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Toxins
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Clinical and Anatomical Perspectives of Botulinum Neurotoxin
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Clinical and Anatomical Perspectives of Botulinum Neurotoxin

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 34065

Special Issue Editors

Prof. Dr. Hee-Jin Kim

E-Mail Website
Guest Editor
Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Interests: botulinum; neurotoxin; clinical studies
Special Issues, Collections and Topics in MDPI journals
Dr. Kyu-ho Yi

E-Mail Website
Guest Editor
Wonju City Public Health Center, Wonju-Si, Kangwondo 26417, Korea
Interests: rehabilitation medicine; aesthetics medicine; plastic reconstructive surgery

Special Issue Information

Dear Colleagues,

The clinical usage of the botulinum neurotoxin (BoNT) extended in recent decades, which is a common substance used in clinical practices. However, accurate injection techniques and anatomical guidelines are still lacking information. In the clinical procedures of botulinum toxin injections in the fields of therapeutics or cosmetics, various clinical adverse effects have been reported. The background of the side effects includes not only the improper injection techniques, but also the lack of anatomical understanding of the conflicting clinical experiences.

Clinical practices guided by ultrasonography have been used to avoid the adverse effects known to be associated with BoNT injection. This enables precise injection with accurate doses of toxins, but until this day the clinical anatomical knowledge lacked much in recent clinical practices of BoNT.

This Special Issue includes anatomical and ultrasonography injection guidelines for accurate and for the most safe injection points related to BoNT injection. Current knowledge on identifying of the BoNT injection point from the more recent anatomical research will be assessed. It is also welcome with clinical guided approach such as electromyography and other new injection techniques using different equipment.

Prof. Dr. Hee-Jin Kim
Dr. Kyu-ho Yi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Toxins is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • surface anatomy
  • injection guideline
  • injection point
  • ultrasonography
  • aesthetics
  • clinical appli-cation
  • movement disorder
  • pain
  • spasticity

Published Papers (6 papers)

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Research

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12 pages, 6047 KiB  
Article
The Efficacy of Transvaginal Ultrasound-Guided BoNT-A External Sphincter Injection in Female Patients with Underactive Bladder
by Cheng-Yen Tsai, Yao-Hung Yeh, Li-Hsien Tsai and Eric Chieh-Lung Chou
Toxins 2023, 15(3), 199; https://0-doi-org.brum.beds.ac.uk/10.3390/toxins15030199 - 4 Mar 2023
Cited by 2 | Viewed by 5095 | Correction
Abstract
Owing to the diverse treatment outcomes after a botulinum toxin A (BoNT-A) injection to the external sphincter, this study aimed to develop a new technique: an ultrasound-guided BoNT-A external sphincter injection. This single-center prospective cohort study was conducted at a tertiary medical center [...] Read more.
Owing to the diverse treatment outcomes after a botulinum toxin A (BoNT-A) injection to the external sphincter, this study aimed to develop a new technique: an ultrasound-guided BoNT-A external sphincter injection. This single-center prospective cohort study was conducted at a tertiary medical center in Taichung, Taiwan. From December 2020 to September 2022, 12 women were enrolled. The patients were evaluated for lower urinary tract syndrome using patient perception of bladder condition (PPBC), international prostate symptom score (IPSS), uroflowmetry, post-void residual volume (PVR), cystometry, and external sphincter electromyography. We evaluated the patients the day before surgery and 1 week after the BoNT-A injection. For the patients requiring self-catheterization, we recorded the number of times they required clean intermittent catheterization (CIC) per day before the procedure and 1 month after the procedure. The IPSS, PPBC, and PVR were significantly better after the transvaginal ultrasound-guided BoNT-A external sphincter injection. The number of times the patients required daily CIC was also reduced after the injection. Only one patient developed de novo urge urinary incontinence. Our results demonstrated that a transvaginal ultrasound-guided BoNT-A injection was efficacious and safe in the treatment of underactive bladder. Full article
(This article belongs to the Special Issue Clinical and Anatomical Perspectives of Botulinum Neurotoxin)
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13 pages, 1049 KiB  
Article
Shear Wave Velocity to Evaluate the Effect of Botulinum Toxin on Post-Stroke Spasticity of the Lower Limb
by Yuki Hasegawa, Masachika Niimi, Takatoshi Hara, Yoshihiro Sakurai, Shigeru Soshi, Jun Udaka and Masahiro Abo
Toxins 2023, 15(1), 14; https://0-doi-org.brum.beds.ac.uk/10.3390/toxins15010014 - 26 Dec 2022
Cited by 1 | Viewed by 2163
Abstract
(1) Background: The evaluation of muscles with spasticity using ultrasound elastography has attracted attention recently, and the shear wave velocity (SWV) technique can measure the mechanical properties of tissues objectively and quantitatively. The purpose of this study was to evaluate the effect of [...] Read more.
(1) Background: The evaluation of muscles with spasticity using ultrasound elastography has attracted attention recently, and the shear wave velocity (SWV) technique can measure the mechanical properties of tissues objectively and quantitatively. The purpose of this study was to evaluate the effect of using SWV to assess the effect of Botulinum toxin type A (BoNT-A) treatment in adult patients with post-stroke lower limb spasticity. (2) Methods: We assessed the modified Ashworth Scale, the modified Tardieu Scale, and SWV at rest and after stretching before and at 1 month after BoNT-A treatment in 10 adult participants with post-stroke lower limb spasticity. (3) Results: Significant changes in SWV of the ankle joint in maximum dorsiflexion to the extent possible (SWV stretched) were observed after BoNT-A treatment. SWV stretched was positively correlated with joint range of motion. Participants whose joint range of motion did not improve (i.e., gastrocnemius medialis muscle (GCM) extension distance did not change) had significantly more reductions in SWV stretched after BoNT-A treatment. (4) Conclusions: Our results suggest that the SWV measurements may serve as a quantitative assessment to determine the effect of the BoNT-A treatment in adult stroke patients. SWV measurements to assess GCM spasticity should consider the effects of tension, material properties and activation level of muscles. The challenge is to measure SWV with matching limb positions in patients without contractures. Full article
(This article belongs to the Special Issue Clinical and Anatomical Perspectives of Botulinum Neurotoxin)
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12 pages, 1590 KiB  
Article
Effects of Flexor Digitorum Longus Muscle Anatomical Structure on the Response to Botulinum Toxin Treatment in Patients with Post-Stroke Claw Foot Deformity
by Toru Takekawa, Kazushige Kobayashi, Naoki Yamada, Satoshi Takagi, Takatoshi Hara, Tomohide Kitajima, Tomoharu Sato, Hiroshi Sugihara, Kazuo Kinoshita and Masahiro Abo
Toxins 2022, 14(10), 666; https://0-doi-org.brum.beds.ac.uk/10.3390/toxins14100666 - 25 Sep 2022
Cited by 1 | Viewed by 2148
Abstract
(1) Background: The purpose of this retrospective case-control study was to determine the relationship between the control of toe movements by flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles and the response to treatment with botulinum toxin (BoNT) in post-stroke patients [...] Read more.
(1) Background: The purpose of this retrospective case-control study was to determine the relationship between the control of toe movements by flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles and the response to treatment with botulinum toxin (BoNT) in post-stroke patients with claw toe. (2) Methods: Subjects with stroke-related leg paralysis/spasticity and claw toes received multiple injections of BoNT (onabotulinumtoxin A) into the FHL or FDL muscles. We investigated the relationship between the mode of transmission of FHL and FDL muscle tension to each toe (MCT) and treatment outcome using the data of 53 patients who received 124 injections with clinically recorded treatment outcome. We also dissected the potential variables that could determine the treatment outcome. (3) Results: The effectiveness of BoNT treatment was significantly altered by FDL-MCT (OR = 0.400, 95% CI = 0.162–0.987, p = 0.047). Analysis of the response to the first BoNT injection showed an odds ratio of FDL-MCT of approximately 6.0 times (OR = 0.168, 95% CI = 0.033–0.857, p = 0.032). The more tibial the influence of the FDL muscle on each toe, the better the treatment outcome on the claw toe. (4) Conclusions: The anatomic relation between FDL muscle and each toe seems to affect the response to treatment with BoNT in post-stroke patients with claw toes. Full article
(This article belongs to the Special Issue Clinical and Anatomical Perspectives of Botulinum Neurotoxin)
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Review

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14 pages, 515 KiB  
Review
Efficacy and Safety of Botulinum Toxin B in Focal Hyperhidrosis: A Narrative Review
by Anna Campanati, Federico Diotallevi, Giulia Radi, Emanuela Martina, Barbara Marconi, Ivan Bobyr and Annamaria Offidani
Toxins 2023, 15(2), 147; https://0-doi-org.brum.beds.ac.uk/10.3390/toxins15020147 - 11 Feb 2023
Cited by 5 | Viewed by 2072
Abstract
Botulinum toxin type B (BoNT-B), known as Myobloc® in the United States and as Neurobloc® in Europe, is a new therapeutically available serotype among the botulinum toxin family. During the last years several data have been reported in literature investigating its [...] Read more.
Botulinum toxin type B (BoNT-B), known as Myobloc® in the United States and as Neurobloc® in Europe, is a new therapeutically available serotype among the botulinum toxin family. During the last years several data have been reported in literature investigating its efficacy and safety, as well as defining the dosing and application regiments of BoNT-B in the treatment of hyperhidrosis. Moreover, recent studies have been examining its safety profile, which may be different from those known about BoNT-A. The aim of this review is to provide information about what is currently known about BoNT-B in regards to the treatment of focal hyperhidrosis. Full article
(This article belongs to the Special Issue Clinical and Anatomical Perspectives of Botulinum Neurotoxin)
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7 pages, 1982 KiB  
Review
Anatomical Proposal for Botulinum Neurotoxin Injection Targeting the Platysma Muscle for Treating Platysmal Band and Jawline Lifting: A Review
by Kyu-Ho Yi, Ji-Hyun Lee, Kangwoo Lee, Hye-Won Hu, Hyung-Jin Lee and Hee-Jin Kim
Toxins 2022, 14(12), 868; https://0-doi-org.brum.beds.ac.uk/10.3390/toxins14120868 - 10 Dec 2022
Cited by 22 | Viewed by 16608
Abstract
The platysma muscle is a thin superficial muscle that covers the entire neck and lower part of the face. The platysma muscle is the primary target muscle for botulinum neurotoxin injection therapy aimed at treating platysmal band and lower facial lifting. In the [...] Read more.
The platysma muscle is a thin superficial muscle that covers the entire neck and lower part of the face. The platysma muscle is the primary target muscle for botulinum neurotoxin injection therapy aimed at treating platysmal band and lower facial lifting. In the procedure of botulinum neurotoxin injection therapy, a lack of knowledge of the anatomy of the platysma muscle and the properties of botulinum neurotoxin can lead to side effects such as dysphagia, dysphonia, and weakness of the neck muscles. Anatomically safe injection sites have been proposed for the platysma muscle, and the appropriate injection technique has been reviewed. We proposed optimal injection sites based on the external anatomical features of the mandible. The aim of these proposal was to standardize the procedure for the effective use of botulinum neurotoxin injections by minimizing the dose unit and injection points and thereby preventing adverse events. Full article
(This article belongs to the Special Issue Clinical and Anatomical Perspectives of Botulinum Neurotoxin)
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9 pages, 3864 KiB  
Review
Novel Anatomical Proposal for Botulinum Neurotoxin Injection Targeting Lateral Canthal Rhytids
by Kyu-Ho Yi, Ji-Hyun Lee, Ga-Young Kim, Seong-Wook Yoon, Wook Oh and Hee-Jin Kim
Toxins 2022, 14(7), 462; https://0-doi-org.brum.beds.ac.uk/10.3390/toxins14070462 - 6 Jul 2022
Cited by 14 | Viewed by 5025
Abstract
Botulinum neurotoxin injections near the lateral canthal rhytids are commonly used in cosmetic settings; however, there is a lack of thorough anatomical knowledge, and an effective way to treat them with accumulating knowledge is needed. The anatomical characteristics concerning the injection of botulinum [...] Read more.
Botulinum neurotoxin injections near the lateral canthal rhytids are commonly used in cosmetic settings; however, there is a lack of thorough anatomical knowledge, and an effective way to treat them with accumulating knowledge is needed. The anatomical characteristics concerning the injection of botulinum neurotoxin into the orbicularis oculi muscle were evaluated in this review. Current knowledge on the identification of botulinum neurotoxin injection points from recent anatomical research was assessed. The lateral canthal lines are involved with the orbicularis oculi muscle and nearby anatomical structures, and the injection points can be more precisely defined. The best possible injection sites were provided, and the injection procedure was described. This review proposes evidence for injection sites associated with the surface anatomy of the orbicularis oculi muscles to enhance the effectiveness of easing lateral canthal rhytids. Full article
(This article belongs to the Special Issue Clinical and Anatomical Perspectives of Botulinum Neurotoxin)
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