Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 Anita, I was glad to read and learn more about Botox, since I now knew someone who had used it. I thought I would explain the pharmacology of Botox so others would see how it works. Botulinum toxin is produced by the anaerobic bacterium Clostridium Botulinum, a rod-shaped gram-positive organism found in soil and water. Botulinum toxin type A (BTX-A) is composed of a family of neurotoxins with similar properties. It causes degrees of flaccid (rather than rigid or tetanic) paralysis by blocking acetylcholine, required for muscle contraction, from release at the nerve terminal. Therapeutic benefit may be derived by exploiting pharmacologic properties of carefully administered regional application of this purified neurotoxin. BTX-A's success in pain management is attributed to its ability to block acetylcholine from being released at the synapse. One important feature of BTX-A in pain treatment is that the effects of the neurotoxin are thought to act only upon motor nerve endings while sensory nerve fibers are spared from such effects. Thus, analgesic effects are likely to occur, not as a result of blocking afferent sensory fibers at the site of injection, but rather from secondary effects that may be attributed to muscle paralysis, improved blood flow, and release of nerve fibers under compression by abnormally contracting muscle. I found an interesting article at: <A HREF= " http://www.medscape.com/viewarticle/407950_1 " > http://www.medscape.com/viewarticle/407950_1</A> (Of particular interest is the fact that the presentation is given by Dr. Lehman, of the Indiana University ERCP Dept. His partner, Dr. Fogel, will be speaking at the symposium.) Here are a few excerpts; Conference Report: Update on Liver Disease 35th Annual Meeting of the European Association for the Study of the Liver, Rotterdam, The Netherlands -- April 30 - May 3, 2000 " Sphincter of Oddi Disease: What Should We Do? " Dr. Lehman defined sphincter of Oddi dysfunction (SOD) as a benign, noncalculus obstructive disorder of the sphincter of Oddi causing pancreatobiliary pain, cholestasis, and/or Pancreatitis. ......... Therapy of SOD remains controversial, except in cases of type I obstruction, for which endoscopic sphincterotomy or surgical sphincteroplasty are both effective. .............. Recent experience with Botox injection into the sphincter as a predictor of a good outcome from sphincterotomy[40] is encouraging, but indiscriminate sphincterotomy in these patients should be balanced by the poor response rate (only 50%) and high complication risk.[37,41] ............ Although medical therapy has been disappointing, with a limited literature to support it, Dr. Lehman advised that it be tried first in all patients before resorting to more invasive therapy.[46,47] ................ -end- There was another good article on Botox and Pain Management found at: <A HREF= " http://www.emedicine.com/pmr/topic218.htm " > http://www.emedicine.com/pmr/topic218.htm</A> This article provides both general direction and practical details for the clinician considering Botulinum toxin for treatment of pain. Author: K. Childers, DO, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Missouri School of Medicine Another article which I found, to my surprise, was written by Stuart Sherman, also of IU ERCP Dept. It is located at: <A HREF= " http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed & cmd=Retrieve & list_\ uids=95395203 & dopt=Citation " > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed & cmd=Retrieve & list_uids=9\ 5395203 & dopt=Citation</A> It is entitled, Percutaneous celiac plexus block with Botulinum toxin A did not help the pain of chronic Pancreatitis. By the nature of the title of the study the results were not the best. There does seem to be an increasing amount of research to use Botox in the treatment of SOD spasms and in EUS guided celiac blocks, as well as a host of other areas. It doesn't seem to be very effective, or not for very long, based on the studies I have read. Has anyone besides Anita used Botox in the treatment of Pancreatitis? Karyn , RN Executive Director, PAI Symposium August 28 & 29, 2003 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2003 Report Share Posted July 1, 2003 Hi Karyn! I've been out of town and just got to my hundreds of e-mails!! Thanks for the great explanation about the Botox. I printed it out for my friend Tina. For some reason she feels that this web site depresses her - she's been going through sheer misery for the last year but I think she's not ready yet to accept this may be ongoing (very understandable!). I suggested to her husband Jeff, my co-worker that he get on the site because although he is very supportive I know that he's gotta be totally stressed out by all of this and he has lots of questions. I gave him the info on the gastric pacemaker, which they put in yesterday at Virginia Mason in Seattle. Tina also got the botox and it also helped her initially but didn't last. She went back for more and he gave her alot, but that didn't last either. I'd be interested to hear if it worked for others. I'm back to pain again. I was really hopeful that this surgery (sphincteroplasty or sphincterotomy - I'm not sure) to cut my pancreatic duct due to my pancreas divisum, would take care of the problem. I apparently already had scar tissue there and the doc had trouble even finding the duct. So - I'm trying to hold out on fairly low dose pain meds because for one thing, I'm out of sick time! And I can't even count the # of $75.00 co-pays I owe the ER, or $100.00 co-pays for procedures. Plus with my insurance I have to pay $200.00 per day for the first three days of in-pt. hospitalization. Still, I shouldn't complain. Alot of people don't have insurance. Anyway, I'm rambling. Just kind of down that this pain is coming back again. I'm sure I'm still not in as much pain as most people on this site, but I guess it's all relative. Thanks for listening! Anita Re: Botox Has anyone besides Anita used Botox in the treatment of Pancreatitis? Karyn , RN Executive Director, PAI Symposium August 28 & 29, 2003 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2006 Report Share Posted March 23, 2006 Hi everyone, Please may I ask for advice, the physio's came today and she apparently has been told to consider botox injections in my legs..by it would appear someone in my consultants team. Has anyone any experience with this in mito. good or bad ? I am not at all happy with the idea and suggested that she phoned the consultant and read about mito.. All input would be really appreciated here, Thanks Gillian Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2006 Report Share Posted March 23, 2006 Hi, Gillian - (I'm new - will eventually write an intro!) My 14 yo daughter who has spastic quadriparesis and dystonia has benefited greatly from Botox in both her legs (hamstrings and tensor fascia lata) and arms (elbow and wrist flexors and whatever makes you ulnar deviate). The Botox has helped with function, spasticity and muscles spasms. She is also on oral Baclofen and was on oral Zanaflex, and does physical therapy. She actually had an intrathecal catheter implanted for an intrathecal Baclofen pump (had great results from her test dose), but has since had issues with autonomic nervous system dysfunction and neurogenic hypotension, so the pump has not been hooked up. Kathy (mito mom to 3 mito kids - one with a fresh muscle biopsy positive for Complex I and III deficiency and secondary dopaminergic neurotransmitter disorder and Carnitine deficiency, probable mtDNA point mutation and maternal inheritance) Botox Hi everyone, Please may I ask for advice, the physio's came today and she apparently has been told to consider botox injections in my legs..by it would appear someone in my consultants team. Has anyone any experience with this in mito. good or bad ? I am not at all happy with the idea and suggested that she phoned the consultant and read about mito.. All input would be really appreciated here, Thanks Gillian Medical advice, information, opinions, data and statements contained herein are not necessarily those of the list moderators. The author of this e mail is entirely responsible for its content. List members are reminded of their responsibility to evaluate the content of the postings and consult with their physicians regarding changes in their own treatment. Personal attacks are not permitted on the list and anyone who sends one is automatically moderated or removed depending on the severity of the attack. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2006 Report Share Posted March 23, 2006 Gillian This was mentioned at an option for my dystonia, but my MDA neuro felt it was not a good option, since it increases weakness in the area that it is used. It is temporary (a few months), but he felt it might lead to my inability to walk the little I do now. Since my dystonia is in several areas, that would also pose a problem. This is just my story. laurie > Hi everyone, > > Please may I ask for advice, the physio's came today and she apparently > has been told to consider botox injections in my legs..by it would > appear someone in my consultants team. > Has anyone any experience with this in mito. good or bad ? I am not at > all happy with the idea and suggested that she phoned the consultant > and read about mito.. > All input would be really appreciated here, > Thanks Gillian > > > > > > > Medical advice, information, opinions, data and statements contained herein > are not necessarily those of the list moderators. The author of this e mail > is entirely responsible for its content. List members are reminded of their > responsibility to evaluate the content of the postings and consult with > their physicians regarding changes in their own treatment. > > Personal attacks are not permitted on the list and anyone who sends one is > automatically moderated or removed depending on the severity of the attack. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2006 Report Share Posted March 24, 2006 Gillian - has a lot of spasticity in addition to her dystonia. While the Botox helped with frequency of muscle spasms, it had far more impact on her spasticity (in that she was able to functionally move her arms, in spite of hypotonia). I don't know what the impact would be on dystonia alone. Kathy Re: Botox Gillian This was mentioned at an option for my dystonia, but my MDA neuro felt it was not a good option, since it increases weakness in the area that it is used. It is temporary (a few months), but he felt it might lead to my inability to walk the little I do now. Since my dystonia is in several areas, that would also pose a problem. This is just my story. laurie > Hi everyone, > > Please may I ask for advice, the physio's came today and she apparently > has been told to consider botox injections in my legs..by it would > appear someone in my consultants team. > Has anyone any experience with this in mito. good or bad ? I am not at > all happy with the idea and suggested that she phoned the consultant > and read about mito.. > All input would be really appreciated here, > Thanks Gillian > > > > > > > Medical advice, information, opinions, data and statements contained herein > are not necessarily those of the list moderators. The author of this e mail > is entirely responsible for its content. List members are reminded of their > responsibility to evaluate the content of the postings and consult with > their physicians regarding changes in their own treatment. > > Personal attacks are not permitted on the list and anyone who sends one is > automatically moderated or removed depending on the severity of the attack. > > > > > > Quote Link to comment Share on other sites More sharing options...
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