Skip to Main Content

++

Botulinum toxins are potent neurotoxins produced by the bacteria Clostridium botulinum. The most widely studied effect of botulinum toxins is at the neuromuscular junction where they block the release of acetylcholine preventing muscle contraction and causing local flaccid paralysis (rather than rigid, or tetanic, paralysis caused by a related clostridial protein, tetanus toxin). This results in a temporary (months) chemodenervation and the loss or reduction in activity in the target organ (muscle, sweat gland, or sphincter) with minimal risk of systemic adverse effects. However, botulinum toxins work not only at the neuromuscular junction but also alter the sensory input, producing secondary changes at the central level. The broadening clinical role of botulinum toxins depends on the multiple direct and indirect effects that the toxin exerts in both the peripheral nervous system and in the central nervous system (CNS).

++

In 1989, the FDA approved botulinum toxin type A (BTX-A) for use in treating strabismus, blepharospasm and hemifacial spasm. In 2000–2001, both BTX-A (Allergan, Inc.) and botulinum toxin type B (BTX-B; Elan Pharmaceuticals) were FDA-approved for use in treating cervical dystonia, and in 2002, BTX-A was approved by the FDA for treatment of glabellar frown lines. Besides the FDA-approved indications, botulinum toxins have been used in a vast array of clinical problems, including achalasia; anismus; benign prostatic hypertrophy; dysphonia; dystonias; essential tremor; hyperhidrosis; kyphoscoliosis; low back pain; migraine and tension-type headache; myofascial pain; pancreatitis; pelvic floor disorders; rectal fissures; sialorrhea; spasticity; temporomandibular joint syndrome; urinary sphincter dysfunction; wrinkles; and various other movement disorders.

++

Clostridium botulinum was first identified as a causative agent in food poisoning by Van Ermengem following a fatal outbreak in 1895.1 In the 1920s, additional outbreaks lead to the isolation of a relatively crude form of botulinum toxin (BTX),2 the neurotoxin responsible for food-borne botulism.

++

Early development of BTX began during WW II in the course of studying the nature of certain toxins, including BTX, and the means for protecting against them.3 Although much of this initial work was carried out on BTX-A, other types of botulinum toxin were also studied, including types B, C, D, and E. The purpose was to develop a polyvalent toxoid for immunization purposes. After the war, a crystallized form of BTX-A became available and stimulated considerable scientific interest. Dr. Alan B. Scott, of the Smith-Kettlewell Eye Research Foundation, initiated efforts to study BTX in a monkey model of strabismus in the late 1960s.4 Sufficient data was collected by 1978 to file an investigational new drug (IND) application for human clinical studies.5 The passage of the Orphan Drug Act of 1983 and FDA approval aided clinical development of BTX-A as an orphan drug in December 1989.

++

There are two types of commercial botulinum toxins presently available in the United States: Botox (Botulinum toxin type A Purified Neurotoxin Complex, Allergan, Inc., 2525 Dupont Drive, Irvine, CA) and BTX-B (Myobloc, Elan Pharmaceuticals, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.