Introduction Botulinum Toxin acts by blocking ACH release from nerve terminals at the neuromuscular junction Discovery in 1897 Therapeutic agent in 1977 Today, versatile clinical tool
History Botulus, Greek Van Ermengen in 1895 Alan Scott in the late 1960s Human volunteers in 1977 FDA approval in 1989 Expanded use in late 2000
Basic Science Produced by bacteria (exotoxin of Clostridium Botulinum, G(+), anaerobic, spore-forming) 8 serotypes(A-G) Similar structure - light chain linked by a disulfide bond to a heavy chain Type A is available
Contraindication Hypersensitvity to Albumin Neuromuscular ds. Pt. Treated with aminogycosides, penicillamine, quinine, Ca channel blockers Preg./Lactation Pt. On anticoagulation therapy Poor psychological adjustment
Facial rejuvenation; loss of facial expression incomplete m. paralysis unwanted m. paralysis
Therapeutic failure presence of circulating neutralizing antibodies ; correlated with numbers of inj., length of Tx., total cumulative dose Psychological ; unprepared to the paralysis and changes of face
Cinical Use Rhytides Facial Contour Body Contour Hyperhidrosis Etc.
Summary Transient and nondestructive Graded by varying dose and frequency of injections Safety Autonomic disorders and control of pain are being explored Primarily treatment of hyperfunctional muscle disorder No standard dose and injection strategy