Sunday, July 21, 2024

Botox And Parkinson’s Disease

Types Of Movement Disorders That May Be Helped By Botox

Botulinum Toxin in Parkinson Disease Tremor & an Injection Approach

In addition to Parkinsons disease, cerebral palsy, and MS, Botox may help people with spinal cord injury, restless legs syndrome, and writers cramp. These conditions and others cause different types of movement disorders that may benefit from chemical denervation with , including:

  • Dystonia: Involuntary muscle contractions that cause repetitive movements or abnormal postures that may be painful. Dystonia may affect one muscle or many muscles. There are various types of , including blepharospasm , cervical dystonia , and dystonia of the foot or leg.
  • Myoclonus: Muscle jerks or that most often affect the neck, torso, arms or hands. About half of people with myoclonus also develop dystonia.
  • Spasticity: Abnormally tight muscles due to muscle contraction. Spasticity is often associated with brain, spinal cord or motor nerve damage due to cerebral palsy, spinal cord injury, multiple sclerosis, and .
  • Tremor: Rhythmic shaking of a body part due to muscle contractions. It may be intermittent or continuous. Tremors are often seen in people with Parkinsons disease.
  • Motor and complex tics: Sporadic appearance of brief, sudden, exaggerated movements.

Excessive Sweating And Body Odor

For those who sweat too much or who have trouble reducing their body odor with the use of traditional deodorants, Botox injections may be helpful, research has shown. Normally, sweat is produced when the small muscles around sweat glands squeeze the liquid out, Maman said.”And if you can paralyze those small muscles, then the sweat glands are no longer functioning like they normally would,” he said.

In a 2007 study published in the journal Dermatologic Surgery, researchers injected Botox into the armpits of 51 people. Both the participants and the independent raters of smell samples from the people’s armpits said the people’s underarm odor was less unpleasant after they received the injections. Botox was approved by the FDA to treat excessive sweating in 2004.

Why Does Parkinsons Disease Cause Drooling

Saliva is produced by small glands around our mouth, called Salivary glands.

It is a common misconception that Parkinsons patients have drooling because they are producing too much saliva. In fact, multiple studies have shown that most Parkinsons patients produce less saliva.

Our salivary glands continuously produce saliva, even when we are not eating.

Normally, we automatically swallow this saliva, through small gulps that we dont even notice.

But in Parkinsons disease, there is a marked decrease in all automatic movements, including automatic swallowing.

Therefore, saliva accumulates in the mouth. When the mouth is full, it drips out. We call this Drooling.

Lets talk about treatment

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How Effective Is Botox Therapy

Botox therapy for neurological disorders is not a cure, it is an ongoing treatment used to help manage symptoms. Approximately 80% of patients treated with Botox to manage their neuromuscular disorder experience a relief in their symptoms following their injection.

At the point the effects of the injection seem to diminish, you will return to your physician for additional evaluation and treatment.

Oral medications in combination with physical therapy, stretching and strengthening exercises are recommended and are typically the first line of treatment. Without daily physical activity, your muscles will remain contracted and joints will become immobile, making it difficult to manage everyday tasks such as sitting, walking and eating. Complementary therapies can include occupational therapy, physical therapy, speech/voice therapy, yoga or tai chi, and other interventions, depending on a persons symptoms.

Data Collection And Analysis


Selection of studies

We will merge search results using reference management software, remove duplicate records of the same report, and import the results into Covidence, a webbased systematic review software platform . In Covidence two review authors will independently examine titles, abstracts and key words identified from the literature search. The results of this search will be categorised as either yes, no, or maybe relevant. If it is unclear from titles and abstracts whether a study should be included, we will obtain full texts of these trial reports for further examination. We will resolve disagreement about selection of studies by consensus discussion. We will list those studies excluded in the Characteristics of excluded studies table. FH will retrieve full texts of relevant and potentially relevant reports and link multiple reports of the same study. Two authors will independently examine the full texts for compliance with eligibility criteria. We will contact study authors for further information, where appropriate, to clarify study eligibility. The review team will not be blinded to information about study authors, institutions, journal of publication, or results. We will resolve any disagreements through discussion.

Data extraction and management

Assessment of risk of bias in included studies

Measures of treatment effect

  • 0% to 40%: might not be important.

  • Data synthesis

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    Why Do Parkinsons Patients Cough While Swallowing Food

    When a small particle of food goes into the wind-pipe, we gag & start coughing vigorously to throw the particles out. These are called the Gag and Cough reflexes.

    Food can go into the wrong pipe often in Parkinsons patients . Therefore they frequently cough while swallowing food.

    But the condition becomes even more problematic in advanced Parkinsons disease.

    In advanced Parkinsons disease, there may be no coughing even when particles are entering the windpipe. This is dangerous!

    Thus, particles of food may repeatedly go into the lungs of Parkinsons patients without them noticing it. This is called Silent Aspiration.

    Uses Of Botulinum Toxin In Parkinsons Disease

    You most likely know that Botulinum toxin is used for cosmetic purposes to decrease wrinkles. Prior to being used in this way, Botulinum toxin was used for medical purposes to control abnormal movements. In the right hands, it can be a very effective measure to control a variety of problems related to PD.

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    Oral Dysfunction In Parkinsons: Swallowing Problems And Drooling

    Ask the MD: Dystonia in Parkinson’s Disease

    Two common and distressing problems that can develop in Parkinsons disease are swallowing dysfunction and drooling. I want to help you better understand these issues and learn what you can do to improve them so read on!

    Thank you to Christine Sapienza, PhD, CCC-SLP and Bari Hoffman Ruddy, PhD, CCC-SLP for providing some of the material below.

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    S Of The Body Affected By Dystonia

    • Arms, hands, legs and feet: Involuntary movements, spasms or twisting and “curling”
    • Neck: May twist uncomfortably, causing the head to be pulled down or to the side. This is called cervical dystonia or spasmodic torticollis
    • Muscles around the eyes: May squeeze involuntarily, leading to a person to blink too much or to have difficulty opening the eyes. This is also called blepharospasm
    • Vocal chords and swallowing muscles: May cause a person’s voice to sound softened, hoarse or breathy
    • Jaw: May open or close forcefully or there may be grimacing of the face
    • Abdominal wall: May cause sustained contractions and involuntary, writhing movements of the abdominal wall

    Different Types Of Botulinum Toxin

    There are eight different botulinum toxin species that occur in nature. There are only two however, that are produced commercially Botulinum toxin A and B.

    The commercially available products are:

  • Botox® Botulinum toxin A
  • Xeomin® Botulinum toxin A which is produced free of complexing proteins
  • Myobloc® Botulinum toxin B
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    Botox Helps Relieve Parkinson’s Symptoms

    “Well, I tripped a lot,” said Eshelman. “Because I dragged my right leg, I just subconsciously — you just don’t pick it up, so I dragged it, and I mean I could literally trip over a line on a basketball court.”

    Help came from something he never expected.

    “Doctor walks in the room, said, ‘I want to try Botox on you,’ and we laughed. We both thought Botox was basically a cosmetic drug,” said Eshelman.

    At the /*Muhammad Ali Parkinson Center*/ in Phoenix, patients with Parkinson’s and other muscular disorders get multiple targeted injections of botulism toxin, guided by electromyography .

    The neurotoxin in Botox can release the grip of muscle spasms, tremors and pain.

    “The Botox, what it does is it goes into the nerve terminals and then makes those nerve terminals fire less, and by firing less the muscles or the limbs return to their original or more normal position,” said Dr. Guillermo Moguel-Cobos, a neurologist at the center.

    “He gave me nine shots in my leg and within a week, that inside muscle relaxed and my foot went back into place and I walked fine,” said Eshelman. “Sometimes I cry when I think about it, like right now. My whole life is back.”

    An active man taking control of his Parkinson’s disease one step at a time.

    Botox is FDA-approved to treat Parkinson’s patients. Injections are administered about every 90 days. It’s not a cure, but doctors say by relieving some of the worst symptoms, Botox therapy can help patients avoid surgery.


    Eating Swallowing And Saliva Control

    Botox helps tremors in people with Parkinsons disease

    Some people with Parkinsons may find they have problems with eating, swallowing and controlling their saliva.

    This information looks at the issues you may face, explains why they happen and what help is available.

    Eating is a social activity and problems that affect chewing and swallowing can have a big impact on how much you enjoy meal times. For example, some people with Parkinsons have told us that they feel self-conscious or embarrassed while eating because of their symptoms.

    Its important to look out for symptoms related to difficulties with eating and swallowing. These can develop slowly over time and you may not notice them, so family, friends or carers should know what to look out for too.

    If youre not able to swallow properly, you may experience:

    • drooling
    • discomfort in the chest or throat

    These things can lead to a number of long-term problems, including:

    Talk to your GP as soon as you can if you have problems with eating or swallowing they may refer you to specialists who can help.

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    Dystonia In Parkinson’s Disease

    Dystonia is a continuous or repetitive muscle twisting, spasm or cramp that can happen at different times of day. Curled, clenched toes or a painful, cramped foot are telltale signs of dystonia. Dystonia can occur in different stages of Parkinsons disease . For example, dystonia is a common early symptom of Young Onset Parkinsons, but it can also appear in middle to advanced stages of Parkinsons.

    What Should I Do Now That I Have Been Diagnosed With Dystonia

    Knowledge is your best tool. Work closely with your doctor to find a treatment plan that works for you. There are plenty of interventions that can be done to help alleviate symptoms. Be sure to alert your doctor if your treatment plan has undesirable side effects or if you have questions or concerns. Remember to persevere and keep a positive attitude.

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    Is Difficulty Swallowing Common In Parkinsons Disease


    Many patients with Parkinsons disease may complain of difficulty swallowing. The medical term for swallowing difficulty is Dysphagia.

    In milder cases, you may just have the feeling that food gets stuck in your throat. Some patients may report that they have a feeling of their throat closing when they try to swallow.

    In more severe cases, you may tend to choke on your food if you try to swallow it too quickly.

    Botox Injections A Mainstay Treatment Of Dystonia

    Botulinum Toxin use in Parkinson Disease – Parkinson Symposium 2016

    Therapeutic botulinum toxin, commonly referred to as Botox therapy, has been used to treat disorders such as dystonia, spasticity and cerebral palsy for over 30 years. Botox® injections can be used effectively to relax excessive muscle contraction in individuals with movement disorders. While exceptionally toxic in large doses, when purified and used in controlled doses botulinum toxin calms muscles and helps reduce or halt muscle activity and control motor symptoms.

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    How Do You Know If You Or Your Loved One Has A Problem With Swallowing

    Swallowing difficulties can start very subtly and initially not be obvious to either the person with PD or their loved ones. There are signs to look out for before swallowing difficulty becomes overt . Some of the signs you should pay attention to include:

    • Slow rate of eating people with difficulty swallowing may slow down their eating in order to avoid coughing or choking
    • Fatigue during eating or decreased enjoyment of food
    • A sensation that food is sticking in the throat
    • Coughing or excessive throat clearing during eating
    • Difficulty in swallowing pills
    • Unexplained weight loss people with difficulty swallowing may reduce their consumption in an attempt to eat without coughing or choking
    • Change in dietary habits people with difficult swallowing may alter their diet in order to avoid foods that cause difficulty. This may not be a choice made consciously
    • Diagnosis of a pneumonia this could be caused by aspiration, or entry of a foreign substance into the airway

    If you think there might be a swallowing issue, it is important to speak with your doctor about it. There are steps you can take to properly assess the situation and improve your swallowing function. This can in turn reduce your risk of choking, make eating more enjoyable, and lessen the chances of unwanted weight loss and/or other discomforts.

    Prevalence Associated Factors And Negative Impacts Of Drooling In Pd

    Due to the lack of a standard definition and criteria for diagnosing drooling in PD patients, estimates of prevalence vary. Previous studies showed that prevalence ranged from 10 to 84% . Various tools such as the Unified Parkinsons Disease Rating Scale part II Scales for Outcomes in PD for Autonomic Symptoms PD non-motor symptoms questionnaire and different types of screening questionnaires were used to screen drooling. The factors associated with drooling have been reported. However, results vary among studies and the conclusion remains unclear. Factors possibly associated with drooling were severity of PD , male gender , aging , hallucinations , duration of PD , the sum of the scores of UPDRS part II and III greater than 28 points, dysarthria, dysphagia, orthostatic hypotension, and a history of using antidepressants . Drooling during PD can have negative impact for both patients and caregivers. Many negative physical sequelae were reported to follow the course of drooling such as perioral dermatitis, poor oral hygiene, bad breath, increased amount of intra-oral occult bacteria, eating and speaking difficulty, and an increased rate of respiratory tract infection from silent aspiration of saliva . Psychosocially, drooling PD patients showed poor quality of life , i.e., social embarrassment and increasing emotional distress . In addition, drooling patients affected their caregivers by increasing their burden, depression and anxiety, and reducing their QoL .

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    Can I Continue Taking My Oral Medications For Dystonia

    Botulinum toxin injections can be used in conjunction with oral medications as well as in place of oral medications. The response to drug therapies for dystonia can be inconsistent. No single drug works for every individual and several trials of medications may be necessary. Establishing a satisfactory treatment plan requires patience on the part of the patient and the neurologist.

    Medications typically used to treat cervical dystonia include:

    • Artane
    • Valium

    Are There Potential Side Effects

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    Side effects from botulinum toxin injections are infrequent and transient. For blepharospasm patients, mild side effects may include drooping of the eyelid, blurred vision, facial asymmetry and double vision. Tearing may occur.

    General side effets of botulinum toxin injections may include pain, tenderness and/or bruising at the injection site, difficulty swallowing, upper respiratory infection, neck pain and headache. Most side effects recover spontaneously.

    Rare but serious side effects include severe problems swallowing, serious heart problems and severe allergic reactions. If you are experiencing a severe side effect, contact emergency services immediately.

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    Therapies To Manage Dystonia

    Physical and occupational therapy are also options for managing dystonia. It may be difficult to exercise when you are in pain. However, if you are in pain while moving and suddenly stop, the pain can get worse. A physical or occupational therapist can recommend exercises or techniques to target the source of your pain and to stretch and strengthen the body parts most affected by dystonia.

    Dropped Head Syndrome And Camptocormia

    Approximately 5-10% of people with PD have a more pronounced problem with their posture. One potential difficulty is a pronounced forward flexion of their head, called dropped head syndrome . Another, is a pronounced flexion of their entire trunk, called camptocormia or bent spine syndrome . These two conditions have many causes besides PD including other neurodegenerative diseases such as the Parkinson plus syndrome, multiple system atrophy , amyotrophic lateral sclerosis , and muscle or nerve diseases such as chronic inflammatory demyelinating polyneuropathy .

    Typically, in dropped head syndrome and camptocormia, the forward flexion is present with sitting and increases with walking. When lying down on the back however, the neck and trunk can mostly or completely straighten out. This distinguishes it from a fixed posture of the neck or back called kyphosis or kyphoscoliosis, which does not straighten out when lying on the back. Kyphosis is common as people age and is not related to PD. It can be caused by osteoporosis, leading to compression fractures of the spine, arthritic changes in the spine, and degenerative disc disease. Both kyphosis and camptocormia can co-exist in one person, which complicates the diagnosis. Both are also more common in women than men.

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