Review by M Hawthorne
Having been injecting botulinum toxin since 1986, I thought that I would enjoy this book. I did not. I was very disappointed by its superficial treatment of the subject. Furthermore, I found that, frequently, the recommended starting doses of toxin seemed to me to be excessively high and would carry a risk of significant side effects or poor results in a number of patients.Whilst I would agree with the recommended starting doses for hemifacial spasm, I would not agree with a starting dose of 2.0 to 2.5 units Botox to each cord. I would normally start at 1.0 unit and usually get a good result – at 2.5 units each side I am confident that the many patients with adductor laryngeal dystonia would get swallowing problems.The book is divided into three sections: dystonias, functional disorders and cosmetic uses. A good example of the superficial nature of the book can be found in the first chapter, when the author states:
“One of the primary complications of botulinum toxin therapy has been the formation of antibodies to type-A toxin. This obliterates treatmentresponse, therefore other serotypes have been sought for therapeutic use. … Type B botulinum,however, has been manufactured under the name Myobloc. Although type B is more often associated with autonomic side effects, its production has become invaluable for patients that develop antibodies to type A.”
This implies that once you get antibodies to any brand of type-A toxin, the patient should be switched to type B. This is not the case. The antibodies are brand specific, probably developing in response to the carrier protein. I find that you just need to switch to another brand of type A. I thought the chapter on treating laryngeal dystonia was good, and the different laryngeal injecting techniques well described. Whilst the authors identified that treating mixed laryngeal dystonia was a challenge,I was disappointed that there was not more on how they rose to this challenge.The chapter on oromandibular dystonia was disappointing. The authors concentrated on the muscles acting on the jaw and did not cover any of the different techniques for managing dystonia of the tongue. The authors even get the names of the pterygoid muscles mixed up on page 51, where they describe and illustrate an external (lateral) pterygoid injection but refer to it as the internal pterygoid in the text.In summary, there are many competitors to this book and most of them are more helpful, thorough and accurate.
Amazon Link: Techniques of Botulinum Toxin Injections in the Head and Neck
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