Nikolina Semerdjieva

By Nikolina Ilkova Semerdjieva

There is irrefutable evidence for the effectiveness of botulinum toxin (BoNT) in the treatment of various disorders associated with excessive muscle contraction or autonomic dysfunction. One of the earliest indications as well as the most common BoNT treated movement disorder is dystonia, predominantly its focal forms, including blepharospasm, oromandibular, spasmodic, cervical and limb dystonia. Spastic disorders comprise another area where BoNT treatment has proved beneficial. Optimal therapeutic results, however, depend on several factors, including the BoNT serotype, dose, concentration, injected volume, frequency of application, as well as precise localization of the muscles producing the abnormal movement. The accuracy in targeting muscle localization is considered to be a key factor for determining the outcome of BoNT injections, even more important than dilution volume and dose. Various techniques to find the best injection site for the delivery of BoNT have been described in the literature. An attempt was made to summarize in one place the available evidence, and when possible to compare and point out the advantages and disadvantages of different techniques for localization of BoNT injections. The widely applied clinical indications for dystonia and spasticity have been specifically chosen as our focus in this present work.

Part of the book: Botulinum Toxin Therapy Manual for Dystonia and Spasticity

By Nikolina I. Semerdjieva and Ivan G. Milanov

Isolated dystonia, previously referred to as primary, is the third most common movement disorder, characterized by involuntary muscle contractions causing abnormal movements and postures with or without the presence of tremor. No matter monogenic or sporadic, the form of dystonia is a growing evidence, suggesting the presence of non-motor components to the disorder. Dystonia patients suffer from reduced quality of life, which might be related not only to the dystonic movements itself but to different non-motor symptoms and signs, as well. Based on literature review, this chapter aims to focus on the association of different types of isolated/primary dystonia (forms of focal, segmental, and generalized dystonia) with some non-motor disorders, including sleep and psychiatric disorders, cognition, as though as pain and sensory symptoms, their pathophysiological and biochemical mechanisms, relations with the symptomatic treating strategies for the abnormal movements, and specific treatment for the non-motor signs.

Part of the book: Dystonia