Ultrasound-guided botulinum toxin injections

One of the key conditions for achieving the desirable result during botulinum toxin therapy for muscular dystonia, spasticity, and other diseases accompanied by spasm, pain, and autonomic dysfunction (dystonias, spasticity, etc.) is the proper administration of the agent into the muscles directly involved in the pathological process. The exact entry of botulinum toxin into the target muscles is essential for successful and safe treatment because its injection into a normal muscle may cause side effects. The most common errors are the incorrect depth and incorrect direction of a needle on insertion. Therefore, the exact injection of the agent particularly into the shallow and deep muscles is a difficult task even for an experienced specialist and requires the use of controlling methods.The European Consensus on Botulinum Toxin Therapy points out that various injection techniques are needed for the better identification of necessary muscles. However, there are currently no reports on the clear advantage of any technique. In our country, injections using palpation and anatomical landmarks have been widely used in routine practice so far; electromyographic monitoring and electrostimulation have been less frequently applied. In recent years, the new method ultrasound-guided injection has continued to grow more popular. This effective, accessible, and easy-to-use method makes it possible to manage a real-time injection process and to ensure the exact entry of the agent into the muscle. This paper is dedicated to a comparative analysis of different injection methods and to a description of the ultrasound-guided technique and its advantages over others

Treatment for spasticity after stroke

The epidemiology, symptomatology, pathogenesis, diagnosis of post-stroke spasticity, and its basic treatment principles based on the current methods of evidence-based medicine are described. Possibilities for post-stroke spasticity therapy with botulinum, in particular botulinum toxin type A (Xeomin) used in these patients, are discussed

Practical aspects of balance and vestibular rehabilitation after stroke

Balance and vestibular disorders are often detected in patients who have suffered a stroke. Instability may be caused by various reasons. In some cases, impairment of gait is caused by spastic paresis, in others by proprioceptive sensitivity and cerebellar disorders. Management of patients with balance disorders in the post-stroke period is composed of a detailed assessment of functional capabilities, the risk of falls and the cause of instability, as well as the adjustment of physical rehabilitation and drug therapy. The effective methods of physical rehabilitation include general exercises to strengthen stability and physical endurance, and special simulators with biological feedback. The drug therapy includes basic pharmacotherapy for the secondary prevention of stroke and symptomatic agents that can manage various disorders due to pathogenetic mechanisms of cerebral stroke (botulinum therapy, Vasobral)

BOTULINUM TOXIN FOR PAIN SYNDROMES

The purpose of this scientific review was to analyze and summarize the most relevant and new published scientific data on the effectiveness of antinociceptive action of botulinum toxin type A (BTA). The publications were searched for in the Medline, Pub med, Cochrane Library databases. As a result, high-level evidence was selected (RCT, national clinical guidelines, international clinical guidelines, meta-analyzes, systematic reviews). The article is devoted to the problem of pain syndromes in various neurological disorders, features and efficacy of antinociceptive action of botulinum toxin type A (BTA). Data on the efficacy of onаbotulotoxin (Botox®) in the treatment of pain syndromes are presented in accordance with the recorded indications. Also, based on the analysis, it was shown that BTA therapy is a valuable alternative to traditional therapy for many conditions accompanied by pain syndromes

Role of palbociclib in the treatment of hormone receptor-positive HER2-negative metastatic breast cancer. Generalizing results of randomized trials and real clinical practice

Palbociclib is the first-in-class drug of CDK 4/6 inhibitors group. The use of palbociclib in combination with endocrinotherapy (ET) opens up new possibilities for the treatment of metastatic hormone receptor-positive (HRP+) HER2-negative (HER2-) breast cancer (mBC). Palbociclib has gained world attention and is included in all clinical guidelines, both international and domestic, as a new standard of first- and second-line therapy of HRP+ HER2- mBC. The article presents the updated results of PALOMA-2 and PALOMA-3 studies and the results of use of palbociclib in combination with ET in real clinical practice