Uso de botox em musculo piriforme

Authors:
Loren M. Fishman, MD Craig Konnoth Bernard Rozner, PhD

Electrodiagnosis

Affiliations:
From Columbia College of Physicians and Surgeons, New York, New York (LMF); Fordham University New York, New York (CK); and Deaconess and Brigham and Women’s Hospitals, Harvard Medical School, Boston, Massachusetts (BR).

CME Article ● 2004 Series ● Number 1

Correspondence:
All correspondence and requests for reprints should be addressed to Loren M. Fishman, MD, 3 East 83rd Street, New York, New York 10028. 0894-9115/04/8301-0042/0 American Journal of Physical Medicine & Rehabilitation Copyright © 2003 by Lippincott Williams & Wilkins
DOI: 10.1097/01.PHM.0000104669.86076.30

Botulinum Neurotoxin Type B and Physical Therapy in the Treatment of Piriformis Syndrome
A Dose-Finding Study
ABSTRACT
Fishman LM, Konnoth C, Rozner B: Botulinum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: A dose-finding study. Am J Phys Med Rehabil 2004;83:42–50. Objective: To measure dosage effects of botulinum neurotoxin type B with physical therapy in piriformis syndrome. Design: Prospective study of consecutive patients complaining of buttock pain and sciatica, measuring serial H-reflex tests in flexion, adduction, and internal rotation; visual analog scale; and adverse effects at 0, 2, 4, 8, and 12 wks. We used an electrophysiologic criterion for piriformis syndrome: a 1.86msec prolongation of the H-reflex with the flexion, adduction, and internal rotation test. Four piriformis syndrome groups were identified. Serial groups were injected once with either 5000, 7500, 10,000, or 12,500 units of botulinum neurotoxin type B in successive months under electromyographic guidance in four separate locations of the affected piriformis muscle, with a 1-mo safety observation period between groups. Patients received physical therapy twice weekly for 3 mos. Results: The flexion, adduction, and internal rotation test and visual analog scale declined significantly, correlating at