Botox (botulinum toxin )

Introduction:

The BTX Botulinum toxin or Botox is a vital nerve toxin and is associated with potential outbreaks of deadly food poisoning caused by eating canned food as a result often corrupt and has also the role of special treatment.

Doctors investigated the use of serotype A (BTX-A) in patients with neurological disorders since 1970, while the FDA in 1989 confirmed the usefulness of BTX-A (BOTOX from a company Allergan) to address the squint, eyelid spasm and disorders of nerve VII. And was then study a wide range of different applications for BOTOX for many decades.

Biochemistry:

Producing clostridia botulinum Clostridium botolinum (Gram-positive bacteria, a problem for the anaerobic spores) toxin multiple foreign proteins. The exotoxic Alothbt and strongest is the BTX-A, and the median lethal dose than in monkeys is approximately 39 units / kg. But when injected into the human lethal dose Vtkon almost 2500 - 3000 units. BTX-A leads to neurotoxic effects by inhibiting transport Alkolanerjeeh synaptic nerve endings. When it interferes with the endings before the clamp, it prevents the liberation of extracellular acetylcholine. The side effects are limited and peripheral nervous system occur primarily neuromuscular connecting the dots, but the nerve endings can be Ttatheroadha Streptococcus.

Once affects the nerve endings at the neuromuscular junction, the BTX-A removes the innervation of muscle fibers and cause paralysis, "soft." After injection to about 2-3 days, the BTX-A causes the vulnerable "muscle" distinctive ", and complete paralysis typically occurs within 10 days and that the de-innervation neuromuscular junction does not cause harm to" always "to the end of the nerve and the Ekosa." Can be supplied by the muscle is atrophying after incitement to BTX but the re-development of the sensitivity of neurotransmission to produce acetylcholine receptors outside the junctional.

Motor neurons sprout new endings also so that if given enough time, they ultimately reflect the paralysis. In fact, when injected BTX-A in the muscle for therapeutic purposes, the period of its impact is often limited few months.

Therapeutic applications:

Has expanded the number of therapeutic applications for BTX in Kberkhalal years of studies in humans where the injection is localized for BTX-A first-line treatment for focal dystonia spasm of the eyelids, Alassar Torticollis throat tension and imbalance in addition to strabismus. This treatment can be delayed or controlled on the need for surgical procedures in many patients, thereby reducing the risks associated with surgery.

As for patients who can not afford the surgery to benefit from this procedure, note that it does not correct the neurological imbalances, but leads to a temporary disappearance of the symptoms.

Indications:

A - Hol:

Strabismus is the kind Indications, who has studied carefully and strictly for the use of BTX-A. It is characterized by a lack of parallelism in-kind and is accompanied by excessive contraction of the muscles outside the eye. Can achieve the parallel kind outside of the eye muscles weaken shrinking sharply by the injection of BTX-A.

Varied results of clinical trials, but in general, the BTX-A to reduce the deviation in kind by 50% -80%, and accidents were side effects were rare and usually temporary, and determine the effectiveness of commonly correct the deviation and the impact, if failed, it can resort to surgery.

B - facial dystonia

C - Eyelid spasm:

Tension is a focal defect of the orbital muscles in kind. Demonstrations in the initial appearance is similar to strabismus, which can cause closure "temporarily" to the eye with a possible functional blindness.

In the mid and late in 1980 showed cases and a variety of experiences that injection of BTX-A was effective "in this area, and is now the treatment of choice instead of surgery cut muscle orbital, Valmaaljh produce improvement" initially "in 82-100% of patients, and in the study of double Altamama improvement 12 patients were "significantly after treatment with BTX-A treatment compared with placebo Almohm and the period of the average benefit was 12.5 weeks."

D - hemifacial spasm:

Hemifacial spasm is a bug of tension and a single side of the lower facial muscles. Can be accompanied by cramps participate clonus Cloms paroxysmal or Nfdhat Twitching.

Can be treated with anti-convulsants, but often not effective, studies have shown that 90% of patients with hemifacial spasm improved after BTX-A injections into the affected muscles. The 'recorded the results of other similar investigations, and the initial dose 2.5-20 units. And the effect tends to be slightly longer in patients with hemifacial spasm compared with those eyelids spasms.

Other indications for Botox:

1 - Focal Hyperhidrosis: Focal Hyperhidrosis (excessive production of sweat spot)

It is one of the most Indications modern and investigate for which BTX, has proposed reports initial several experiments documented that the BTX-A is a good alternative to sympathectomy for patients with excessive sweating has been reduced by the drug considerably sweat secreted from the glands Nathh remove blindfolded endings Alkolanerjeeh chemically.

In fact, some reports indicated that the treatment can inhibit excessive sweating for about a year and did not record serious side effects so far, however, observed when the number of patients twice the grip of the hand after a transient injection volar. And one of the experiments have shown improvement after 13 weeks "by 31% compared with 2% in the untreated hands.

Recorded a series of 12 patients had "excessive sweating armpits period of interest period of 3-12 months after injection under the skin two-sided (250 units of BTX-A), while in another experiment, described 50 units BTX-A under the skin for the treatment of axillary hyperhidrosis period Medium effectiveness of 5.2 months. " Therefore, the results suggested that this treatment is a good alternative to surgical intervention

2 - Alrererh: Nystagmus

Reported beneficial results with somewhat shared. BTX-A in patients with acquired nystagmus. In a study of 12 patients "and the other 6 patients there was an improvement," transient "acute vision after injection behind the eyeball by 15-30 units BTX-A, but recorded negative results shared. With the treatment of nystagmus acquired in 3 patients. All patients suffered from diplopia, lack of visual acuity.

Is clear from these published studies that retrobulbar injection of BTX-A for the management of acquired nystagmus has limited value with complications such as Alanssadol Ptosis and diplopia (in patients not candidates for surgery).

BTX-A description of one side with the closure of the other eye and led to improved vision while avoiding the even

3 - Parkinson's disease: Tremors

Tremor of the head, neck and limbs are also indications for treatment with BTX, including Parkinson's disease and primary and secondary to other disorders.

4 - Aelchenaj Spasticity

5 - Traumatic brain injury

6 - Cerebral Palsy Cerebral Palsy

7 - Aelchenaj post-traumatic
8 - Additional indications: hypersalivation, myoclonic Myoclonus, stuttering.

Indications are not documented:

1. Dystoniasis cervical dystonia

2. Dystonia oral mandibular

3. Stress disorder throat

4. Writer's cramp

5. Gastrointestinal disorders

6. La Artakaúah Achalasia

7. Anal fissures and Anismus

8. Dysfunction and finally presses the Audi "

9. Aesthetic correction of wrinkles: wrinkles associated Almoktbah severe contraction in the muscles of the front. Thus, these muscles paralyzed by Botox is a possible alternative for surgery corrected. Therefore, patients treated for wrinkles Almoktbah patients in addition to wrinkles around the orbital

There has been a latent interest in correcting wrinkles of the forehead, and wrinkles around the eye and Almoktbah as we see in the two forms of the wrinkles before and after Botox injection

Preparation, treatment and management:

The BOTOX commercially available in bottles containing 100 units.

Preparation requires special care and treatment for injection before processing, the product dried syncytial should be stored in a refrigerator at -5 degree of processing and using sterile normal saline serum-free preservatives. Should be used BTX-A during the 4 hours of processing for injection, and during this period, the solution should be stored in a refrigerator degree (2-8).

Side effects:

Although it is highly lethal dose, the localized injection of BTX-A is accompanied by serious side effects, but few tend to be injected in the region specific, with few complications of systemic or non-existent.

There are two common types lead to severe weakness in the muscles of the hand:

I injected a large amount of BTX-A injection and the second is dopey in the vicinity and that the appropriate injection technique can reduce the side effects.

Facial injections of BTX-A can lead to prolapse, dry eyes and bruises, especially if given around the eye. The injection into muscle cervical and jaw oral can lead to dysphagia, dry mouth, or ten votes, and there is also "interactions side additional after injection facial or cervical are nausea, conjunctivitis, diplopia, blurred vision, fatigue, hematoma and phobia light. mild neck weakness occurs at different rates in recipients of BTX-A for the defect neck tension by 10-25%, and similarly weak party, wrist, or hand occurred in patients treated for spasticity, tremor, writer's cramp, excessive sweating.

The Few systemic effects, including: flu-like syndromes, rash, dry eyes, dry mouth, urinary retention, and Rare cases of generalized weakness and poor gallbladder function.

Immune resistance and serotypes:

Formed antibodies against BTX-A can lead to a lack of effectiveness with repeated treatment. Thus, it can take advantage of these resisters to repeated injections of nervous Balvevan treatment alternative.

Register for Literature Humanities serotypes of BTX are B, C, and F. Each toxin nervous innervation removes nerve endings Alkolanerjeeh chemically in a manner similar to BTX-A, although the exact mechanism can vary. The antibody-mediated resistance to serotype A does not move cross-resistance to BTX-B or BTX-F. As a result, patients resistance to repeated injections of BTX-A can respond to the treatment of other serological patterns.

Although the evidence in support of the serological patterns of alternative therapy is limited in quantity and quality, the serotype B was a point of deep studies in patients resistant to BTX-A classic.

Indications and one obtained by the resistance to BTX-A and described the tension in the neck defect and the treatment with BTX-B effective in patients resistant to BTX-A. The effect of the BTX-B tend to be similar or slightly shorter than BTX-A. In a randomized trial one, the duration of treatment response in patients with defective tension neck is 12-16 weeks. "In addition, demonstrated BTX-B effectiveness of initial in patients who were not fighters for BTX-A, and the injection of mutual two types worshipers could delay a This modified antibodies can prolong the period of effective therapeutic full.

In early studies, BTX-F was useful in patients resistant to BTX-A. The patients with impaired resistance to tension neck denervation with BTX-A have benefited from treatment with BTX-F. In addition, I BTX-F for the treatment of patients with resistance to BTX-A but did not form antibodies "animated pattern A and in the study due for 18 patients" were treated by BTX-F we get further evidence that this serotype can prove to be a substitute "in patients resistant to BTX-A. There's an early investigation BTX-C showed that it also could be a future role in the treatment of patients resistant immunologically.

Result:

The list of therapeutic indications for BTX is increasingly where the branches of medicine gain confidence to use them. But expensive treatment in any case With full doses exceeding 100 units in several indications, the cost of treatment considerably. Costs of prescribing repeated adds another cost, however, when evaluating the high cost of BTX, we must take into account the cost of alternative treatments that avoid them (mainly surgical), and regardless of indication, the physician to make sure as much as possible that the BTX will benefit the patient.

Several disturbances, which is used for which BTX be debilitating and often resistant to traditional treatments. Thus, the worker interest in patients is small if there are alternatives, but nevertheless it is not without risk and side effects with a wide range of severity, and the specified period of influence determine the use in the indications are numerous and beyond, the resistance immune can hold course treatment, despite the fact that alternative serotypes can give the treatment "at length". When you make a decision as to whether we will or not we were to BTX, it must take into account the following:

1. Long-term costs of the repeated injections.

2. Likelihood of success.

3. Extent of improvement possible treatment with BTX.

4. Alternative therapies.