BOTOX® is a prescription medicine that is injected into muscles to treat increased muscle stiffness in elbow, wrist, finger, thumb, ankle, and toe muscles in people 18 years and older with upper and lower limb spasticity.
NOTE: Injection should be carried out only with electromyographic guidance. The toxin must be suitably diluted, and the volume injected should be between 0.05—0.15 mL per muscle, dependent on the extent of strabismus. Use the lower doses for small deviations and the larger doses only for large deviations. Initial doses typically create paralysis of injected muscles beginning 1—2 days after injection and increasing in intensity best Botox in Las Vegas during the first week. The paralysis lasts for 2—6 weeks and gradually resolves over a similar time period. Overcorrections lasting longer than 6 months rarely occur. About 50% of patients will require subsequent doses because of inadequate paralytic response to the initial dose, because of mechanical factors such as large deviations or restrictions, or because of the lack of binocular motor fusion to stabilize the alignment.
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Study 2 compared 3 doses of BOTOX with placebo and included 91 patients BOTOX 360 Units (N=21), BOTOX 180 Units (N=23), BOTOX 90 Units (N=21), and placebo (N=26) with upper limb spasticity (expanded Ashworth score of at least 2 for elbow flexor tone and at least 3 for wrist flexor tone) who were at least 6 weeks post-stroke. BOTOX and placebo were injected with EMG guidance into the flexor digitorum profundus, flexor digitorum sublimis, flexor carpi radialis, flexor carpi ulnaris, and biceps brachii (see Table 25 ).
With the new FDA approval for cosmetic use, Xeomin now joins the ranks of Botox Cosmetic to reduce frown lines, wrinkles around the eyes and forehead. Worldwide, more than 84,000 people have been treated with Xeomin injections. The U.S. is actually the 20th country to approve this new drug. It will be available in 50-unit and 100-unit vials. This Botox alternative was already approved for use in adults with cervical dystonia and blepharospasm. Cervical dystonia is characterized by abnormal neck pain and movements, and blepharospasm is marked by abnormal, involuntary blinking or spasm of the eyelids. Xeomin is manufactured by Merz Pharmaceuticals.
Autonomic dysreflexia Autonomic dysreflexia associated with intradetrusor injections of BOTOX® could occur in patients treated for detrusor overactivity associated with a neurologic condition and may require prompt medical therapy. In clinical trials, the incidence of autonomic dysreflexia was greater in patients treated with BOTOX® 200 Units compared with placebo (1.5% versus 0.4%, respectively).