Botox Treatment For Parkinson’s Disease

Dystonia In Parkinsons 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.

More Than A Cosmetic Solution

Botulinum toxin injections may be familiar for cosmetic use getting rid of wrinkles but they have been used primarily to help patients with dystonia and spasticity, in which there are involuntary muscle movements because of damage to the portion of the brain or spinal cord that controls voluntary movement. Spasticity can occur in a person who has had a stroke, multiple sclerosis, traumatic brain injury or cerebral palsy.

The injections have also been successful for patients who attend the weekly Spasticity Clinic at Cedars-Sinai. The clinic which takes place every Friday from 8 a.m. to noon provides relief to patients who need assistance with tightened muscles. The botulinum toxin injections help patients improve their ability to move, and combined with physical and occupational therapy enable them to increase their flexibility as they move their arms and legs and stretch their bodies.

We have patients who, obviously after a devastating stroke or traumatic brain injury, are unable to walk, move or feed themselves, said Echo E. Tan, MD, a neurologist at Cedars-Sinai. The injections can allow a patient to open their fist so their palms can be cleaned, which can prevent skin erosion, and their nails can be clipped to prevent them from cutting into their palms.

Patient Specific Treatment Plans

Treatment with botulinum toxin injections should be administered by a trained physician however collaboration from various specialties is very helpful for developing a comprehensive treatment plan. Your doctor may refer you to other specialties that work closely together including physical and occupational therapy, psychology, psychiatry and social work.

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Botox Treatment For Essential Tremor

Most of us are familiar with botoxthe drug that doctors have been using for years to reduce the appearance of wrinkles and fine lines on people of all ages. But did you know that botox isnt just for cosmetic purposes? Botox can actually be used for a lot of health applications, such as treating essential tremor . Botox is a common method of treatment for essential tremor as it can help to alleviate symptoms.

In this article, we will discuss what exactly botox is, how botox can help essential tremor, botox facts, and more. Living with tremors is frustrating, especially if it impacts your daily life, so finding a solution is crucial. And botox might be just that.

Conditions Treated Using Botulinum Toxin In Parkinsons Disease

Dystonia Dystonia refers to an involuntary twisting of a body part, which can be painful and can interfere with a persons desired movement. In PD, dystonia can be a motor symptom due to the disease, appearing first thing in the morning before taking medication or as a dose of medication is wearing off. Alternatively, dystonia can be a side effect of Levodopa. A common dystonia in young onset PD involves toe curling or foot inversion . This dystonia often occurs only in particular circumstances such as while walking or running. Other dystonias involve frequent and persistent eye closure, known as blepharospasm, or neck turning, known as cervical dystonia. These can be associated with PD, but may also accompany other forms of parkinsonism such as Multiple System Atrophy or Progressive Supranuclear Palsy. Botulinum toxin injections, targeting the particular muscles that are moving excessively, can be effective in all these scenarios.

Tremor Although Botulinum toxin is not commonly used for this purpose, there are case reports in the literature showing its effective use for the control of tremor.

Drooling Likely due to the decreased swallowing rate of patients with PD, sialorrhea, or drooling, can be a feature of the disease. Drooling is not only an annoyance, but can result in significant embarrassment and social isolation. Botulinum toxin injections into the salivary glands can decrease production of saliva and thereby decrease drooling.

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Disorders Of The Autonomic Nervous System

Botulinum toxin interferes with transmission not only at the neuromuscular junction but also in the cholinergic autonomic parasympathetic and postganglionic sympathetic nervous system. As such it is increasingly found useful in the treatment of various disorders of the autonomic nervous system. Essential focal hyperhidrosisdefined as excessive sweating of the palms, feet, or axillaeaffects about 0.5% of the population. Thought to be caused by hypothalamic dysfunction it rarely responds to medical treatment, and sympathectomy can be associated with considerable risk. An intradermal injection of botulinum toxin has provided a highly effective treatment for focal hyperhidrosis, markedly improving the quality of life of the affected individuals. In a multicentre placebo controlled trial, axillary injections of botulinum toxin in 145 patients with hyperhidrosis reduced axillary sweat production sixfold. In contrast to other conditions treated with botulinum toxin, the duration of benefit in patients treated for hyperhidrosis may last up to one to two years. Botulinum toxin injections into the axillae have been associated with a marked reduction in secretion from the apocrine axillary sweat glands that normally produce a pungent smell when degraded by certain local microbes, and this treatment has led to a reduction in body odour .

Treatments For Parkinsons Disease

Although PD has no cure, the symptoms of the disease are treatable.

Because each patient experiences symptoms differently, physicians base each patients treatments on his or her specific symptoms. The Movement Disorders team works closely with other UT Southwestern specialists such as those in psychiatry and speech, physical, and occupational therapy to provide patients with individualized care to manage symptoms and maximize mobility, balance, and coordination.

Treatments for Parkinsons disease include:

• Medication: Many experts now believe that medication should be initiated immediately after diagnosis. Medication can help manage problems with walking, movement, and tremor by correcting or compensating for dopamine deficiency in the brain.
• Botulinum toxin injection: UT Southwestern specializes in the use of botulinum toxin injections for a variety of conditions that result in involuntary muscle contractions. Botulinum toxin weakens the muscle that it is injected into, thus promoting relaxation of muscle spasm. These injections can be a particularly effective treatment for PD patients with dystonia , eye twitching, and drooling. Patients who might benefit from botulinum toxin are examined to determine which muscles are overactive. The botulinum toxin is injected into only those muscles. Benefits gradually develop over seven to 10 days. The treatment is usually effective for three months, so injections are repeated several times a year to maintain ongoing benefits.

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What Types Of Sleep Problems Do People With Parkinsons Disease Have

Parkinsons disease affects every person differently. It also impacts sleep in different ways. People with Parkinsons may have:

• Insomnia, finding it hard to fall asleep.
• Fragmented sleep, waking up many times over the night.
• Excessive daytime sleepiness, finding it hard to stay awake during the day.
• Very vivid dreams, which may cause hallucinations or confusion after waking up.
• Emotional dreams or nightmares, which may make you feel emotionally drained after waking up.

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Are There Any Potential Side Effects With Botox Treatments

As a general rule, patients should go home and rest immediately following the injection of Botox and refrain from strenuous activity for 2 to 3 days.

Side effects of Botox therapy are generally mild and wear off quickly. For example, because the drug makes the targeted muscles weaken, patients may notice a new pain that arises from the shrinkage of the affected muscle or the other muscles trying to compensate.

According to the FDA warning on this class of drugs, the risk of symptoms is greatest in children with cerebral palsy treated for spasticity.

The most common side effects of Botulinum toxin are:

• temporary general weakness
• soreness at the injection site or affecting your whole body
• weakness in muscles that have been injected
• trouble swallowing, particularly for patients treated for cervical dystonia
• an infection at the injection site

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Risk Factors For Drooling In Pd

If susceptibility to anterior drooling is not related to hypersalivation, other factors must be at work. Suggested candidates have been dysphagia, oro-facial rigidity/hypomimia, lingual bradykinesia, cognitive status, male gender and more advanced disease stage.23,24,28,31,39,43,50,51 Individuals with non-tremor dominant PD phenotypes were at higher risk of drooling.31,52 The precise contribution of these factors remains unsettled. The uncertainty rests partly on general issues above regarding why estimates of drooling prevalence and flow rates exist, but variability in individual profiles of impairment and disability also contributes.

Susceptibility of males probably relates to greater absolute flow rate when body mass and gland sizes are not controlled for though not all studies have found a male predominance.23,24,29 Relationship to greater disease severity likely reflects increased rigidity, poorer cognitive status and more marked dysphagia of later stages, and, in as far as medications may alter the picture, higher medication dependency.21

L-dopa can influence variables in swallowing efficiency,3,58 and thus indirectly change drooling. Currently, dysphagia study outcomes do not afford sufficient evidence to conclude a positive, neutral or negative effect of possible swallowing changes on sialorrhoea.

Good Night: Sleep And Parkinsons Disease

Lack of good sleep can worsen Parkinsons symptoms. In this 45-minute lecture, Dr. Rafael Zuzuárregui addresses causes of sleep loss and the latest treatments for: insomnia, restless leg syndrome, REM sleep behavior disorder, nocturnal urination, hallucinations, wearing off of medication, dystonia and sleep apnea.

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Muscle Spasms And Other Painful Disorder Including Headaches

One of the most rapidly expanding indications for botulinum toxin is in the treatment of various painful muscle spasms. In a double blind, placebo controlled study using a total of 200 units of Botox® injected at five lumbar paravertebral sites on the side of maximum discomfort, Foster et al showed a significant improvement in pain on a visual analogue scale and the Oswestry low back pain questionnaire compared with placebo at three and eight weeks after injection. Other disorders causing muscle spasm or muscle tenderness reported to benefit from botulinum toxin injections include fibromyalgia-myofascial pain, temporomandibular joint and orofacial pain , and other musculoskeletal pain and spasm syndromes.

• inhibition of release of substances that sensitise muscle nociceptors

• an effect on spindle afferents favourably altering the firing pattern of supraspinal projections and changing the central sensory processing

• suppression of neurogenic inflammation

• inhibition of substance P, glutamate, and other peptides and neurotransmitters involved in mediating pain.

Deep Brain Stimulation In The Treatment Of Sleep Disorders In Pd

Studies investigating the effect of DBS in the treatment of sleep disorders in PD patients showed that DBS improved the sleep scales and quality . Baumann-Vogel et al. found that subthalamic nucleus DBS-enhanced subjective sleep quality, reduced sleepiness measured by the Epworth sleepiness scale, and reduced sleep fragmentation shown by actigraphy recordings. However, the authors observed that subthalamic DBS was not improved REM sleep features . Similarly, Cicolin et al. reported that RBD symptoms did not benefit from STN DBS. On the other hand, Chahine et al. reported that STN DBS improved significantly symptoms of RLS in PD patients. The effect of PPN DBS on sleep disorders in PD has been investigated in several studies . One study showed that PPN DBS improved sleep quality and reduced EDS however, it caused a reduction in REM latency and a relevant increase in REM sleep . In another study, it has been reported that PPN DBS improved the total duration and rate of REM sleep . As a result, DBS seems to be beneficial in the treatment of sleep disorders in PD because it seems to be useful in improving sleep quality. However, large-scale prospective studies are needed to understand the benefits of DBS in the treatment of sleep disorders in PD.

8. Loddo G, Calandra-Buonaura G, Sambati L, Giannini G, Cecere A, Cortelli P, Provini F. The treatment of sleep disorders in Parkinsons disease: From research to clinical practice. Frontiers in Neurology. 2017 8 :42

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Eating Swallowing And Saliva Control

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:

• 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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Attacking Pd From Every Angle

Well be more relentless than your PD, always determined to find the best treatment for your individual symptoms.

Medication will be our first line of treatment, and our pharmacists are always available to answer questions, provide support and help with medication management. If the side effect of any medication is bothersome, well try another.

If medication fails to control your symptoms enough, there are many other advanced therapies, neurosurgery and innovative treatment options, such as Botox or infusions, that we can try. As another layer of targeted care, we may even recommend psychotherapy, such as biweekly cognitive behavioral therapy, which has been proven to improve mobility issues over time.

In addition, our centers active research program offers access to gene therapy and new treatments that may not be available elsewhere.

We also have a Parkinsons disease genetic counseling clinic to help families uncover and understand the potential risk of PD for other family members.

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How Can Botox Help Essential Tremor

Now that were familiar with what Botox is, well discuss how Botox is used for essential tremor treatment. Since Botox works by weakening the muscle it is injected into, it can be helpful to alleviate symptoms of essential tremor. When Botox is injected into the body part with tremor, the toxin paralyzes the muscle and the nerve, thus temporarily stopping the tremor. Botox can be used for head, voice, hand and facial tremors. If its done properly, using Botox for essential tremor can be safe, but there are still a few important facts to keep in mind, which will be covered later in the post.

Peripheral Clock Gene Expression

Hair follicles were collected by gripping and tugging the hair shaft with a pair of tweezers and were quickly soaked in Lysis Solution . Hair follicle cells attached to the hair shafts were stored at 20°C until RNA purification. Approximately 210 scalp hair follicles were required to detect clock gene expression at each sampling timepoint. To minimize skin damage, samples were obtained from different regions of the scalp. The RNAqueous-Micro Kit was used with frozen cytolysis solution to purify total RNA. After checking the quality and concentration using a NanoDrop , total RNA was reverse-transcribed using a SuperScript VILO cDNA Synthesis Kit , and real-time PCR was performed using a TaqMan MGB probe and a 1/20 volume of the reverse transcription product. Data were obtained using a PRISM7300 and corrected by 18S ribosomal RNA , the expression of which is constant regardless of cell type and sampling time. The sequences of the primers and probe for the Per3, Nr1d1 , Nr1d2 and 18S-rRNA transcripts are listed in our previous report.

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Botulinum Toxin For Treatment Of Dystonia Sialorrhea And Tremor In Parkinsons

Being happy doesnt mean that everything is perfect. It means that youve decided to look beyond the imperfections. Gerard Way

Rules for Happiness: something to do, someone to love, something to hope for. Immanuel Kant

Introduction: I have a new friend with Parkinsons. He has always been very active and genuinely enjoys playing golf. However, he has a hard time controlling dystonia, which has hindered much of his daily exercise. This got me thinking, and it leads me to the topic of this blog post. The goal is to describe how botulinum toxin works, allowing someone with Parkinsons and bothersome dystonia some regular relief. Botulinum toxin is also used to treat excessive drooling and even the Parkinsons tremor in some clinical studies.

If you want to live a happy life, tie it to a goal, not to people or objects. Albert Einstein

Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful. Albert Schweitzer

Given at the end of the post are some references/literature for anyone interested in the original study/review.

The happiness of your life depends upon the quality of your thoughts. Marcus Aurelius

Dystonia on its own is a movement disorder, and it occupies the number three slot in terms of the number of cases of movement disorders. Dystonia is a frequent component of Parkinsons. It is estimated that between 50-60% of PwP have some first-hand experience with dystonia.