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
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