1. Copyright © 2001 American Medical Association. All rights reserved.
From: Botulinum Toxin as a Biological WeaponMedical and Public Health Management
JAMA. 2001;285(8): doi: /jama
Figure Legend:
A, Release of acetylcholine at the neuromuscular junction is mediatedby the assembly of a synaptic fusion complex that allows the membrane of thesynaptic vesicle containing acetylcholine to fuse with the neuronal cell membrane.The synaptic fusion complex is a set of SNARE proteins, which include synaptobrevin,SNAP-25, and syntaxin. After membrane fusion, acetylcholine is released intothe synaptic cleft and then bound by receptors on the muscle cell. B, Botulinumtoxin binds to the neuronal cell membrane at the nerve terminus and entersthe neuron by endocytosis. The light chain of botulinum toxin cleaves specificsites on the SNARE proteins, preventing complete assembly of the synapticfusion complex and thereby blocking acetylcholine release. Botulinum toxinstypes B, D, F, and G cleave synaptobrevin; types A, C, and E cleave SNAP-25;and type C cleaves syntaxin. Without acetylcholine release, the muscle isunable to contract. SNARE indicates soluble NSF-attachment protein receptor;NSF, N-ethylmaleimide-sensitive fusion protein; and SNAP-25, synaptosomal-associatedprotein of 25 kd.
Date of download: 10/7/2017
Copyright © 2001 American Medical Association. All rights reserved.

2. Copyright © 2001 American Medical Association. All rights reserved.
From: Botulinum Toxin as a Biological WeaponMedical and Public Health Management
JAMA. 2001;285(8): doi: /jama
Figure Legend:
A, Patient at rest. Note bilateral mild ptosis, dilated pupils, disconjugategaze, and symmetric facial muscles. B, Patient was requested to perform hismaximum smile. Note absent periorbital smile creases, ptosis, disconjugategaze, dilated pupils, and minimally asymmetric smile. As an indication ofthe extreme potency of botulinum toxin, the patient had 40 × 10−12g/mL of type A botulinum toxin in his serum (ie, 1.25 mouseunits/mL) when these photographs were taken.
Date of download: 10/7/2017
Copyright © 2001 American Medical Association. All rights reserved.

3. Copyright © 2001 American Medical Association. All rights reserved.
From: Botulinum Toxin as a Biological WeaponMedical and Public Health Management
JAMA. 2001;285(8): doi: /jama
Figure Legend:
Reproduced from Terranova et alwith permission of Oxford University Press.
Date of download: 10/7/2017
Copyright © 2001 American Medical Association. All rights reserved.

4. Copyright © 2001 American Medical Association. All rights reserved.
From: Botulinum Toxin as a Biological WeaponMedical and Public Health Management
JAMA. 2001;285(8): doi: /jama
Figure Legend:
Note flat, rigid mattress tilted at 20°, tightly rolled clothto support cervical vertebrae, and bumpers to prevent downward sliding. Useof this position may postpone or avoid the need for mechanical ventilationin mildly affected patients because of improved respiratory mechanics andairway protection.
Date of download: 10/7/2017
Copyright © 2001 American Medical Association. All rights reserved.