Depression – An emerging indication for botulinum toxin treatment

Krüger, Tillmann H.C.; Wollmer, M. Axel

doi:10.1016/j.toxicon.2015.09.035

Cited by 26 publications

(12 citation statements)

References 27 publications

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“…However, Aydinlar et al found no significant changes in the 21-items depression, anxiety, and stress (DASS-21) score after 1 year of therapy ( 38 ), and Maasumi et al revealed no significant changes in the median of patient health questionnaire-9 (PHQ-9) ( 39 ). Despite the question about the OnabotA effects on depressive symptoms remains open ( 40 ), in our observations no improvements on depressive or anxiety symptoms were observed using ZUNG-A and ZUNG-D scores. The small sample sizes and the different questionnaires administered limit the reliability of every comparison.…”

Section: Discussioncontrasting

confidence: 78%

Long-term Treatment Benefits and Prolonged Efficacy of OnabotulinumtoxinA in Patients Affected by Chronic Migraine and Medication Overuse Headache over 3 Years of Therapy

Guerzoni¹,

Pellesi²,

Baraldi³

et al. 2017

Front. Neurol.

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BackgroundChronic migraine (CM) affects about the 2% of the general population and it has been recognized as one of the most-disabling conditions worldwide by the World Health Organization. CM is often associated with the overuse of abortive medication, which determines the worsening of headache itself and the development of a secondary headache called medication overuse headache. The management of these associated conditions is difficult, but a growing amount of evidence is pointing out the effectiveness and the good safety profile of OnabotulinumtoxinA (OnabotA). Despite this, data on OnabotA effects and safety in long-term use lack. The purpose of the present article is to retrospectively assess the efficacy and safety of OnabotA in a cohort of chronic migraineurs with drug overuse from the 18th month of treatment until the third year.Materials and methods90 chronic migraineurs with medication overuse were enrolled between January 2013 and February 2017. All patients were treated with OnabotA according to PREEMPT dictates. Before every injection session the headache index, the analgesic consumption, the visual analog scale for pain score, the 36-items short form health survey questionnaire score, the 6-items headache impact test (HIT-6) score and the Zung self-rating anxiety and depression scale scores were collected. Adverse events were carefully registered. A simple linear regression was performed to explore the mean changes in the abovementioned parameters for a single injection session and mean comparison tests were performed using the one-way analysis of variance followed by Tukey–Kramer post-hoc test.ResultsA significantly improvement for a single injection was registered for all the above-mentioned parameters. Headache index, analgesic consumption, visual analog pain scale, and 6-items HIT-6 scores were significantly lower than baseline from the 18th month of treatment onwards. The 36-items short form health survey questionnaire scores were significantly higher than baseline at every injections session from the 18th months onwards. Zung scales did not change. No serious adverse events were assessed and no adverse events-related drop-outs were seen.ConclusionOnabotA effectiveness and safety last until 3 years of therapy, raising the possibility of the use of this therapy even for many years in CM prevention.

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Section: Discussioncontrasting

confidence: 78%

Long-term Treatment Benefits and Prolonged Efficacy of OnabotulinumtoxinA in Patients Affected by Chronic Migraine and Medication Overuse Headache over 3 Years of Therapy

Guerzoni¹,

Pellesi²,

Baraldi³

et al. 2017

Front. Neurol.

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“…Since then, ideal dosing has decreased to provide patients with a more natural and balanced look while still diminishing unwanted lines 119 . BoNT‐A treatment has also been associated with improvement in depression in depressed patients 120‐122 . Subjective evaluations have therefore become increasingly important to achieve because patient satisfaction influences treatment choice but do not give an accurate representation of molecular potency.…”

Section: Postulate IVmentioning

confidence: 99%

The mechanisms of action and use of botulinum neurotoxin type A in aesthetics: Key Clinical Postulates II

Nestor

Arnold

Fischer

2020

J of Cosmetic Dermatology

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Background The literature on botulinum neurotoxin type A (BoNT‐A) is extensive, often contradictory, and confounded by a competitive market of products and research attempting to distinguish brand individuality. Methods A comprehensive review of literature on the principles of BoNT‐A in aesthetics as well as clinical examples. Results In 2017, the Eight Key Clinical Postulates were formulated as a guide for the aesthetic practitioner in understanding BoNT‐A pharmacodynamics and to compare different toxins. These are now updated to include (a) All type A toxins act identically; (b) The mathematical relationship between toxin and receptor is the basis of efficacy, and clinical efficacy is influenced by molecular potency and patient attributes including muscle mass, gender, age, and ethnicity; (c) Efficacy, onset, and duration are functions of “molecular potency” defined as the number of active 150 kDa molecules available for binding; (d) “Molecular potency” is difficult to objectively quantify for commercially available toxins; (e) Up to a point, increased molecular potency decreases time to onset and increases duration of effect, and the “Molecular Potency Quotient” is a construct for comparing molecular potency commercial cost; (f) The area of effect of a toxin injection is dependent upon molecular potency, diffusion (passive), and spread (active); (g) Differing reconstitution volumes; and (h) Increased number of injection sites can affect spread, onset, and duration of effect. Conclusions The principles of BoNT‐A use in aesthetics are complex yet understandable as outlined in the framework of the updated Eight Key Clinical Postulates and serves as a useful tool for providing the most effective treatment and interpreting research on present and future toxin formulations.

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“…A subject who experiences a serious adverse event after BoNT-A injection of a dose substantially exceeding that commonly used in the clinic provides an unusual opportunity to investigate the pharmacological and toxicological mechanisms of BoNT-A, especially the effect of BoNT-A on brain function. These observations could contribute to a better understanding of the therapeutic effects of BoNT-A on dystonia [1, 19], spasticity [1, 19], depression [20, 21], and pain [22, 23], among others. Moreover, a better understanding of the mechanisms underlying BoNT-A poisoning could also improve the guidelines for BoNT-A administration, as well as the outcomes, and minimize adverse events.…”

Section: Introductionmentioning

confidence: 99%

Brain functional changes in patients with botulism after illegal cosmetic injections of botulinum toxin: A resting-state fMRI study

Ban

Wang

et al. 2018

PLoS ONE

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BackgroundBotulinum toxin type A (BoNT-A) is generally considered safe and is widely used to treat a variety of clinical conditions involving muscle hyperactivity and for cosmetic purposes. However, the effects of BoNT-A poisoning (botulism) on brain function are poorly understood.Methodology/Principal findingsHerein, we investigated brain functions in 9 patients who received illegal cosmetic injections of botulinum and 18 matched controls by combining the analysis methods of regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) based on resting-state fMRI. Compared with the controls, the patients with botulism exhibited significantly reduced ReHo values in the left posterior lobe of the cerebellum extending to the right anterior lobe of the cerebellum, as well as in the right anterior lobe of the cerebellum extending to the parahippocampal gyrus and right posterior lobe of the cerebellum. The patients with botulism also showed weakened ALFF values in the right anterior lobe of the cerebellum extending to the left anterior lobe of the cerebellum and right posterior lobe of the cerebellum, as well as in the right anterior lobe of the cerebellum.Conclusions/SignificanceThe results indicate that BoNT-A may modulate cerebral activation in specific areas, which may play roles in both the adverse effects of botulism and the mechanism underlying clinical treatment with BoNT-A.

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Depression – An emerging indication for botulinum toxin treatment

Cited by 26 publications

References 27 publications

Long-term Treatment Benefits and Prolonged Efficacy of OnabotulinumtoxinA in Patients Affected by Chronic Migraine and Medication Overuse Headache over 3 Years of Therapy

Long-term Treatment Benefits and Prolonged Efficacy of OnabotulinumtoxinA in Patients Affected by Chronic Migraine and Medication Overuse Headache over 3 Years of Therapy

The mechanisms of action and use of botulinum neurotoxin type A in aesthetics: Key Clinical Postulates II

Brain functional changes in patients with botulism after illegal cosmetic injections of botulinum toxin: A resting-state fMRI study

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