Botulinum toxin treatment of neurologic disorders

Khashayar Dashtipour MD PhD (

Dr. Dashtipour of Loma Linda University School of Medicine received honorariums as consultant and speaker from Acadia, Acorda, Adamas, Allergan, Ipsen, Lundbeck, Merz, Neurocrine, Teva, and US World Meds..

)
Jessa Koch PharmD (

Dr. Koch of Loma Linda University School of Pharmacy has no relevant financial relationships to disclose.

)
Joseph Jankovic MD, editor. (

Dr. Jankovic, Director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine, received research and training funding from Allergan, F Hoffmann-La Roche, Medtronic Neuromodulation, Merz, Neurocrine  Biosciences, Nuvelution, Revance, and Teva and consulting/advisory board honorariums from Abide, Lundbeck, Retrophin, Parexel, Teva, and Allergan.

)
Originally released May 27, 2004; last updated April 29, 2019; expires April 29, 2022

Overview

Botulinum toxins (BoNT) are widely used in clinical practice and their clinical application is ever expanding. Seven different serotypes of botulinum toxins are available on the market; however, only types A and B are available for clinical applications. There is interest to use other serotypes or modifications of these serotypes in order to change the duration of action of the toxin. In this review, the general aspect of botulinum toxins will be discussed and then each available toxin will be discussed in detail in regard to its clinical, therapeutic applications. This article will not delve into the cosmetic application of the toxins nor go into detail on non-FDA-approved indications.

Key points

 

• There is an expansion/modification of current uses of botulinum toxins in noncosmetic applications as metered by durational effects.

 

• Two distinct serotypes of botulinum toxins, types A and B, are commercially available for clinical and cosmetic applications.

Historical note and terminology

In 1817, Christian Andreas Justinus Kerner first recognized that muscle paralyses due to food-born botulism was caused by botulinum toxin (Jankovic et al 2009). He proposed that it could be used to treat abnormal spasms and movements; however, it took until 1973, when Alan Scott applied botulinum toxin injections into the extraocular muscles in monkeys to correct strabismus, to demonstrate this. The first publication of therapeutic application of botulinum toxin dates to 1984 in the treatment of blepharospasm. Subsequently, multiple studies provided evidence in the benefit of botulinum toxin to treat a variety of neurologic, ophthalmologic, and urologic disorders and more (Jankovic et al 2009).

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