The Multispecialty Toxin: A Literature Review of Botulinum Toxin

Abstract

Background: Botulinum toxin (BoNT) is a potent biological exotoxin produced from Clostridium botulinum. Although it was first used therapeutically to treat strabismus, its clinical role has since expanded rapidly over the years to include treatment of a variety of head and neck, gastrointestinal, urogenital, musculoskeletal, neurological, dermatological, and cosmetic disorders. The main purpose of this review is to provide a brief updated overview of the history, mechanism of action, and clinical applications of BoNT therapy across multiple medical specialties, including the most common adverse effects and recommended Botox dosages. Methods: A literature review was conducted in the PubMed database limited to English language articles. Specific search terms related to botulinum toxin in combination with various subspecialty fields were used, and relevant articles were identified and analyzed. The reference section for each article was also searched to find additional articles. Results: BoNT is a powerful therapeutic tool and has a vast array of clinical uses in many specialties, including ophthalmology, neurology, plastic surgery, dermatology, orthopedic, gastrointestinal, gynecology, urology, and rheumatology. Due to its chemodenervation effects at the presynaptic nerve terminal, it is useful in treatments of disorders characterized by abnormal inappropriate muscle contractions. Conclusions: BoNT has many clinical applications in several medical specialties. Future studies should focus on any additional indications of BoNT therapy as they arise and on any novel product developments.

Comparative Pharmacodynamics of Three Different Botulinum Toxin Type A Preparations following Repeated Intramuscular Administration in Mice

“…BoNT/A is a highly effective presynaptic neuromuscular blocking agent and has been approved as a first-line treatment for various indications such as strabismus, hemifacial spasm, cervical dystonia, limb spasticity, cerebral palsy, chronic migraine, axillary hyperhidrosis and overactive bladder [20,21,38,39]. However, like most drugs, the pharmacological effect of BoNT/A is temporary, and patients with chronic conditions require repeated injections at specific intervals for continuous therapeutic benefits [26,40].…”

How Does Botulinum Toxin Inhibit Itch?

“…Botulinum neurotoxin serotype A (BoNTA) is the most toxic substance known to man with an estimated intravenous lethal dose (LD50) of 1–2 nanogram per kilogram (ng/kg) in humans [ 23 ]. Now, however, the lethal toxin has been developed as a safe medicinal product for clinical pharmacotherapy in a large number of medical conditions in humans [ 24 , 25 ], and it is also used in the field of veterinary medicine [ 26 ].…”

Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia

“…Attempts to add more surgical effect without operating on more muscles led the surgeons to the adjunctive use of botulinum toxin in surgery for large angle ocular deviations. Botulinum toxin is a potent neurotoxin produced by bacterium, Clostridium botulinum, it has many antigenic types but only type A is used in ophthalmology [7] . It works by blocking the release of acetylcholine from the cholinergic synapses without causing damage to the myotendinous nerve endings [8] .…”