Clinical use of botulinum toxin
Keywords:
botulinum toxin, dermatology, neurologyAbstract
The botulinum toxin has been used in the clinical practice for more than 35 years for patients with increased muscle activity, like dystonia, spasticity, tremor and face wrinkles. It has also effects on the cholinergic autonomic terminals if injected in the smooth muscles and decreases the muscle contractions. If injected in the glands decreases the secretion. It is useful for chronic pain syndromes and some headaches as it is capable to decrease the release of proinflammatory peptides from the nociceptive terminals. There is a huge clinical experience in the field of neurology and dermatology. The serotype A is used more frequently, as it has some advantages as compared to other serotypes. The usual ratio between different trademarks is Botox: Xeomin: Dysport: Neurobloc = 1:1:2,5:50 U. The lyophilized toxin is diluted immediately before injection with 0,9% nonpreserved or preserved with benzyl alcohol saline (bacteriostatic water). The diluted with preserved saline botulinum toxin may be chilled for at least 4 weeks before usage without decreased efficacy. The dilution may be higher for injection in bigger muscles. In this case there will be more injection pain, more diffusion of the toxin to neighbor muscles and more local side effects. Lower dilution is used for smaller (usually face) muscles. The recommended toxin doses depend on the patients’ symptoms and muscles involved. The maximal total doses for Botox per session are 600 U, and for Dysport – 2000 U. However systemic side effects have never been reported. The toxin acts only in the motor zones, but it is possible not to be injected sharply on place (evaluated by electromyography), as the motor zones are broad and the toxin diffuses in 1-2 cm in diameter. The small muscles are injected in only one point, while the larger – in more points. In order to avoid forming of neutralizing antibodies the smallest effective amounts of the toxin should be used not more frequently than 3 months. If neutralizing antibodies to serotype A appear, the treatment should continue with serotype B.
In conclusion the clinical use of botulinum toxin is a contemporary therapy used not only in the neurological practice but by a lot of different specialists.
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