ABSTRACT
NationalInstituteofNeurologicalDisordersandStroke,NationalInstitutesofHealth, Bethesda,Maryland
I.INTRODUCTION2
II.PREPARATIONFORUSEINHUMANS2
Ill.PHYSIOLOGICANDMORPHOLOGICEFFECTS2
IV.METHODANDOUTCOMEOFTREATMENT3 V.THERAPEUTICAPPLICATIONS6
A.Strabismus6 B.HemifacialSpasm7 C.Dystonia8
VI.OTHERAPPLICATIONS13 A.Tremor13 B.PalatalTremor14 c.VocalTremor14 D.TardiveDyskinesia14 E.Spasticity15 F.UrinaryRetention15 G.Anismus15 H.Stuttering16 I.OphthalmicUsesOtherThanforStrabismus16 J.OrthopedicUses16
K.MiscellaneousUses17 VII.CONCLUSIONS17
REFERENCES17
I. INTRODUCTION
Bacterial toxins were first used medicinally during the late 19th century. Small amounts were injected into animals to produce antiserum to counteract the toxin's own poisonous effects. It is only recently, however, that the toxic properties of these compounds have been exploited to directly treat human disease. This latter use of botulinum toxin was pioneered by Scott. Following extensive animal experimentation, he injected the oculomotor muscles of strabismic patients in an attempt to selectively weaken the muscle that was causing misalignment (Scott, 1981). Botulinum toxin was chosen because of its known mechanism of action, selectivity, low antigenicity, and long-lasting effect. The safety and success of botulinum toxin treatment for strabismus led to trials of its use in blepharospasm and subsequently other focal dystonias and hemifacial spasm (Jankovic and Brin, 1991).
