Profile of botulinum toxin injections in a neurology outpatient service Hospital: A preliminary report

Abstract

Background: The use of botulinum toxin in neurology outpatient service is at its infancy in sub-Saharan Africa owing largely to the prohibitive cost and lack of requisite expertise in the use of the toxin. This leaves a huge gap in the treatment of focal dystonias and dyskinesias. Objective: The objective of this study is to profile the use of botulinum toxin in a neurology outpatient service in Nigeria. Methods: Ten consecutive patients with different neurologic disorders who had the injection of onabotulinum toxin type A (Otesaly ®, Guangzhou Boss Biological Technique Ltd., China) were reviewed for demographics and clinical diagnosis and whether or not they have been exposed to botulinum toxin before, units of botulinum toxin received, and response to the injection. Botulinum toxin was supplied with strict adherence to the cold chain prescription (2°C–8°C) and constituted with normal saline before injection, and all injections were given by a neurologist-trained hands-on in the use of botulinum toxin. Results: The mean age of study participants was 54.77 ± 10.17 years and all of them were males. Blepharospasm alone or as part of Meige syndrome with spasmodic dysphonia was the most frequent clinical diagnosis, which accounted for 7 (70%) of the total; 1 (10%) had cervical dystonia and 2 (20%) had hemifacial dyskinesia. The median dose of botulinum toxin type A injected was 83.33 units (interquartile range [IQR]: 50–100) and the median duration of symptoms was 5 years (IQR: 5–10). Eight (80%) cases had good response with moderate-to-complete resolution of symptoms by Jankovic rating 0–2. Conclusion: The gap in the treatment of craniocervical dystonias and blepharospasm as the dominant presentation is obvious.

Keywords

• Africa
• botulinum toxin
• focal dystonia
• profile
• Sub-Saharan