Percorrer por autor "Ernberg, Malin"
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- Botulinum toxin type A for the prevention of migraines : an umbrella review of systematic reviewsPublication . Chamani, Goli; Jasim, Hajer; Minston, Ava; Dias, Marlon Ferreira; Poluha, Rodrigo Lorenzi; Gonçalves, Daniela A. Godoi; Christidis, Maria; Al-Moraissi, Essam Ahmed; Christidis, Nikolaos; Canales, Giancarlo De la Torre; Ernberg, MalinBotulinum toxin type A (BoNT-A) is an established preventive therapy for chronic migraines; however, uncertainty remains regarding its comparative efficacy and safety. Thus, we aimed to summarize current evidence from high-quality systematic reviews of the therapeutic effects of BoNT-A in migraine management. An umbrella review was conducted following PRISMA guidelines and registered in PROSPERO. High-quality systematic reviews with meta-analysis evaluating BoNT-A efficacy were identified through five databases up to August 2024. Primary outcomes included monthly headache frequency and severity. Methodological quality and risk of bias were assessed using the umbrella review checklist. Fourteen articles were included. Overall, quantitative evidence indicated favorable effects of BoNT-A compared with placebo for chronic migraines, across headache frequency, headache severity, and acute medication use, but less efficacy than topiramate and the CGRP monoclonal antibodies (CGRPmAbs) galcanezumab and fremanezumab. Though the adverse events were frequent, BoNT-A was generally well-tolerated. Comparative data suggested superior tolerability versus topiramate and a safety profile like CGRPmAbs. Although botulinum toxin type A is widely used as a preventive treatment for chronic migraines, the available evidence supports its efficacy at a moderate level. Further head-to-head and long-term analyses are needed to clarify its comparative role alongside newer biologic treatments.
- Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain : a randomized double-blind clinical trialPublication . Canales, Giancarlo De la Torre; Poluha, Rodrigo Lorenzi; Bonjardim, Leonardo Rigoldi; Ernberg, Malin; Conti, Paulo César RodriguesThe antinociceptive effect of BoNT-A have been well documented in animal studies; however, results of few but well-designed randomized placebo-controlled clinical trials about BoNT-A efficacy in masticatory myofascial pain (MFP) are inconsistent. Therefore, the present randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy of BoNT-A in patients with refractory MFP. Twenty-eight patients with pain reduction of less than 30% despite conservative treatment and with an average pain intensity of > 50 mm on the visual analogue scale (VAS) participated. Patients were randomly assigned to receive a total of 80 U of BoNT-A or saline solution (SS) injected into the masseter and anterior temporalis muscles. Pain intensity (VAS), quantitative sensory testing (QST), conditioned pain modulation (CPM), and psychosocial status were examined. Follow-up was performed at 1 and 6 months. For repeated-measure comparisons between evaluation times, Friedman test with Bonferroni correction was used for pain and somatosensory variables and the Wilcoxon test for the psychosocial variables. The Mann–Whitney test was used for all comparisons between groups. The BoNT-A group had a significant decrease in pain intensity at follow-ups compared with the SS group (p < 0.001). QST assessment revealed higher pressure pain threshold values in the masseter muscle for BoNT-A group compared to SS (p < 0.03) at all follow-ups. No differences were found for mechanical pain threshold and wind-up ratio values (p > 0.05) in the entire study. The BoNT-A group presented the most efficient CPM effect (p < 0.03) only at the 1 month follow-up in the masseter muscle. There was a significant time effect for BoNT-A in all psychosocial variables (p < 0.05) and a drug effect in the Central Sensitization Inventory (p < 0.01), Pittsburgh Sleep Quality Index (p < 0.004), and Healthy Survey 36 (p < 0.05) at 6 months follow-up. The study demonstrates that a single injection-session of BoNT-A has positive effects on the hall pain spectrum of patients with refractory masticatory myofascial pain.
- Botulinum toxin-A for the treatment of myogenous temporomandibular disorders : an umbrella review of systematic reviewsPublication . Canales, Giancarlo De la Torre; Câmara-Souza, Mariana Barbosa; Ernberg, Malin; Al-Moraissi, Essam Ahmed; Grigoriadis, Anastasios; Poluha, Rodrigo Lorenzi; Christidis, Maria; Jasim, Hajer; Lövgren, Anna; Christidis, NikolaosObjective: Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. Method: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. Results: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. Conclusion: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.
- Efficacy of botulinum toxin type-A I in the improvement of mandibular motion and muscle sensibility in myofascial pain TMD subjects : a randomized controlled trialPublication . Canales, Giancarlo De la Torre; Poluha, Rodrigo Lorenzi; Pinzón, Natalia Alvarez; Silva, Bruno Rodrigues Da; Almeida, André Mariz; Ernberg, Malin; Manso, Ana Cristina; Bonjardim, Leonardo Rigoldi; Rizzatti-Barbosa, Célia MarisaThis study assessed the effects of botulinum toxin type A (BoNT-A) in mandibular range of motion and muscle tenderness to palpation in persistent myofascial pain (MFP) patients (ReBEC RBR-2d4vvv). Eighty consecutive female subjects with persistent MFP, were randomly divided into four groups (n = 20): three BoNT-A groups with different doses and a saline solution group (placebo control group). Treatments were injected bilaterally in the masseter and anterior temporalis muscle in a single session. Clinical measurements of mandibular movements included: pain-free opening, maximum unassisted and assisted opening, and right and left lateral excursions. Palpation tests were performed bilaterally in the masseter and temporalis muscle. Follow-up occurred 28 and 180 days after treatment. For the statistical analysis the Mann–Whitney U-test with Bonferroni correction was used for groups comparisons. Regardless of dose, all parameters of mandibular range of motion significantly improved after 180 days in all BoNT-A groups, compared with the control group. Palpation pain over the masseter and temporalis muscles were significantly reduced in all BoNT-A groups regardless of dose, compared with the control group, after 28 and 180 days of treatment. Independent of doses, BoNT-A improved mandibular range of motion and muscle tenderness to palpation in persistent MFP patients.
- Exploring botulinum toxin’s impact on masseter hypertrophy : a randomized, triple-blinded clinical trialPublication . Nobre, Bryanne Brissian de Souza; Rezende, Luciana; Câmara-Souza, Mariana Barbosa; Sanchez-Ayala, Alfonso; Blass, Rodrigo; Carbone, Ana Claudia; Manso, Ana Cristina; Ernberg, Malin; Christidis, Nikolaos; Canales, Giancarlo De la TorreThe present study aimed to assess the effectiveness and functional adverse effects of a single and multiple injections of botulinum toxin A (BoNT-A) for masseter hypertrophy (MH). Twenty-six women complaining about lower third facial enlargement due to MH, received 75 U of BoNT-A (abobotulinum toxin) in each masseter muscles. After 3 months, patients were randomly assigned to receive a second treatment session of Saline Solution: (G1; n = 11) or BoNT-A: (G2; n = 12). Muscle thickness (ultrasound), electrical activity (electromyography; EMG), masticatory performance, and subjective perception of MH were evaluated. Follow-up was performed at 1, 3 and 6 months. Muscle thickness, EMG activity, and masticatory performance were analyzed using ANOVA two-way and Sidak test as post-hoc. Masticatory performance was analyzed by the Friedman’s test and Mann–Whitney test. Regarding inter-groups comparisons, there was a significant decrease in the left masseter muscle thickness in the G2 group at the 6 month follow-up (p < 0.02). For EMG, significant differences were evident at the 6 month assessment, with higher masseter activity for G1 (p < 0.05). For masticatory performance, no significant differences were observed throughout the study (p > 0.05) and a higher improvement in subjective perception of MH was observed in the 1 month follow-up for G2 (p < 0.05). In conclusion, BoNT-A is effective for MH, however multiple injections cause functional adverse effects in masseter muscle.
- Is there a link between diet and painful temporomandibular disorders? A cross-sectional studyPublication . Marques, Camila Cury; Cebola, Pedro Miguel Teixeira Carvas; Burusco, Idoya Orradre; González, Maria García; Pedro, Miguel de; Christidis, Nikolaos; Ernberg, Malin; Canales, Giancarlo De la TorreBackground: Nutrition and diet have emerged as potentially modifiable factors in the management of chronic pain, however, there is still limited evidence regarding the direct relationship between diet, nutrition, and Temporomandibular disorders (TMD). The aim of this cross-sectional study was to explore the relationship between dietary patterns and painful TMD, with a particular focus on dietary inflammatory potential, adherence to the Mediterranean diet, and psychosocial predictors. Methods: Ninety-two participants (45 TMD patients and 47 controls) aged 20–50 were recruited in Portugal and Spain. TMD diagnosis was based on the Diagnostic Criteria for TMD (DC/TMD). Psychosocial status was assessed using PHQ-9 (depression), PHQ-15 (somatic symptoms), and the Oral Behavior Checklist (OBC). Dietary data were collected through a 24-hour recall and assessed using the Healthy Eating Index (HEI), Dietary Inflammatory Index (DII), and Mediterranean Diet Adherence Screener (MEDAS). Pressure pain thresholds (PPT) were recorded at the TMJ and masticatory muscles. Data was analyzed using independent t-tests, Mann-Whitney U, and OPLS-DA multivariate modeling. Results: TMD patients showed significantly higher scores for somatic symptoms, depressive symptoms, and maladaptive oral behaviors. While no significant differences were found for DII or MEDAS scores between groups, TMD patients had significantly lower HEI scores and PPTs values in the masseter, temporalis, and TMJ regions. OPLS-DA identified oral behaviors, somatic symptoms, and lower HEI as the strongest predictors distinguishing TMD patients from controls. Conclusions: Painful TMD is associated with higher psychosocial distress and poorer dietary quality. These findings underscore the need to include dietary assessment in the clinical evaluation and management of TMD.
- Sociodemographic profile : a forgotten factor in temporomandibular disorders? A scoping reviewPublication . Carapinha, Ivo Henrique Alexandrino; Canales, Giancarlo De la Torre; Poluha, Rodrigo Lorenzi; Câmara-Souza, Mariana Barbosa; Christidis, Nikolaos; Ernberg, Malin; Almeida, André Mariz de; Manso, Ana Cristina Garcia de MatosThe literature on Temporomandibular Disorders (TMD) incidence commonly reports sociodemographic factors such as gender and age. However, the role and prevalence of other sociodemographic factors in TMD are not well defined. Therefore, this scoping review aimed to report the prevalence of sociodemographic factors in TMD patients. A systematic search was conducted in the PubMed and Web of Science databases to identify clinical trials in adult populations, using the Research Diagnostic Criteria for TMD (RDC/TMD) or the Diagnostic Criteria for TMD (DC/TMD) and reporting sociodemographic data in TMD patients. Twenty-seven studies meeting the criteria were included in this review. The most commonly reported sociodemographic factors assessed in the included studies were age, race, education, job, income, and marital status. TMD prevalence was observed to be higher among younger and divorced individuals among the included studies. However, conflicting results were found for education level, and employment was not considered a risk factor for TMD. Although this review has methodological limitations, it suggests an association between TMD incidence and certain sociodemographic factors; nevertheless, further studies are needed to establish this relationship more conclusively.
- Who is the patient with resistant myofascial temporomandibular disorders pain? A somatosensory, psychosocial, and genetic characterizationPublication . Canales, Giancarlo De la Torre; Poluha, Rodrigo Lorenzi; Soares, Flávia Fonseca Carvalho; Ferreira, Dyna Mara Araújo Oliveira; Sánchez-Ayala, Alfonso; Bonjardim, Leonardo Rigoldi; Ernberg, Malin; Conti, Paulo César RodriguesBackground: Resistance to treatments have been assessed in chronic conditions such as migraine, but not in temporomandibular disorders (TMD). This study aimed to identify factors that influence treatment outcome in patients with myofascial TMD pain. Methods: Seventy-two females were divided into three groups: TMD successfully treated (TMD-S, n = 24), TMD resistant to treatment (TMD-R, n = 24) and Controls without TMD (n = 24). Criteria for resistance included: less than 30% pain reduction after three months of conservative treatment and an average pain intensity > 50 mm (VAS) during the last month. Quantitative sensory testing (QST), psychosocial status and genetic polymorphisms were examined. ANOVA on ranks (psychosocial variables) with Dunn’s test as post-hoc or ANOVA (age and somatosensory variables) with Tukey test as post-hoc test, and Dwass-Steel-Critchlow-Fligner test (genetic variables) were used for univariate groups comparisons. Multivariate statistics were used to identify outcomes that separated the groups. Results: QST assessment revealed lower baseline pressure pain threshold and higher wind-up ratio in the trigeminally and spinally innervated areas in the TMD-R group compared with the other groups (p = 0.01). Also, the TMD-R group presented higher values in all assessed psychosocial variables (p < 0.01) and higher prevalence of the HTR1A polymorphism rs6295 (p = 0.02) compared with the other groups at baseline. Multivariate analysis showed that the three variables that distinguished the best between TMD-R and TMD-S were sleeping quality, central sensitization, and depressive symptoms. Conclusion: Psychosocial, somatosensory, and genetic alterations are related to unsuccessful treatment response in myofascial TMD patients.