Botulinum Toxin in Therapy
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Introduction[edit | edit source]
Treatment algorithms[edit | edit source]
Treatment algorithms are determined by various factors including:[1]
- Target muscle dosing
- Total BT doses
- Injection intervals
- The type of BT drugs (with different BT drugs posessing different physical and chemical properties)
- Drug potency labeling
- BT application (this considers the volume of BT injected together with those substances which are used to dilute BT - most often NaCl/H20)
- Drug stability
- Guidance techniques. This includes palpation, EMG and ultrasound.
The principle in BT administration is to "hit the right muscle with the right dose"[1]and is described as a dosage scheme.
The right muscle is selected based on pathological positioning and movements by the patients as well as the presence of pain. It is important in this regard to distinguish pathological movement from compensatory muscle activity and protective postures[1]
The right dose is dependent on:[1]
- Target muscle mass
- Therapeutic window (Sensitivity of a target muscle to receive BT without functional impairment)
- Paresis risk of adjacent muscles
While there are prescriptive amounts when considering these variables, whether to administer on the higher or lower spectrum of these recommendations further depends on:
- Pathological muscle activity
- The usefulness of pathological muscle activity.
In considering dosing algorithms it is important to note that dosing for spasticity is different to that for dystonia. Thus treatment goals for BT administration should be different for each. In an article written to provide clearer guidelines and consensus to dosage administration, Dressler et al (2021) noted the presence of paresis in spasticity, often not involved in dystonia. This leads to less functional improvement following BT administration.[1]
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Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Dressler D, Altavista MC, Altenmueller E, Bhidayasiri R, Bohlega S, Chana P, Chung TM, Colosimo C, Fheodoroff K, Garcia-Ruiz PJ, Jeon B. Consensus guidelines for botulinum toxin therapy: general algorithms and dosing tables for dystonia and spasticity. Journal of Neural Transmission. 2021 Mar;128:321-35. Page 3
