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  • Updated 03.06.2024
  • Released 05.27.2004
  • Expires For CME 03.06.2027

Botulinum toxin treatment of neurologic disorders



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 paralysis due to food-born botulism was caused by botulinum toxin (22). 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 the therapeutic application of botulinum toxin dates to 1984 in the treatment of blepharospasm. Subsequently, multiple studies provided evidence of the benefit of botulinum toxin to treat a variety of neurologic, ophthalmologic, and urologic disorders and more (22). The name comes from the Latin word “botuls,” meaning sausage as Kerner called it “sausage poison” (32).

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