הפרעות תנועה והטיפול בבוטולינום טוקסין

1. הפרעות תנועה והטיפול בבוטולינום טוקסין • ד" ר מריאטה אנקה הרשקוביץ • מנהלת מרפאה להפרעות תנועה • מרפאה נוירולוגית • בית חולים ע"ש אדית וולפסון

2. Botulinum toxin history In 1822 Justus Kerner described the signs and symptoms of ”botulism”, which became known as Kerner's disease. He also predicted the therapeutic use of the toxin. The word botulinum comes from the Latin word botulus, meaning sausage, as infected food was recognised early on as being responsible for the food intoxication syndrome originally referred to as Kerner's disease, but known as botulism since 1897. In 1970s Dr Allan B Scott at the Smith-Kettelwell Eye Research Institute in California used purified type A toxin to induce strabismus in animals by local injection into eye muscles. In the same period, he started to treat squinting in humans using a similar technique. He also introduced local injections of botulinum in the treatment of dystonias, first blepharospasm and later torticollis in collaboration with neurologists. Up to now torticollis has been the main indication for therapy.

9. Craniofacial Movement Disorders Area affected Diagnostic Group Hemifacial Spasm Blepharospasm Oromandibular Dystonia Tardive Dyskinesia Craniofacial Tics Craniofacial Tremor Craniofacial Chorea Craniofacial Myoclonus Unilateral eye and face Bilateral eyes Masticatory muscles Face, lips, tongue Eyes, face, lip Chin or jaw Mouth and lips facial or palatal

10. Hemifacial spasm • Age 50-60 at onset • Female = 2x male • Frontalis muscle involvement in 15% • Persists while sleeping (D/D with EBS) • 66% associated with HTN

11. Benign essential blepharospasm( EBS) • Bilateral • Affects orbicularis oculi muscle • Central in origin • Progresses to functional blindness • Onset > 50 y/o • Female > male • Absent during sleep • Associated with anxiety disorder

12. BOTULINUM INJECTION SITES FOR EBS