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Pharmacology And Clinical Applications Of Botulinum Toxins A And B

M. Thakker, P. Rubin
Published 2004 · Medicine

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The evolution of botulinum toxin from being one of the most lethal poisons to one of the most popular and costly cosmetic drugs is certainly one of the more ironic, if not bizarre, twists in modern medicine. Prior to its use as a medical and cosmetic drug, the toxin was known for causing the food-borne illness botulism, characterized by symptoms of muscular weakness ranging from mild ptosis and diplopia to life-threatening respiratory failure. The ubiquitous gram-positive anaerobe Clostridium botulinum was first identified as the cause of botulism in 1895 by the Belgian professor Emile Pierre van Ermengem. Over the next 2 decades, other strains of C. botulinum producing different serotypes of toxin were isolated and identified. A crude form of botulinum toxin A was produced by Dr. Herman Sommer from the University of California, San Francisco in 1926. Pure botulinum toxin-A was first purified by Dr. Edward Schantz and his colleagues in 1946. Although the capability of botulinum toxin to inhibit acetylcholine release by motor neurons was discovered in the early 1950s, it was not until the late 1970s that the clinical potential of this substance was initially appreciated. Dr. Alan Scott, an ophthalmologist and researcher, successfully pioneered the use of botulinum toxin in humans by injecting it into extraocular muscles to correct strabismus. Over the past 2 decades, the therapeutic applications of botulinum toxin have greatly expanded beyond strabismus to include the treatment of various disorders of muscle hyperactivity, hyperdynamic rhytides, hyperhidrosis, and migraine headaches. In this article, we will review the biochemistry, pharmacology, clinical uses, side effects, and contraindications of botulinum toxins A and B. Because of the increase in its use by ophthalmologists and other physicians, familiarity with botulinum toxin is important not only for physicians who administer the drug, but also for all health care professionals with patients being treated with this potentially dangerous substance.
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