Toxina botulínica tipo a: experiencia con 2.000 aplicaciones
Botulinum toxin type a: an experience with 2.000 injections
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Hemández, L. F., & Palacios, E. (2012). Toxina botulínica tipo a: experiencia con 2.000 aplicaciones. Revista Repertorio De Medicina Y Cirugía, 21(4), 298–306. https://doi.org/10.31260/RepertMedCir.v21.n4.2012.834
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Los múltiples usos terapéuticos de la toxina botulínica tipo A son una herramienta importante para el abordaje de algunos trastornos del movimiento. Damos a conocer la experiencia, resultados y conclusiones obtenidas en el servicio de neurología del Hospital de San José de Bogotá DC, al completar más de 2.000 aplicaciones en distonías, espasticidad y cefalea. En espasmo hemifacial la mejoría varió entre 60 y 80%, en blefaroespasmo 70 y 90%, en distonía cervical con patrones básicos 70-80% y en complejas (dos o más patrones de movimiento) de 50 a 60%. En espasticidad la mejoría se evidenció por aumento en los rangos de movimientos medidos con goniómetro antes y después de la aplicación, siendo variable de acuerdo con el tiempo de evolución, severidad y patrón de la espasticidad, haciendo seguimiento con la escala de siste ma de clasificación de la función motora global (GMFCS). En cefalea crónica diaria hubo remisión total del dolor en 60%, disminución marcada en 30% y sin mejoría el 10%. Conclusión: La administración de toxina botulínica es segura y debe ser un proceso dinámico ajustado a cada paciente, el efecto terapéutico se evidencia a partir del segundo día de la aplicación con una expresión máxima a los 14 días, la duración del efecto oscila entre 2 y 6 meses con una media de 2.8. Los efectos adversos desaparecen en los siguientes treinta días de la aplicación.
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2. Botulismo. En: Eulenburg A. Diccionario enciclopédico de medicina y cirugía prácticas. Madrid: Agustín Jubera editor; 1886. p. 113-9.
3. Bulloch W. History. En: Medica! Research Council. A System of Bacteriology in Relation to Medicine. London: His Majesty's Statíonery Office;l929. p. 373-4.
4. Hatheway CL. Clostridium botulinum. In: Gorbach SL, Bartlett JG, BlackJow NR. Jnfectious Diseases. Philadelphía: WB Saunders; 1992. p. 1583- 7.
5. Hallett M, Glocker F, DeuschJ G. Mechanism of action of botulinum toxin. Ann Neurol. 1994; 36:449-50.
6. Schantz EJ, Johnson EA. Properties and use of botulinum toxin and other micro bial neurotoxins in medicine. Microbio! Rev. 1992; 56: 80-99.
7. Bressman SB. Dystonia genotypes, phenotypes and classification. Adv neurol. 2004; 94: 101-7.
8. MDVU. MD Virtual university. Adult dosing guidelines. In: Management of dys tonia with Borulinum Toxin Type A (Botox). Edition 2.0. Revised, August 2005.
9. Odderson IR. Botulinum toxin injection guide. New York: Demos Medica! Pub lishing; 2008.
10. Yoshimura DM, Aminoff MJ, Tami TA, Scott AB. Treatment of hemifacial spasm with botulinum toxin. Muscle Nerve. 1992; 15(9):1045-9.
11. Brin MF, Fahn S, Moskowitz C, et al. (1987). Localized injections of botuli num toxin for the treatment of focal dystonia and hemifacial spasm. Mov Disord. 1987; 2 : 237 54.
12. Berardelli A, Rothwell JC, Day BL, Marsden CD. Pathophysiology of blepharo spasm and oromandibular dystonia. Brain. 1985; 108(Pt 3): 593-608.
13. Berardelli A, Rothwell JC, Hallett M, et al. The pathopbysiology of primary dys tonia. Brain. 1998; 121 (Pt 7): 1195-212.
14. Marsden CD. Blepharospasm-oromandibular dystonia syndrome (Brueghel's syndrome). A variant of adult-onset torsion dystonia? J Neurol Neurosurg Psy chiatry. 1976; 39: 1204-9.
15. Jankovic J. Treatment of dystonia. Lancet Neurol. 2006; 5: 864-72.
16. Campos EC, Bolzani R, Schiavi C, et al. Effect of injection sites of Botulinum toxin for blepbarospasm treatment: statistical analysis. Neuro-ophtlzalmol 1999; 22:17-23.
17. Jankovic J, Orman J. Botulinum A toxin for cranial-cervical dystonia: a double blind, placebocontrolled study. Neurology. 1987; 37: 616-23.
18. Toro J, Yepes M, Palacios E. Neurología. 2da ed. Bogotá: Manual Moderno; 2010. p. 479-80.
19. Foltz EL, Knopp LM, Ward AA. Experimental spasmodic torticollis. J Neuro surg. 1959; 16: 55 72.
20. Van Zandijcke M. Cervical dystonia (spasmodic torticollis). Sorne aspecls of the natural bistory. Acta Neurol Belg. 1995; 95(4): 210-15.
21. Kessler KR, Skutta M, Benecke R. Long-term treatment of cervical dystonia with botulinum toxin A: efficacy, safety, and antibody frequency. J Neurology. 1999; 246: 265 74.
22. Truong D, Dubinski R, Hermanowicz N, et al. Posttraumatic torticollis. Arch Neurol. 1991; 48: 221-3.
23. Truong D, Lewitt, P, Cullis, P. Effects of different injection techniques in the treatment of torticollis with botulinumtoxin. Neurology. 1989; 39 (Suppl): 294.
24. Anderson TJ, Rivest J, Stell R, et al. Botulinumtoxin treatment of spasmodic torticollis. J R Soc Med. 1992; 85: 524-9.
25. Poewe W, Schelosky L, Kleedorfer B, et al. (1992). Treatment of spasmodic torticollis with local injections of botulinum toxin. One-year follow-up in thirty seven patients. J Neurol. 1992; 239: 21-5.
26. Lance JW. Disordered muscle tone and movement. Clin Exp Neurol. 1981; 18: 27-35.
27. Brashear A, Gordon MF, Elovic E, et al. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med. 2002; 347: 395-400.
28. Childers MK, Brasbear A, Jozefczyk P, el al. Dose-dependent response to in tramuscular botulinum toxin type A for upper-limb spasticity in patients after a stroke. Arch Phys Med Rehabil. 2004; 85: 1063-9.
29. Suputtitada A, Suwanwela NC. The lowest effective dose of botulinum A toxin in adult patients with upper limb spasticity. Disabil Rehabil. 2005; 27: 176-84.
30. Chin TY, Nattrass GR, Selber P, Graham HK. Accuracy of intramuscular injec tion of botulinum toxin A in juvenile cerebral palsy: a comparison between ma nual needle placement and placement guided by electrical stimulation. J Pediatr Orthop. 2005; 25: 286-91.
31. Hyman N, Barnes M, Bbakta B, el al. Botulinum toxin (Dysport) treatment of bip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study. J Neurol Neurosurg Psychiatry. 2000; 68: 707-12.
32. Mayer NH, Esquenazi A, Childers MK. Common patterns of clinical motor dys function. In Mayer NH, Simpson DM, editors. Spasticity: etiology, evaluation, managemenl and the role of botulinum toxin. New York: WE MOVE; 2002. p. 16-26.
33. Bhakta BB, Cozens JA, Chamberlain MA, Bamford JM. lmpact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. J Neurol Neurosurg Psychiatry; 2000; 69: 217-21.
34. Brashear A, McAfee AL, Kuhn ER, Fyffe J. (2004). Botulinum toxin type B in upper-limb poststroke spasticity: a double-blind, placebo-controlled tria!. Arch Phys Med Rehabil. 2004; 85: 705 9.
35. Brashear A, McAfee AL, Kuhn ER, Ambrosius WT. Treatment with botulinum toxin type B for upper limb spasticity. Arch Phys Med Rehabil. 2003; 84: 103-7.
36. MDVU. We Move. Guidelines. Edition 1.0. Botulinum Toxin Type B (Myob loc). Bronx: We Move; 2012. [citado 24 Sep. 2012]. Disponible en: http://www. mdvu.org/
37. Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lance!. 2004; 363(9421): 1619-31.
38. Palisano RJ, Rosenbaum P, Walter S, et al. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997; 45: 113-20.
39. Russman BS, Tilton AH, Gorrnley ME, Jr. Cerebral palsy: a rational approach to a treatment protocol, and the role of botulinum toxin in treatment. In: Mayer NH, Simpson DM, eds. Spasticity: Etiology, Evaluation, Management, and the Role of Botulinum Toxin. New York: WE MOVE; 2002. pp. 134-43.
40. Dolly O. Synaptic transmission: inhibition of neurotransmitter release by botuli num toxins. Headacbe. 2003; 43 (Suppl 1): Sl6-24.
41. Welcb M, Purkiss J, Foster K. Sensitivity of embryonic rat dorsal root ganglia neurons to Clostridium botulinum neurotoxins. Toxicon. 2000; 38: 245-58.
42. Durham P, Cady R. Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine the rapy. Headache. 2004; 44: 35-43.
43. Cui M, Khanijou S, Rubino J, Aoki R. Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain 2004; 107: 125-33.
44. Tatji J, Uddman R, Edvinsson L. Neuropeptide localization in the 'migraine ge nerator' region of the human brainstem. Cephalalgia. 2001; 21: 96-101.
45. Mathew MT, Frishberg M, Gawel M, et al. Botox CDH study group. Headache
2005; 45:293-307.
46. Blumenfeld A, Binder W, Silberstein SD, Blitzer A. Procedures for Adrniniste ring botulinum toxin type A for migraine and tension-type headache. Headache. 2003; 43:884-91.
47. Silberstein S, Mathew N, Saper J, et al. Botulinum toxin type A as a migraine preventative treatment. For the BOTOX Migraine Clinical Research Group. Headache. 2000; 40:445-50.
48. Mauskop, A. The use of botulinum toxin in the treatment of headaches. Pain Physician. 2004; 7: 377 87.
49. Agencia de Evaluacion de Tecnología e investigación Médicas de Cataluña. Guía de práctica clínica del ictus. 2 ed. Barcelona: AATRM; 2007.
50. García-Alfonso F, Guallar E, Bakke OM, Carné X. El placebo en ensayos clíni cos con medicamentos. Med Clin (Barc). 1997; 109: 797-801.
51. Ramos JMJ. Efecto placebo y dolor: bases cerebrales. Neurología. 2007; 22: 99- 105.
52. Lahuerta J, Gutiérrez-Rivas E, Frías J, Gracia D, Dal-Ré R. Controversias éticas sobre la utilización de placebo como tratamiento control en los ensayos clínicos en neurología. Neurología. 2007; 22: 106-13.
2. Botulismo. En: Eulenburg A. Diccionario enciclopédico de medicina y cirugía prácticas. Madrid: Agustín Jubera editor; 1886. p. 113-9.
3. Bulloch W. History. En: Medica! Research Council. A System of Bacteriology in Relation to Medicine. London: His Majesty's Statíonery Office;l929. p. 373-4.
4. Hatheway CL. Clostridium botulinum. In: Gorbach SL, Bartlett JG, BlackJow NR. Jnfectious Diseases. Philadelphía: WB Saunders; 1992. p. 1583- 7.
5. Hallett M, Glocker F, DeuschJ G. Mechanism of action of botulinum toxin. Ann Neurol. 1994; 36:449-50.
6. Schantz EJ, Johnson EA. Properties and use of botulinum toxin and other micro bial neurotoxins in medicine. Microbio! Rev. 1992; 56: 80-99.
7. Bressman SB. Dystonia genotypes, phenotypes and classification. Adv neurol. 2004; 94: 101-7.
8. MDVU. MD Virtual university. Adult dosing guidelines. In: Management of dys tonia with Borulinum Toxin Type A (Botox). Edition 2.0. Revised, August 2005.
9. Odderson IR. Botulinum toxin injection guide. New York: Demos Medica! Pub lishing; 2008.
10. Yoshimura DM, Aminoff MJ, Tami TA, Scott AB. Treatment of hemifacial spasm with botulinum toxin. Muscle Nerve. 1992; 15(9):1045-9.
11. Brin MF, Fahn S, Moskowitz C, et al. (1987). Localized injections of botuli num toxin for the treatment of focal dystonia and hemifacial spasm. Mov Disord. 1987; 2 : 237 54.
12. Berardelli A, Rothwell JC, Day BL, Marsden CD. Pathophysiology of blepharo spasm and oromandibular dystonia. Brain. 1985; 108(Pt 3): 593-608.
13. Berardelli A, Rothwell JC, Hallett M, et al. The pathopbysiology of primary dys tonia. Brain. 1998; 121 (Pt 7): 1195-212.
14. Marsden CD. Blepharospasm-oromandibular dystonia syndrome (Brueghel's syndrome). A variant of adult-onset torsion dystonia? J Neurol Neurosurg Psy chiatry. 1976; 39: 1204-9.
15. Jankovic J. Treatment of dystonia. Lancet Neurol. 2006; 5: 864-72.
16. Campos EC, Bolzani R, Schiavi C, et al. Effect of injection sites of Botulinum toxin for blepbarospasm treatment: statistical analysis. Neuro-ophtlzalmol 1999; 22:17-23.
17. Jankovic J, Orman J. Botulinum A toxin for cranial-cervical dystonia: a double blind, placebocontrolled study. Neurology. 1987; 37: 616-23.
18. Toro J, Yepes M, Palacios E. Neurología. 2da ed. Bogotá: Manual Moderno; 2010. p. 479-80.
19. Foltz EL, Knopp LM, Ward AA. Experimental spasmodic torticollis. J Neuro surg. 1959; 16: 55 72.
20. Van Zandijcke M. Cervical dystonia (spasmodic torticollis). Sorne aspecls of the natural bistory. Acta Neurol Belg. 1995; 95(4): 210-15.
21. Kessler KR, Skutta M, Benecke R. Long-term treatment of cervical dystonia with botulinum toxin A: efficacy, safety, and antibody frequency. J Neurology. 1999; 246: 265 74.
22. Truong D, Dubinski R, Hermanowicz N, et al. Posttraumatic torticollis. Arch Neurol. 1991; 48: 221-3.
23. Truong D, Lewitt, P, Cullis, P. Effects of different injection techniques in the treatment of torticollis with botulinumtoxin. Neurology. 1989; 39 (Suppl): 294.
24. Anderson TJ, Rivest J, Stell R, et al. Botulinumtoxin treatment of spasmodic torticollis. J R Soc Med. 1992; 85: 524-9.
25. Poewe W, Schelosky L, Kleedorfer B, et al. (1992). Treatment of spasmodic torticollis with local injections of botulinum toxin. One-year follow-up in thirty seven patients. J Neurol. 1992; 239: 21-5.
26. Lance JW. Disordered muscle tone and movement. Clin Exp Neurol. 1981; 18: 27-35.
27. Brashear A, Gordon MF, Elovic E, et al. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med. 2002; 347: 395-400.
28. Childers MK, Brasbear A, Jozefczyk P, el al. Dose-dependent response to in tramuscular botulinum toxin type A for upper-limb spasticity in patients after a stroke. Arch Phys Med Rehabil. 2004; 85: 1063-9.
29. Suputtitada A, Suwanwela NC. The lowest effective dose of botulinum A toxin in adult patients with upper limb spasticity. Disabil Rehabil. 2005; 27: 176-84.
30. Chin TY, Nattrass GR, Selber P, Graham HK. Accuracy of intramuscular injec tion of botulinum toxin A in juvenile cerebral palsy: a comparison between ma nual needle placement and placement guided by electrical stimulation. J Pediatr Orthop. 2005; 25: 286-91.
31. Hyman N, Barnes M, Bbakta B, el al. Botulinum toxin (Dysport) treatment of bip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study. J Neurol Neurosurg Psychiatry. 2000; 68: 707-12.
32. Mayer NH, Esquenazi A, Childers MK. Common patterns of clinical motor dys function. In Mayer NH, Simpson DM, editors. Spasticity: etiology, evaluation, managemenl and the role of botulinum toxin. New York: WE MOVE; 2002. p. 16-26.
33. Bhakta BB, Cozens JA, Chamberlain MA, Bamford JM. lmpact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. J Neurol Neurosurg Psychiatry; 2000; 69: 217-21.
34. Brashear A, McAfee AL, Kuhn ER, Fyffe J. (2004). Botulinum toxin type B in upper-limb poststroke spasticity: a double-blind, placebo-controlled tria!. Arch Phys Med Rehabil. 2004; 85: 705 9.
35. Brashear A, McAfee AL, Kuhn ER, Ambrosius WT. Treatment with botulinum toxin type B for upper limb spasticity. Arch Phys Med Rehabil. 2003; 84: 103-7.
36. MDVU. We Move. Guidelines. Edition 1.0. Botulinum Toxin Type B (Myob loc). Bronx: We Move; 2012. [citado 24 Sep. 2012]. Disponible en: http://www. mdvu.org/
37. Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lance!. 2004; 363(9421): 1619-31.
38. Palisano RJ, Rosenbaum P, Walter S, et al. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997; 45: 113-20.
39. Russman BS, Tilton AH, Gorrnley ME, Jr. Cerebral palsy: a rational approach to a treatment protocol, and the role of botulinum toxin in treatment. In: Mayer NH, Simpson DM, eds. Spasticity: Etiology, Evaluation, Management, and the Role of Botulinum Toxin. New York: WE MOVE; 2002. pp. 134-43.
40. Dolly O. Synaptic transmission: inhibition of neurotransmitter release by botuli num toxins. Headacbe. 2003; 43 (Suppl 1): Sl6-24.
41. Welcb M, Purkiss J, Foster K. Sensitivity of embryonic rat dorsal root ganglia neurons to Clostridium botulinum neurotoxins. Toxicon. 2000; 38: 245-58.
42. Durham P, Cady R. Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine the rapy. Headache. 2004; 44: 35-43.
43. Cui M, Khanijou S, Rubino J, Aoki R. Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain 2004; 107: 125-33.
44. Tatji J, Uddman R, Edvinsson L. Neuropeptide localization in the 'migraine ge nerator' region of the human brainstem. Cephalalgia. 2001; 21: 96-101.
45. Mathew MT, Frishberg M, Gawel M, et al. Botox CDH study group. Headache
2005; 45:293-307.
46. Blumenfeld A, Binder W, Silberstein SD, Blitzer A. Procedures for Adrniniste ring botulinum toxin type A for migraine and tension-type headache. Headache. 2003; 43:884-91.
47. Silberstein S, Mathew N, Saper J, et al. Botulinum toxin type A as a migraine preventative treatment. For the BOTOX Migraine Clinical Research Group. Headache. 2000; 40:445-50.
48. Mauskop, A. The use of botulinum toxin in the treatment of headaches. Pain Physician. 2004; 7: 377 87.
49. Agencia de Evaluacion de Tecnología e investigación Médicas de Cataluña. Guía de práctica clínica del ictus. 2 ed. Barcelona: AATRM; 2007.
50. García-Alfonso F, Guallar E, Bakke OM, Carné X. El placebo en ensayos clíni cos con medicamentos. Med Clin (Barc). 1997; 109: 797-801.
51. Ramos JMJ. Efecto placebo y dolor: bases cerebrales. Neurología. 2007; 22: 99- 105.
52. Lahuerta J, Gutiérrez-Rivas E, Frías J, Gracia D, Dal-Ré R. Controversias éticas sobre la utilización de placebo como tratamiento control en los ensayos clínicos en neurología. Neurología. 2007; 22: 106-13.