Botulinum Toxins - Science topic

Thank you for your answer. I think I will pilot this in my next experiment.

This is not difficult PROVIDED you are experienced in injecting the standard 3 areas for at least a year and have a thorough knowledge of the anatomy

Look up levator labii superioris

You need to inject 2U Botox. Start with 1U first attempt till you're experienced. You can add more later. The site of injection is in the hollow just lateral to the nares. Approx 3 to 4 mm deep.

Good luck

Botox blocks the release of neuropeptides/neurotransmitters from the sensory free nerve endings in exactly the same way as it blocks the release of Acetylcholine at the neuro-muscular junction. Ths reduces the sensory tone going to the brain. In migraines you are primarily blocking the fibres from V1 trunk of the trigeminal nerve, but also the cervical nerves.

These project to the same place in the trigemino-cervical tract and reduce the excitability state of the neurones, which in turn reduces the follow-on stimulation of higher centres

Interestingly, botox does not pass from neurone to neurone (unlike tetanus toxin) and stays only in the neurones that it enters at the site of injection. Using immunofluorescence techniques to show traces of botox in both the brain stem and the areas of meninges where V1 innervates because the individual fibres each have 3 branches from the nucleus in the trigeminal ganglion. skin, brain stem and meninges

Essentially, migraines are a generalised neuronal hyperexcitability disorder, and Botox reduces the level of hyperexcitability

You can read more on improving the botox treatment protocols in my paper included in my profile here. Honestly the PREEMPT Protocol is rather old hat since Allergan patented all that it could, and this blocked further commercial research into better botox protocols. In my experience, targeted higher doses of Botox into the glabella is equally as effective as the PREEMPT Protocol. PREEMPT thus doesn't reach the highest number of free nerve endings in the enthesis (attachment of the corrugators to its glabellar fascial compartment) of the glabella.

I hope this is useful

Go to: https://www.researchgate.net/profile/Chris-Blatchley

Your analogy is very interesting, dear colleague.

Although the main cause of any form of myofibrillar myopathy is a violation of the structure of the protein components of sarcomeres caused by genetic mutations, why not assume that due to mutations, the sensitivity of the postsynaptic membrane of myofibrils in myofibrillar myopathy to acetylcholine may also be impaired.

Botox is made from a toxin produced by the bacterium Clostridium botulinum. ... Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves, with effects lasting roughly three months. However studies show that in rare instances the toxin can spread, paralysing other parts of the body

I would be interested to read any studies on this topic.

You may want to consider Glycopyrrolate (Glycopyrronium bromide) as a anti-cholinergic drug. See also:

@ Dr. Sikandar Hayat Khan

Botox is a most popular treatment for the ageing face. It effectively removes the appearance of lines and wrinkles on the face to give a younger and youthful look. It's various side effects include rash, itching, fever, loss of appetite, headache, neck pain, stomach pain, muscle stiffness, difficulty in swallowing, shortness of breath, nausea, diarrhoea, muscle weakness, cough, respiratory infections, dizziness, drowsiness, anxiety, temporary blindness and urinary tract infections.

Thank you Mary C R Wilson and Mehmet Sarier !

Yes, I agree with the opinion of Dr. Johnson.In any case the topic is worth further investigation. In my opinion, especially the formation of fibrosis in denervated muscles reduces blood flow. Does this fact enhances the possibility of virus infection ? I think this question can be answered controversially and needs investigation.

Concerning botulinum toxin (BT), it is important to check whether the patient presents lower urinary tract symptoms (LUTS), which are highly prevalent in MS. Intradetrusor BT injections may be indicated for refractory overactive bladder symptoms, such as urgency, frequency, and urgency urinary incontinence. In this setting, both aesthetic and therapeutic BT injections should be performed in the same week. Repeated injections should be avoided within the first 3 to 4 months after one treatment cycle.

no, don't think so

See these:

I was at a meeting where Alastair Carrathers was asked about post Botox recommendations. He said when they were starting he was using the most powerful neurotoxin in the world to treat wrinkles - he thought he should give them some take home instructions (no exercise, don't lie down, don't drink alcohol). He said he just made them up and does not use them any more.

But don't rub the face too much

I could not disagree more with Vinod's comments about BoTN-A. However I do agree with his general point finding a comprehesive explanation about the evolution of migraines. The wider research on its action on free pain nerve endings and how it travels by axonal transport to the CNS and other sites such as the dura all help with the wider study that has improved our understanding of the pathogenesis of migraines

If one drills down into the results of the PREEMPT protocol there is a significant reduction in the intensity and duration of the headaches after treatment. I agree that the results of PREEMPT are not in themselves overwhelming evidence but this is more related to the inadequacies of the protocol, and I have written on this here at Researchgate. Gradually the number of neurologists who dismiss Botox has fallen as they use it for themselves!

RCTs are useful tools but should not allow the tail to wag the dog. They are only as good as their design. In itself absence of evidence is not evidence of absence and the first step is our clinical experience. Mine is certainly that Botox can work spectacularly well. The interesting development of this is to find ways of both refining injection technique and finding effective clinical assessment methods that help us define the patients for whom it will not be useful as much as those for whom it will

Yes, Botox can cause ptosis but you would expect improvement 5 months later. Any pupillary abnormalities?

Botox could have unmasked myasthenia gravis, and would check acetylcholine receptor antibodies. Was the onset acute? Sometimes patients do not realize they had some degree of ptosis all along. Progressive external ophthalmoplegia would be another consideration if the course was more chronic.

There is more and more agreement that botulinum toxin type A by axonal transport enters the CNS, motor but also sensory nuclei (Matak, I., Lacković, Z. 2014 Botulinum toxin A, brain and pain. Prog Neurobiol. 119-20, 39-59. Review). Our experinece on experimental animals (infraorbital nerve constrictioninjury) is that botulinum toxin is effective in reducing pain if applied in the painful region of the head as well as directly in trigeminal ganglia. Thus place of maximal pain or  "way of pain" as Marcus Coletta describes should be beneficial.

I don't know if a scientific evidence exist, but I think that benefit depends on injection site and possible adverse events.

Treatment of submentalis muscle complex, including anterior digastric belly muscle, could increase swallowing disorders, limiting the treatment effectiveness. So, lateral pterygoid is actually often the only muscle treated, and it is not so easy to inject. Intra-oral way seems to be the best one.

On the other side, it seems that patient's feeling improve more when jaw-closing dystonia is treated, with the return of an oral feeding.

You can use 2D Kinematic Software "Kinovea", available free at www.kinovea.org .

Dear Gary, you should contact Prof. Wolfgang Jost, as mentioned above. 

KR

eric

The European clinical guidelines are very helpful regarding the best approaches.

Hi Ahmed

What a great question and some good references above from Giacomo.  This is not my field of research but certainly something that warrants consideration, particularly given its increasing use cosmetically.  If this is your field of research, do keep us updated on progress and good luck!

Hi Nidia,

You may also look at the following paper:

Anal Biochem. 2015 Mar 15;473:7-10. A new peptide substrate for enhanced botulinum neurotoxin type B detection by endopeptidase-liquid chromatography-tandem mass spectrometry/multiple reaction monitoring assay.

Rosen O, Feldberg L, Gura S, Zichel R.

Arik

Piriformis-syndrome: a mimimum of 50 units Botox/Xeomin or 200 units Dysport,

standard twice as much

Thank you Dr Niroshan. I will take your advise of rephrasing. I do admit that understanding botox action was necessary before posting the question. I thank you for making me go back to my basics.

Satyaprasad,

The above mentioned factors that Islam pointed out are important in the duration of botulinum toxin.  The reason that the effect of botox wears off in that amount of time is because the presynaptic terminals recover function.

However, there is some findings that suggest Zytase (zinc and the enzyme phytase) can prolong the life of Botox.  This is because zinc is required for botox to work effectively.  After all, Botulinum toxin A is zinc matrix metalloprotease.  Below is a paper about the study that showed the efficacy of zinc/phytase supplementation.

Reference

Please try this link with a well-documented chapter on wrinkle formation.

we have used N2O for the last 10 years for 85% of all BTX-A injections (up to 500 treatments/yearly) with for the most part excellent results. Children in GMFCS level IV-V will often need add on treatment with sufentanyl given nasaly. We also always use EMLA creme, paracetamol in a high dose ( 30-40 mg/kg bw) and give oral steroids , bethametason, 1.5-2hours prior to treatment to minimize nausea. You should make an appointment with your pediatric anestehesiologist to discuss your options and make a treatment paradigm. In Sweden the presence of a anesthesiology trained doctor or nurse will be mandatory if any sort of risk factor is present ( such as respiratory problems that is quite frequent in this group of children). otherwise our specially trained nurses handle the NO2 procedure that also includes a more holistic way of acting in the treatment room. Low talking volumes, soft music, one nurse speaking softly to the child about a pleasant experiance are all ingredients of the guided imagery method that is run parallell and part of the success.