To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Providing practical, visually oriented guidance on the benefits of botulinum toxin in a wide variety of disorders, some new and unexpected, this new edition of Manual of Botulinum Toxin Therapy is fully updated in scope and detail. Chapters discuss the pathophysiology of each condition, summarizing the rationale for botulinum toxin, and describing the injection approach. Clear illustrations of the injection sites are included, using a 'clinician's eye' perspective, which allows physicians to readily identify anatomical landmarks and approach angles for injection. Dosing tables for available toxin formulations are included. The Manual covers cosmetic treatment of the upper and lower face, as well as aesthetic smile correction. Extensive guidance on how to use ultrasound and how cadaveric dissections can assist localization and targeting of injections is provided. Designed for teaching and bedside guidance, the Manual is useful to a diverse range of clinicians looking to use botulinum toxin in their practice.
Mayank S. Pathak, The Parkinson and Movement Disorder Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA, USA,
Allison Brashear, Department of Neurology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
Spasticity is part of the upper motor neuron syndrome produced by conditions such as stroke, multiple sclerosis, traumatic brain injury, spinal cord injury or cerebral palsy that affect upper motor neurons or their efferent pathways in the brain or spinal cord. It is characterized by increased muscle tone, exaggerated tendon reflexes, repetitive stretch reflex discharges (clonus) and released flexor reflexes (great toe extension; flexion at the ankle, knee and hip) (Lance, 1981). Late sequelae may include contracture, pain, fibrosis and muscle atrophy.
Chemodenervation by intramuscular injection of botulinum neurotoxin (BoNT) can reduce spastic muscle tone (usually measured by the Ashworth Scale or Modified Ashworth Scale), normalize limb posture, ameliorate pain, modestly improve motor function (measured by performance of standardized motor tasks or activities of daily living) and prevent contractures. Such efficacy is best documented for the upper limbs (Bhakta et al., 2000; Sheean, 2001; Brashear et al., 2002; Childers et al., 2004; Suputtitada and Suwanwela, 2005; Bergfeldt et al., 2006; Kaňovský et al., 2009; Barnes et al., 2010; Ryuji et al., 2010a; Shaw et al., 2011). In the lower limbs, efficacy is more limited, although rectification of plantar-flexed foot posture is documented (Baricich et al., 2008), and there is a modicum of evidence for amelioration of gait (Bleyenheuft et al., 2009; Ryuji et al., 2010b). In 2008, a large evidence-based review concluded that BoNT should be offered for treatment of spasticity in adults, with level A evidence for improvement of muscle tone and level B for improvement of motor function (Simpson et al., 2008; Elia et al., 2009).
Spasticity is part of the upper motor neuron syndrome produced by conditions such as stroke, multiple sclerosis, traumatic brain injury, spinal cord injury, or cerebral palsy that affect upper motor neurons or their efferent pathways in the brain or spinal cord. It is characterized by increased muscle tone, exaggerated tendon reflexes, repetitive stretch reflex discharges (clonus), and released flexor reflexes (great toe extension; flexion at the ankle, knee, and hip) (Lance, 1981). Late sequelae may include contracture, pain, fibrosis, and muscle atrophy. Chemodenervation by intramuscular injection of botulinum toxin can reduce spastic muscle tone, normalize limb posture, ameliorate pain, and may improve motor function and prevent contractures.
Reduction of muscle tone, as measured by the Ashworth scale and by changes in range of motion after treatment with botulinum toxin, is best documented in the upper limbs (Brashear et al., 2002; Childers et al., 2004; Suputtitada & Suwanwela, 2005). In the lower limbs, muscle tone improvements are modest, with best results achieved from treatment below the knee.
Improvement of motor function has been noted in some studies, using measures such as the Barthel index, dressing, analyses of gait parameters such as walking speed, and the performance of other standardized tasks (Sheean, 2001; Brashear et al., 2002). In summary, motor function may be improved in a select subgroup of patients who retain selective motor control and some degree of dexterity in important distal muscles, require injection of relatively few target muscles, and especially if combined with other interventions such as physical therapy (Bhakta et al., 2000; Sheean, 2001).
Email your librarian or administrator to recommend adding this to your organisation's collection.