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CME ARTICLE |
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| Year : 2010 | Volume
: 55
| Issue : 1 | Page : 8-14 |
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| Botulinum toxin |
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PK Nigam1, Anjana Nigam2
1 Department of Dermatology and STD, Pt. J.N.M. Medical College and Assoc. Dr. B.R.A.M. Hospital, Raipur - 492 001, India
2 Department of Surgery, Pt. J.N.M. Medical College and Assoc. Dr. B.R.A.M. Hospital, Raipur - 492 001, India
| Date of Web Publication | 4-Mar-2010 |
Correspondence Address:
P K Nigam
Prof. and Head, Department of Dermatology and STD, Pt. J.N.M. Medical College and Assoc. Dr. B.R.A.M. Hospital, Raipur - 492 001, (C.G.)
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.60343
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 Abstract | | |
Botulinum toxin, one of the most poisonous biological substances known, is a neurotoxin produced by the bacterium Clostridium botulinum. C. botulinum elaborates eight antigenically distinguishable exotoxins (A, B, C 1 , C 2 , D, E, F and G). All serotypes interfere with neural transmission by blocking the release of acetylcholine, the principal neurotransmitter at the neuromuscular junction, causing muscle paralysis. The weakness induced by injection with botulinum toxin A usually lasts about three months. Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, and various spastic movement disorders, headaches, hypersalivation, hyperhidrosis, and some chronic conditions that respond only partially to medical treatment. The list of possible new indications is rapidly expanding. The cosmetological applications include correction of lines, creases and wrinkling all over the face, chin, neck, and chest to dermatological applications such as hyperhidrosis. Injections with botulinum toxin are generally well tolerated and side effects are few. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice.
Keywords: Botulinum toxin, Clostridium botulinum, clinical applications, adverse effects
How to cite this article:
Nigam P K, Nigam A. Botulinum toxin. Indian J Dermatol 2010;55:8-14 |
| Introduction | |  |
Botulinum toxin, also called "miracle poison," is one of the most poisonous biological substances known. [1] It is a neurotoxin produced by the bacterium Clostridium botulinum, an anaerobic, gram-positive, spore-forming rod commonly found on plants, in soil, water and the intestinal tracts of animals. Scott [2] first demonstrated the effectiveness of botulinum toxin type A for the management of strabismus in humans. Subsequently, botulinum toxin was approved for the treatment of numerous disorders of spasticiy [1] and a host of other conditions. Currently it is used in almost every sub-specialty of medicine. In 2002, the FDA approved the use of Botox® (Botulinum toxin-A) for the cosmetic purpose of temporarily reducing glabeller forehead frown lines.
Biochemical aspects
C . botulinum elaborates eight antigenically distinguishable exotoxins (A, B, C 1 , C 2 , D, E, F and G). Type A is the most potent toxin, followed by types B and F toxin. Types A, B and E are commonly associated with systemic botulism in humans. [3] All botulinum neurotoxins are produced as relatively inactive, single polypeptide chains with a molecular mass of about 150 kDa with a high degree of amino acid sequence homology among the toxin types. The polypeptide chain consists of a heavy (H) chain and a light (L) chain of roughly 100 and 50 kDa respectively, linked by a disulfide bond. [4] The botulinum toxin neurotoxin complex is also associated with various other nontoxic proteins, which may also have hemagglutinating properties. [5]
How botulinum toxin works
All the serotypes interfere with neural transmission by blocking the release of acetylcholine, which is the principal neurotransmitter at the neuromuscular junction. Intramuscular administration of botulinum toxin acts at the neuromuscular junction to cause muscle paralysis by inhibiting the release of acetylcholine from presynaptic motor neurons. [6] Botulinum toxins act at four different sites in the body: The neuromuscular junction, autonomic ganglia, postganglionic parasympathetic nerve endings and postganglionic sympathetic nerve endings that release acetylcholine. [5] The heavy (H) chain of the toxin binds selectively and irreversibly to high affinity receptors at the presynaptic surface of cholinergic neurones, and the toxin-receptor complex is taken up into the cell by endocytosis. The disulphide bond between the two chains is cleaved and the toxin escapes into the cytoplasm. The light (L) chain interact with different proteins (synaptosomal associated protein (SNAP) 25, vesicle associated membrane protein and syntaxin) in the nerve terminals to prevent fusion of acetylcholine vesicles with the cell membrane. [5],[7] The peak of the paralytic effect occurs four to seven days after injection. Doses of all commercially available botulinum toxins are expressed in terms of units of biologic activity. One unit of botulinum toxin corresponds to the calculated median intraperitoneal lethal dose (LD 50 ) in female Swiss-Webster mice. [8] The affected nerve terminals do not degenerate, but the blockage of neurotransmitter release is irreversible. Function can be recovered by the sprouting of nerve terminals and formation of new synaptic contacts; this usually takes two to three months.
Botulinum toxin induces weakness of striated muscles by inhibiting transmission of alpha motor neurones at the neuromuscular junction. This has led to its use in conditions with muscular overactivity, such as dystonia. Transmission is also inhibited at gamma neurones in muscle spindles, which may alter reflex overactivity. [9] The toxin also inhibits release of acetylcholine in all parasympathetic and cholinergic postganglionic sympathetic neurons. This has generated interest in its use as a treatment for overactive smooth muscles (for example, in achalasia) or abnormal activity of glands (for example, hyperhidrosis). [1]
The toxin requires 24-72 hours to take effect, reflecting the time necessary to disrupt the synaptosomal process. In very rare circumstances, some individuals may require as many as five days for the full effect to be observed. Peaking at about 10 days, the effect of botulinum toxin lasts nearly 8-12 weeks.
Immunologic considerations
An estimated 5-15% of patients injected serially with earlier preparations of Botox® (79-11) developed secondary nonresponsiveness from the production of neutralizing antibodies. [10]
Risk factors associated with the development of neutralizing antibodies include, injection of more than 200 units per session and repeat or booster injections given within one month of treatment. Hopefully, the new (BCB 2024) Botox® has reduced immunogenicity and a lower potential for neutralizing antibody production because of its decreased protein load, though the fact is not proven in clinical trial yet. [11] In rabbit studies, no antibody formation occurred with new (BCB 2024) Botox® after six months of treatment, while old (79-11) Botox® caused antibody formation in all rabbits by five months.
Limited information is available on whether neutralizing antibodies resolve over time and, consequently, whether attempts at reinjection should be made after a prolonged period. An investigation is underway to determine whether injections of botulinum toxin type B are useful in patients with neutralizing antibodies to type A. Using the lowest dose of toxin necessary to achieve the desired clinical effect and avoiding reinjection within one month appear prudent in an effort to keep antibody formation as low and unlikely as possible.
Formulation
Serotype A is the only commercially available form of botulinum toxin for clinical use, although experience is emerging with development of other serotypes: B, C, and F preparations. [12] Two preparations of botulinum toxin A exist: Dysport® and Botox® . Unfortunately, there has been much confusion over the doses and units of potency of the two preparations. [13],[14] Although doses are quoted in mouse units (which is the amount of toxin that kills 50% of a group of 18-20 g female Swiss-Webster mice), implying some standardization, Botox® seems to be more potent. Recently, it has been shown that a unit of Botox® is three times as potent as a unit of Dysport® . [14] Botox® is a sterile lyophilized form of botulinum toxin type A. It is produced from a culture of the Hall strain of C. botulinum and purified by a series of acid precipitations to a crystalline complex containing the toxin and other proteins. The FDA approved Botox® in December 1989 as an orphan drug for the treatment of strabismus, hemifacial spasms, and blepharospasm. The specific activity of Botox® is approximately 20 Units/ nanogram of neurotoxin protein complex. Each vial of Botox® contains 100 Units (U) of Clostridium botulinum type A neurotoxin complex, 0.5 milligrams of Albumin (Human), and 0.9 milligrams of sodium chloride in a sterile, vacuum-dried form without a preservative. The original batch of neurotoxin prepared by Shantz [15] in November 1979 (designated batch 79-11) constituted the original Botox® formulation and was used until December 1997. It was replaced by a new neurotoxin complex batch designated BCB 2024. The new bulk batch is five to six times more potent on a weight basis. In a 100-unit vial, only 4.8 ng of neurotoxin is needed compared to 25 ng of 79-11. The new Botox® is comparable in clinical efficacy and safety to the old, and a unit dose of new Botox® provides an equivalent response to the same unit dose of old Botox® .
Dysport® , another formulation of botulinum toxin type A available in Europe and a few other countries, is prepared using column-based purification techniques and distributed in 500-unit vials that can be stored at room temperature. Botox® and Dysport® are both botulinum toxin type A preparations but are quite distinct from one another. Differences in these toxins may relate to differences in the strain of bacterium, preparation, diffusion, and potency testing.
Myobloc is a botulinum toxin type B preparation. [16]
| Preparations | | |
Botox cosmetic®
Botulinum toxin type A (BOTOX® ; Allergan, Irvine, Calif) was the first commercially available type in the United States. Its safety is well established. The drawback is that once the contents of a vial are dissolved, the reconstituted product loses its potency. Therefore, dermatologists tend to schedule the treatments for several patients on the same day so that they can use the entire contents of the vial. This scheduling may be inconvenient for some patients, who may decide not to proceed.
Dysport® (Ipsen pharmaceuticals) (Botulinum toxin type A)
In Europe, botulinum toxin of the same serotype is marketed by another company (Dysport® ; Speywood, United Kingdom). One unit of BOTOX® has a potency that is approximately equal to 4 unit of Dysport® .
Xeomin®
Xeomin® is the third botulinum toxin type A licensed in the UK. Xeomin® is an innovative Botulinum type A formulation, in which the complexing proteins have been removed by an extensive purification process from the botulinum toxin complex. In contrast to the other commercially available preparations, Xeomin® contains the pure 150 kD neurotoxin. Xeomin® , without the complexing proteins, has the lowest content of bacterial protein of all of the available botulinum toxins and furthermore show that repeated application of Xeomin® , even in high doses, does not induce the formation of neutralising anti-bodies. Clinical studies have suggested that Xeomin® has been found similar in its effect to Botox® in clinical studies. one unit of Xeomin® is equal to 1 unit of Botox®
Neurobloc®
Neurobloc® (Myobloc) is a registered trademark of Solstice Neurosciences Inc, San Francisco, Calif. It is a Clostridium botulinum type - B neurotoxin complex which became available in the U.K. in 2001.There is limited experience in the use of this type of toxin, and the product does not currently have approval for cosmetic use anywhere in the world. It is marketed as Myobloc® Injectable Solution (botulinum toxin type B) in the United States and Canada and Neurobloc® in Europe.
Myobloc (Elan)
Myobloc® (Elan), Dysport® when reconstituted, has a shelf life of more than 12 months. This feature is advantageous in terms of patient scheduling. However, larger volumes of Myobloc® may be needed to obtain effects similar to those of Botox® . Antibody formation against this product may occur more often because of its higher protein content.
Reconstitution and storage
Botox® is stored in a freezer at or below -5°C. The package insert recommends reconstitution using sterile saline without preservative; 0.9% sodium chloride is the preferred diluent. Some investigators suggest that reconstitution with sterile saline solution with preservative (0.9% benzyl alcohol) reduces microbial contamination and provides a weak local anesthetic effect.
Botox® is denatured easily by bubbling or agitation; gently inject the diluent onto the inside wall of the vial and discard the vial if a vacuum does not pull the diluent in. The final dilution of Botox® is mostly a matter of personal preference; 100 units commonly are reconstituted in 1-10 ml of diluent. Theoretically, more concentrated solutions reduce reliability in delivering a specific unit dose, and more dilute solutions lead to greater diffusion of the toxin.
Once reconstituted, Botox® is kept refrigerated at 2-8°C. The reconstituted Botox® should be used within 4 hours. One study found no loss of activity at 6 hours but a 44% loss after 12 hours and a 70% loss with refreezing at 1-2 weeks. [17] Other authors report no substantial loss of potency in a 10 U/1 ml reconstituted solution kept refrigerated for 1 month.
How botulinum toxin is given
Botulinum toxin is injected into affected muscles or glands using a 30-gauge 1-inch needle. Doses are tailored according to the mode of use and individual patients, and the dose depends on the mass of muscle being injected: The larger the muscle mass the higher the dose required. However, lower doses may be required in patients with preexisting weakness and in females.
Toxin injections are given through hollow teflon coated needles directly into affected/overactive muscles. In localized muscle overactivity, especially, in delicate places such as strabismus, the injections are usually guided by electromyography.
Electromyograph monitoring
Many authors [18] have chosen to administer injections under the guidance of electromyograph (EMG) monitoring. This technique involves using a 27-gauge (1.5 in) polytef-coated EMG needle connected to an EMG recorder by an alligator clip on its shaft. The patient is asked to contract the muscle in question. The injection is placed where the maximal EMG recording can be found within the muscle. This technique ensures that the injection is at the point of the muscle that is contributing most to the hyperfunctional facial line. As these injections have become routine, many centers have obtained satisfactory results without EMG guidance. Many physicians use a readily available 30-gauge insulin syringe instead. However, EMG-guided injections remain a useful adjunct in patients who have residual function after their initial injection.
Precautions after botulinum toxin injection
As a general precaution, one should go home immediately and rest after Botox® . Do nothing strenuous for one or two days and refrain from laser/IPL treatments, facials and facial massage for one to two weeks after injections. This is to minimize toxins dislodging and traveling (due to increased blood circulation or direct pressure) to the surrounding muscles.
Follow-up monitoring
The weakness induced by injection with botulinum toxin A usually lasts about three months. Hence, further injections at regular intervals are required and the interval varies widely depending on the dose and individual susceptibility. Response after the injections should be assessed both by subjective and by objective measures. Most patients treated with botulinum toxin require repeated injections over many years. Some patients who respond well initially develop tolerance to the injections due to development of neutralizing antibodies to the toxin. Patients who receive higher individual doses or frequent booster injections seem to have a higher risk of developing antibodies. Injections should therefore be given at the lowest effective dose and as infrequently as possible. Several types of antibody assay are available. [4] In clinical trials patients resistant to botulinum A have benefited from injections with other serotypes, including B, C, and F. [19]
Clinical applications
Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, and various spastic movement disorders. [9],[20] Besides these, encouraging clinical reports have appeared for other uses such as headaches, [21] hypersalivation, [22] hyperhidrosis, [23] and some chronic conditions that respond only partially to medical treatment. Sometimes it can be used as an alternative to surgical intervention. [24] It seems to be a promising alternative to sphincterotomy in patients with chronic anal fissures [25] and is effective in achalasia. [26] Some autonomic disorders resulting in hypersecretion of glands like ptyalism or gustatory sweating, which often occur after surgery to the parotid gland, respond well to botulinum toxin. [23],[27],[28] Surprisingly, the response seems to last much longer than in conditions caused by overactivity of striated or smooth muscles. [28] The list of possible new indications is rapidly expanding [Table 1].
Dermato-cosmetological applications
Cosmetic use of BTX has skyrocketed in recent years, especially since the approval of BTX-A for treatment of glabellar lines. Until recently, Botox® use was mainly confined to correct muscles of facial expression over the upper one-third of the face. Presently it's application ranges from correction of lines, creases and wrinkling all over the face, chin, neck, and chest, depressor anguli oris, nasolabial folds, mentalis, medial and lateral brow lifts, to lessen shadows on one's face and maintain a smooth outline of the jaw and cheeks from all directions, to dermatological applications such as localized axillary or palmar hyperhidrosis that is nonresponsive to topical or systemic treatment [Table 1].
Adverse effects
Injections with botulinum toxin are generally well tolerated and side effects are few. Generalized idiosyncratic reactions are uncommon, generally mild, and transient. There can be mild injection pain and local edema, erythema, transient numbness, headache, malaise or mild nausea. Its effect diminishes with increasing distance from the injection site, but spread to nearby muscles and other tissues is possible. The most feared adverse effect is temporary unwanted weakness/paralysis of nearby musculature caused by the action of the toxin. It usually resolves in several months and in some patients in a few weeks, depending on the site, strength of the injections, and the muscles made excessively weak. Approximately 1-3% of patients may experience a temporary upper lid or brow ptosis. This results from migration of the botulinum toxin to the levator palpebrae superioris muscle. Patients often are instructed to remain in an upright position for three to four hours following injection and avoid manual manipulation of the area. Active contraction of the muscles under treatment may increase the uptake of toxin and decrease its diffusion.
The ptosis usually lasts two to six weeks. It can be treated with apraclonidine 0.5% eyedrops. This is an alpha-adrenergic agent that stimulates the Müller muscle and immediately elevates the upper eyelid. This treatment usually can raise the eyelid 1-3 mm. The treatment of one to two drops three times per day continues until the ptosis resolves. To avoid ptosis, place injections 1 cm above the eyebrow and do not cross the midpupillary line. Apraclonidine is contraindicated in patients with documented hypersensitivity. Phenylephrine 2.5% can be used alternatively. Neo-Synephrine is contraindicated in patients with narrow-angle glaucoma and in patients with aneurysms.
Weakness of the lower eyelid or lateral rectus can occur following injection of the lateral orbicularis oculi. If severe lower lid weakness occurs, an exposure keratitis may result and if the lateral rectus is weakened, diplopia results. Treatment is symptomatic.
Patients receiving injections into the neck muscles for torticollis may therefore develop dysphagia because of diffusion of the toxin into the oropharynx. When this occurs, it usually lasts only a few days or weeks. Some patients may require soft foods. Although a swallowing weakness does not herald systemic toxicity, if it is severe, patients may be at risk of aspiration. Some patients experience neck weakness, which is especially noticeable when attempting to raise the head from a supine position. This occurs after weakening of the sternocleidomastoid muscles, either from direct injection or diffusion. This is more common in women with long thin necks. Avoid these adverse effects by using the lowest effective doses and precisely placing toxin into the platysma.
Distant effects shown by specialized electromyographic tests can also occur, but weakness of distant muscles or generalized weakness, possibly due to the toxin spreading in the blood, is very rare. [29],[30] however, avoid intravascular injections because diffuse spread of large amounts of toxin can mimic the symptoms of botulism.
Bruising can occur, particularly if a small vein is lacerated or a patient is taking aspirin, vitamin E, or NSAIDs. Ideally, patients should stop taking these products two weeks before the procedure. Headaches can occur after Botox® injections; however, in one study by Carruthers et al, [31] this did not exceed the placebo group. This is thought to be due to the trauma of the injection and not something inherent in the toxin. In fact, botulinum toxin injections are extremely safe. To date, no significant long-term hazards of botulinum toxin injections have been identified in excess of placebo groups.
Other systemic side effects include an influenza-like illness and, rarely, brachial plexopathy, which may be immune mediated. [32] No severe allergic reactions have been reported, however, patient may be allergic to any of its components. Gallbladder dysfunction attributed to autonomic side effects of the toxin and a case of necrotizing fasciitis in a immunosuppressed woman with blepharospasm have been noted. [33],[34]
Contraindications to botulinum toxin injection
Botulinum toxin is contraindicated in patients afflicted with a preexisting motor neuron disease, myasthenia gravis, Eaton-Lambert syndrome, neuropathies, psychological unstability, history of reaction to toxin or albumin, pregnancy and lactating females, and infection at the injection site. Careful monitoring should be done in children as it might alter cell functions such as axonal growth. [35]
Relative contraindications
Some medications decrease neuromuscular transmission and generally should be avoided in patients treated with botulinum toxin. These include aminoglycosides (may increase effect of botulinum toxin), penicillamine, quinine, chloroquine and hydroxychloroquine (may reduce effect), calcium channel blockers, and blood thining agents eg. warfarin or aspirin (may result in bruising).
Therapeutic failure
Some patients do not respond to injections and, having never previously responded, are designated as primary nonresponders. Many reasons may lead to a lack of response. Patients with rhytids that are not dynamic in origin (eg, photodamage, age-related changes) do not respond. Improper injection technique or the denatured toxin may also result into therapeutic failure. Some patients may have neutralizing antibodies from prior subclinical exposure, or individual variations in docking proteins may exist. [36] Secondary nonresponders respond initially but lose the response on subsequent injections. Most of these patients may have developed neutralizing antibodies.
| Future research | | |
Type A botulinum toxin has widened its clinical range of applications, but the risk of developing antibodies limits the repeated use of high-dose injection. Other serotypes of botulinum toxin are being investigated as useful alternatives. Botulinum toxin type F differs from type A, mainly by its lower potency, efficacy and shorter duration of action [37] and blocks a different SNARE protein as compared to type A toxin. Therefore, a combination of toxins A and F has been suggested to reduce the total units and overall antigenic dose. [38]
| Conclusion | | |
The use of botulinum toxins has revolutionised the treatment of various ophthalmic spastic disorders, facial dystonias and periocular wrinkles. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice. Adverse effects are usually mild and transient. The most common substantive complication is excessive or unwanted weakness, and this resolves as the action of the toxin is lost. Brow ptosis, eyelid ptosis, neck weakness, dysphagia, and diplopia may occur. Knowledge of the functional anatomy and experience with the procedure help injectors avoid complications. In future, the development of new potent toxins with increasing effectiveness and duration of effect will further aid this expanding and interesting field of chemodenervation.
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[Table 1] |
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Botulinum Toxin to Reduce Cleft Lip/Palate Scars After Surgery and Improves Scar Quality in Children: A Systematic Review and Meta-Analysis |
|
| Ms. Laxmi Ojha, Dr. Afaf Hamze, Prof. Raed M. Al-Zoubi, Dr. Abdelfatteh El Omri, Dr. Kalpana Singh, Prof. Omar M. Aboumarzouk, Dr. Mustafa Al-Khalil | | Global Pediatrics. 2023; : 100054 | | [Pubmed] | [DOI] | | | 5 |
Rivastigmine ameliorates botulinum-induced hippocampal damage and spatial memory impairment in male rats |
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| Keyvan Mehri, Zohreh Zavvari Oskuye, Ehsan Nassireslami, Esmail Karami, Mohammad Reza Parvizi | | NeuroToxicology. 2023; 98: 29 | | [Pubmed] | [DOI] | | | 6 |
Outbreaks of iatrogenic botulism in Europe: Combating off-label medical use of Botulinum Neurotoxin (BoNT) in bariatric procedures |
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| Nityanand Jain, Edouard Lansiaux, Umut Yucel, Swantje Hunermund, Stella Goeschl, Patricia Schlagenhauf | | New Microbes and New Infections. 2023; : 101152 | | [Pubmed] | [DOI] | | | 7 |
Physiologically-Based Toxicokinetic Model of Botulinum Neurotoxin Biodistribution in Mice and Rats |
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| Bradford Gutting, Joseph Gillard, Gabriel Intano | | Computational Toxicology. 2023; : 100278 | | [Pubmed] | [DOI] | | | 8 |
Blepharospasm |
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| Tiffany C. Ho, John B. Holds | | Advances in Ophthalmology and Optometry. 2023; | | [Pubmed] | [DOI] | | | 9 |
Toxin-linked mobile genetic elements in major enteric bacterial pathogens |
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| Shruti Panwar, Shashi Kumari, Jyoti Verma, Susmita Bakshi, Lekshmi Narendrakumar, Deepjyoti Paul, Bhabatosh Das | | Gut Microbiome. 2023; 4 | | [Pubmed] | [DOI] | | | 10 |
Pathogenicity and virulence of Clostridium botulinum |
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| Alexander M. Rawson, Andrew W. Dempster, Christopher M. Humphreys, Nigel P. Minton | | Virulence. 2023; 14(1) | | [Pubmed] | [DOI] | | | 11 |
Adverse effect of botulinum toxin-A injections on mandibular bone: A systematic review and meta-analysis |
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| Mahmoud S. Moussa, Dona Bachour, Svetlana V. Komarova | | Journal of Oral Rehabilitation. 2023; | | [Pubmed] | [DOI] | | | 12 |
The Effect of Botulinum Toxin Type A Injection in the Rectus Femoris in Stroke Patients Walking With a Stiff Knee Gait: A Randomized Controlled Trial |
|
| Martin J. B. Tenniglo, Anand V. Nene, Johan S. Rietman, Jaap H. Buurke, Erik C. Prinsen | | Neurorehabilitation and Neural Repair. 2023; | | [Pubmed] | [DOI] | | | 13 |
The use of platelet-rich plasma, hyaluronic acid, and botulinum toxin for the treatment of TMJ disorders |
|
| Odette Guadarrama Plata | | Journal of Dental Health, Oral Disorders & Therapy. 2023; 14(1): 15 | | [Pubmed] | [DOI] | | | 14 |
Mechanism and clinical use of botulinum neurotoxin in head and facial region |
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| Swarnalakshmi Raman, Yumiko Yamamoto, Yoshitaka Suzuki, Yoshizo Matsuka | | Journal of Prosthodontic Research. 2023; | | [Pubmed] | [DOI] | | | 15 |
The clinical approach to botulinum toxin in dermatology: A literature review |
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| Rabab Hunaid Abbas, Rowyna Reji Koshy, Yusra Fathima, Ranasinghe Arachchige Dona Kashmira Weerasekara, Ziya Sherin, Niveditha Selvakumar, Naga Harika Korrapati | | Cosmoderma. 2023; 3: 58 | | [Pubmed] | [DOI] | | | 16 |
In silico prediction of molecular mechanisms of toxicity mediated by the leptospiral PF07598 gene family-encoded virulence-modifying proteins |
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| Reetika Chaurasia, Joseph M. Vinetz | | Frontiers in Molecular Biosciences. 2023; 9 | | [Pubmed] | [DOI] | | | 17 |
Dermatological Management of Aged Skin |
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| Ewelina Rostkowska, Ewa Poleszak, Katarzyna Wojciechowska, Katarzyna Dos Santos Szewczyk | | Cosmetics. 2023; 10(2): 55 | | [Pubmed] | [DOI] | | | 18 |
Botox: Beauty and Brains |
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| Donell D. Deremer | | Journal of Dermatology for Physician Assistants. 2023; 17(2) | | [Pubmed] | [DOI] | | | 19 |
Immunogenicity of botulinum toxin |
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| Syeo Young Wee, Eun Soo Park | | Archives of Plastic Surgery. 2022; 49(1): 12 | | [Pubmed] | [DOI] | | | 20 |
Therapeutic Efficacy of Botulinum Toxin in Trigeminal Neuralgia |
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| Abdul Mueez Alam Kayani, Minollie Suzanne Silva, Maleesha Jayasinghe , Malay Singhal, Snigdha Karnakoti, Samiksha Jain, Rahul Jena | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 21 |
The Development of Psychiatric Illness and Chemoprophylaxis of Botulinum Toxin in Migraine: A Narrative Review |
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| Ayushi S Dhengare, Darshna G Fulmali | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 22 |
Assessment of Electromyographic Changes in a Patient with Masseter Hypertrophy and Muscle Pain after Botulinum Injections: A Case Report and 5 Months Follow-up |
|
| Marcello Maddalone, Luca Mirabelli, Edoardo Bianco, Ruggero Tagliabue | | The Journal of Contemporary Dental Practice. 2022; 23(2): 226 | | [Pubmed] | [DOI] | | | 23 |
Augmented Reality Can Improve Accuracy in
Identifying Botulinum Toxin Injection Sites |
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| Chevonne van Rhee, John Jacob, Kinan Muhammed | | EMJ Innovations. 2022; : 25 | | [Pubmed] | [DOI] | | | 24 |
Model-Based Anticancer Effect of Botulinum Neurotoxin Type A1 on Syngeneic Melanoma Mice |
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| Won-Ho Kang, Hyo-Jeong Ryu, Seongsung Kwak, Hwi-Yeol Yun | | Frontiers in Pharmacology. 2022; 12 | | [Pubmed] | [DOI] | | | 25 |
Systematic Review and Meta-Analysis on the Frequency of Antibiotic-Resistant Clostridium Species in Saudi Arabia |
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| Saeed S. Banawas | | Antibiotics. 2022; 11(9): 1165 | | [Pubmed] | [DOI] | | | 26 |
An Introduction to Bacterial Biofilms and Their Proteases, and Their Roles in Host Infection and Immune Evasion |
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| Juan Sebastián Ramírez-Larrota, Ulrich Eckhard | | Biomolecules. 2022; 12(2): 306 | | [Pubmed] | [DOI] | | | 27 |
Effectiveness of Botulinum Neurotoxin in Treatment of Scoliosis among Children and Adolescents: A Systematic Review and Meta-Analysis |
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| Yu-Chi Su, Yu-Ching Lin, Pei-Chun Hsieh, Chung-Lun Liao, Yao-Hong Guo | | Children. 2022; 9(10): 1505 | | [Pubmed] | [DOI] | | | 28 |
Do Bacteria Provide an Alternative to Cancer Treatment and What Role Does Lactic Acid Bacteria Play? |
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| Leon M. T. Dicks, Wian Vermeulen | | Microorganisms. 2022; 10(9): 1733 | | [Pubmed] | [DOI] | | | 29 |
High Precision Use of Botulinum Toxin Type A (BONT-A) in Aesthetics Based on Muscle Atrophy, Is Muscular Architecture Reprogramming a Possibility? A Systematic Review of Literature on Muscle Atrophy after BoNT-A Injections |
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| Alexander D. Nassif, Ricardo F. Boggio, Sheila Espicalsky, Gladstone E. L. Faria | | Toxins. 2022; 14(2): 81 | | [Pubmed] | [DOI] | | | 30 |
Botulinum Neurotoxin Therapy in the Clinical Management of Laryngeal Dystonia |
|
| Winnie Yeung, Amanda L. Richards, Daniel Novakovic | | Toxins. 2022; 14(12): 844 | | [Pubmed] | [DOI] | | | 31 |
Duane Retraction Syndrome: The Role of Botulinum Toxin A Injection in Adults and Its Impact on Quality of Life in an Indian Population |
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| Kamlesh Anand, Avani Hariani, Prateek Kumar, Anju Rastogi, Paromita Dutta, Ashish Krishnan | | Journal of Pediatric Ophthalmology & Strabismus. 2022; : 1 | | [Pubmed] | [DOI] | | | 32 |
A Case Report of a Middle Cerebral Artery Infarction Patient Complaining of Hyperhidrosis and Left Upper Extremity Paresthesia |
|
| Kyeong-hwa Lee, Hye-min Heo, Hye-jin Lee, Tae-bin Yim, Seong-uk Park, Jung-mi Park, Chang-nam Ko, Seung-yeon Cho | | The Journal of Internal Korean Medicine. 2022; 43(2): 294 | | [Pubmed] | [DOI] | | | 33 |
Antihemorrhagic Properties of Therapeutic Botulinum Toxin in Experimental Mice |
|
| Sowbarnika Ravichandran, Jerly Helan Mary Joseph, Shanmugaapriya Sellathamby, Mahesh Kandasamy | | SSRN Electronic Journal. 2022; | | [Pubmed] | [DOI] | | | 34 |
Bell felcinin viral patojenitesi ve tedavi olarak botulinum toksin tip A kullanimi |
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| Abraham MELARA, Sathees CHANDRA | | Journal of Contemporary Medicine. 2022; 12(4): 579 | | [Pubmed] | [DOI] | | | 35 |
Botulinum Toxin Injection Therapy for Lingual Dystonia: A Case Report |
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| So-Yeon Bae, Ji-Rak Kim | | Journal of Oral Medicine and Pain. 2022; 47(3): 152 | | [Pubmed] | [DOI] | | | 36 |
Efficacy of botulinum toxin in masseter muscle hypertrophy for lower face contouring |
|
| Nisha Kundu, Rohit Kothari, Nimish Shah, Sunmeet Sandhu, Durga Madhab Tripathy, Hassan Galadari, Michael H. Gold, Mitchel P. Goldman, Martin Kassir, Hadrian Schepler, Stephan Grabbe, Mohamad Goldust | | Journal of Cosmetic Dermatology. 2022; | | [Pubmed] | [DOI] | | | 37 |
Oxymetazoline hydrochloride ophthalmic solution, 0.1%, boosts the effects of botulinum toxin on blepharospasm: a case series |
|
| Jonathan Sung, Alice Song, Michael Song, Julia Song | | Journal of Medical Case Reports. 2022; 16(1) | | [Pubmed] | [DOI] | | | 38 |
Harnessing the Natural Toxic Metabolites in COVID-19 |
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| Ali Bahrami, Mohammad Taheri, Mohammad Reza Arabestani, Meysam Soleimani, Mojdeh Mohammadi, Fatemeh Golabchi, Maryam Banitorfi, Seyed Mostafa Hosseini, Sodabe Khodabandehlou, Fatemeh Nouri, Jelena Zivkovic | | Evidence-Based Complementary and Alternative Medicine. 2022; 2022: 1 | | [Pubmed] | [DOI] | | | 39 |
Efficacy and safety of botulinum toxin-A in writer’s cramp: a systematic review, meta-analysis, and meta-regression |
|
| Anant Patil, Summaiya Zareen Shaikh, Asmita Karajgi, Mohammed Usman Ali | | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2022; 58(1) | | [Pubmed] | [DOI] | | | 40 |
Single injection of very mild dose botulinum toxin in the vastus lateralis improves testicular spermatogenesis and sperm motility in ageing experimental mice |
|
| Risna Kanjirassery Radhakrishnan, Sowbarnika Ravichandran, Aishwarya Sukesh, Balamuthu Kadalmani, Mahesh Kandasamy | | Laboratory Animal Research. 2022; 38(1) | | [Pubmed] | [DOI] | | | 41 |
Variations in cost of transport and their ecological consequences: a review |
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| Miki Jahn, Frank Seebacher | | Journal of Experimental Biology. 2022; 225(15) | | [Pubmed] | [DOI] | | | 42 |
Overactive bladder: not just a normal part of getting older |
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| Lucy Carpenter, Nicholas J Campain | | British Journal of Nursing. 2022; 31(18): S16 | | [Pubmed] | [DOI] | | | 43 |
Effects of Botulinum Toxin Injection on Reducing Myogenic Artifacts during Video-EEG Monitoring: A Longitudinal Study |
|
| Babak Ghelichnia, Pargol Balali, Ghasem Farahmand, Mahdi Shafiee Sabet, Somaye Feizi, Bahareh Pourghaz, Melika Jameie, Abbas Tafakhori | | The Neurodiagnostic Journal. 2022; 62(4): 222 | | [Pubmed] | [DOI] | | | 44 |
Pore Size-Dependent Stereoscopic Hydrogels Enhance the Therapeutic Efficiency of Botulinum Toxin for the Treatment of Nerve-Related Diseases |
|
| Jeong Man An, S. M. Shatil Shahriar, Dong Yun Lee, Seung Rim Hwang, Yong-kyu Lee | | ACS Applied Materials & Interfaces. 2022; | | [Pubmed] | [DOI] | | | 45 |
Pharmacology of Aesthetic Medicines |
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| Natalie Dunlop, Shelly Abramowicz, Elda Fisher | | Oral and Maxillofacial Surgery Clinics of North America. 2022; 34(1): 189 | | [Pubmed] | [DOI] | | | 46 |
Botulinum toxin promotes orofacial antinociception by modulating TRPV1 and NMDA receptors in adult zebrafish |
|
| Rachel Rocha Barreto, Pedro Jesse Lima Veras, Gerlânia de Oliveira Leite, Antonio Eufrásio Vieira Neto, Lucas Villaça Zogheib, Barry John Sessle, Adriana Rolim Campos | | Toxicon. 2022; | | [Pubmed] | [DOI] | | | 47 |
Use of botulinum neurotoxin in the treatment of piriformis syndrome: A systematic review |
|
| Minghe Moses Koh, Yeow Leng Tan | | Journal of Clinical Orthopaedics and Trauma. 2022; : 101951 | | [Pubmed] | [DOI] | | | 48 |
Detection of Potential Microbial Contaminants and Their Toxins in Fermented Dairy Products: a Comprehensive Review |
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| Alaa S. El-Sayed, Hany Ibrahim, Mohamed A. Farag | | Food Analytical Methods. 2022; | | [Pubmed] | [DOI] | | | 49 |
Supporting Lactation in Otolaryngology Patients Through Medication Optimization, Radiology Considerations, and More |
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| Emily Elder, Kiersten Pianosi, Claire M. Lawlor, M. Elise Graham | | JAMA Otolaryngology–Head & Neck Surgery. 2022; | | [Pubmed] | [DOI] | | | 50 |
Comparison of Effectiveness and Safety of a Botulinum Toxin Monotherapy and a Combination Therapy with Hyaluronic Acid Filler for Improving Glabellar Frown |
|
| Jun Hyun Kim, Eun Soo Park, Seung Min Nam, Chang Yong Choi | | Aesthetic Plastic Surgery. 2022; | | [Pubmed] | [DOI] | | | 51 |
Topographic anatomical localization of the motor nerve entry points (MEPs) of the masseter muscle |
|
| Istemihan Coban, Kaan Yucel, Yelda Pinar | | Surgical and Radiologic Anatomy. 2021; 43(11): 1859 | | [Pubmed] | [DOI] | | | 52 |
Therapeutic efficacy of new botulinum toxin identified in CCUG 7968 strain |
|
| Yeongduk An, Young-Je Kim, Chung-sei Kim, Hyeona Yim, Myungseob Kim, Eui-Kyung Lee, Hyeon-Ji Oh, Jun-Hyeok Han, Eunseon Yoo, Sunghyun Kim, Joongseok Woo, Edward R. B. Moore, Ji-Youn Jung, Wooram Park | | Applied Microbiology and Biotechnology. 2021; 105(23): 8727 | | [Pubmed] | [DOI] | | | 53 |
To evaluate the effect and longevity of Botulinum toxin type A (Botox®) in the management of gummy smile – A longitudinal study upto 4 years follow-up |
|
| Athreya Rajagopal, Manoj Goyal, Sagrika Shukla, Neeti Mittal | | Journal of Oral Biology and Craniofacial Research. 2021; 11(2): 219 | | [Pubmed] | [DOI] | | | 54 |
Post-Mastectomy Pain Syndrome: An Up-to-Date Review of Treatment Outcomes |
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| Ava G. Chappell, Selcen Yuksel, Daniel C. Sasson, Annie B. Wescott, Lauren M. Connor, Marco F. Ellis | | JPRAS Open. 2021; 30: 97 | | [Pubmed] | [DOI] | | | 55 |
Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now? |
|
| Amit G. Reddy, Brian P. Dick, Caleb Natale, Kole P. Akula, Ayad Yousif, Wayne J.G. Hellstrom | | Sexual Medicine Reviews. 2021; 9(2): 320 | | [Pubmed] | [DOI] | | | 56 |
First Reported Case of Neuromodulator Use in a Patient Who Received the Botulinum Vaccine |
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| Vinayak Bhatt, Emmy Graber | | Dermatologic Surgery. 2021; 47(2): 282 | | [Pubmed] | [DOI] | | | 57 |
Comparative efficacy, safety, and cost-effectiveness of abobotulinumtoxinA and onabotulinumtoxinA in children with upper limb spasticity: a systematic literature review, indirect treatment comparison, and economic evaluation |
|
| N. Danchenko, K. M. Johnston, K. Haeussler, J. Whalen | | Journal of Medical Economics. 2021; 24(1): 949 | | [Pubmed] | [DOI] | | | 58 |
Safety and efficacy of botulinum neurotoxin in the treatment of erectile dysfunction refractory to phosphodiesterase inhibitors: Results of a randomized controlled trial |
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| Islam Fathy Soliman Abdelrahman, Amr Abdel Raheem, Yaser Elkhiat, Abdelrahman A. Aburahma, Tarek Abdel-Raheem, Hussein Ghanem | | Andrology. 2021; | | [Pubmed] | [DOI] | | | 59 |
Analysis of Facial Muscle Depths to Guide Botulinum Toxin Therapy of the Periocular Region |
|
| Arian S. Mowlavi, Rebecca L. Van Alstine, Mariam Berri, Samar Arshad, Michael Ablavsky, Swapnil Kachare, Bradon J. Wilhelmi | | The American Journal of Cosmetic Surgery. 2021; : 0748806821 | | [Pubmed] | [DOI] | | | 60 |
The Use of Botulinum Toxin in a Case of Acquired Periodic Alternating Nystagmus |
|
| Nadia Venturi, Gillian Adams, Maria Theodorou | | British and Irish Orthoptic Journal. 2021; 17(1): 85 | | [Pubmed] | [DOI] | | | 61 |
Botulinum toxin – Know the product before injecting |
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| Gulhima Arora | | Cosmoderma. 2021; 1: 56 | | [Pubmed] | [DOI] | | | 62 |
Effect of BoNT/A in the Surface Electromyographic Characteristics of the Pelvic Floor Muscles for the Treatment of Chronic Pelvic Pain |
|
| Monica Albaladejo-Belmonte, Francisco J. Nohales-Alfonso, Marta Tarazona-Motes, Maria De-Arriba, Jose Alberola-Rubio, Javier Garcia-Casado | | Sensors. 2021; 21(14): 4668 | | [Pubmed] | [DOI] | | | 63 |
Botulinum Neurotoxins (BoNTs) and Their Biological, Pharmacological, and Toxicological Issues: A Scoping Review |
|
| Massimo Corsalini, Francesco Inchingolo, Gianna Dipalma, Angelika Elzbieta Wegierska, Ioannis Alexandros Charitos, Maria Assunta Potenza, Antonio Scarano, Felice Lorusso, Alessio Danilo Inchingolo, Monica Montagnani, Luigi Santacroce | | Applied Sciences. 2021; 11(19): 8849 | | [Pubmed] | [DOI] | | | 64 |
Quantum Dots as Biosensors in the Determination of Biochemical Parameters in Xenobiotic Exposure and Toxins |
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| Poorvisha RAVI, Muthupandian GANESAN | | Analytical Sciences. 2021; 37(5): 661 | | [Pubmed] | [DOI] | | | 65 |
Trigonal-Sparing vs. Trigonal-Involved OnabotulinumtoxinA Injection for the Treatment of Overactive Bladder: A Systematic Review and Meta-Analysis |
|
| Yuanshan Cui, Tong Cai, Tiantian Dong, Xiaoyi Zhang, Zhongbao Zhou, Youyi Lu, Yong Zhang, Jitao Wu, Zhenli Gao, Yongqiang Wang, Liying Dong | | Frontiers in Neurology. 2021; 12 | | [Pubmed] | [DOI] | | | 66 |
Neurocosmetics in Skincare—The Fascinating World of Skin–Brain Connection: A Review to Explore Ingredients, Commercial Products for Skin Aging, and Cosmetic Regulation |
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| Vito Rizzi, Jennifer Gubitosa, Paola Fini, Pinalysa Cosma | | Cosmetics. 2021; 8(3): 66 | | [Pubmed] | [DOI] | | | 67 |
Botulinum Toxin A Injection for the Treatment of Intractable Dry Eye Disease |
|
| Eun Woo Choi, Dong Ju Yeom, Sun Young Jang | | Medicina. 2021; 57(3): 247 | | [Pubmed] | [DOI] | | | 68 |
Novel Applications of Non-Invasive Intravesical Botulinum Toxin a Delivery in the Treatment of Functional Bladder Disorders |
|
| Jia-Fong Jhang, Hann-Chorng Kuo | | Toxins. 2021; 13(5): 359 | | [Pubmed] | [DOI] | | | 69 |
Management of parotid fistula and Frey's syndrome with Botulinum neurotoxin type A |
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| Ripon Chowdhury, Dev Roy, Abhimanyu Roy | | National Journal of Maxillofacial Surgery. 2021; 12(1): 106 | | [Pubmed] | [DOI] | | | 70 |
Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis |
|
| Michael Farrell, Barbara I. Karp, Panagiotis Kassavetis, William Berrigan, Simge Yonter, Debra Ehrlich, Katharine E. Alter | | Toxins. 2020; 12(10): 626 | | [Pubmed] | [DOI] | | | 71 |
Sialorrhea in Parkinson’s Disease |
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| Jonathan Isaacson, Sanskruti Patel, Yasar Torres-Yaghi, Fernando Pagán | | Toxins. 2020; 12(11): 691 | | [Pubmed] | [DOI] | | | 72 |
Alternative Methods for Testing Botulinum Toxin: Current Status and Future Perspectives |
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| Mahesh Raj Nepal, Tae Cheon Jeong | | Biomolecules & Therapeutics. 2020; 28(4): 302 | | [Pubmed] | [DOI] | | | 73 |
OnabotulinumtoxinA Injections for Patients with Chronic Migraine During the COVID-19 Pandemic |
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| Samer Narouze | | Annals Of Headache Medicine Journal. 2020; | | [Pubmed] | [DOI] | | | 74 |
Benefits, Safety, and Adjunct Modality Prevalences of Long-Term Botulinum Toxin Injections for Cervical Dystonia and Myofascial Neck Pain: A Retrospective Cohort Study |
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| Dion Diep, Jasmine Ko, John Lan, Kinga T Koprowicz, Gordon Ko | | Journal of Pain Research. 2020; Volume 13: 1297 | | [Pubmed] | [DOI] | | | 75 |
Effect of Botulinum Toxin on Equinus Foot Deformity in Cerebral Palsy Patients: A Systematic Review and Network Meta-analysis |
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| Mohamed Fathi, Ahmed S. Hussein, Shrouk M.Elghazaly, Asmaa M. Al-Kinawy, Ahmed K. Abdeltawab, Yasmin M. Mansour, Nada A. Elbehbeh, Ahmed Sherif, Ahmed M. Afifi | | Current Pharmaceutical Design. 2020; 26(37): 4796 | | [Pubmed] | [DOI] | | | 76 |
Botulinum toxin injections for shoulder and upper limb pain: a narrative review |
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| Ke-Vin Chang, Yi-Hsiang Chiu, Wei-Ting Wu, Po-Cheng Hsu, Levent Özçakar | | Pain Management. 2020; 10(6): 411 | | [Pubmed] | [DOI] | | | 77 |
The uses of botulinum toxin A in facial aesthetics |
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| Gemma Fromage | | Journal of Aesthetic Nursing. 2020; 9(10): 414 | | [Pubmed] | [DOI] | | | 78 |
Pharmacology of Botulinum Toxins: From Poison to Remedy |
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| Kansu BÜYÜKAFSAR | | Düzce Tip Fakültesi Dergisi. 2020; | | [Pubmed] | [DOI] | | | 79 |
Dramatic neurological and biological effects by botulinum neurotoxin type A on SH-SY5Y neuroblastoma cells, beyond the blockade of neurotransmitter release |
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| Lei Wang, Carol S. Ringelberg, Bal R. Singh | | BMC Pharmacology and Toxicology. 2020; 21(1) | | [Pubmed] | [DOI] | | | 80 |
Multicenter Efficacy Trial of a Percutaneous Radiofrequency System for the Reduction of Glabellar Lines |
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| James Newman, James Chan, Z Paul Lorenc, Braden C Stridde, David James Russell | | Aesthetic Surgery Journal. 2020; 40(6): 650 | | [Pubmed] | [DOI] | | | 81 |
Long-term efficacy and safety of a new botulinum toxin type A preparation in mouse gastrocnemius muscle |
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| Jungtae Na, Esther Lee, Yu-jin Kim, Mi Ji Choi, Su-Young Kim, Jeong Sun Nam, Bum Jin Yun, Beom Joon Kim | | Toxicon. 2020; 187: 163 | | [Pubmed] | [DOI] | | | 82 |
Perspectives for the use of therapeutic Botulinum toxin as a multifaceted candidate drug to attenuate COVID-19 |
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| Mahesh Kandasamy | | Medicine in Drug Discovery. 2020; 6: 100042 | | [Pubmed] | [DOI] | | | 83 |
Overactive Bladder Syndrome Treatments and Their Effect on Female Sexual Function: A Review |
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| Gali Levy, Lior Lowenstein | | Sexual Medicine. 2020; 8(1): 1 | | [Pubmed] | [DOI] | | | 84 |
Intramuscular Injection of BOTOX® Boosts Learning and Memory in Adult Mice in Association with Enriched Circulation of Platelets and Enhanced Density of Pyramidal Neurons in the Hippocampus |
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| Ajisha Yesudhas, Syed Aasish Roshan, Risna Kanjirassery Radhakrishnan, G. P. Poornimai Abirami, Nivethitha Manickam, Kaviya Selvaraj, Gokul Elumalai, Sellathamby Shanmugaapriya, Muthuswamy Anusuyadevi, Mahesh Kandasamy | | Neurochemical Research. 2020; 45(12): 2856 | | [Pubmed] | [DOI] | | | 85 |
Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions |
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| Angelos Mantelakis, Harry Spencer, Jean-Luc Duval, Anil Joshi | | Current Otorhinolaryngology Reports. 2020; 8(4): 358 | | [Pubmed] | [DOI] | | | 86 |
Botox and Dermal Fillers |
|
| David Sheen, Earl Clarkson | | Dental Clinics of North America. 2020; 64(2): 325 | | [Pubmed] | [DOI] | | | 87 |
Nerve input to tumours: Pathophysiological consequences of a dynamic relationship |
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| Charlotte Hutchings, Jade A. Phillips, Mustafa B.A. Djamgoz | | Biochimica et Biophysica Acta (BBA) - Reviews on Cancer. 2020; 1874(2): 188411 | | [Pubmed] | [DOI] | | | 88 |
Crystal Structures of Protein-Bound Cyclic Peptides |
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| Alpeshkumar K. Malde, Timothy A. Hill, Abishek Iyer, David P. Fairlie | | Chemical Reviews. 2019; 119(17): 9861 | | [Pubmed] | [DOI] | | | 89 |
Randomized controlled trial comparing botulinum vs surgery for drooling in neurodisabilities |
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| Stijn Bekkers, Corinne P. Delsing, Saskia E. Kok, Karen van Hulst, Corrie E. Erasmus, Arthur R.T. Scheffer, Frank J.A. van den Hoogen | | Neurology. 2019; 92(11): e1195 | | [Pubmed] | [DOI] | | | 90 |
A Glance into Botulinum Toxin Outpatient Clinic in Movement Disorders Practice: Self Experience |
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| Yildiz DEGIRMENCI | | Düzce Tip Fakültesi Dergisi. 2019; 21(3): 162 | | [Pubmed] | [DOI] | | | 91 |
Treating the effects of bruxism with botulinum toxin type A: an overview |
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| BETH HALL | | Journal of Aesthetic Nursing. 2019; 8(3): 116 | | [Pubmed] | [DOI] | | | 92 |
Radiation-Induced Painful Neurogenic Hypertrophy Treated With Botulinum Toxin A |
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| Alexandra Filippakis, Doreen T. Ho, Juan E. Small, Kirstin M. Small, Erik R. Ensrud | | Journal of Clinical Neuromuscular Disease. 2018; 19(3): 135 | | [Pubmed] | [DOI] | | | 93 |
Consensus Recommendations for Treatment Strategies in Indians Using Botulinum Toxin and Hyaluronic Acid Fillers |
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Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures |
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Objective assessment of cortical activity changes in stroke patients before and after hand rehabilitation with and without botulinum toxin injection |
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Ultrasound and Electromyography Guidance for Injection of the Longus Colli With Botulinum Toxin for the Treatment of Cervical Dystonia |
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Optimal Dosing of Botulinum Toxin for Treatment of Chronic Anal Fissure: A Systematic Review and Meta-Analysis |
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Use of botulinum toxin type A for the treatment of radiation therapy–induced myokymia and neuromyotonia in a dog |
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| Cleo P. Rogatko, Eric N. Glass, Marc Kent, James J. Hammond, Alexander de Lahunta | | Journal of the American Veterinary Medical Association. 2016; 248(5): 532 | | [Pubmed] | [DOI] | | | 99 |
Unilateral blepharoptosis secondary to the intramuscular injection of botulinum toxin |
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| Raina Zarb Adami, Dariush Nikkhah, Zakir Shariff, Jeremy Rodrigues, Alexandra Saetta | | Journal of Aesthetic Nursing. 2015; 4(10): 493 | | [Pubmed] | [DOI] | | | 100 |
Effectiveness of Botulinum Toxin (Type-A) Administered by the Fixed-Site Dosing Approach Versus the Muscle Area Identification |
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Application of Botulinum Toxin on Masticatory Muscle of Patients with Bruxism |
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Efficacy of botulinum toxin injections in the treatment of various types of facial region disorders [Yüz bölgesi hastaliklarinin çeşitli tiplerinde botulinum toksini enjeksiyonlarinin etkinliǧi] |
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Comparative study of the diffusion of five botulinum toxins type-A in five dosages of use: Are there differences amongst the commercially-available products? |
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Pseudoaneurysm of the superficial temporal artery: A complication of botulinum toxin injection |
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| Skaf, G.S. and Domloj, N.T. and Salameh, J.A. and Atiyeh, B. | | Aesthetic Plastic Surgery. 2012; 36(4): 982-985 | | [Pubmed] | | | 105 |
Botulinum toxin: Benefit from centralized pharmaceutical preparation of injected doses | [Toxine botulinique: intérêt de la préparation centralisée des doses à injecter] |
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Minimally invasive botulinum toxin type A injection from the ocular surface to extraocular muscles |
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| Wan, X.-M., Chu, R.-X., Gong, H.-Q. | | International Journal of Ophthalmology. 2011; | | [Pubmed] | |
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