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The Twentieth Century and Beyond
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
After failing to weaponize the toxin as a biological agent during World War II, researchers continued to study it for other purposes; eventually, in the 1960s, it occurred to the American ophthalmologist Alan Scott (1932–2021) to research substances as a treatment for strabismus (malalignment of the eyes). In 1978, Scott conducted a study in which botulinum toxin was injected into the periocular muscles of strabismus patients. After his successes and the successes of several other investigators in the 1980s, botulinum toxin, marketed by Allergan, received FDA approval as a treatment for strabismus, hemifacial spasms, and blepharospasm in 1989. In 1987, two Canadian physicians—an ophthalmologist named Jean Carruthers and her husband Alastair, a dermatologist—noted that periocular injection of botulinum toxin for blepharospasm seemed to rid a person temporarily of forehead wrinkles. After many years of research, the duo published their data in 1996, and botulinum received FDA approval for glabellar wrinkles in 2002. Since that time, botulinum toxin injections for upper face wrinkles have been a trendy and safe procedure that is offered in dermatology offices. Seven million Americans per year receive these injections, and the procedure has one of the highest patient satisfaction rates of any cosmetic procedure. In addition, botulinum toxin injections have received FDA approval for many other indications, including migraine headaches, dystonia, spasticity, laryngeal disorders, urinary incontinence, and hyperhidrosis.
Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
Botulinum toxin can be injected directly into the target muscle, which blocks the release of acetylcholine at nerve synapses. The effects last for around three months. It may be associated with a ‘flu-like illness' immediately after injections. Botulinum toxin injections can reduce spasticity, which can increase range of movement and assist with delivering care, but do not improve function.6 The oral drugs, including baclofen, tizanidine, gabapentin and diazepam, have been tried in the management of spasticity. Although they may have a small effect on reducing spasticity, this is offset by a high incidence of adverse effects, including sedation and weakness.6,100 If tried, people should be monitored for beneficial and adverse effects, with drug withdrawal if there is no net benefit.
Botulinum toxin complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Headache is a relatively common side effect from botulinum toxin treatment and occurs in as many as one in 100 patients treated. Despite being so common, the pathophysiology of a post-procedure headache is relatively poorly understood. Hypotheses into this include increased contraction of facial muscles trying to combat the paralysis induced by botulinum toxin, impurities in the drug itself and direct trauma to the periosteum of the frontal bone or muscle groups treated.
Lacrimal gland botulinum toxin injection for epiphora management
Published in Orbit, 2022
Johnathan Jeffers, Katherine Lucarelli, Sruti Akella, Pete Setabutr, Ted H. Wojno, Vinay Aakalu
Botulinum toxin was first purified in 1897, with seven different serotypes eventually identified.15,16 The toxin works by inhibiting the presynaptic release of acetylcholine at the neuromuscular junction and by autonomic nerve fibers. This ultimately results in a decreased concentration of post-synaptic acetylcholine receptors and subsequent muscle weakening.17 In the field of ophthalmology, botulinum toxin is commonly used to treat strabismus, blepharospasm, and hemifacial spasm. The use of botulinum toxin injection in medical treatments first started in 1970s, with the use of Botulinum Toxin A in animal trials.18 Dr. Allen Scott, an ophthalmologist was one of the first medical professionals to utilize the toxin as a medical treatment.19 The use of botulinum toxin for injection has been proven to be a safe procedure after over 40 years of use. Initial utilization of the purified toxin in ophthalmology included intramuscular injections for cases of strabismus.18 Frueh, Felt, Wojno, and Musch first described the use of botulinum toxin, previously known as oculinum for treatment of benign blepharospasm in 1984.20 There is also interest in using botulinum toxin to treat epiphora by injecting the lacrimal gland.21–23 Here, the inactivation of acetylcholine release from postganglionic parasympathetic secretomotor fibers lead to decreased tearing.16
Abobotulinum toxin A for periorbital facial rejuvenation: impact on ocular refractive parameters
Published in Clinical and Experimental Optometry, 2021
Mohammad H Eftekhari, Hossein Aghaei, Haleh Kangari, Milad Bahrami, Shervin Eftekhari, Seyed M Tabatabaee, Kourosh Shahraki, Mobin Bahrami, Mohammad G Broumand
Facial wrinkles, such as the forehead lines, glabellar wrinkles and crow’s feet lines (lines at the corners of the eye), are created by the contraction of facial muscles. Contraction of the mimic muscles of the face result in the overlying skin moving and forming dynamic wrinkles at 90 degrees to the contraction of muscle direction. The most significant improvement in dynamic wrinkles is observed in patients with injecting botulinum toxin, so these patients can be considered the most appropriate candidates. There are various non‐surgical and surgical facial rejuvenation techniques. The injection of a small amount of botulinum toxin into overactive muscles can relax the muscles. Some side effects of Botox are redness, bruising, haemorrhage, pain at the injection location, infection and inflammatory reaction. Some of these symptoms may indicate an allergic reaction; other allergy symptoms are itching, wheezing, asthma, a rash, red welts, dizziness and faintness. Botox is likely to spread to nearby tissues of the injection site. For instance, temporary droop in the eyebrows or upper eyelids can result from injecting into the forehead around these sites. There are three types of side effects associated with botulinum toxin: (1) the effect expected of this neuromuscular toxin, that is, excessive weakness of the muscle injected; (2) the effect of the diffusion of this neuromuscular toxin to the adjacent non‐injected muscles; and (3) the effect caused by the systemic diffusion of this toxin.8–13
Focal arm weakness following intradetrusor botulinum toxin administration in spinal cord injury: Report of two cases
Published in The Journal of Spinal Cord Medicine, 2020
Christopher Goodrich, Henry York, Andrew Shapiro, Peter Howard Gorman
Botulinum toxin is a potent neurotoxin originally derived from the bacterium Clostridium botulinum.9 The toxin’s best-known mechanism of action is to inhibit acetylcholine release into the neuromuscular junction, thereby blocking neuromuscular signal transmission and causing sustained paralysis.9,10 It was first reported in 1996 for the treatment of urologic disorders by Schurch et al. and is now used frequently in the treatment of detrusor overactivity.10,11 Recent research points to larger neural effects of botulinum toxin on the bladder apart from its effects on acetylcholine release. These include inhibition of multiple neurotransmitters and down-regulation of purinergic and capsaicin receptors on afferent neurons.9,10 Additional postulated mechanisms include decreased axonal sprouting in botulinum toxin treated smooth muscle as compared to striated muscle, as well as decreased levels of the sensory receptors P2X3 and/or TRPV1.12–14