BOTULINUM

TOXIN [BTX] OR
[BONTX]
{ M.GOMATHI
CRRI
DEPARTMENT OF OMFS
INTRODUCTION
clostridium botulinum

gram +ve anaerobe

Clinical syndrome occurs by

contaminated food

colonization of infant gastrointestinal tract

wound infection
BONT – 7 NEUROTOXINS
TYPE A, B ,C [C1,C2] , D ,E ,F ,G
antigenitically and serologically distinct but structurally
similar

human botulism caused mainly by TYPE – A, B, E,

AND RARELY F.

TYPE C AND D toxic only in animals.

 BOTULINUM TOXIN is the most poisonous substance
known to man.

Initially used in RX of STRABISMUS.

now accepted in RX of wide spectrum of disorders.

has over 100 potential medical applications.

THERAPEUTIC USES OF BOTULINUM TOXIN

NEUROLOGICAL DISORDERS

cervical dystonia

blepharospasm

oromandibular dystonia

hemifacial spasm

spasticity

chronic migraine
DISORDERS OF SECRETION
hyperhidrosis
Sialorrhea

DISORDERS OF PELVIC FLOOR

Neurogenic detrusor overactivity
Idiopathic detrusor overacctivity

OPTHALMOLOGICAL DISORDERS
Strabismus
Dry eye disease

GASTROINTESTINAL DISORDERS
achalasia
HEMIFACIAL SPASM
Caused by abberant artery abutting the facial nerve.

Microvascular surgery result in complete resolution of symptoms.

Symptomatic RX with botulinum toxin is therefore first-line for this condition.

Evidance

open label studies and small placcebo controlled trials.

Yoshimura et al. investigated efficiency of botulinum toxin in 11 patients and

79% reported a subjective improvement.

it gained FDA approval in 1989.

transient facial weakness is very common and tolerable side effecct.

 CHRONIC MIGRAINE
highly disabling disorder, affects around 1-2% of population
headache on >15 days per month for >3 months, >8 days meet the
criteria for migraine with or without aura or respond to migraine specific
RX.
efficiency of BOTOX was surfaced when patients were treated
cosmetically for wrinkles.
effeciency of its treatment was established in PHASE III
research evaluating migraine prophylaxis therapy [PREEMPT].
 In a randomised controlled trial, 1384 patients were
assigned to either Onabotulinumtoxin A or placcebo,
those in treatment experienced significant reduction in
number of headaches per days,headache episodes and
migraine episodes.

 FDA in USA and medicine healthcare product

regulatory agency [MHRA] in UK endorsed the use of
BOTULINUM TOXIN for CM prophylaxis in 2010.

 later approved by NATIONAL HEALTH

SERVICE (NHS) in UK. high placebo rate was pointed
out in PREEMPT TRIAL, Observers have criticised
10% additional benefits over placebo.
 Botulinum toxin for prophylaxis of chronic migraine is
well tolerated.

 Adverse reactions are usually transient and include ptosis,

muscle weakness, neck pain and neck stiffness.
 CONCLUSION
 botulinum toxin, unlike sereval other plants and animal toxins, has not only

turned from poison to therapeutic agent, but also to potential ‘wonder

drug’.
 it has been sucessfully used in an ever growing list of neurological and non
neurological disorders.

 its mechanism of action in neuromuscular blockade is well understood,

however less is known of its mechanism in relieving chronic migraine.

 Long term studies in some conditions have confirmed its saftey and efficacy.

 further research still need to be carried out to clarify its efficacy in other
conditions.

 Questions surrounding conditions – specific optimal dosage and frequency of

injections also need to be arressed.
REFERENCE
JOURNAL OF CLINICAL TOXICOLOGY
ISSN: 2161-0495