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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 (BotoxÆ, MyoblocÆ, XeominÆ, and DysportÆ), 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.
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.
Contributors
Preface
Section One Botulinum Neurotoxin: Basic Science and Reconstitution
1. Pharmacology of Botulinum Neurotoxins
Katharine E. Alter, Fatta B. Nahab, and Barbara I. Karp
2. Comparison of Botulinum Neurotoxin Products
Katharine E. Alter and Fatta B. Nahab
3. Neurotoxin Storage, Reconstitution, Handling, and Dilution
Katharine E. Alter and Codrin Lungu
4. Guidance Techniques for Botulinum Neurotoxin Injections
Katharine E. Alter and Michael C. Munin
5. Phenol Nerve Blocks
Zachary Bohart, Stephen Koelbel, and Katharine E. Alter
Section Two Clinical Applications of Botulinum Neurotoxins
Part I Botulinum Neurotoxins for the Treatment of Muscle Overactivity Associated with Focal Dystonia Syndromes and Upper Motor Neuron Syndromes
Craniofacial Dystonia
6. Benign Essential Blepharospasm
Katharine E. Alter and Barbara I. Karp
7. Botulinum Neurotoxin Therapy for Hemifacial Spasm
8. Botulinum Neurotoxin Injections for Oromandibular Dystonias
Illustrations for Craniofacial DystoniaóChapters 6ñ8
Cervical Dystonia
9. Botulinum Neurotoxin Injections for Cervical Dystonia
Katharine E. Alter, Michael C. Munin, and Sherry A. Downie
Illustrations for Cervical DystoniaóChapter 9
Upper Limb, Lower Limb, and Trunk Dystonia
10. Botulinum Neurotoxin for the Treatment of Idiopathic Primary Focal Limb Dystonia
Katharine E. Alter, David Simpson, and Elie Elovic
11. Botulinum Neurotoxin for Treatment of Muscle Overactivity Associated with Upper Motor Neuron Syndromes
Katharine E. Alter, John McGuire, and Stephen Nichols
12. Botulinum Neurotoxin for the Treatment of Trunk Dystonia/Camptocormia
13. Botulinum Neurotoxin Injections for the Treatment of Tremor
Katharine E. Alter and Pritha Ghosh
Illustrations for Upper Limb, Lower Limb, and Trunk DystoniaóChapters 10ñ13
Part II Botulinum Neurotoxins for Neurosecretory Disorders
14. Botulinum Neurotoxin Therapy for Problematic Sialorrhea
Katharine E. Alter
15. Botulinum Neurotoxin Therapy for Hyperhidrosis
Part III Botulinum Neurotoxins for Urologic Disorders
16. Botulinum Neurotoxin for Urologic Conditions
Katharine E. Alter and Dallas A. Lea II
Part IV Botulinum Neurotoxins for Pain Conditions
17. Botulinum Neurotoxins for the Treatment of Headache
Illustrations for Migraine Injection PatternsóChapter 17
18. Botulinum Neurotoxin for Musculoskeletal Pain Conditions
Katharine E. Alter and Nicole A. Wilson
Appendices
A. Ashworth and Modified Ashworth Scale for Grading Muscle Hypertonia
B. Blepharospasm Disability Index Scale
C. Blepharospasm Disability Scale
D. BurkeñFahnñMarsden Dystonia Scale
E. Dystonia Discomfort Scale
F. Modified Tardieu Scale
G. Toronto Western Spasmodic Torticollis Severity Scale
References
Index
Anatomic Illustrations
Illustrations for Craniofacial Dystonia
Figure 1 Technique for intradermal botulinum neurotoxin injections.
Figure 2 Injection patterns for blepharospasm.
Figure 3 Muscles of facial expression, hemifacial spasm.
Figure 4 Temporalis muscle, oromandibular dystonia.
Figure 5 Medial and lateral pterygoid muscles, oromandibular dystonia.
Illustrations for Cervical Dystonia
Figure 1 Cervical muscles, anterolateral view, superficial and intermediate muscle layers.
Figure 2 Cervical muscles, anterior view, intermediate and deep muscle layers.
Figure 3 Cervical muscles, posterior view, intermediate and deep muscle layers.
Illustrations for Upper Limb, Lower Limb, and Trunk Dystonia
Figure 1 Thigh muscles, cross-sectional anatomy.
Figure 2 Calf muscles, cross-sectional anatomy.
Figure 3 Arm muscles, cross-sectional anatomy.
Figure 4 Forearm muscles, cross-sectional anatomy.
Figure 5 Abdominal muscles.
Illustrations for Migraine Injection Patterns
Figure 1 Botulinum neurotoxin injection pattern for migraine, facial muscle injection sites.
Figure 2 Botulinum neurotoxin injection pattern for migraine, facial and neck muscle injection sites.
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