Clinical applications of botulinum toxin
Highlights
► Botulinum Toxin (BT) may block the neuromuscular junction and the autonomic innervation of sweat, tear and salivary glands and the smooth muscles. ► This mechanism is the basis for BT's therapeutic use in a large number of medical specialties. ► BT's main indications are dystonia, spasticity, cerebral palsy, hyperhidrosis, hypersalivation, bladder dysfunction, pain and muscular wrinkles. ► Adverse effects are usually mild and always transient. BT type B may have additional systemic autonomic adverse effects.
Introduction
Never before in the history of mankind has any substance undergone a more dramatic change in its perception than botulinum toxin (BT): Known for centuries as a deadly poison it is now used in a large number of medical specialties as a highly potent drug introducing a completely novel therapeutic principle.
Section snippets
History
The therapeutic use of BT was prepared during the late 1960s by Alan B. Scott from the Smith-Kettlewell Eye Research Institute, San Francisco, CA, USA [67]. Searching for a substance with long lasting paretic effects to treat infant strabismus he was attracted by BT. Standardised BT preparations as well as rigorous safety standards for these experiments were developed by Edward J. Schantz (1908–2005) and Eric A. Johnson from the Department of Microbiology and Toxicology, University of
Structure
BT drugs comprise of the BT component and excipients. The BT component is formed by BNT and by non-toxic proteins also known as complexing proteins (CP). In Xeomin® the CP have been removed [6]. BNT consists of a heavy amino acid chain with a molecular weight of 100 kD and a light amino acid chain with a molecular weight of 50 kDa, which are interconnected by a single disulfide-bridge. The integrity of this disulfide bridge is essential for BNT's biological activity making BNT fragile to various
Clinical applications of botulinum toxin therapy
Table 2 gives an overview about the currently used indications for BT therapy.
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
•• of outstanding interest
References (84)
- et al.
Neuralgic amyotrophy following botulinum toxin injection
Parkinsonism Relat Disord
(2010) - et al.
Pharmacology of botulinum toxin therapy
- et al.
Histopathologic features in esophagomyotomy specimens from patients with achalasia
Gastroenterology
(1996) - et al.
Polyradiculoneuritis following botulinum toxin therapy
J Neurol
(1990) - et al.
Short-term electrical stimulation enhances the effectiveness of Botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients
Neurosci Lett
(1995) - et al.
Long term effects of intra-articular botulinum toxin A for refractory joint pain
Neurotox Res
(2006) - et al.
Differential inhibition by botulinum neurotoxin A of cotransmitters released from autonomic vasodilator neurons
Am J Physiol Heart Circ Physiol
(2001) - et al.
Neuromuscular effects distant from the site of botulinum neurotoxin injection
Neurology
(1988) Foreword
- et al.
Botulinum toxin F in the treatment of torticollis
J Neurol Neurosurg Psychiat
(1995)
Primary esophageal motility disorders: medical treatment
Minerva Dietol Gastroenterol
Long-distance retrograde effects of botulinum neurotoxin A
J Neurosci
OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-Week PREEMPT clinical program
Headache
Use of botulinum toxin the the treatment of muscle pain
Schmerz
A new botulinum toxin type A free of complexing proteins for treatment of cervical dystonia
Neurology
Proteolysis of SNAP-25 by types E and A botulinal neurotoxins
J Biol Chem
Botulinum toxin (BOTOX) for the treatment of “spastic dysphonia” as part of a trial of toxin injections for the treatment of other cranial dystonias
Laryngoscope
Polyradiculoneuritis after botulinum toxin therapy for cervical dystonia
Clin Neuropharmacol
Comparison of botulinum toxin serotypes A and B for the treatment of cervical dystonia
Neurology
Mechanisms of the antinociceptive effect of subcutaneous Botox: inhibition of peripheral and central nociceptive processing
Arch Pharmacol
Functional repair of motor endplates after botulinum neurotoxin type A poisoning: biphasic switch of synaptic activity between nerve sprouts and their parent terminals
Proc Natl Acad Sci USA
SV2 is the protein receptor for botulinum neurotoxin A
Science
Synaptotagmins I and II mediate entry of botulinum neurotoxin B into cells
J Cell Biol
Complete secondary botulinum toxin therapy failure in blepharospasm
J Neurol
New formulation of BOTOX®: complete antibody-induced therapy failure in hemifacial spasm
J Neurol
Routine use of Xeomin in patients previously treated with Botox: long term results
Eur J Neurol
Comparing Botox and Xeomin for axillar hyperhidrosis
J Neural Transm
First high dose use of complex free botulinum toxin type A
Mov Disord
Safety aspects of high dose Xeomin® therapy
J Neurol
Autonomic side effects of botulinum toxin type B treatment of cervical dystonia and hyperhidrosis
Eur Neurol
Xeomin® eine neue therapeutische Botulinum Toxin Typ A-Präparation
Akt Neurol
Botulinum toxin therapy: risk factors for therapy failure
Mov Disord
Clinical use of non-A botulinum toxins: botulinum toxin type B
Neurotox Res
Botulinum toxin type B for treatment of axillar hyperhidrosis
J Neurol
Somatosensorisch Evozierte Potentiale bei Schreibkrampf: normalisierung pathologischer Befunde unter Botulinum Toxin Therapie
Z EEG EMG
Equivalent potency of Xeomin® and Botox®
Mov Disord
An electron microscopic study of the changes induced by botulinum toxin in the motor end-plates of slow and fast skeletal muscle fibres of the mouse
J Neurol Sci
Changes in the electron microscopic structure of slow and fast skeletal muscle fibres of the mouse after the local injection of botulinum toxin
J Neurol Sci
Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients
J Urol
The variability in the clinical effect induced by botulinum toxin type A: the role of muscle activity in humans
Mov Disord
Systemic effect of local botulinum toxin injections unmasks subclinical Lambert-Eaton myasthenic syndrome
J Neurol Neurosurg Psychiat
toxin effects on rat jaw muscle spindles
Acta Otolaryngol
Cited by (132)
Antidodes in esthetic medicine
2023, Antidotes to Toxins and Drugs: From Natural Sources to Drug Discovery in ToxicologyProduction and Purification of Polyclonal Antibodies Against Recombinant BoNT/A-HcC Domain for Sandwich ELISA Detection of BoNT/A
2024, Iranian Journal of Pharmaceutical SciencesBotulinum Toxin to Improve the Prognosis of Skin Transplantation: A Short Narrative Review
2024, International Journal of Lower Extremity Wounds