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

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.
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.
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).
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.
AuthorsJ M Holmes, R W Beck, K E Kip, P J Droste, D A Leske
JournalJournal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus (J AAPOS) Vol. 4 Issue 3 Pg. 145-9 (Jun 2000) ISSN: 1091-8531 [Print] UNITED STATES
PMID10849389 (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
  • 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

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