Special Issue "Neurophysiology of Botulinum Toxins in Clinical Practice"

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

Deadline for manuscript submissions: 31 January 2022.

Special Issue Editor

Prof. Dr. Roberto Eleopra
E-Mail Website
Guest Editor
Neurological Unit 1, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, 20133 Milan, Italy
Interests: movement disorders; neurophysiology; botulinum toxin; deep brain stimulation; MRgFUS

Special Issue Information

Dear Colleagues,

Botulinum neurotoxin (BoNT) is one of the most powerful toxins in nature, and is a polypeptide produced by different serotypes of the bacterium (Clostridium botulinum) that are now well identified. Serotypes A and B are largely used in clinical practice to treat different neurological diseases characterized by neuromuscular hyperactivity, autonomic dysfunction, pain syndrome, and so on.

The electrophysiological effects of BoNT have been investigated in systemic human botulism, where the most commonly used tests include the evaluation of variations in compound muscle action potentials (CMAPs), repetitive nerve stimulation, and single-fiber EMG (SFEMG), However, in clinical practice the role of neurophysiology is still unclear, making it difficult to evaluate the neuromuscular block induced by different BoNT serotypes. Therefore, the role of electrophysiology during therapeutic BoNT injections in clinical practice is controversial.

In the literature, the utility of neurophysiology to evaluate the systemic spread of BTX in peripheral or central nervous systems following local injection has been reported, but how electrophysiology may help to check subtle changes in autonomic and nociceptive terminal endings is not well defined.

The aim of this Special Issue is to review the role of neurophysiology in BoNT poisoning in humans. Preliminarily, the electrophysiological findings in wound botulism will be reviewed . Then, the neurophysiological features of BoNT treatment will be revised for: improving the clinical strategy of BoNT injections; detecting local or systemic effects in the PNS and CNS; quantifying the effect of BoNTs on autonomic or nociceptive fibers; detecting adverse local or distant side effects and evaluating true BoNT-resistant subjects.

Prof. Dr. Roberto Eleopra
Guest Editor

Manuscript Submission Information

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  • botulinum toxins
  • neurophysiology
  • botulism
  • electrophysiology

Published Papers (1 paper)

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Low-Dose Neubotulinum Toxin A versus Low-Dose Abobotulinum Toxin A Injection for the Treatment of Cervical Dystonia: A Multicenter, 48-Week, Prospective, Double-Blinded, Randomized Crossover Design Study
Toxins 2021, 13(10), 694; https://0-doi-org.brum.beds.ac.uk/10.3390/toxins13100694 - 01 Oct 2021
Viewed by 381
Various types of botulinum toxin (BoNT) have been studied to treat cervical dystonia (CD). Although high-dose BoNT has proven efficacy, it increases the risk of adverse events. For this reason, this study was planned to identify the non-inferiority efficacy, tolerability, and safety of [...] Read more.
Various types of botulinum toxin (BoNT) have been studied to treat cervical dystonia (CD). Although high-dose BoNT has proven efficacy, it increases the risk of adverse events. For this reason, this study was planned to identify the non-inferiority efficacy, tolerability, and safety of low-dose neubotulinum toxin A (Neu-BoNT-A) versus low-dose abobotulinum toxin A (Abo-BoNT-A) in CD treatment. The 48-week, prospective, randomized, controlled crossover design study of CD treatment, with 50-unit Neu-BoNT-A and 250-unit Abo-BoNT-A injections at 12-week intervals, was conducted over a 24-week treatment period. This study used the following standardized rating scales to assess the efficacy of BoNT: the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS); health-related quality of life (HRQoL); the Cervical Dystonia Impact Profile (CDIP-58); the Short Form 36 health survey questionnaire (SF-36); and, for the depressive symptoms of CD patients, the Center for Epidemiological Studies-Depression Scale (CES-D) and the Patient Health Questionnaire-9 (PHQ-9). Fifty-two CD patients were enrolled from October 2019 to January 2021. The mean scores of the TWSTRS total at the post-treatments in both Neu-BoNT-A and Abo-BoNT-A had a significant reduction from baseline (p = 0.008 and 0.002, respectively). However, the mean changes of the TWSTRS total at the 12- and 24-week treatments between the two treatment groups were not significantly different (p = 0.284 and 0.129, respectively). The mean scores of the HRQoL questionnaires (the CIDP-58 and the SF-36) and the depressive symptoms (the CES-D and the PHQ-9) in both treated groups at the post-treatments did not significantly decrease from baseline and were comparable. Two patients treated with Abo-BoNT-A (250 units) reported cervical tension and benign paroxysmal positional vertigo (BPPV). There were no serious adverse events reported. Though both low-dose BoNT-As were effective at improving clinical symptoms without significant side effects, both treatments did not predict change in quality of life and depression. With the non-inferiority criteria, low-dose Neu-BoNT-A has a similar efficacy, safety, and tolerability to Abo-BoNT-A. Full article
(This article belongs to the Special Issue Neurophysiology of Botulinum Toxins in Clinical Practice)
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