Botulinum Toxin Type B in the Treatment of Residual Limb Hyperhidrosis for Lower Limb Amputees

Kern, Uwe; Kohl, Matthias; Seifert, U; Schlereth, Tanja

doi:10.1097/phm.0b013e31820636fd

Cited by 26 publications

(44 citation statements)

References 46 publications

(49 reference statements)

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“…Moreover, three studies evaluated both upper and lower limbs; in two additional studies, the evaluation was based on upper, lower, and multiple limbs. Table 2 represents methodological evaluations of the selected studies [6][7][11][12][13][16][17][18]21,29,. Studies that reported heat and/or perspiration discomfort the most were conducted in 1996, 2001, and 2012, each with four studies.…”

Section: Resultsmentioning

confidence: 99%

“…Figure 1 shows the procedure for study selection. Table 1 represents the demographic characteristics of subjects in the selected studies [6][7][11][12][13][16][17][18]21,29,. The number of subjects in the studies ranged from 4 [43,48] to 581 [59].…”

Section: Resultsmentioning

confidence: 99%

“…Botox injection is an invasive treatment that could cause pain, hematoma at the injection site, mouth and olfactory tract dryness, and optical problems. Moreover, it requires periodic injections to maintain effectiveness [11]. In some cases, hypnosis, psychotherapy, and biofeedback could be implemented to decrease sweating [77].…”

Section: Discussionmentioning

confidence: 99%

“…These consequences could negatively affect quality of life, prosthesis suspension, prosthesis use, and activity level. Moreover, they cause discomfort, skin irritation, skin maceration, friction blisters, infection, unpleasant odor, and an environment for bacterial invasion to hair follicles of the residual limb [6][7][8][9][10][11][12][13][14][15][16][17]. Findings of a survey in 2001 revealed that thermal discomfort with the prosthetic socket could decrease quality of life in many people with amputation [12].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of heat and perspiration discomfort inside prostheses: Literature review

Ghoseiri¹,

Safari²

2014

J Rehabil Res Dev

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Abstract-People with limb amputation deal with thermal stresses in their daily activities. Unfortunately, in the majority of this population, all thermal transfer mechanisms, including convection, radiation, evaporation, and conduction, can be disturbed due to the prosthetic socket barrier, decreased body surface area, and/or vascular disease. The thermal environment inside prosthetic sockets, in addition to decreased quality of life and prosthesis use, comfort, and satisfaction, could put people with amputation at high risk for skin irritations. The current review explores the importance of thermal and perspiration discomfort inside prosthetic sockets by providing an insight into the prevalence of the problem. The literature search was performed in two databases, PubMed and Web of Knowledge, to find relevant articles. After considering the review criteria and hand-searching the reference sections of the selected studies, 38 studies were listed for review and data extraction. This review revealed that more than 53% of people with amputation in the selected studies experienced heat and/or perspiration discomfort inside their prostheses. In spite of great technological advances, current prostheses are unable to resolve this problem. Therefore, more attention must be paid by researchers, clinicians, and manufacturers of prosthetic components to thermal-related biomechanics of soft tissues, proper fabrication technique, material selection, and introduction of efficient thermoregulatory systems.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of heat and perspiration discomfort inside prostheses: Literature review

Ghoseiri¹,

Safari²

2014

J Rehabil Res Dev

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“…There are no convincing data that certain liner types are superior to others as it relates to sweat control [30]. Botulinum toxin is regarded as an important management option in other forms of hyperhidrosis [21], and there are a few case reports and small case series that highlight botulinum toxin as a possible treatment in people with amputation [13,[19][20]31]. It may be possible for patients to be treated only once per year, given this study's finding that sweating is most burdensome in the warmer months and the long duration of action of botulinum toxin for hyperhidrosis (up to 200 d in one large trial of botulinum toxin A in axillary hyperhidrosis [32]).…”

Section: Discussionmentioning

confidence: 99%

Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation

et al. 2015

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Abstract-To assess the incidence and severity of selfreported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed.Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60 yr, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

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Pharmacologic interventions for treating phantom limb pain

Alviar

Hale

Dungca³

2016

Cochrane Database of Systematic Reviews

135

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Since the last version of this review, we identified another study that added another form of medical therapy, BoNTs, specifically BoNT/A, to the list of pharmacologic interventions being reviewed for clinical efficacy in phantom limb pain. However, the results of this study did not substantially change the main conclusions. The short- and long-term effectiveness of BoNT/A, opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and local anaesthetics for clinically relevant outcomes including pain, function, mood, sleep, quality of life, treatment satisfaction, and adverse events remain unclear. Based on a small study, BoNT/A (versus lidocaine/methylprednisolone) does not decrease phantom limb pain. Morphine, gabapentin, and ketamine demonstrate favourable short-term analgesic efficacy compared with placebo. Memantine and amitriptyline may not be effective for PLP. However, results must be interpreted with caution, as they were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, local anaesthetics, and dextromethorphan needs further clarification. Overall, the efficacy evidence for the reviewed medications is thus far inconclusive. Larger and more rigorous randomised controlled trials are needed for us to reach more definitive conclusions about which medications would be useful for clinical practice.

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Botulinum Toxin Type B in the Treatment of Residual Limb Hyperhidrosis for Lower Limb Amputees

Abstract: Low-dose BTX-B significantly reduced sweating of the residual limb, thereby improving the use of the artificial limb, steadiness of gait, and quality-of-life. Because this has a tremendous impact on amputees, we are in dire need for systematic, larger studies.

Cited by 26 publications

References 46 publications

Prevalence of heat and perspiration discomfort inside prostheses: Literature review

Prevalence of heat and perspiration discomfort inside prostheses: Literature review

Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation

Pharmacologic interventions for treating phantom limb pain

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