Does botulinum toxin a make prosthesis use easier for amputees?

Abstract

Four post-amputation patients (1 with phantom pain, 3 with stump pain) were each treated with 100 IU botulinum toxin A, divided between several trigger points in the distal stump musculature. In 1 female patient (along with a pronounced reduction in phantom pain) hyperhidrosis of the stump ceased completely, probably after diffusion of the drug into the dermal sweat glands, leading to longer and safer use of the prosthesis. Intentional intradermal injection for this issue therefore could be valuable. Another patient was able to use her prosthesis for the whole day again after botulinum toxin A treatment for substantial stump pain, compared with only 4 hours a day before treatment. In 2 male patients, stump pain while wearing the prosthesis subsided to a considerable extent, 1 of the 2 reported an improvement in steadiness of gait. We suggest that stump treatment with botulinum toxin in rehabilitative medicine should be investigated in more detail.

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

“…Interestingly, BTX can also decrease the expression of calcitonin geneYrelated www.ajpmr.com Treatment of Residual Limb Hyperhidrosis peptide, 21 a neuropeptide that can significantly enhance acetylcholine-induced sweating 22 and is a potential contributor to pain transmission. 23 BTX treatment of sweating of the residual limb has so far been described in only 12 patients 1,8,9,18,24 ; in all cases, the agent administered was BTX-A. Charrow et al 9 successfully managed to improve stump sweating and use of the prosthetic device by BTX-A in eight amputees; the administered doses of 300Y500 IU Botox were, however, rather high (and thus expensive).…”

“…This was also reflected by corresponding improvements in gait, work performance, and quality-of-life. Previously, the administration of BTX-A had enabled us to improve patient use of an artificial leg by reducing sweating, 8 with the effect that the prosthetic device could be used all day long without interruption. In the case described, this effect was sustained for 8 mos after only one BTX-A treatment.…”

“…7 After the first case report on the successful treatment of amputation stump dermatitis with botulinum toxin (BTX) (associated with sweating of the residual limb), 1 we observed a notable reduction in sweating and (consequentially) improved use of the artificial limb within the context of intramuscular treatment for pain control. 8 As suggested by our group, Charrow et al 9 subsequently investigated the systematic intracutaneous administration of BTX type A (BTX-A) in eight patients and found a significant reduction in sweating of the residual limb.…”

Wirkung von Botulinumtoxin Typ B auf Stumpfschwitzen und Stumpfschmerzen

“…Botulinumtoxin(BTX)-Injektionen sind eine erprobte Behandlung der Hyperhidrose. Nach dem ersten Bericht einer erfolgreichen Behandlung einer Amputationsstumpfdermatitis [84] beobachteten wir bei einer intramuskulären Behandlung zur Schmerztherapie eine deutliche Reduktion von Stumpfschwitzen und eine dadurch verbesserte Prothesennutzung [53]. Charrow et al [18] überprüf-ten dann die von uns vorgeschlagene, intrakutane Anwendung an 8 Patienten mit BTX Typ A (BTX-A) mit signifikantem Erfolg.…”

“…B. bei zervikaler Dystonie signifikant und häu-figer als BTX-A[59], eine Behandlung des Stumpfschwitzens nach Amputation wurde bisher aber immer mit BTX-A durchgeführt und auch lediglich bei 12 Patienten beschrieben[18, 38,53,72,84]. Ersten Beschreibungen von uns folgend[53,57] erzielten Charrow et al [18] mit BTX-A bei 8 Amputierten eine signifikante Verbesserung des Stumpfschwitzens und der Prothesennutzung, allerdings mit einer hohen (und somit teuren) Dosis von 300-500 IE BTX-A (Botox®). Garcia-Morales [38] beschrieb einen erfolgreich mit 100 IE Botox® behandelten Fall.…”