Persistent Diplopia in Visually Mature Patients. Is it Intractable or something else? A Review and Case Series

2017 ◽  
pp. 90-108
Keyword(s):  
Botulinum Toxin ◽  
Extraocular Muscle ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Sensory Adaptation ◽  
Single Vision ◽  
Injection Treatment ◽  
Vision Therapy ◽  
Extraocular Muscle Surgery

Diplopia is described as being intractable when there is inability to both fuse the two images and suppress the second image. Intractable diplopia persists despite achieving ocular alignment using either prisms, lenses,vision therapy,extraocular muscle surgery, or botulinum toxin injection. Treatment usually resorts to occluding or fogging the patient’s nondominant eye. Often times, however, adults having other causative mechanisms for supposedly persistent diplopia are able to achieve comfortable single vision with treatment that either establishes fusion or reactivates a preexisting sensory adaptation. This case series reviews these other causes of diplopia.

Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache

2008 ◽  
Vol 123 (4) ◽  
pp. 412-417 ◽  
Author(s):  
J A de Ru ◽  
J Buwalda
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Effective Means ◽  
Case Series ◽  
Botulinum Toxin Type ◽  
Toxin A ◽  
Tertiary Referral Centre ◽  
Corrugator Supercilii

AbstractObjective:To describe our results with botulinum toxin type A injection for headache in carefully selected patients, and to present the rationale behind this therapy.Setting:Tertiary referral centre.Patients and methods:This article describes a case series of 10 consecutive patients with frontally localised headache, whose pain worsened when pressure was applied at the orbital rim near the supratrochlear nerve. The patients received a local anaesthetic nerve block with Xylocaine 2 per cent at this site. If this reduced the pain, they were then offered treatment with botulinum toxin.Intervention:Injection with 12.5 IU of botulinum toxin A into the corrugator supercilii muscle on both sides (a total of 25 IU).Main outcome measure:Pain severity scoring by the patients, ranging from zero (no pain) to 10 (severe pain) on a verbal scale.Results:Following injection, all patients had less pain for approximately two months. This treatment did not appear to have lasting side effects.Conclusion:Xylocaine injection is a good predictor of the effectiveness of botulinum toxin injection into the corrugator muscle as treatment of frontally localised headache. We hypothesise that this pain is caused by entrapment of the supratrochlearis nerve in the corrugator muscle. Furthermore, we found botulinum toxin injection to be a safe and effective means of achieving pain relief in this patient group.

Unilateral True Vocal Fold Synkinesis Presenting with Airway Obstruction

2009 ◽  
Vol 118 (8) ◽  
pp. 587-591 ◽  
Author(s):  
Roya Azadarmaki ◽  
Natasha Mirza ◽  
Ahmed M. S. Soliman
Keyword(s):  
Botulinum Toxin ◽  
Airway Obstruction ◽  
Vocal Fold ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Nerve Section ◽  
Breathing Therapy ◽  
Vocal Fold Motion

Objectives We present a case series of 10 patients with unilateral true vocal fold paralysis who presented with airway obstruction. Methods A retrospective review of the authors' patients at 2 institutions with unilateral true vocal fold motion impairment was carried out over a 10-year period. Of these, 10 patients were identified who presented with stridor and dyspnea as a result of synkinesis. Six cases were a result of thyroidectomy, 1 case resulted from recurrent laryngeal nerve section for spasmodic dysphonia, 1 case occurred after anterior cervical diskectomy and fusion, and in 2 cases no cause was identified. Results Three patients underwent tracheotomy. Two patients underwent partial arytenoidectomy. Seven patients underwent botulinum toxin injection; 2 were treated with breathing therapy, and in 1 case breathing therapy was recommended. Seven patients underwent treatment with more than 1 method. Conclusions Unilateral vocal fold paralysis may present with airway obstruction as a result of synkinesis. Treatment should be incremental and starts with breathing therapy and botulinum toxin injection. Partial arytenoidectomy or tracheotomy may be necessary for refractory cases.

Comparing Botulinum Toxin Injections with Extraocular Muscle Surgery in Toddlers with Esotropia: A Retrospective Analysis

2021 ◽  
Vol 238 (04) ◽  
pp. 478-481
Author(s):  
Tristan Michael Handschin ◽  
Francoise Roulez ◽  
Andreas Schötzau ◽  
Anja Palmowski-Wolfe
Keyword(s):  
Botulinum Toxin ◽  
Extraocular Muscle ◽  
Dose Effect ◽  
Advantages And Disadvantages ◽  
Angle Of Deviation ◽  
Group 2 ◽  
Encrypted Database ◽  
Botulinum Toxin Injections ◽  
Extraocular Muscle Surgery

Abstract Background In toddlers with esotropia, early alignment of the visual axes either with extraocular muscle surgery (EOMS) or botulinum toxin injections (BTIs) into both medial rectus muscles may result in improved depth perception. We compared the outcome of BTIs with EOMS in toddlers in order to gain further insight into the advantages and disadvantages of either method. Patients and Methods In this retrospective study, our encrypted database was searched for toddlers with esotropia aged 35 months or younger at the time of initial treatment with either BTIs or EOMS and who had a follow-up of at least 2 years. We analyzed the angle of deviation, dose effect (DE), and binocularity as well as the number of interventions. Results We identified 26 toddlers who received their first treatment for esotropia within the first 35 months of life: 16 with BTIs (9 males, 7 females) and 10 with EOMS (3 males, 7 females). Mean follow-up was considerably longer in the EOMS (87.7 months) than in the BTI group (35.7 months). Age at first intervention was 22.8 months in the BTI and 24.1 months in the EOMS group, and each toddler wore its full cycloplegic refraction. Mean angle at treatment was 41.25 prism diopters (PD) in the BTI compared to 52.9 PD in the EOMS group. The BTI group received an average of 1.68 BTIs, with a mean dosage of 14.5 IU Botox and a mean DE (mDE) of 1.8 PD/IU. In the EOMS group, the average number of surgeries was 1.4, with a mean dosage of 16.85 mm and a mDE of 3.14 PD/mm surgery. Some degree of binocularity could be observed in 9 (56%) of the BTI (5 × Bagolini positive, 2 × 550″, 2 × 220″) and in 4 (40%) of the EOMS group (2 × 3600″, 1 × 550″, 1 × 300″). By the end of the BTI group follow-up, four toddlers electively underwent EOMS rather than a 3rd BTI (followed by a 3rd BTI in 1), which resulted in the appearance of measurable binocularity in all four (1 × Bagolini positive, 1 × 220″, 1 × 200″, 1 × 60″). Conclusions Our results show that BTIs are a viable treatment alternative in early esotropia. Even if EOMS is ultimately required, some binocularity may develop as the visual axes are aligned for some time in the sensitive phase owing to the effects of Botox. Moreover, less surgical dosage is needed than would have otherwise been necessary to treat the original angle of deviation. BTIs are faster, less invasive, and present as an effective alternative when patient compliance is too low to reliably measure the angle of deviation, which is essential for the planning of EOMS.

scholarly journals Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment

2019 ◽  
Vol 44 (9) ◽  
pp. 886-892 ◽  
Author(s):  
Hannah K Tandon ◽  
Pamela Stratton ◽  
Ninet Sinaii ◽  
Jay Shah ◽  
Barbara I Karp
Keyword(s):  
Botulinum Toxin ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Pelvic Floor Muscle ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Pain Medication ◽  
Muscle Spasm ◽  
Open Label ◽  
Topical Anesthetic

Background and objectivesMany women with endometriosis continue to have pelvic pain despite optimal surgical and hormonal treatment; some also have palpable pelvic floor muscle spasm. We describe changes in pain, spasm, and disability after pelvic muscle onabotulinumtoxinA injection in women with endometriosis-associated pelvic pain, a specific population not addressed in prior pelvic pain studies on botulinum toxin.MethodsWe present an open-label proof-of-concept case series of women with surgically diagnosed endometriosis. Under conscious sedation and with topical anesthetic, 100 units of onabotulinumtoxinA was injected transvaginally into pelvic floor muscle spasm areas under electromyography guidance. Changes in pain intensity, muscle spasm, disability, and pain medication use were assessed at periodic visits for up to 1 year after injection.ResultsThirteen women underwent botulinum toxin injection and were followed for at least 4 months. Before injection, 11 of the 13 women had spasm in >4/6 assessed pelvic muscles and reported moderate pain (median visual analog scale (VAS): 5/10; range: 2–7). By 4–8 weeks after injection, spasm was absent/less widespread (≤3 muscles) in all (p=0.0005). Eleven rated their postinjection pain as absent/mild (median VAS: 2; range: 0–5; p<0.0001); 7/13 reduced pain medication. Disability decreased in 6/8 women with at least moderate preinjection disability (p=0.0033). Relief lasted 5–11 months in 7 of the 11 patients followed for up to 1 year. Adverse events were mild and transient.ConclusionsThese findings suggest pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain. Botulinum toxin injection may provide meaningful relief of pain and associated disability.Trial registration numberNCT01553201

scholarly journals Permanent extraocular muscle damage following botulinum toxin injection

1999 ◽  
Vol 83 (11) ◽  
pp. 1306d-1306d ◽  
Author(s):  
M MOHAN ◽  
S TOW ◽  
B W FLECK ◽  
J P LEE
Keyword(s):  
Botulinum Toxin ◽  
Muscle Damage ◽  
Extraocular Muscle ◽  
Botulinum Toxin Injection

scholarly journals The Long-term Efficacy of Botulinum Toxin Injection to Treat Retrograde Cricopharyngeus Dysfunction

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2093834
Author(s):  
Rebecca C. Hoesli ◽  
Melissa L. Wingo ◽  
Robert W. Bastian
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Symptom Relief ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Case ◽  
Duration Of Action ◽  
Cricopharyngeus Muscle ◽  
Cardinal Symptoms

Objectives To report the percentage of patients with symptom relief 6 or more months after botulinum toxin injection into the cricopharyngeus muscle for retrograde cricopharyngeus dysfunction (R-CPD). Study Design Retrospective case series of consecutively treated patients. Setting Tertiary care laryngology clinic. Subjects and Methods A review was performed of the first 200 patients who were diagnosed with R-CPD and treated with botulinum toxin injection into the cricopharyngeus muscle by a single surgeon. The study group was limited to those for whom a minimum of 6 months has elapsed since the injection. Items assessed were efficacy, safety, complications, and duration of benefit. Results Of 200 patients treated, (99.5%) gained the ability to burp and 95% experienced relief of the cardinal symptoms of R-CPD: inability to belch, socially awkward gurgling noises, abdominal/chest pressure and bloating, and excessive flatulence. For those who experienced relief, 159 (79.9%) maintained a satisfactory ability to burp after 6 months. Of those who did not maintain the ability, 12 underwent a second injection, 1 patient underwent 3 subsequent injections, and 3 patients underwent partial myotomy. No patients experienced complications of botulinum toxin injection itself, and 4 patients had complications from esophagoscopy or anesthesia. Conclusion In a case series of 200 patients with retrograde cricopharyngeus dysfunction, 99% experienced relief of the cardinal symptoms and 79.9% experienced lasting relief of their symptoms beyond pharmacologic duration of action after a single injection of botulinum toxin into the cricopharyngeus muscle. Relief can be reestablished in the remainder via additional injection or cricopharyngeus myotomy.

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