ABSTRACT
INTRODUCTION In the 1820s a German physician, Justinus Kerner, reported his clinical experience with 230 patients who developed weakness, gastrointestinal (GI) disturbances, dry eyes, and dry skin associated with the ingestion of contaminated meat. This condition, termed by Kerner as “sausage poison,” was later named “botulism,” from the Latin term botulus or sausage (1). A century later, Edward Schantz fi rst purifi ed the toxin associated with Clostridium botulinum. In 1973 Alan Scott fi rst used botulinum toxin type A (BoNT-A) in monkey experiments, and in 1980 tested this drug in humans (2), culminating with U.S. Food and Drug Administration (FDA) approval of Oculinum®/Botox® for the treatment of strabismus and VII cranial nerve disorders (e.g., blepharospasm and hemifacial spasm) in December 1989. An indication for the treatment of cervical dystonia (CD) was given in 2000, and approvals for cosmesis (2002), hyperhidrosis (2004), upper limb spasticity (2010), and migraine (2010) followed. Two other BoNT-A have gained approval in the USA for the treatment of CD. Dysport® was developed in Europe and received approval in the USA in 2009. Xeomin® was fi rst available in Germany and was approved in the USA in 2010. Myobloc®, a BoNT-B therapy, was approved in the USA for the treatment of CD in 2000; this agent was also approved for usage in Europe under the trade name, Neurobloc® (Table 26.1) (3).
