Strabismus repair is considered cosmetic in adults with uncorrected congenital strabismus and no binocular fusion. Blepharospasm, characterized by intermittent or sustained closure of the eyelids caused by involuntary contractions of the orbicularis oculi muscle, including blepharospasm associated with dystonia and mulligan manual therapy pdf essential blepharospasm. Alternative causes of the member’s symptoms have been considered and ruled out, including chronic neuroleptic treatment, contractures, or other neuromuscular disorders. Spastic hemiplegia, such as due to stroke or brain injury.
Have an epiphrenic diverticulum or hiatal hernia, both of which increase the risk of dilation-induced perforation. Topical aluminum chloride or other extra-strength antiperspirants are ineffective or result in a severe rash. Documentation of medically significant complications of sialorrhea, such as chronic skin maceration or infections that cannot be controlled with topical treatments or hygiene. Facial myokymia and trismus associated with post-radiation myokymia.
Hirschsprung’s disease with internal sphincter achalasia following endorectal pull-through. Additional botulinum toxin injections are considered medically necessary if response to a trial of botulinum toxin enables ADLs or communication. Botulinum toxin is considered experimental and investigational for migraines that do not meet the above-listed criteria. Treatment is being requested to enhance function or allow additional therapeutic modalities to be employed. Spasticity of the upper limb in adults.
Aetna considers testing for neutralizing antibodies to botulinum toxin experimental and investigational. In patients with congenital strabismus who have compromised or absent binocular vision, treatment is cosmetic as ocular realignment is not capable of restoring binocular vision. Ninety percent of spasmodic torticollis patients show some improvement of pain relief, head position, and disability, and botulinum toxin is now the treatment of choice for this condition. Botox has been evaluated in various spastic disorders. Botox has been shown to improve gait patterns in patients with cerebral palsy with progressive dynamic equinovarus or equinovalgus foot deformities. Treatment of children with cerebral palsy during the early years when functional skills in walking are being developed improves the outcome and may help to avoid surgery for contracture and bony torsion. Botox in spasticity in cerebral palsy.
These researchers conducted a randomized, double-blind, placebo-controlled, parallel-group study of Botox for leg spasticity in 64 children with CP. Treatment with Botox has been shown to be safe and effective in the jaw-closing variant of oromandibular dystonia. Injections of Botox into the masseter, temporalis, and internal pterygoid muscles result in reduction in the oromandibular and lingual spasms and an improvement in chewing and speech. Botox has also been shown to be effective in the treatment of achalasia.
Two-thirds of patients with this condition respond within 6 months and effectiveness lasts on an average of a little over 1 year for an initial treatment, although shorter and longer duration have been reported. There is some question whether Botox treatments are as good as or better than conventional therapy, pneumatic dilation, or myotomy. Botox has been shown to be a promising alternative to sphincterotomy in patients with chronic anal fissures. A in the treatment of chronic daily headache, examining outcomes for a subgroup of subjects who were not receiving prophylactic medications. Eligible patients were injected with Botox at 225 U, 150 U, 75 U, or placebo and returned for additional masked treatments at day 90 and day 180.