treatment with contradictory results. Our results indicate that cutaneus allodynia could be a predictive factor for responders and non-responders to BTX -A prophylactic therapy in migraine.

All patients refered to botulinum toxin treatment shoul have copmpleted neurological examination. Here we present the first case of Klippel-Feil syndrome in combination with pheochromocytoma. Although botulium toxin is not the first choice medication in this indication, in the described patient the local aplication led to complete regresion of painful component

BACKGROUND: There is an unmet medical need for safe, effective migraine prophylaxis. BoNTA is well-tolerated and may be effective as migraine prophylaxis. OBJECTIVE: To evaluate the safety and efficacy of BoNTA compared with placebo (PBO) for prophylaxis of episodic migraine. DESIGN AND METHODS: An 11-month, double-blind, randomized, placebo-controlled study required daily record of headache symptoms and acute medication use with an electronic diary. Patients were screened during a 30-day period ; patients with >3 migraines and

This study was designed to investigate the antinociceptive profile of botulinum toxin type A (BTX-A) using different animal models of pain and inflammation. Over the last 20 years BTX-A has been used for treating a variety of disorders characterized by increased muscle contraction. Recently, there has been an increase of BTX-A usage in the treatment of various pain syndromes. However, assumptions in what type of pain is BTX-A effective, what doses are effective, how long the effect does last are currently only derived from small clinical trials or individual experience. Peripheral administration of formalin, capsaicin and carrageenan solutions was used to provoke acute pain states associated with inflammation. Peripheral neuropathic pain was evoked by partial sciatic nerve transection. As a model of experimental postsurgical pain, gastrocnemius muscle was incised. Pain of musculoskeletal origin was made by low pH saline injection. The results of present experiments show that peripherally administered BTX-A produces analgesic effect in second phase of formalin test that seems not to be dose-dependent. The analgesic effect becomes significant on day 5 following toxin’ s application in the rat paw pad and lasts for 30 days. BTX-A has also been effective in other two models of inflammatory pain as well as in models of chronic pain states, including the diabetic neuropathy. In all models, peripherally administered BTX-A reduces the mechanical and thermal hyperalgesia. This study, for the first time, demonstrated the efficacy of BTX-A on the neural component of pain associated with inflammation in various experimental pain conditions. In conclusion, these observations suggest that BTX-A might be effective in different pain syndromes, probably of neural origin with an inflammatory component.

Over the last 20 years BTX-A has been used for treating a variety of disorders characterized by increased muscle contraction and recently few clinical observations on several patients indicated that it might be useful in neuropathic pain. However up to now preclinical nociceptive action of BTX-A has been investigated in only few studies employing formalin and capsaicin tests. Here we report on the efficacy of BTX-A in rat models of neuropathic pain. After dose-response and time-course experiments performed with BTX-A using formalin and carrageenan to provoke acute pain associated with inflammation, the effectiveness of BTX-A on chronic neuropathic pain was tested. Peripheral neuropathy was evoked by partial sciatic nerve transection. Animals which developed neuropathic pain showed increased sensitivity to thermal and mechanical stimuli and were included in further investigation and treated with BTX-A. The results of present experiments show that peripherally administered BTX-A produces analgesic effect in formalin test that seems not to be clearly dose-dependent. The analgesic effect becomes significant on day 5 following toxin’s application in the rat paw pad and lasts for 30 days. However, peripherally applied BTX-A has also found to be effective in peripheral neuropathy reducing the enhanced sensitivity to pain stimuli. This study, for the first time, in experimental animals demonstrated the efficacy of BTX-A in treating experimental peripheral neuropathic pain.

Effectiveness od Botulinum toxin type-A (BTX-A) against pain associated with cervical dystonia has been established. The aim of the present study was to investigate the effectiveness of different doses of BTX-A in pain associated with dystonia. Our results appear to demonstrate for the first time that BTX-A may have a direct antinociceptive effect distinct from the effect on muscle relexation.

Introduction The possible involvement of sustained contraction of the pericranial muscles in tension-type headache (TTH) prompted us to investigate botulinum toxin type-A (BTX-A) in the treatment of TTH patients. After double-blind, placebocontrolled studeis had shown that BTX-A is significantly better than placebo for symptomatic relief of pain in patients with TTH (ReljaM, Korsic M. Neurology 1999;52(suppl 2):A203;Smuts JA et al. Eur J Neurol 1999;6(suppl 4):S99,we performed longterm follow-up of patients treated eith BTX-A for TTH. Design/Methods:30 patients with TTH, who had been resistent to standard therapy, were enrolled into a 18-month, open-label prospective study. First, the tenderness of pericranial muscles was evalueted by manual palpation in all patients. The patients received BTX-A BTX-A as Botox (dose range 40-95 U, 100 diluted in 1 ml saline) by intramuscular injections into the most tender muscles (frontalis, temporalis, trapezius, sternocleidomastoideus/mastoid process). The clinical outcome was monitored at 4 week intervals using a tenderness assesment score and home diary kept be each patient. Result In total, 28 patients completed the study. There was a sustained improvement in the number of headache-free days over the 18-month period (P

Introduction It has been shown in double-blind, placebo controlled studies, that BTX-A is significantly better than placebo for symptomatic relief of patients eith TTH. Here we present long-term follow-up of patients treated with BTX-A for TTH. Objective To evaluete the long-term benefit of botulinum toxin type-A (BTX-A)for the symptomatic relief of pain associated with chronic tensio-type headache (TTH). Methods Twenty-five patients with TTH, who had been resistant to standard therapy, were enrolled into a 15-month, open-label, prospective study. The patients recieved BTX-A a Botox (dose range 40-90 U) by intramuscular injection into the most tender pericranial muscles every 3 months.Tenderness of the pericranial muscles was evalueted by manual palpation performed bilaterally in the frontalis, temporalis, trapezius, sternocleidomastoideus (mastoid process) muscles. Clinical assessment was performed at 4 week intervals using the total tenderness score (TTS) and a home diary kept by each patients. Result In total, 24 patients compeleted the study. There was a constant improvment in the number of headache-free days ove the 15-month period (P

Several reports suggest that botulinum toxin type A is beneficial for reducing spasticity in patients with a variety of neurological problems. Here we pšresent a 19-year-old girl with spaastic cerebral palsy, predominately diplegia type. She is wheelchair-bound with difficulties in communication due to speech and voice problems (spastic dysarthria in combination with spastic dysphonia). She has had physical therapy since she was 15 months old, serial casting and hip surgery. She had her first botulinum toxin type A treatment in the spring of 1999 (Botox 200 U total dose, both gastrocnemii). According to modified Aschworth scale and ROM assessment, her improvement was moderate. But, surprisingly, 24 hours after Botox injections she was able to communicate with reletives and friends significantly better. Improvement lasted 3 months, when Botox weas reinjected (gastrocnemius muscle) with the same result on speech and voice. This clearly indicates that Botox gastrocnemius injections was connected with speech improvement.

The objective was to evaluate the safety and efficacy of botulinum toxin A injections in the treatment of patients with chronic tension type headaches (TTH). BTX-A was compared with placebo with TTH. We investigate 16 patients with TTH (F/M=9/7, age range 23-64 years) through 8 weeks double.blind, cross over, placebo controlled study. BTX-A and/or placebo were injected in the most tender pericranial muscle.Tendernes was evaluated by manual palpation in the frontalis, trapezius and sternocleidomastoideus muscles. The tenderness assessment (scale 0-3) was performed at bazeline and 1, 2, 4, and 8 weeks after injections. In addition, a home diary recording any change in headache severity was kept by each patient. BTX-A treatment resulted in significant decrease of the total tenderness score, obtained by the palpation method, one week, 2 weeks, 4 weeks, as well as 8 weeks after injection. Placebo had no effect. According to patients` diaries the severity and the duration of the attacks decreased significantly during BTX-A treatment period. This is the first double-blind study that suggests that BTX-A is safe and effective substance in the treatment of patients with TTH.

Recent studies indicate that increased motor activity can increase presentation of SV2-specific botulinum toxin type A (BTX-A) receptor. This might result in higher efficacy of BTX-A injected. The aim of the present study was to investigate whether post-injection activation program may increase the duration of clinical benefit in cervical dystonia (CD). A total of 27 patients (17 female and 10 male, age range 26–63 years, disease duration >2 years) who had improved significantly to BTX-A injections during the previous year were enrolled into this single-centre, single-blind, crossover study. Each patient was injected with previously used effective dose of BTX-A (100–200 U of BOTOX, Allergan). CD was assessed using validated scales for dystonia (TWSTRS, ADL) every 2 weeks. In addition, patients were asked to contact their doctor immediately when they deemed the effect of BTX-A. Only after the second BTX-A injection activation and physical therapy, with the help of a physiotherapist, were performed 15 min before and immediately after BTX-A administration (60 min daily during 2 weeks). Physical activity protocol included biofeedback training and active stretching to increase specific muscle activity. Our results showed that BTX-A was effective in improving CD symptoms during both treatment periods. But the duration of clinical improvement was significantly longer (10–15 days) when the same dose of BTX-A was administered in combination with activation physiotherapy.

We have investigated the efficacy of local ijection of Botulinum toxin in serum patients with head tremor by using quantitative head tremor measurments. All 7 patinets (F/M= 4/3 ) had failed to risponde to standard drugs. Quantitative assesment were performed before and one and two weeks. After applicatiohn of Botulinum toxin in splenius capitis and trapesius muscles.Tremor amplitudes showed significant reduction one and /or 2 weeks after Botox injection.

Recent studies implicate sustained pericranial muscular contraction in the causation of cronic tension-type headache. To investigate this, we performed a study on the use of botulinum toxin A in the treatment of patients with chronic tension-type headaches. Significant decreases in tenderness scores for the frontalis, trapezius and sternocleidomastoideus muscles were obtained in all 10 patients between 1 and 2 weeks after an injection of toxin. In addition all patients experienced a gradual decrease in severity and duration of attacks. Clinical improvement lasted up to 8 weeks. Our preliminary study demonstrates that injection of botulinum toxin A could be an effective treatment for patients with chronic tension-type headaches.