Botulinum Neurotoxin Injection Manual

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Botulinum Neurotoxin Injection Manual

Authors

Katharine E. Alter, MD

Nicole A. Wilson, PhD, MD

Description

The Essential Guide for Clinicians Who Prescribe and Inject BoNTs

This is a detailed and practical guide to botulinum neurotoxin therapy (BoNT) and the wide range of applications for neurological and pain disorders. A unique reference source for new injectors and experienced clinicians alike, this indispensable manual provides information on dose, dilution, and indications for all four FDA-approved toxins in one handy text.

Following a brief review of relevant pharmacology, the book provides product information and comparative distinctions between the four FDA-approved toxins (Botox^‚àÜ, Myobloc^‚àÜ, Xeomin^‚àÜ, and Dysport^‚àÜ), along with indications and doses for FDA-approved conditions, guidance techniques, and common and emerging clinical applications. The heart of the book is an injection manual, organized anatomically and by condition and covering all applications for medical treatment. For each condition or site, information is provided on typical muscle pattern or muscle groups involved, dosing guidelines and dilution for the applicable toxins, number of injection sites, and potential risks and benefits. Targeting techniques are organized in table format for quick retrieval. Anatomic illustrations and cross-sections are provided to orient injectors and help identify optimal insertion points. An appendix with useful clinical rating scales is also included.

Key Features:

Presents state-of-the-art information about current indications for all four FDA-approved botulinum neurotoxins
Compares and contrasts the four toxins along with common and emerging clinical applications
Provides dosing guidelines for various indications and injection sites for each muscle
Includes anatomic drawings and cross-sections to illustrate muscle relationships and insertion points
Serves as a practical, portable, how-to guide for new and experienced clinicians

Contents

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Contributors

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Preface

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Section One Botulinum Neurotoxin: Basic Science and Reconstitution

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1. Pharmacology of Botulinum Neurotoxins

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Katharine E. Alter, Fatta B. Nahab, and Barbara I. Karp

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2. Comparison of Botulinum Neurotoxin Products

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Katharine E. Alter and Fatta B. Nahab

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3. Neurotoxin Storage, Reconstitution, Handling, and Dilution

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Katharine E. Alter and Codrin Lungu

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4. Guidance Techniques for Botulinum Neurotoxin Injections

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Katharine E. Alter and Michael C. Munin

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5. Phenol Nerve Blocks

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Zachary Bohart, Stephen Koelbel, and Katharine E. Alter

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Section Two Clinical Applications of Botulinum Neurotoxins

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Part I Botulinum Neurotoxins for the Treatment of Muscle Overactivity Associated with Focal Dystonia Syndromes and Upper Motor Neuron Syndromes

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Craniofacial Dystonia

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6. Benign Essential Blepharospasm

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Katharine E. Alter and Barbara I. Karp

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7. Botulinum Neurotoxin Therapy for Hemifacial Spasm

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Katharine E. Alter and Barbara I. Karp

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8. Botulinum Neurotoxin Injections for Oromandibular Dystonias

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Katharine E. Alter and Barbara I. Karp

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Illustrations for Craniofacial DystoniaóChapters 6ñ8

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Cervical Dystonia

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9. Botulinum Neurotoxin Injections for Cervical Dystonia

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Katharine E. Alter, Michael C. Munin, and Sherry A. Downie

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Illustrations for Cervical DystoniaóChapter 9

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Upper Limb, Lower Limb, and Trunk Dystonia

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10. Botulinum Neurotoxin for the Treatment of Idiopathic Primary Focal Limb Dystonia

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Katharine E. Alter, David Simpson, and Elie Elovic

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11. Botulinum Neurotoxin for Treatment of Muscle Overactivity Associated with Upper Motor Neuron Syndromes

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Katharine E. Alter, John McGuire, and Stephen Nichols

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12. Botulinum Neurotoxin for the Treatment of Trunk Dystonia/Camptocormia

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Katharine E. Alter and Codrin Lungu

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13. Botulinum Neurotoxin Injections for the Treatment of Tremor

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Katharine E. Alter and Pritha Ghosh

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Illustrations for Upper Limb, Lower Limb, and Trunk DystoniaóChapters 10ñ13

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Part II Botulinum Neurotoxins for Neurosecretory Disorders

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14. Botulinum Neurotoxin Therapy for Problematic Sialorrhea

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Katharine E. Alter

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15. Botulinum Neurotoxin Therapy for Hyperhidrosis

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Katharine E. Alter and Codrin Lungu

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Part III Botulinum Neurotoxins for Urologic Disorders

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16. Botulinum Neurotoxin for Urologic Conditions

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Katharine E. Alter and Dallas A. Lea II

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Part IV Botulinum Neurotoxins for Pain Conditions

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17. Botulinum Neurotoxins for the Treatment of Headache

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Katharine E. Alter and Pritha Ghosh

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Illustrations for Migraine Injection PatternsóChapter 17

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18. Botulinum Neurotoxin for Musculoskeletal Pain Conditions

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Katharine E. Alter and Nicole A. Wilson

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Appendices

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A. Ashworth and Modified Ashworth Scale for Grading Muscle Hypertonia

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B. Blepharospasm Disability Index Scale

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C. Blepharospasm Disability Scale

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D. BurkeñFahnñMarsden Dystonia Scale

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E. Dystonia Discomfort Scale

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F. Modified Tardieu Scale

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G. Toronto Western Spasmodic Torticollis Severity Scale

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References

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Index

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Anatomic Illustrations

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Illustrations for Craniofacial Dystonia

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Figure 1 Technique for intradermal botulinum neurotoxin injections.

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Figure 2 Injection patterns for blepharospasm.

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Figure 3 Muscles of facial expression, hemifacial spasm.

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Figure 4 Temporalis muscle, oromandibular dystonia.

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Figure 5 Medial and lateral pterygoid muscles, oromandibular dystonia.

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Illustrations for Cervical Dystonia

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Figure 1 Cervical muscles, anterolateral view, superficial and intermediate muscle layers.

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Figure 2 Cervical muscles, anterior view, intermediate and deep muscle layers.

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Figure 3 Cervical muscles, posterior view, intermediate and deep muscle layers.

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Illustrations for Upper Limb, Lower Limb, and Trunk Dystonia

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Figure 1 Thigh muscles, cross-sectional anatomy.

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Figure 2 Calf muscles, cross-sectional anatomy.

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Figure 3 Arm muscles, cross-sectional anatomy.

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Figure 4 Forearm muscles, cross-sectional anatomy.

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Figure 5 Abdominal muscles.

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Illustrations for Migraine Injection Patterns

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Figure 1 Botulinum neurotoxin injection pattern for migraine, facial muscle injection sites.

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Figure 2 Botulinum neurotoxin injection pattern for migraine, facial and neck muscle injection sites.

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Authors

Katharine E. Alter, MD, is Medical Director, Rehabilitation Programs, Mount Washington Pediatric Hospital, Baltimore, Maryland. She is also a Senior Clinician, National Institutes of Health, Bethesda, Maryland.

Nicole A. Wilson, PhD, MD is Principal, Roth Affinity LLC, St. Louis, Missouri. She is also a Special Volunteer, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland.

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