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Prof. Bahman Jabbari
Department of Neurology, Yale University School of Medicine, New Haven, CT 06519, USA

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0 Neuropathic Pain
0 Pain
0 botulinum toxin
0 pain medicine
0 Neuralgia

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Pain
Botulinum neurotoxin
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Review
Published: 31 December 2020 in Tremor and Other Hyperkinetic Movements
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Hand tremor associated with Parkinson disease (PD) and essential tremor (ET) can often become challenging to treat in clinical practice. Local injections of botulinum toxin-A (BoNT-A) for hand tremor is an evolving field with newer injection techniques being utilized in clinical studies. The utility of BoNT-A therapy for ET and PD-tremor however, has been questioned based on the high incidence of finger and hand weakness after treatment. The study includes detailed analysis of the techniques utilized in BoNT injection in ET and PD tremor. There were 4 high-quality investigations which consisted of Class I or II double-blind placebo-controlled trials and one medium-quality study that was a prospective, open label, class III investigation. This paper discusses two recently developed technology-based injection methods for BoNT-A therapy of ET and PD tremor, which includes comprehensive EMG screening of forearm and arm muscles with selective injections (Yale method) and the whole arm kinematic tremor assessment developed by Jog et al. In recent years, controlled, blinded studies of these two methods have shown significant post-injection reduction of finger, hand and whole limb tremor compared to the previously published controlled clinical trials not using these methodologies.

ACS Style

Shivam Om Mittal; Mandar Jog; Jack Lee; Bahman Jabbari. Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor – the Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment. Tremor and Other Hyperkinetic Movements 2020, 10, 1 .

AMA Style

Shivam Om Mittal, Mandar Jog, Jack Lee, Bahman Jabbari. Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor – the Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment. Tremor and Other Hyperkinetic Movements. 2020; 10 (1):1.

Chicago/Turabian Style

Shivam Om Mittal; Mandar Jog; Jack Lee; Bahman Jabbari. 2020. "Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor – the Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment." Tremor and Other Hyperkinetic Movements 10, no. 1: 1.

Full length article
Published: 31 October 2020 in Journal of Stroke and Cerebrovascular Diseases
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Objectives The objective of this study is to describe the mechanism of damage to subcortical structures in chronic kidney disease (CKD) and to describe the range of movement disorders associated with CKD. Materials and Methods We have reviewed the Medline literature up to January of 2020 using key words movement disorders and chronic kidney disease. The reviewed articles were studied for mechanisms of subcortical damage in CKD as well as type of the reported movements, their frequency and updated treatment. Results The search revealed 183 articles most of them dealing with restless legs syndrome. The damage to basal ganglia in CKD resulted from several mechanisms including accumulation of nitro tyrosine caused by reactive oxygen species and action of uremic toxins leading to endothelial damage and dysfunction of blood-brain barrier. Involuntary movements in CKD include restless legs syndrome (RLS), myoclonus, asterixis, dystonia, chorea, tremor, and Parkinsonism. Conclusions Chronic kidney disease can cause several abnormal involuntary movements via damaging basal ganglia and subcortical structures. The most common movement disorders in CKD are RLS, myoclonus and asterixis. Restless legs syndrome and myoclonus when severe, need and respond to treatment. Movement disorders in CKD improve with improvement of kidney function.

ACS Style

Yasaman Safarpour; Nosratola D. Vaziri; Bahman Jabbari. Movement Disorders in Chronic Kidney Disease – A Descriptive Review. Journal of Stroke and Cerebrovascular Diseases 2020, 30, 105408 .

AMA Style

Yasaman Safarpour, Nosratola D. Vaziri, Bahman Jabbari. Movement Disorders in Chronic Kidney Disease – A Descriptive Review. Journal of Stroke and Cerebrovascular Diseases. 2020; 30 (9):105408.

Chicago/Turabian Style

Yasaman Safarpour; Nosratola D. Vaziri; Bahman Jabbari. 2020. "Movement Disorders in Chronic Kidney Disease – A Descriptive Review." Journal of Stroke and Cerebrovascular Diseases 30, no. 9: 105408.

Chapter
Published: 07 October 2020 in Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine
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Animal studies have shown that local injection of botulinum neurotoxins (BoNTs) reduces neuropathic pain. This effect is exerted via interfering with the function of pain transmitters and modulators at peripheral and central levels. Recent studies in humans have demonstrated an analgesic effect in several pain disorders. In this chapter, the effect of BoNT therapy in different medical, human pain syndromes is reviewed. The level of efficacy in each pain syndrome is determined according to the guidelines of the Assessment Subcommittee of the American Academy of Neurology.

ACS Style

Delaram Safarpour; Bahman Jabbari. Botulinum Toxin Therapy in Medical Pain Disorders. Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine 2020, 131 -156.

AMA Style

Delaram Safarpour, Bahman Jabbari. Botulinum Toxin Therapy in Medical Pain Disorders. Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine. 2020; ():131-156.

Chicago/Turabian Style

Delaram Safarpour; Bahman Jabbari. 2020. "Botulinum Toxin Therapy in Medical Pain Disorders." Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine , no. : 131-156.

Chapter
Published: 07 October 2020 in Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine
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Nearly 200 years ago (1820), a young German physician Justinus Kerner predicted that the agent responsible for “sausage poisoning “could have therapeutic implications. The agent Clostridium botulinum was discovered at the end of the nineteenth century by the Belgian bacteriologist Emile Van Ermengem. Close to end of World War II, the toxin was isolated and purified by Lamanna and Duff and was prepared and produced for clinical use by Schantz. Allen Scott, following a series of studies in monkeys, published the first utility of botulinum neurotoxin (BoNT) in humans for correcting strabismus in 1980. The past 40 years witnessed the development of vast clinical indications of botulinum neurotoxin (BoNT) therapy. This chapter, in addition to the older historical data, also briefly discusses the contribution of some of contemporary basic scientists and clinical neurotoxicologists who are responsible for the therapeutic success of BoNT therapy in medical and surgical fields.

ACS Style

Bahman Jabbari. The History of Botulinum Neurotoxins: From 1820 to 2020. Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine 2020, 1 -13.

AMA Style

Bahman Jabbari. The History of Botulinum Neurotoxins: From 1820 to 2020. Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine. 2020; ():1-13.

Chicago/Turabian Style

Bahman Jabbari. 2020. "The History of Botulinum Neurotoxins: From 1820 to 2020." Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine , no. : 1-13.

Chapter
Published: 07 October 2020 in Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine
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A considerable number of orthopedic disorders are accompanied by pain which can be a clinical challenge for clinicians and a major problem for patients. Botulinum neurotoxins (BoNTs) have been recently shown to possess analgesic effects leading to their extensive use in various situations, including pain control for orthopedic issues. This chapter presents information on BoNT treatment of five orthopedic disorders with available placebo-controlled studies. The recommendations of the Assessment Subcommittee of the American Academy of Neurology are applied to establish an evidence-based level of efficacy for these disorders that include chronic lateral epicondylitis, refractory pain following total knee arthroplasty, painful local arthritis, anterior knee pain related to vastus lateralis imbalance, and orthopedic contracture and/or pain release (French and Gronseth, Neurology 71:1634–8, 2008; Gronseth and French, Neurology 71:1639–43, 2008). According to the studies discussed in the following sections, an “A” level of evidence has been provided for chronic lateral epicondylitis, defining BoNT-A as being “effective” for this disorder. In painful local arthritis and issues related to orthopedic contracture and/or pain release including distraction osteogenesis and correction of scoliosis, the level of evidence is “B” demonstrating BoNT-A therapy to be “probably ineffective.” For refractory pain after total knee arthroplasty, anterior knee pain related to vastus lateralis imbalance, and other problems related to orthopedic contracture and/or pain release, the level of evidence is determined as “C” or “possibly effective.” Some of the studies providing these levels of evidence are of class III and IV types, and the number of class I studies in a few of these disorders is limited. Further class I/II studies are required to support a definitive analgesic role of BoNTs in orthopedic disorders.

ACS Style

Christian Wong; Shahroo Etemad-Moghadam; Bahman Jabbari. Botulinum Toxins for Treatment of Pain in Orthopedic Disorders. Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine 2020, 195 -215.

AMA Style

Christian Wong, Shahroo Etemad-Moghadam, Bahman Jabbari. Botulinum Toxins for Treatment of Pain in Orthopedic Disorders. Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine. 2020; ():195-215.

Chicago/Turabian Style

Christian Wong; Shahroo Etemad-Moghadam; Bahman Jabbari. 2020. "Botulinum Toxins for Treatment of Pain in Orthopedic Disorders." Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine , no. : 195-215.

Review
Published: 05 January 2020 in Toxins
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Botulinum neurotoxins (BoNT) possess an analgesic effect through several mechanisms including an inhibition of acetylcholine release from the neuromuscular junction as well as an inhibition of specific pain transmitters and mediators. Animal studies have shown that a peripheral injection of BoNTs impairs the release of major pain transmitters such as substance P, calcitonin gene related peptide (CGRP) and glutamate from peripheral nerve endings as well as peripheral and central neurons (dorsal root ganglia and spinal cord). These effects lead to pain relief via the reduction of peripheral and central sensitization both of which reflect important mechanisms of pain chronicity. This review provides updated information about the effect of botulinum toxin injection on local pain caused by cancer, painful muscle spasms from a remote cancer, and pain at the site of cancer surgery and radiation. The data from the literature suggests that the local injection of BoNTs improves muscle spasms caused by cancerous mass lesions and alleviates the post-operative neuropathic pain at the site of surgery and radiation. It also helps repair the parotid damage (fistula, sialocele) caused by facial surgery and radiation and improves post-parotidectomy gustatory hyperhidrosis. The limited literature that suggests adding botulinum toxins to cell culture slows/halts the growth of certain cancer cells is also reviewed and discussed.

ACS Style

Shivam O. Mittal; Bahman Jabbari. Botulinum Neurotoxins and Cancer—A Review of the Literature. Toxins 2020, 12, 32 .

AMA Style

Shivam O. Mittal, Bahman Jabbari. Botulinum Neurotoxins and Cancer—A Review of the Literature. Toxins. 2020; 12 (1):32.

Chicago/Turabian Style

Shivam O. Mittal; Bahman Jabbari. 2020. "Botulinum Neurotoxins and Cancer—A Review of the Literature." Toxins 12, no. 1: 32.

Review
Published: 25 March 2019 in International Journal of Anesthesiology and Pain Research
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Diabetic neuropathy (DN) is one of the most common peripheral nervous system disorders. It affects 16% of individuals with type I (young onset) diabetes and 25-26% of individuals with type II (late onset) diabetes [1]. Pain and numbness of the feet and, in advanced cases, weakness in the feet or hands are the usual symptoms. These symptoms are typically more prominent in the lower limbs. The skin in the affected areas is sensitive to touch (hyperesthesia); sometimes touch evokes pain (allodynia). The pain of diabetic neuropathy may develop spontaneously or may be provoked by touch or motion. Pain often interferes with patient’s rest and sleep and has typical characteristics of a neuropathic pain i.e having a sharp and burning quality. Dorsum of the foot and toes are most commonly affected in diabetic neuropathy. On examination, the patients demonstrate decreased sensations (heat, cold, touch, position) in the affected limb. Diabetic neuropathy (DN) is usually bilateral and presents in form of a polyneuropathy.

ACS Style

Bahman Jabbari; Yasaman Safarpour. Botulinum Toxin Treatment for Painful Diabetic Neuropathy A Review. International Journal of Anesthesiology and Pain Research 2019, 1, 01 -04.

AMA Style

Bahman Jabbari, Yasaman Safarpour. Botulinum Toxin Treatment for Painful Diabetic Neuropathy A Review. International Journal of Anesthesiology and Pain Research. 2019; 1 (1):01-04.

Chicago/Turabian Style

Bahman Jabbari; Yasaman Safarpour. 2019. "Botulinum Toxin Treatment for Painful Diabetic Neuropathy A Review." International Journal of Anesthesiology and Pain Research 1, no. 1: 01-04.

Randomized controlled trial
Published: 29 September 2018 in Toxins
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Background: Restless Legs Syndrome (RLS) is a common movement disorder with an estimated prevalence of up to 12%. Previous small studies with onabotulinumtoxin A (OnaA) for RLS have shown inconsistent results. Methods: Twenty-four patients with an International RLS score (IRLS) of >11 (moderate-severe) were enrolled in this blinded, placebo-controlled crossover study. Twenty-one patients completed the evaluations at 4, 6, and 8 weeks after each injection. One-hundred units of Incobotulinumtoxin A (IncoA) or normal saline were injected into tibialis anterior, gastrocnemius, and biceps femoris muscles each side. Results: Improvement from a severe (IRLS >21) to a mild/moderate (IRLS ≤20) score was significant at four weeks (p = 0.0036) and six weeks (p = 0.0325) following IncoA administration compared to placebo. Additionally, there was significant improvement in pain score at six weeks as measured by Visual Analogue Scale (p = 0.04) and the Johns Hopkins Quality of Life Questionnaire (p = 0.01) in the IncoA group. Definite or marked improvement on Patient Global Impression of Change was seen in 7 out of 21 patients in the IncoA group vs. 1 out of 21 patients in the placebo group at 4 weeks (p = 0.012). Conclusion: IncoA injection lead to a reduction in severity of RLS symptoms, pain score, and quality of life, without any adverse effects.

ACS Style

Shivam Om Mittal; Duarte Machado; Diana Richardson; Divyanshu Dubey; Bahman Jabbari. Botulinum Toxin in Restless Legs Syndrome—A Randomized Double-Blind Placebo-Controlled Crossover Study. Toxins 2018, 10, 401 .

AMA Style

Shivam Om Mittal, Duarte Machado, Diana Richardson, Divyanshu Dubey, Bahman Jabbari. Botulinum Toxin in Restless Legs Syndrome—A Randomized Double-Blind Placebo-Controlled Crossover Study. Toxins. 2018; 10 (10):401.

Chicago/Turabian Style

Shivam Om Mittal; Duarte Machado; Diana Richardson; Divyanshu Dubey; Bahman Jabbari. 2018. "Botulinum Toxin in Restless Legs Syndrome—A Randomized Double-Blind Placebo-Controlled Crossover Study." Toxins 10, no. 10: 401.

Review
Published: 01 June 2018 in Toxicon
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This review evaluates the existing level of evidence for efficacy of BoNTs in different pain syndromes using the recommended efficacy criteria from the Assessment and Therapeutic Subcommittee of the American Academy of Neurology. There is a level A evidence (effective) for BoNT therapy in post-herpetic neuralgia, trigeminal neuralgia, and posttraumatic neuralgia. There is a level B evidence (probably effective) for diabetic neuropathy, plantar fasciitis, piriformis syndrome, pain associated with total knee arthroplasty, male pelvic pain syndrome, chronic low back pain, male pelvic pain, and neuropathic pain secondary to traumatic spinal cord injury. BoNTs are possibly effective (Level C -one class II study) for female pelvic pain, painful knee osteoarthritis, post-operative pain in children with cerebral palsy after adductor release surgery, anterior knee pain with vastus lateralis imbalance. There is a level B evidence (one class I study) that BoNT treatment is probably ineffective in carpal tunnel syndrome. For myofascial pain syndrome, the level of evidence is U (undetermined) due to contradicting results. More high quality (Class I) studies and studies with different types of BoNTs are needed for better understanding of the role of BoNTs in pain syndromes.

ACS Style

Yasaman Safarpour; Bahman Jabbari. Botulinum toxin treatment of pain syndromes –an evidence based review. Toxicon 2018, 147, 120 -128.

AMA Style

Yasaman Safarpour, Bahman Jabbari. Botulinum toxin treatment of pain syndromes –an evidence based review. Toxicon. 2018; 147 ():120-128.

Chicago/Turabian Style

Yasaman Safarpour; Bahman Jabbari. 2018. "Botulinum toxin treatment of pain syndromes –an evidence based review." Toxicon 147, no. : 120-128.

Review
Published: 24 February 2018 in Current Treatment Options in Neurology
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Botulinum neurotoxins (BoNTs) are now among the most widely used therapeutic agents in clinical medicine with indications applied to the fields of movement disorders, pain disorders, and autonomic dysfunction. In this literature review, the efficacy and utility of BoNTs in the field of movement disorders are assessed using the criteria of the Guideline Development Subcommittee of the American Academy of Neurology. The literature supports a level A efficacy (established) for BoNT therapy in cervical dystonia and a level B efficacy (probably effective) for blepharospasm, hemifacial spasm, laryngeal dystonia (spasmodic dysphonia), task-specific dystonias, essential tremor, and Parkinson rest tremor. It is the view of movement disorder experts, however, that despite the level B efficacy, BoNTs should be considered treatment of first choice for blepharospasm, hemifacial spasm, laryngeal, and task-specific dystonias. The emerging data on motor and vocal tics of Tourette syndrome and oromandibular dystonias are encouraging but the current level of efficacy is U (undetermined) due to lack of published high-quality studies.

ACS Style

Yasaman Safarpour; Bahman Jabbari. Botulinum Toxin Treatment of Movement Disorders. Current Treatment Options in Neurology 2018, 20, 4 .

AMA Style

Yasaman Safarpour, Bahman Jabbari. Botulinum Toxin Treatment of Movement Disorders. Current Treatment Options in Neurology. 2018; 20 (2):4.

Chicago/Turabian Style

Yasaman Safarpour; Bahman Jabbari. 2018. "Botulinum Toxin Treatment of Movement Disorders." Current Treatment Options in Neurology 20, no. 2: 4.

Chapter
Published: 24 August 2017 in Botulinum Toxin Treatment in Clinical Medicine
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Primary headaches consist of migraine, tension headaches, and trigeminal autonomic neuralgias. Randomized multicenter blinded studies have shown the efficacy of onabotulinumtoxinA in chronic migraine (15 or more times/month). Long-term follow-up of patients who have participated in the multicenter studies of chronic migraine (PREEMPT studies) have shown continued efficacy and tolerability and improvement of the quality of life after repeated botulinum neurotoxin (BoNT) therapy. Blinded studies of BONTs in tension headaches have produced mostly negative results but the results are confounded by selection of rigid primary outcome criteria, application of low doses, and suboptimal techniques. Anecdotal observations suggest efficacy in cluster headaches and some forms of secondary headaches (post-traumatic) but as yet no randomized clinical trials are available for this form of headaches.

ACS Style

Sara M. Schaefer; Bahman Jabbari. Botulinum Toxin Treatment of Migraine and Other Headaches. Botulinum Toxin Treatment in Clinical Medicine 2017, 145 -165.

AMA Style

Sara M. Schaefer, Bahman Jabbari. Botulinum Toxin Treatment of Migraine and Other Headaches. Botulinum Toxin Treatment in Clinical Medicine. 2017; ():145-165.

Chicago/Turabian Style

Sara M. Schaefer; Bahman Jabbari. 2017. "Botulinum Toxin Treatment of Migraine and Other Headaches." Botulinum Toxin Treatment in Clinical Medicine , no. : 145-165.

Chapter
Published: 24 August 2017 in Botulinum Toxin Treatment in Clinical Medicine
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Emerging literature suggests new potential applications for botulinum neurotoxin (BoNT) therapy in clinical medicine. This chapter discusses four areas in which, in the author’s opinion, botulinum toxin has a potential to make a major impact in patient care. The disciplines likely to benefit from the use of botulinum toxins include Orthopedics (ostheoarthritis), Cardiology (atrial fibrillation), Psychiatry (depression), and Autonomic System (prevention of radiation damage to salivary glands).

ACS Style

Bahman Jabbari. Botulinum Toxin Therapy: Future Perspectives. Botulinum Toxin Treatment in Clinical Medicine 2017, 293 -301.

AMA Style

Bahman Jabbari. Botulinum Toxin Therapy: Future Perspectives. Botulinum Toxin Treatment in Clinical Medicine. 2017; ():293-301.

Chicago/Turabian Style

Bahman Jabbari. 2017. "Botulinum Toxin Therapy: Future Perspectives." Botulinum Toxin Treatment in Clinical Medicine , no. : 293-301.

Chapter
Published: 24 August 2017 in Botulinum Toxin Treatment in Clinical Medicine
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Multiple sclerosis is a common disease in which the disease process involves multiple levels of the central nervous system leading to the emergence of a myriad of clinical symptoms. The symptomatic treatment of multiple sclerosis often does not meet patient’s satisfaction despite the availability of a variety of pharmacotherapeutic agents. This evidence-based review discusses the utility of botulinum neurotoxin therapy for treating the symptoms of multipe sclerosis. The available data from randomized, blinded clinical trials indicate that BoNT therapy is efficacious for the treatment of spasticity, bladder dysfunction, and certain types of focal pain in multiple sclerosis. Emerging literature from open-label observations suggests the utility of BoNT therapy in several other symptoms caused by MS: certain tremors, myokymia, tonic spasms, spastic dysphagia, and internuclear ophthalmoplegia. The data on MS-related sialorrhea are not available.

ACS Style

Yasaman Safarpour; Bahman Jabbari. Botulinum Toxin Treatment in Multiple Sclerosis. Botulinum Toxin Treatment in Clinical Medicine 2017, 109 -129.

AMA Style

Yasaman Safarpour, Bahman Jabbari. Botulinum Toxin Treatment in Multiple Sclerosis. Botulinum Toxin Treatment in Clinical Medicine. 2017; ():109-129.

Chicago/Turabian Style

Yasaman Safarpour; Bahman Jabbari. 2017. "Botulinum Toxin Treatment in Multiple Sclerosis." Botulinum Toxin Treatment in Clinical Medicine , no. : 109-129.

Chapter
Published: 24 August 2017 in Botulinum Toxin Treatment in Clinical Medicine
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Neuropathic pain (NP) results from damage to or a lesion in the peripheral or central nervous system. It is a common form of human pain, often with poor response to analgesic medications. In this chapter, we discuss our current knowledge of the pathophysiology of NP followed by its conventional treatment and provide evidence-based comments on the efficacy of botulinum neurotoxins (BoNTs) in the management of NP. The published guidelines of the American Academy of Neurology are used as determinants of the level of efficacy of BoNT therapy in different NP categories. Available data indicate that BoNT therapy is effective (level A evidence) in post-herpetic, post-traumatic, and trigeminal neuralgias. It is probably effective (Level B) in painful diabetic neuropathy, plantar fasciitis, and central (spinal cord) neuropathic pain. The data available on the use of BoNTs in complex regional pain syndrome, carpal tunnel syndrome, occipital neuralgia, and phantom limb pain are of low quality and controversial; hence, conduction of clinical trials of higher quality is required to determine if there is a therapeutic role for BoNTs in these conditions. The dosage and technique of injection, dilutions, and differences among BoNTs in the treatment of neuropathic pain remains to be established.

ACS Style

Shivam Om Mittal; Bahman Jabbari. Botulinum Toxin Treatment of Neuropathic Pain. Botulinum Toxin Treatment in Clinical Medicine 2017, 167 -191.

AMA Style

Shivam Om Mittal, Bahman Jabbari. Botulinum Toxin Treatment of Neuropathic Pain. Botulinum Toxin Treatment in Clinical Medicine. 2017; ():167-191.

Chicago/Turabian Style

Shivam Om Mittal; Bahman Jabbari. 2017. "Botulinum Toxin Treatment of Neuropathic Pain." Botulinum Toxin Treatment in Clinical Medicine , no. : 167-191.

Chapter
Published: 24 August 2017 in Botulinum Toxin Treatment in Clinical Medicine
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Cancer-related pain arises from a variety of different mechanisms. Notable among them are direct local invasion leading to irritation of motor and sensory nerve fibers and post-radiation/post-surgical pain due to nervous system damage. Botulinum neurotoxins (BoNTs) exert their analgesic effect via impeding conduction at the neuromuscular junction as well as inhibition of the release of pain mediators from peripheral nerve endings, dorsal root ganglia, and spinal sensory neurons. One double blind and five open label prospective studies have demonstrated effectiveness of BoNT-As in relieving pain at the site of radiation or surgery for cancer. Single case observations have shown that local intramuscular injection of BoNTs can alleviate chronic and disabling local pain and improve quality of the end of life state among patients with terminal cancer. One blinded study reported that in head and neck cancer, pretreatment of salivary glands with botulinum toxins reduces the incidence of post-radiation damage to the salivary glands.

ACS Style

Delaram Safarpour; Bahman Jabbari. The Role of Botulinum Toxins in Treatment of Cancer-Related Issues: Post-radiation and Post-surgical Pain and Radiation-Induced Damage to the Salivary Glands. Botulinum Toxin Treatment in Clinical Medicine 2017, 247 -258.

AMA Style

Delaram Safarpour, Bahman Jabbari. The Role of Botulinum Toxins in Treatment of Cancer-Related Issues: Post-radiation and Post-surgical Pain and Radiation-Induced Damage to the Salivary Glands. Botulinum Toxin Treatment in Clinical Medicine. 2017; ():247-258.

Chicago/Turabian Style

Delaram Safarpour; Bahman Jabbari. 2017. "The Role of Botulinum Toxins in Treatment of Cancer-Related Issues: Post-radiation and Post-surgical Pain and Radiation-Induced Damage to the Salivary Glands." Botulinum Toxin Treatment in Clinical Medicine , no. : 247-258.

Review
Published: 17 August 2017 in Current Treatment Options in Neurology
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Purpose of review The purpose of this review is to provide updated information on the role of botulinum neurotoxin (BoNT) therapy in multiple sclerosis (MS). This review aims to answer which symptoms of multiple sclerosis may be amenable to BoNT therapy. Recent findings We searched the literature on the efficacy of BoNTs for treatment of MS symptoms up to April 1st 2017 via the Yale University Library’s search engine including but not limited to Pub Med and Ovis SP. The level of efficacy was defined according to the assessment’s criteria set forth by the Subcommittee on Guideline Development of the American Academy of Neurology. Significant efficacy was found for two indications based on the available blinded studies (class I and II) and has been suggested for several others through open-label clinical trials. Summary There is level A evidence (effective- two or more class I) that injection of BoNT-A into the bladder’s detrusor muscle improves MS-related neurogenic detrusor overactivity (NDO) and MS-related overactive (OA) bladder. There is level B evidence (probably effective- two class II studies) for utility of intramuscular BoNT-A injections for spasticity of multiple sclerosis. Emerging data based on retrospective class IV studies demonstrates that intramuscular injection of BoNTs may help other symptoms of MS such as focal tonic spasms, focal myokymia, spastic dysphagia, and double vision in internuclear ophthalmoplegia. There is no data on MS-related trigeminal neuralgia and sialorrhea, two conditions which have been shown to respond to BoNT therapy in non-MS population.

ACS Style

Yasaman Safarpour; Tahereh Mousavi; Bahman Jabbari. Botulinum Toxin Treatment in Multiple Sclerosis—a Review. Current Treatment Options in Neurology 2017, 19, 33 .

AMA Style

Yasaman Safarpour, Tahereh Mousavi, Bahman Jabbari. Botulinum Toxin Treatment in Multiple Sclerosis—a Review. Current Treatment Options in Neurology. 2017; 19 (10):33.

Chicago/Turabian Style

Yasaman Safarpour; Tahereh Mousavi; Bahman Jabbari. 2017. "Botulinum Toxin Treatment in Multiple Sclerosis—a Review." Current Treatment Options in Neurology 19, no. 10: 33.

Review
Published: 11 August 2017 in Hemodialysis International
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Perhaps no other organ in the body is affected as often and in as many ways as the brain is in patients with chronic kidney disease (CKD). Several factors contribute to the neurological disorders in CKD including accumulation of uremic toxins, metabolic and hemodynamic disorders, oxidative stress, inflammation, and impaired blood brain barrier among others. The neurological disorders in CKD involve both peripheral and central nervous system. The peripheral neurological symptoms of CKD are due to somatic and cranial peripheral neuropathies as well as a myopathy. The central neurological symptoms of CKD are due to the cortical predominantly cortical, or subcortical lesions. Cognitive decline, encephalopathy, cortical myoclonus, asterixis and epileptic seizures are distinct features of the cortical disorders of CKD. Diffuse white matter disease due to ischemia and hypoxia may be an important cause of subcortical encephalopathy. A special and more benign form of subcortical disorder caused by brain edema in CKD is termed posterior reversible encephalopathy. Subcortical pathology especially when it affects the basal ganglia causes a number of movement disorders including Parkinsonism, chorea and dystonia. A stimulus-sensitive reflex myoclonus is believed to originate from the medullary structures. Sleep disorder and restless leg syndrome are common in CKD and have both central and peripheral origin. This article provides an overview of the available data on the nature, prevalence, pathophysiology, consequences and treatment of neurological complications of CKD.

ACS Style

Bahman Jabbari; Nosratola D. Vaziri. The nature, consequences, and management of neurological disorders in chronic kidney disease. Hemodialysis International 2017, 22, 150 -160.

AMA Style

Bahman Jabbari, Nosratola D. Vaziri. The nature, consequences, and management of neurological disorders in chronic kidney disease. Hemodialysis International. 2017; 22 (2):150-160.

Chicago/Turabian Style

Bahman Jabbari; Nosratola D. Vaziri. 2017. "The nature, consequences, and management of neurological disorders in chronic kidney disease." Hemodialysis International 22, no. 2: 150-160.

Review
Published: 06 June 2017 in Journal of Clinical Movement Disorders
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The aim of this study was to examine the efficacy, safety and dosing practices of rimabotulinumtoxinB (BoNT-B) for the treatment of patients with sialorrhea based on a systematic review of clinical trials. A systematic literature review was performed to identify randomized controlled trials and other comparative clinical studies of BoNT-B for the treatment of sialorrhea published in English between January 1999 and December 2015. Medical literature databases (PubMed, Cochrane Library, and EMBASE) were searched and a total of 41 records were identified. Of these, six primary publications that evaluated BoNT-B for the treatment of sialorrhea met criteria and were included in the final data report. Total BoNT-B doses ranged from 1500 to 4000 units for sialorrhea. Most of the studies in sialorrhea showed statistically significant benefits of BoNT-B versus placebo (range 4–19.2 weeks). BoNT-B was generally well tolerated across the individual studies; most adverse events reported were considered unrelated to treatment. Adverse events considered potentially associated with BoNT-B included: dry mouth, change in saliva thickness, mild transient dysphagia, mild weakness of chewing and diarrhea. BoNT-B significantly reduces sialorrhea at doses between 1500 and 4000 units. The relatively mild dose-dependent adverse events suggest both direct and remote toxin effects.

ACS Style

Khashayar Dashtipour; Roongroj Bhidayasiri; Jack J. Chen; Bahman Jabbari; Mark Lew; Diego Torres-Russotto. RimabotulinumtoxinB in sialorrhea: systematic review of clinical trials. Journal of Clinical Movement Disorders 2017, 4, 1 -9.

AMA Style

Khashayar Dashtipour, Roongroj Bhidayasiri, Jack J. Chen, Bahman Jabbari, Mark Lew, Diego Torres-Russotto. RimabotulinumtoxinB in sialorrhea: systematic review of clinical trials. Journal of Clinical Movement Disorders. 2017; 4 (1):1-9.

Chicago/Turabian Style

Khashayar Dashtipour; Roongroj Bhidayasiri; Jack J. Chen; Bahman Jabbari; Mark Lew; Diego Torres-Russotto. 2017. "RimabotulinumtoxinB in sialorrhea: systematic review of clinical trials." Journal of Clinical Movement Disorders 4, no. 1: 1-9.

Randomized controlled trial
Published: 15 December 2016 in Toxins
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Chronic low back pain is a debilitating condition with a complex and multifactorial pathophysiology. Botulinum neurotoxins (BoNTs) have strong analgesic effects, as shown in both animal models of pain and in human beings. A randomized, double-blind, placebo-controlled, parallel format study to investigate the efficacy of abobotulinum toxin A (aboA) in chronic low back pain was conducted. The study cohort consisted of 18 patients who received 100 units of aboA into each of the five lumbar extensor spinae muscles unilaterally or bilaterally (total dose 500 to 1000 units), and 19 who received normal saline of the same volume. The level of pain and quality of life were assessed using the visual analogue scale (VAS) and three questionnaires including the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ). Patients’ perception of improvement was recorded via patient global impression of change (PGIC). The primary outcome measure, the proportion of responders with VAS of <4 at 6 weeks, was not met, but the data was significantly in favor of aboA at 4 weeks (p = 0.008). The total Oswestry score representing quality of life improved in the aboA group compared to the placebo group (p = 0.0448). Moreover, significantly more patients reported their low back pain as “much improved” in the abobotulinum toxin A group (0.0293).

ACS Style

Duarte Machado; Aditya Kumar; Bahman Jabbari. Abobotulinum Toxin A in the Treatment of Chronic Low Back Pain. Toxins 2016, 8, 374 .

AMA Style

Duarte Machado, Aditya Kumar, Bahman Jabbari. Abobotulinum Toxin A in the Treatment of Chronic Low Back Pain. Toxins. 2016; 8 (12):374.

Chicago/Turabian Style

Duarte Machado; Aditya Kumar; Bahman Jabbari. 2016. "Abobotulinum Toxin A in the Treatment of Chronic Low Back Pain." Toxins 8, no. 12: 374.

Review
Published: 28 November 2016 in Tremor and Other Hyperkinetic Movements
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The frontiers of clinical medicine constantly expand as a result of the innovative efforts of visionary researchers and keen observations of seasoned clinicians. In medicine, rarely has a therapeutic agent been found efficacious in the management of so many symptoms and in such a relatively short time as botulinum toxin. One of the most notable contributions of botulinum toxin therapy in clinical medicine is in the field of movement disorders. The English literature was searched using the Yale search engine including but not limited to PubMed and Ovid. The search includes articles from January 1 1980 to March 1 2016. A total of 2055 articles were identified. Of these, 132 met the criteria for this review. This historical review highlights early and seminal contributions that have introduced the application of botulinum toxins in the field of movement disorders and provides evidence-based contributions that have established botulinum toxin as an effective treatment for abnormal movements.

ACS Style

Bahman Jabbari. History of Botulinum Toxin Treatment in Movement Disorders. Tremor and Other Hyperkinetic Movements 2016, 6, 1 .

AMA Style

Bahman Jabbari. History of Botulinum Toxin Treatment in Movement Disorders. Tremor and Other Hyperkinetic Movements. 2016; 6 ():1.

Chicago/Turabian Style

Bahman Jabbari. 2016. "History of Botulinum Toxin Treatment in Movement Disorders." Tremor and Other Hyperkinetic Movements 6, no. : 1.