{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T22:37:57Z","timestamp":1772750277969,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,10,16]],"date-time":"2018-10-16T00:00:00Z","timestamp":1539648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Garibaldi Hospital"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Muscle cramps occur in &gt;50% of diabetic patients and reduce the quality of life. No effective treatment is available. We evaluated the clinical effectiveness of botulinum toxin A (BTX\u2010A) injections for treating cramps in diabetic patients with neuropathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center, double\u2010blind, placebo\u2010controlled perspective study investigated the efficacy and safety of BTX\u2010A intramuscular injection for treating calf or foot cramps refractory to common pharmacological drugs. Fifty diabetic patients with peripheral neuropathy and cramps were randomly assigned to 2 matched groups. BTX\u2010A (100 or 30 units) or saline was injected on each side into the gastrocnemius or the small flexor foot muscles. Changes in pain intensity (primary outcome) and cramp frequency were evaluated over the course of 20 weeks after BTX\u2010A administration. Cramp interference in daily life and the electrophysiological cramp threshold frequency were also measured. The treatment was repeated 5 months after first injection in 19 responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All outcome measures improved significantly after BTX\u2010A compared with placebo. The changes with respect to baseline were already significant after 1 week and persisted up to week 14. Only 5 of 25 (20%) patients were nonresponders (&lt;50% decrease of the primary outcome). The responses to a second BTX\u2010A injection provided results similar to the first administration. Mild pain at the injection site (4\/25 cases) was the only adverse event, and it disappeared within 2 to 3 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Local BTX\u2010A infiltration is an efficacious and safe procedure for obtaining a sustained amelioration of muscle cramps associated with diabetic neuropathy. Ann Neurol 2018;84:682\u2013690<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.25340","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T22:10:10Z","timestamp":1537222210000},"page":"674-682","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Efficacy of Botulinum Toxin\n                    <scp>A<\/scp>\n                    for Treating Cramps in Diabetic Neuropathy"],"prefix":"10.1002","volume":"84","author":[{"given":"Domenico A.","family":"Restivo","sequence":"first","affiliation":[{"name":"Department of Medicine Neurological Unit and Service of Clinical Neurophysiology, Garibaldi Hospital Catania Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonino","family":"Casabona","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, Section of Physiology University of Catania Catania Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Frittitta","sequence":"additional","affiliation":[{"name":"S. 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