Už niekoľko desaťročí podiel seniorov v populácii vyspelých krajín rastie, a to aj pre predlžovanie života. To má byť spojené s napĺňaním jedného zo základných princípov geriatrie – s „pridávaním života rokom“, t. j. so zlepšovaním kvality života. Tá je medzi ľuďmi i v odbornej komunite hodnotená rôzne, multidimenzionálne. U nemalej časti starších ľudí pozorujeme stúpajúcu tendenciu akejsi „estetickej komponenty“ vnímania kvality vlastného života – aj seniori stále častejšie dbajú na svoj estetický vzhľad. V tzv. západnom svete je tento trend dokumentovaný dlhšie, v ostatných rokoch ho pozorujeme už aj na Slovensku. Moderná medicína ponúka viacero prístupov, ako naplniť očakávania seniorov, ktorí chcú zlepšiť vlastný pocit zo svojho vzhľadu. Z medicínskeho hľadiska budeme u seniorov aj v tomto prípade preferovať neinvazívne alebo miniinvazívne metódy. Predkladaná práca sa zaoberá možnosťami a obmedzeniami niektorých bežne dostupných minimálne invazívnych „antiageingových“ procedúr u starších ľudí.
For several decades, there has been an increase in the proportion of seniors in developed countries, one of the reasons of which is the prolongation of life expectancy. In accordance with one of the basic principles of geriatrics, it should be one’s aim to „add life to years“, meaning improving the quality of life of the elderly. Quality of life is evaluated differently among people and in the scientific community – it is multi-dimensional. Among a considerable number of elderly people, we observe a rising tendency of an „aesthetic component“ in the perception of the quality of their life – even seniors pay more attention to their aesthetic appearance. In the so-called Western world this trend has been observed for a long time, and in recent years so have we in Slovakia. Modern medicine offers several approaches to meet the expectations of seniors who want to improve perception of their appearance. From a medical point of view, we will prefer noninvasive or mini invasive methods for seniors. The presented work deals with the possibilities and limitations of some commonly available minimally invasive „anti-ageing“ procedures for seniors.
- MeSH
- Botulinum Toxins, Type A pharmacology therapeutic use MeSH
- Dermal Fillers MeSH
- Esthetics * MeSH
- Geriatrics * methods MeSH
- Cosmetic Techniques classification MeSH
- Quality of Life MeSH
- Hyaluronic Acid pharmacology therapeutic use MeSH
- Humans MeSH
- Mesotherapy methods MeSH
- Minimally Invasive Surgical Procedures methods MeSH
- Aged MeSH
- Skin Aging drug effects MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Review MeSH
Spasticity often results in significant disability, which complicates rehabilitation and daily activities. This review explores the role of botulinum toxin type A (BoNT-A) in the treatment of spasticity, focusing on its effects on muscle structure and activity, function, cortical reorganization, and pain. Our findings indicate that BoNT-A injections improve motor function and gait, particularly in stroke patients, by reducing abnormal muscle activity and enhancing postural control. However, BoNT-A may also induce unwanted biomechanical changes, such as muscle atrophy and alterations in contractile elements, which could impact long-term muscle function. Regarding pain management in spasticity, BoNT-A has shown promise by reducing both peripheral and central sensitization mechanisms. Additionally, BoNT-A influences the central nervous system (CNS) by inducing cortical reorganization, which may further contribute to clinical improvements. Lastly, BoNT-A treatment requires careful consideration of individual patient characteristics to optimize outcomes and minimize side effects. A multidisciplinary approach that combines BoNT-A with physical therapy is essential to maximize functional recovery and improve the quality of life in patients with spasticity.
- MeSH
- Pain * drug therapy MeSH
- Botulinum Toxins, Type A * therapeutic use pharmacology MeSH
- Muscle, Skeletal * drug effects MeSH
- Humans MeSH
- Pain Management MeSH
- Neuromuscular Agents * therapeutic use pharmacology MeSH
- Muscle Spasticity * drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Masticatory muscle hypertrophy (MMH) is a rare clinical phenomenon of uncertain etiology, characterized by a soft swelling near the angle of the jaw. This abnormal enlargement of the masseter muscle can alter the facial profile, leading to aesthetic concerns. Moreover, MMH may also have significant functional repercussions, including pain in the masseter region, often associated with temporomandibular disorders, fatigue, and discomfort during mastication. Non-conservative approaches offer an effective and minimally invasive solution by inducing localized muscle relaxation and reducing hypertrophy. Botulinum neurotoxin type A (BoNT/A) represents a therapeutic option for managing MMH, considering that injections can effectively reduce the masseter muscle volume, improving both facial aesthetics and related symptoms. Currently, the standard non-surgical management of MMH is BoNT/A injections, although consensus on the average dosage has not been definitely reached; on the other hand, there are data available in the literature about the injection technique of BoNT/A for lower face contouring. Therefore, the present comprehensive review aimed at exploring in detail the role of BoNT/A in the treatment of masseter muscle hypertrophy, describing its mechanism of action, the administration protocols, the clinical effects, and any side effects.
- MeSH
- Botulinum Toxins, Type A * therapeutic use administration & dosage MeSH
- Hypertrophy drug therapy MeSH
- Humans MeSH
- Masseter Muscle * drug effects pathology abnormalities MeSH
- Neuromuscular Agents therapeutic use MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Cíl: Popsat charakteristiku a patofyziologii BTX. Účinnost BTX byla hodnocena prostřednictvím metaanalýzy klinických studií využívajících placebo kontroly. Vzhledem k nedostupnosti kontrolovaných studií ve vulvo-perineální oblasti jsme se rozhodli je nahradit kontrolovanými studiemi prováděnými na příčně pruhovaných svalech v různých jiných oblastech lidského těla. Předpokládáme, že biochemická reakce je buď totožná, nebo velmi podobná. Tato práce nastiňuje námi navrhovaná doporučení týkající se aplikací ve vulvo-perineální oblasti, včetně odpovídajícího dávkování. Metody a pacienti: Byl proveden rozbor klinických studií týkajících se aplikace BTX. Hodnoceny byly databáze z let 2000 až 2023. Nebyly zaznamenány žádné vhodné placebem kontrolované studie specificky na svalech vulvo-perineální oblasti. Kritéria placebem kontrolované BTX studie splnilo devět studií pacientů se svalovou spasticitou po cévní mozkové příhodě. Pacienti byli léčeni BTX A, Botoxem nebo Dysportem. Hodnocení změny svalové spasticity zahrnovalo výpočet rozdílu Modified Ashworth Scale (MAS) před a 4-6 týdnů po léčbě u léčené a placebo skupiny. Cohenovo d bylo použito k určení velikosti tohoto rozsahu (effect size). Velikost celkového efektu u metaanalýzy byla 0,97; P < 0,001, což ukazuje na její významný statistický rozměr. Homogenita nebyla porušena, P = 0,076. Heterogenita prezentuje mírné zkreslení, I2 = 46 %. Forest Plot graf tento nález potvrzuje. Trychtýřový graf obsahuje inkorporované studie a prezentuje nevýznamné zkreslení metaanalýzy. Rozdílné dávkování BTX souvisí s faktem, že běžně používaný Botox a Dysport mají vzájemný poměr přepočtu jednotek 1 IU:2,5 IU v tomto pořadí. Dávka Botoxu ≤ 400 jednotek je považována za bezpečnou, s odds ratio (OR) 0,97 bez významného nárůstu nežádoucích účinků (AE); dávka > 600 jednotek má OR 2,98, doprovázená výrazným zvýšením AE. Aplikace Botoxu pro vulvo-perineální oblast je přibližně 100 IU, rozdělená do několika dávek. Po jednom měsíci lze aplikovat booster dávku stejného rozsahu. Diskuze: Shrnuli jsme základní fyziopatologii BTX a prokázali jeho účinnost při zmírňování bolesti a spastické bolesti u pacientů. Prezentovali jsme vhodné dávkování BTX ve vulvo-perineální oblasti a diskutovali o možné limitaci léčby.
The human body can experience pain or muscle spasms due to a wide range of factors. The pursuit of optimal pain management and alleviation has led to the use of botulinum toxin (BTX). Aim: To describe the characteristics and pathophysiology of BTX. The efficacy of BTX was assessed through a meta- analysis of clinical trials employing placebo controls. Due to the unavailability of controlled trials on the vulvo-perineal area, we opted to replace them with controlled trials conducted on striated muscles in various human body regions. We assume that the biochemical reaction is either identical or very similar. This paper outlines our proposed recommendations regarding applications in the vulvo-perineal region, including the corresponding dosage. Methods and Patients: A review of clinical trials pertaining to BTX was performed. Databases from 2000 to 2023 were evaluated. No placebo-controlled studies were conducted specifically on the muscles of the vulvo-perineal area. Nine trials of patients with muscle spasticity after stroke fulfilled the criteria. Patients were treated with BTX A Botox or Dysport. The assessment of muscle spasticity change involved calculating the mean difference of the Modified Ashworth Scale (MAS) before and 4-6 weeks post-treatment. Cohen‘s d was employed to indicate the effect size. The overall study‘s effect size was 0.97; P<.001, indicating a large effect size of the meta-analysis. Homogeneity was not distorted, P = 0.076. Heterogeneity implies slight distortion, I 2 = 46%. The forest plot confirms this finding. The Funnel Plot encompasses a wide range of studies, suggesting consistent findings and limited bias. The dosage of BTX pertains to the fact that commonly used Botox and Dysport have a calculation ratio of 1 IU to 2.5 IU. A Botox dosage ≤400 units is considered safe, with an odds ratio (OR) of 0.97 without a notable rise in adverse events (AEs); a dosage of >600 units has an OR of 2.98, accompanied by a notable increase in AEs. The Botox dosage for the vulvo-perineal area is approximately 100 IU divided into several punctures. After one month, a booster dose is available. Discussion: We summarized the fundamental physiopathology of BTX and demonstrated its efficacy in mitigating pain and spastic pain among patients. We presented a suitable dosage of BTX in the vulvo-perineal area and discussed potential dosage limitations.
Úvod: Syndrom chronické pánevní bolesti (CPPS) je časté onemocnění u žen. Kategorizace stavu je určena příčinou bolesti. Organická bolest doprovází konkrétní onemocnění a zmírňuje se hlavně tím, že se řeší hlavní příčina základní poruchy. Bolest neznámého původu, inaparentní, je zřídka adekvátně zvládnuta. Syndrom myofasciální bolesti pánevního dna je často prezentován jejími různými formami. Frekvence CPPS se odhaduje u přibližně 10 % ženské populace. Myofasciální spoušťové body jsou často identifikovány jako zdroj bolesti. Je to zvláštní forma ischemické lokální svalové bolesti spojené s přenesenou, transferovanou bolestí, která způsobuje, že migruje do odlišné oblasti. Spouštěcí body se liší od klasického vzorce bolesti, často postrádají schopnost hojení a mají tendenci přejít do stavu persistující bolesti. Patofyziologie: Náš přehled se zaměřuje na aktuální teorie týkající se patofyziologie spouštěcích bodů, zejména na hypotézu zahrnující excesivní uvolňování acetylcholinu. Diagnóza: Primárně je založena na různých palpačních technikách. Význam klademe na instrumentální metody jako je elektromyografie, ultrasonografie, USG barevné mapování a elastografie. Terapie: Je zaměřena na eliminaci spouštěcích bodů pomocí různých technik. Používá se metoda suché jehly, aplikace anestetik či antiflogistik. Naší pozornosti neušla velmi oblíbená aplikace botoxu. Jako další se též užívají některé fyzikální techniky včetně elektrografie, laserové aplikace, ultrazvuk a magnetoterapie. Zvláštní pozornost by měla být věnována vhodné aplikaci slibné terapie rázovou vlnou. Diskuze: Myofasciální spouštěcí body se staly oblastí značného zájmu. V tomto sdělení diskutujeme patofyziologii, diagnostiku a léčbu. Zdůrazňujeme potenciální překážky týkající se interpretace, trvání a chronicity bolesti obecně a pánevního dna zvláště.
Introduction: Chronic pelvic pain syndrome (CPPS) is a common disorder in women. The categorisation of the condition is determined by the cause of the pain. Organic pain accompanies a particular disease and is mainly alleviated by addressing the root cause of the underlying disorder. Pain of unknown origin, inapparent, is seldom resolved or adequately managed. Myofascial pain syndrome in the pelvic floor is often linked to different forms of pain. The frequency of CPPS is estimated to be approximately 10% of the female population. Myofascial trigger points are often identified as a source of pain. It is a particular form of ischaemic local muscle pain associated with referred pain, which causes it to migrate to a distinct region. Trigger points differ from a classical pain pattern and have difficulty healing. They often lack healing capability and tend to transition into a state of more persistent pain. Pathophysiology: Our review focuses on recent theories regarding the pathophysiology of trigger points, particularly the hypothesis involving excessive acetylcholine release. Diagnosis: Is based on different palpation techniques. We emphasize instrumental methods such as electromyography, ultrasonography, colour flow mapping and elastography. Therapy: Is focused on eliminating trigger points through the use of different techniques. Dry needling, wet needling, anesthetic, and antiflogistic applications are frequently employed. The highly popular use of Botox has not escaped our attention. Moreover, implementing physical techniques, including electrography, laser application, ultrasound and magnetotherapy, is also useful. Special attention should be paid to properly applying promising shock wave therapy. Discussion: Myofascial trigger points have become an area of considerable interest. In this brief note, we discuss pathophysiology, diagnostics and treatment. We highlight potential hindrances concerning the interpretation, duration and chronicity of pain.
BACKGROUND AND OBJECTIVES: ASPEN-1 was a phase 3, randomized, double-blind, placebo-controlled study to evaluate the efficacy, duration of response, and safety of 2 doses of DaxibotulinumtoxinA for Injection (DAXI), a novel botulinum toxin type A formulation in participants with cervical dystonia (CD). METHODS: Adults (aged 18-80 years) with moderate-to-severe CD (Toronto Western Spasmodic Torticollis Rating Scale [TWSTRS] total score ≥20) were enrolled at 60 sites across 9 countries in Europe and North America. Participants were randomized (3:3:1) to single-dose intramuscular DAXI 125U, 250U, or placebo and followed for up to 36 weeks after injection. The primary end point was change from baseline in TWSTRS total score averaged across weeks 4 and 6. Key secondary end points included duration of effect, Clinical and Patient Global Impression of Change (CGIC, PGIC), TWSTRS subscale scores, and safety. Multiplicity-adjusted intent-to-treat hypothesis tests with multiple imputation were performed using ANCOVA and Cochran-Mantel-Haenszel analyses. RESULTS: Of 444 individuals screened, 301 were randomized to DAXI 125U (n = 125) or 250U (n = 130) or placebo (n = 46). DAXI 125U and 250U significantly improved the mean TWSTRS total score vs placebo (least squares mean [standard error] difference vs placebo: DAXI 125U, -8.5 [1.93], p < 0.0001; DAXI 250U, -6.6 [1.92], p = 0.0006). The median duration of effect (time from treatment until loss of ≥80% of the peak improvement in average TWSTRS total score achieved at weeks 4 and 6) was 24.0 (95% confidence interval 20.3-29.1) weeks with DAXI 125U and 20.3 (16.7-24.0) weeks with DAXI 250U. Significant improvements were also observed with DAXI in CGIC and PGIC responder rates and TWSTRS subscales. Treatment-related treatment-emergent adverse events (TEAEs) were reported by 29.6% of participants with DAXI 125U, 23.8% with DAXI 250U, and 17.4% with placebo, with injection site pain being the most common overall. The most frequently reported treatment-related TEAEs of interest in DAXI 125U, DAXI 250U, and placebo, respectively, were muscular weakness (4.8%, 2.3%, 0%), musculoskeletal pain (2.4%, 3.1%, 0%), and dysphagia (1.6%, 3.8%, 0%). DISCUSSION: This study demonstrated that DAXI, at doses of 125U and 250U, is an effective, safe, long-acting, and well-tolerated treatment for CD. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov identifier (NCT03608397, submitted July 11, 2018) and EU Clinical Trials Register (ClinicalTrialsRegister.eu EudraCT identifier 2018-000446-19, submitted September 13, 2018). First participant enrolled on June 11, 2018. Trial registration was performed in accordance with the Food and Drug Administration Amendments Act (FDAAA 801), which stipulates that the responsible party register an applicable clinical trial not later than 21 calendar days after enrolling the first human participant (42 CFR 11.24). CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in adults with moderate-to-severe idiopathic cervical dystonia, DAXI reduces dystonia more effectively than placebo.
- MeSH
- Botulinum Toxins, Type A * adverse effects MeSH
- Adult MeSH
- Double-Blind Method MeSH
- Dystonic Disorders * drug therapy MeSH
- Injections, Intramuscular MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Neuromuscular Agents * adverse effects MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Torticollis * drug therapy chemically induced MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase III MeSH
- Randomized Controlled Trial MeSH
