Botulinum toxin treatment versus conservative management in acute traumatic sixth nerve palsy or paresis.

Abstract

PURPOSE:

Botulinum toxin (BTX), injected into the ipsilateral medial rectus muscle, has been advocated for the management of acute traumatic sixth nerve palsy or paresis. We conducted a multicenter, nonrandomized, data collection study to evaluate recovery rates of patients treated with either conservative measures or BTX.

METHODS:

All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with acute traumatic sixth nerve palsy or paresis during a 2-year period (between March 1996 and February 1998). The BTX group was defined as patients who received a BTX injection within 3 months of injury. Recovery at 6 months from injury was defined as absence of diplopia in the primary position and a distance esotropia of no more than 10 PD in the primary position. Nonrecovered patients with less than 6 months of follow-up (n = 15) were excluded.

RESULTS:

Eighty-four eligible patients were enrolled by 46 investigators. Sixty-two patients (74%) were treated conservatively and 22 (26%) with BTX. Sixty-two patients (74%) had unilateral palsy, and 22 (26%) had bilateral palsy. Recovery rates were similar between BTX and conservatively treated patients (overall: 73% vs 71%, P = 1.0; unilateral: 81% vs 83%, P = 1.0; bilateral: 50% vs 38%, P = 0.66, respectively).

CONCLUSIONS:

In this prospective multicenter study of acute traumatic sixth nerve palsy or paresis, patients treated with either BTX or conservative measures had similar high recovery rates.

• Authors: J M Holmes, R W Beck, K E Kip, P J Droste, D A Leske
• Journal: Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus (J AAPOS) Vol. 4 Issue 3 Pg. 145-9 (Jun 2000) ISSN: 1091-8531 [Print] United States
• PMID: 10849389 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Anti-Dyskinesia Agents
• Botulinum Toxins

Topics

• Abducens Nerve Injury (complications, drug therapy, physiopathology)
• Acute Disease
• Adolescent
• Adult
• Aged
• Anti-Dyskinesia Agents (administration & dosage, therapeutic use)
• Botulinum Toxins (administration & dosage, therapeutic use)
• Child
• Child, Preschool
• Craniocerebral Trauma (complications)
• Diplopia (drug therapy, etiology, physiopathology)
• Esotropia (drug therapy, etiology, physiopathology)
• Eye Movements (drug effects)
• Female
• Humans
• Injections
• Male
• Middle Aged
• Oculomotor Muscles (drug effects, innervation)
• Prospective Studies
• Treatment Outcome
• Vision, Binocular