Therapeutic Application of Botulinum Toxin in Clinical Practice

Abstract

Botulinum toxin, one of the most potent toxins known, is produced by Clostridium botulinum. It causes a temporary paralysis of muscles by inhibiting vesicular release of acetylcholine in neuromuscular junction and synaptic transmission at cholinergic nerve terminals and causes a temporary paralysis of muscles. Since the approval of botulinum toxin A by FDA for strabismus and blepharospasm in 1989 and botulinum toxin B for cervical dystonia in 2000, its therapeutic uses are expanding. To date, both the serotypes A and B have been used therapeutically. These include various dystonic movement disorders, lacrimal hypersecretion, hyperhydrosis, overactive bladder syndromes both neurogenic and idiopathic, prostatic hyperplasia, various gastrointestinal disorders, headache syndromes like migraine and various spastic disorders. Botulinum toxin does not correct the underlying pathology but only produces clinically symptomatic improvement. The duration of improvement and the percentage of improvement vary between different studies due to differences in doses used; different techniques used for injections and also the dilutions. Still more trials are required to explore newer indications of its use, to find out the exact effective doses, dilutions and techniques, so as to have a prolonged clinical improvement. Though it has a good safety profile, complications are related to chemodenervation of adjacent muscles and injection techniques. This article provides an update on different uses of botulinum toxin in medicine.

Comparative Evaluation of Surgical Procedures for Trigeminal Neuralgia

“…By far, the major advantage of peripheral procedures is the repeatability. However, the same may not be applicable to BI, where due to development of antibodies to botulinum the patient may become a non-responder to repeated injections [99]. Further, many authors reported that repeated peripheral procedures may result in high incidence of complications [50,56,57,70].…”

Botulinum Toxin in Pediatric Neurology

“…Injection of BoNT has been found to provide relief for writer’s cramp, 60 particularly in those with pronation/flexion pattern. 61 A number of studies have shown improvement in 80% of patients following at least one injection series, with efficacy evident at 1 week and lasting up to 12 weeks. 47 Pain is generally improved more than motor function.…”

“…Side effects include hand weakness, mostly mild and transient, and localized pain at the injection site. 61 , 63 …”

“…Side effects include hand weakness, mostly mild and transient, and localized pain at the injection site. 61,63 Spasmodic Dysphonia (SD). It is characterized by taskspecific, action-induced spasm of the vocal cords that can occur independently or as part of other syndromes or disorders including tardive dyskinesia.…”

Therapeutic Application of Botulinum Toxin among Patients suffering from Neurological Diseases: Bangladesh Situation

“…In Bangladesh a large number of patients are suffering from neurological disorders which can be treated by botulinum toxin. The toxin is costly and this leads is a big issue for the application among the patients of this country (Dash and Araf 2009). In National Institute of Neurosciences & Hospital, Dhaka, this therapeutic approach is carried out by a group of well-trained neurologist.…”