Botulinum toxin: Description of injection techniques and examination of controversies surrounding toxin diffusion

Acta Neurologica Scandinavica

Volumn 117, Issue 2, 2008, Pages 73-84

  Lim, E C H ^a,b   Seet, R C S ^a,b  

^a NATIONAL UNIVERSITY OF SINGAPORE   (Singapore)

^b NATIONAL UNIVERSITY HOSPITAL   (Singapore)

Author keywords

Accurate; Botulinum toxin; Diffusion; Electrical stimulation; Electromyography; Localization

Indexed keywords

ACETYLCHOLINESTERASE; ANESTHETIC AGENT; BOTULINUM TOXIN A; BOTULINUM TOXIN B; BUPIVACAINE; CBTX A; EMLA; LIDOCAINE; NEURONOX; UNCLASSIFIED DRUG;

ANUS FISSURE; AUTORADIOGRAPHY; BLEPHAROSPASM; CONSTIPATION; COST BENEFIT ANALYSIS; COST CONTROL; COST EFFECTIVENESS ANALYSIS; DECISION TREE; DETRUSOR DYSSYNERGIA; DILUTION; DRUG DIFFUSION; DRUG EFFICACY; DRUG INDICATION; DRUG MECHANISM; DRUG STORAGE; ECHOGRAPHY; ELECTROMYOGRAPHY; ENDOSCOPY; EQUIPMENT; ESOPHAGUS ACHALASIA; HUMAN; HYPERHIDROSIS; HYPERSALIVATION; IMMUNOHISTOCHEMISTRY; INJECTION; INJECTION SITE PAIN; LOCAL ANESTHESIA; MIGRAINE; MUSCLE WEAKNESS; MYOFASCIAL PAIN; NERVE BLOCK; NONHUMAN; NYSTAGMUS; OBESITY; OSCILLOPSIA; PATIENT; PHYSICIAN; PTOSIS; REVIEW; RHINITIS; SPASTICITY; STRABISMUS; SWEAT GLAND DISEASE; TEMPOROMANDIBULAR JOINT DISORDER; TENSION HEADACHE; TRIGEMINUS NEURALGIA; VAGINISM;

ANIMALS; ANTI-DYSKINESIA AGENTS; BOTULINUM TOXINS; ELECTROMYOGRAPHY; HUMANS; INJECTIONS; MUSCLE, SKELETAL;

EID: 37849017970     PISSN: 00016314     EISSN: 16000404     Source Type: Journal    
DOI: 10.1111/j.1600-0404.2007.00931.x     Document Type: Review

References (114)

1. Simpson LL. Identification of the major steps in botulinum toxin action. Annu Rev Pharmacol Toxicol 2004 44:167 93.
2. Dressler D, Saberi FA, Barbosa ER. Botulinum toxin: mechanisms of action. Arq Neuropsiquiatr 2005 63:180 5.
3. Piovesan EJ, Teive HG, Kowacs PA, Della Coletta MV, Werneck LC, Silberstein SD. An open study of botulinum-A toxin treatment of trigeminal neuralgia. Neurology 2005 65:1306 8.
4. Chuang YC, Huang CC, Kang HY et al. Novel action of botulinum toxin on the stromal and epithelial components of the prostate gland. J Urol 2006 175:1158 63.
5. Jankovic J. Botulinum toxin in clinical practice. J Neurol Neurosurg Psychiatry 2004 75:951 7.
6. Setler PE. Therapeutic use of botulinum toxins: background and history. Clin J Pain 2002 18 (Suppl. S119 24.
7. Dressler D, Eleopra R. Clinical use of non-A botulinum toxins: botulinum toxin type B. Neurotox Res 2006 9:121 5.
8. Comella CL, Jankovic J, Shannon KM et al. Comparison of botulinum toxin serotypes A and B for the treatment of cervical dystonia. Neurology 2005 65:1423 9.
9. Barnes MP, Best D, Kidd L et al. The use of botulinum toxin type-B in the treatment of patients who have become unresponsive to botulinum toxin type-A - initial experiences. Eur J Neurol 2005 12:947 55.
10. Brin MF, Lew MF, Adler CH et al. Safety and efficacy of Neurobloc (botulinum toxin type B) in type A-resistant cervical dystonia. Neurology 1999 53:1431 8.
11. Rosales RL, Bigalke H, Dressler D. Pharmacology of botulinum toxin: differences between type A preparations. Eur J Neurol 2006 13 (Suppl. 1 2 10.
12. Ross MH, Charness ME, Sudarsky L, Logigian EL. Treatment of occupational cramp with botulinum toxin: diffusion of toxin to adjacent noninjected muscles. Muscle Nerve 1997 20:593 8.
13. Defazio G, Abbruzzese G, Girlanda P et al. Botulinum toxin A treatment for primary hemifacial spasm: a 10-year multicenter study. Arch Neurol 2002 59:418 20.
14. Borodic GE, Joseph M, Fay L, Cozzolino D, Ferrante RJ. Botulinum A toxin for the treatment of spasmodic torticollis: dysphagia and regional toxin spread. Head Neck 1990 12:392 9.
15. Borodic GE, Ferrante R, Pearce IB, Smith K. Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum A toxin injections. Mov Disord 1994 9:31 39.
16. Hsu TS, Dover JS, Arndt KA. Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol 2004 140:1351 4.
17. Flynn TC, Clark RE 2nd. Botulinum toxin type B (Myobloc) versus botulinum toxin type A (Botox) frontalis study: rate of onset and radius of diffusion. Dermatol Surg 2003 29:519 22.
18. Eleopra R, Tugnoli V, Caniatti L, De Grandis D. Botulinum toxin treatment in the facial muscles of humans: evidence of an action in untreated near muscles by peripheral local diffusion. Neurology 1996 46:1158 60.
19. Kobayashi T, Niimi S, Kumada M, Kosaki H, Hirose H. Botulinum toxin treatment for spasmodic dysphonia. Acta Otolaryngol Suppl 1993 504:155 7.
20. Arezzo J, Litwak MS, Caputo FA, Meyer KE, Shopp GM. Spread of paralysis to nearby and distant noninjected muscles in a monkey hand model: comparison of BoNTB and BoNTA. In:Brin M, Jankovic J, Hallett M, eds. Scientific and therapeutic aspects of botulinum toxin. Philadelphia:Lippincott, Williams and Wilkins, 2002 123 133.
21. Lorenzano C, Bagnato S, Gilio F, Fabbrini G, Berardelli A. No clinical or neurophysiological evidence of botulinum toxin diffusion to non-injected muscles in patients with hemifacial spasm. Neurotox Res 2006 9:141 4.
22. Tang-Liu DD, Aoki KR, Dolly JO et al. Intramuscular injection of 125I-botulinum neurotoxin-complex versus 125I-botulinum-free neurotoxin: time course of tissue distribution. Toxicon 2003 42:461 9.
23. Lim EC, Oh VM, Ong BK, Chow AW, Seet RC. Where has all the botox gone? (How) will we ever learn....Using monoclonal antibodies to track botulinum toxin. Med Hypotheses 2006 67:440 6.
24. Shaari CM, Sanders I. Quantifying how location and dose of botulinum toxin injections affect muscle paralysis. Muscle Nerve 1993 16:964 9.
25. Kinnett D. Botulinum toxin A injections in children: technique and dosing issues. Am J Phys Med Rehabil 2004 83 (Suppl S59 64.
26. Shaari CM, George E, Wu BL, Biller HF, Sanders I. Quantifying the spread of botulinum toxin through muscle fascia. Laryngoscope 1991 101:960 4.
27. Glogau RG. Hyperhidrosis and botulinum toxin A: patient selection and techniques. Clin Dermatol 2004 22:45 52.
28. Goodman G. Diffusion and short-term efficacy of botulinum toxin A after the addition of hyaluronidase and its possible application for the treatment of axillary hyperhidrosis. Dermatol Surg 2003 29:533 8.
29. Brisinda G, Maria G, Sganga G, Bentivoglio AR, Albanese A, Castagneto M. Effectiveness of higher doses of botulinum toxin to induce healing in patients with chronic anal fissures. Surgery 2002 131:179 84.
30. Molloy FM, Shill HA, Kaelin-Lang A, Karp BI. Accuracy of muscle localization without EMG: implications for treatment of limb dystonia. Neurology 2002 58:805 7.
31. Wong AM, Chen CL, Chen CP, Chou SW, Chung CY, Chen MJ. Clinical effects of botulinum toxin A and phenol block on gait in children with cerebral palsy. Am J Phys Med Rehabil 2004 83:284 91.
32. Gracies JM, Hefter H, Simpson DM, Moore P. Spasticity in adults. In:Moore P, Naumann M, eds. Handbook of botulinum toxin treatment. Oxford:Blackwell Science, 2003 219 71.
33. Pathak MS, Nguyen HT, Graham HK, Moore AP. Management of spasticity in adults: practical application of botulinum toxin. Eur J Neurol 2006 13 (Suppl 1 42 50.
34. Bakheit AM, Ward CD, McLellan DL. Generalised botulism-like syndrome after intramuscular injections of botulinum toxin type A: a report of two cases. J Neurol Neurosurg Psychiatry 1997 62:198.
35. Bhatia KP, Munchau A, Thompson PD et al. Generalised muscular weakness after botulinum toxin injections for dystonia: a report of three cases. J Neurol Neurosurg Psychiatry 1999 67:90 3.
36. Delagi EF, Perotto A. Anatomic guide for the electromyographer. Springfield, IL:Charles C. Thomas, 1980.
37. Willenborg MJ, Shilt JS, Smith BP, Estrada RL, Castle JA, Koman LA. Technique for iliopsoas ultrasound-guided active electromyography-directed botulinum a toxin injection in cerebral palsy. J Pediatr Orthop 2002 22:165 8.
38. Galardi G, Guerriero R, Amadio S et al. Sporadic failure of botulinum toxin treatment in usually responsive patients with adductor spasmodic dysphonia. Neurol Sci 2001 22:303 6.
39. Childers MK. The importance of electromyographic guidance and electrical stimulation for injection of botulinum toxin. Phys Med Rehabil Clin N Am 2003 14:781 92.
40. Sojer M, Wissel J, Muller J, Poewe W. Treatment of focal dystonia with botulinum toxin A. Wien Klin Wochenschr 2001 113 (Suppl 4 6 10.
41. Cheung O, Wald A. Review article: the management of pelvic floor disorders. Aliment Pharmacol Ther 2004 19:481 95.
42. Tan EK. Botulinum toxin treatment of sialorrhea: comparing different therapeutic preparations. Eur J Neurol 2006 13 (Suppl 1 60 4.
43. Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Albanese A. Botulinum toxin in the treatment of outlet obstruction constipation caused by puborectalis syndrome. Dis Colon Rectum 2000 43:376 80.
44. Chuang YC, Chiang PH, Huang CC, Yoshimura N, Chancellor MB. Botulinum toxin type A improves benign prostatic hyperplasia symptoms in patients with small prostates. Urology 2005 66:775 9.
45. Westhoff B, Seller K, Wild A, Jaeger M, Krauspe R. Ultrasound-guided botulinum toxin injection technique for the iliopsoas muscle. Dev Med Child Neurol 2003 45:829 32.
46. Chin TY, Nattrass GR, Selber P, Graham HK. Accuracy of intramuscular injection of botulinum toxin A in juvenile cerebral palsy: a comparison between manual needle placement and placement guided by electrical stimulation. J Pediatr Orthop 2005 25:286 91.
47. Blitzer A, Brin MF, Stewart CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 1998 108:1435 41.
48. Ford CN, Bless DM, Lowery JD. Indirect laryngoscopic approach for injection of botulinum toxin in spasmodic dysphonia. Otolaryngol Head Neck Surg 1990 103:752 8.
49. Rhew K, Fiedler DA, Ludlow CL. Technique for injection of botulinum toxin through a flexible nasolaryngoscope. Otolaryngol Head Neck Surg 1994 111:787 94.
50. Pehlivanov N, Pasricha PJ. Achalasia: botox, dilatation or laparoscopic surgery in 2006. Neurogastroenterol Motil 2006 18:799 804.
51. Bistritz L, Bain VG. Sphincter of Oddi dysfunction: managing the patient with chronic biliary pain. World J Gastroenterol 2006 12:3793 802.
52. Kinney TP, Shah AG, Rogers BH, Ehrenpreis ED. Retrograde endoscopic delivery of botulinum toxin for anal fissures. Endoscopy 2006 38:654.
53. Junior AC, Savassi-Rocha PR, Coelho LG et al. Botulinum A toxin injected into the gastric wall for the treatment of class III obesity: a pilot study. Obes Surg 2006 16:335 43.
54. Mokhless I, Gaafar S, Fouda K, Shafik M, Assem A. Botulinum A toxin urethral sphincter injection in children with nonneurogenic neurogenic bladder. J Urol 2006 176:1767 70.
55. Dressler D. Electromyographic evaluation of cervical dystonia for planning of botulinum toxin therapy. Eur J Neurol 2000 7:713 8.
56. Traba Lopez A, Esteban A. Botulinum toxin in motor disorders: practical considerations with emphasis on interventional neurophysiology. Neurophysiol Clin 2001 31:220 9.
57. Wissel J, Muller J, Poewe W. EMG for identification of dystonic, tremulous and spastic muscles and techniques for guidance of injections. In:Moore P, Naumann M, eds. Handbook of botulinum toxin treatment. Oxford:Blackwell Science, 2003 76 98.
58. Lim EC, Ong BK, Seet RC. Botulinum toxin-A injections for spastic toe clawing. Parkinsonism Relat Disord 2006 12:43 7.
59. Childers MK, Kornegay JN, Aoki R, Otaviani L, Bogan DJ, Petroski G. Evaluating motor end-plate-targeted injections of botulinum toxin type A in a canine model. Muscle Nerve 1998 21:653 5.
60. Wiederholt WC. ''End-plate noise'' in electromyography. Neurology 1970 20:214 224.
61. Dressler D. Pharmacological aspects of therapeutic botulinum toxin preparations. Nervenarzt 2006 77:912 21.
62. Wohlfarth K, Kampe K, Bigalke H. Pharmacokinetic properties of different formulations of botulinum neurotoxin type A. Mov Disord 2004 19 (Suppl 8 S65 7.
63. Simonetta Moreau M, Cauhepe C, Magues JP, Senard JM. A double-blind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidrosis. Br J Dermatol 2003 149:1041 5.
64. Ranoux D, Gury C, Fondarai J, Mas JL, Zuber M. Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia. J Neurol Neurosurg Psychiatry 2002 72:459 62.
65. Klein AW. Dilution and storage of botulinum toxin. Dermatol Surg 1998 24:1179 80.
66. Mantell AM. Dilution, storage, and electromyographic guidance in the use of botulinum toxins. Dermatol Clin 2004 22:135 6.
67. Redaelli A, Forte R. Botulinum toxin dilution: our technique. J Cosmet Laser Ther 2003 5:218 9.
68. Gassner HG, Sherris DA. Addition of an anesthetic agent to enhance the predictability of the effects of botulinum toxin type A injections: a randomized controlled study. Mayo Clin Proc 2000 75:701 4.
69. Botox (botulinum toxin type A) purified neurotoxin complex (package insert). Irvine, CA:Allergan Inc., 2003.
70. Alam M. Pain associated with injection of botulinum toxin A exotoxin reconstituted using isotinic sodium chloride with and without preservative. Arch Dermatol 2002 138:510 4.
71. Paik NJ, Seo K, Eun HC. Reduced potency after refrigerated storage of botulitum toxin A: human extensor digitorum brevis muscle study. Mov Disord 2006 21:1759 63.
72. Ponce-Olivera RM, Tirado-Sanchez A, Arellano-Mendoza MI, Leon-Dorantes G, Kassian-Rank S. Palmar hyperhidrosis. Safety efficacy of two anaesthetic techniques for botulinum toxin therapy. Dermatol Online J 2006 12:9.
73. Gorgu M, Silistreli OK, Karantinaci B, Ayhan M, Ozdemirkiran T, Celebisoy M. Interaction of botulinum toxin type A with local anesthetic agents: an experimental study with rabbits. Aesthetic Plast Surg 2006 30:59 64.
74. Lim EC, Seet RC. Another injection-free method to effect analgesia when injecting botulinum toxin for palmar hyperhidrosis: cryoanalgesia. Dermatol Online J 2007 13:25.
75. Haller I, Hausott B, Tomaselli B et al. Neurotoxicity of lidocaine involves specific activation of the p38 mitogen-activated protein kinase, but not extracellular signal-regulated or c-jun N-terminal kinases, and is mediated by arachidonic acid metabolites. Anesthesiology 2006 105:1024 33.
76. Brin MF. Dosing, administration, and a treatment algorithm for use of botulinum toxin A for adult-onset spasticity. Spasticity Study Group. Muscle Nerve Suppl 1997 6:S208 20.
77. Comella CL, Thompson PD. Treatment of cervical dystonia with botulinum toxins. Eur J Neurol 2006 13 (Suppl. 16 20.
78. Gordon MF, Brashear A, Elovic E et al. Repeated dosing of botulinum toxin type A for upper limb spasticity following stroke. Neurology 2004 63:1971 3.
79. Francisco GE. Botulinum toxin: dosing and dilution. Am J Phys Med Rehabil 2004 83 (Suppl. S30 7.
80. Huang W, Foster JA, Rogachefsky AS. Pharmacology of botulinum toxin. J Am Acad Dermatol 2000 43:249 59.
81. Tilton AH. Injectable neuromuscular blockade in the treatment of spasticity and movement disorders. J Child Neurol 2003 18 (Suppl. S50 66.
82. Hanna PA, Jankovic J. Mouse bioassay versus western blot assay for botulinum toxin antibodies: correlation with clinical response. Neurology 1998 50:1624 9.
83. Newman WJ, Davis TL, Padaliya BB et al. Botulinum toxin type A therapy during pregnancy. Mov Disord 2004 19:1384 5.
84. Fasano A, Bentivoglio AR, Ialongo T, Soleti F, Evoli A. Treatment with botulinum toxin in a patient with myasthenia gravis and cervical dystonia. Neurology 2005 64:2155 6.
85. Comella CL, Buchman AS, Tanner CM, Brown-Toms NC, Goetz CG. Botulinum toxin injection for spasmodic torticollis: increased magnitude of benefit with electromyographic assistance. Neurology 1992 42:878 82.
86. Hunter DG, Nguyen T, Patel SN, Repka MX. Automated analysis of electromyographic (EMG) recordings during botulinum injections. J Pediatr Ophthalmol Strabismus 1996 33:241 6.
87. Brin MF, Blitzer A, Herman S, Stewart C. Oromandibular dystonia. Treatment of 96 patients with botulinum toxin type A. In:Jankovic J, Hallett M, eds. Therapy with botulinum toxin. New York:Marcel Dekker Inc., 1994 429 35.
88. Brin MF, Blitzer A, Stewart C. Laryngeal dystonia (spasmodic dysphonia): observations of 901 patients and treatment with botulinum toxin. Adv Neurol 1998 78:237 52.
89. Gracies JM. Physiological effects of botulinum toxin in spasticity. Mov Disord 2004 19 (Suppl. 8 S120 8.
90. Watanabe T. The role of therapy in spasticity management. Am J Phys Med Rehabil 2004 83 (Suppl. S45 9.
91. Lim EC, Quek AM, Seet RC. Botulinum toxin-A injections via electrical motor point stimulation to treat writer's cramp: pilot study. Neurol Neurophysiol Neurosci 2006 4:1 7.
92. Malaviya GN. Flexor digitorum superficialis - revisited. Indian J Lepr 2005 77:305 16.
93. Schroeder AS, Berweck S, Lee SH, Heinen F. Botulinum toxin treatment of children with cerebral palsy - a short review of different injection techniques. Neurotox Res 2006 9:189 96.
94. Diez J, Endel G. Reimbursement strategies for botulinum toxin type A in Austria. Wien Klin Wochenschr 2001 113 (Suppl. 42 4.
95. Cheng CM, Chen JS, Patel RP. Unlabeled uses of botulinum toxins: a review, part 1. Am J Health Syst Pharm 2006 63:145 52.
96. Ruiz FJ, Guest JF, Lehmann A et al. Costs and consequences of botulinum toxin type A use. Management of children with cerebral palsy in Germany. Eur J Health Econ 2004 5:227 35.
97. Ward A, Roberts G, Warner J, Gillard S. Cost-effectiveness of botulinum toxin type a in the treatment of post-stroke spasticity. J Rehabil Med 2005 37:252 7.
98. Radensky PW, Archer JW, Dournaux SF, O'Brien CF. The estimated cost of managing focal spasticity: a physician practice patterns survey. Neurorehabil Neural Repair 2001 15:57 68.
99. Essani R, Sarkisyan G, Beart RW, Ault G, Vukasin P, Kaiser AM. Cost-saving effect of treatment algorithm for chronic anal fissure: a prospective analysis. J Gastrointest Surg 2005 9:1237 43.
100. Goldberg LD. The cost of migraine and its treatment. Am J Manag Care 2005 2 (Suppl. S62 7.
101. Brefel-Courbon C, Simonetta-Moreau M, More C et al. A pharmacoeconomic evaluation of botulinum toxin in the treatment of spasmodic torticollis. Clin Neuropharmacol 2000 23:203 7.
102. Dodel RC, Kirchner A, Koehne-Volland R et al. Costs of treating dystonias and hemifacial spasm with botulinum toxin A. Pharmacoeconomics 1997 12:695 706.
103. Graboski CL, Gray DS, Burnham RS. Botulinum toxin A versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: a randomised double blind crossover study. Pain 2005 118:170 5.
104. Zaninotto G, Vergadoro V, Annese V et al. Botulinum toxin injection versus laparoscopic myotomy for the treatment of esophageal achalasia: economic analysis of a randomized trial. Surg Endosc 2004 18:691 5.
105. Comella CL, Jankovic J, Brin MF. Use of botulinum toxin type A in the treatment of cervical dystonia. Neurology 2000 12 (Suppl. S15 21.
106. Munchau A, Filipovic SR, Oester-Barkey A, Quinn NP, Rothwell JC, Bhatia KP. Spontaneously changing muscular activation pattern in patients with cervical dystonia. Mov Disord 2001 16:1091 7.
107. O'Brien CF. Injection techniques for botulinum toxin using electromyography and electrical stimulation. Muscle Nerve Suppl 1997 6:S176 80.
108. Klein AW, Mantell A. Electromyographic guidance in injecting botulinum toxin. Dermatol Surg 1998 24:1184 6.
109. Childers MK. Targeting the neuromuscular junction in skeletal muscles. Am J Phys Med Rehabil 2004 83 (Suppl. S38 44.
110. Tugnoli V, Eleopra R, Montecucco C, De Grandis D. The therapeutic use of botulinum toxin. Expert Opin Investig Drugs 1997 6:1383 94.
111. Barbano RL. Needle EMG guidance for injection of botulinum toxin. Needle EMG guidance is useful. Muscle Nerve 2001 24:1567 8.
112. Jankovic J. Needle EMG guidance for injection of botulinum toxin. Needle EMG guidance is rarely required. Muscle Nerve 2001 24:1568 70.
113. Brans JW, Aramideh M, Koelman JH, Lindeboom R, Speelman JD, Ongerboer de Visser BW. Electromyography in cervical dystonia: changes after botulinum and trihexyphenidyl. Neurology 1998 51:815 9.
114. Geenen C, Consky E, Ashby P. Localizing muscles for botulinum toxin treatment of focal hand dystonia. Can J Neurol Sci 1996 23:194 7.