Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum. It is one of the most poisonous naturally occurring substances in the world, and it is the most toxic protein.^[1]BotoxDysport for this purpose. The terms Botox and Dysport are trade names and are not used generically to describe the neurotoxins produced by the clostridia species. Though it is highly toxic, it is used in minute doses both to treat painful muscle spasms, and as a cosmetic treatment in some parts of the world. It is sold commercially under the brand names and

Medical uses

Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of botulinum toxin type A decreased muscle activity by blocking the release of acetylcholine at the neuromuscular junction, thereby rendering the muscle unable to contract for a period of 4 to 6 months.

Alan Scott, a San Francisco ophthalmologist, first applied tiny doses of the toxin in a medicinal sense to treat 'crossed eyes' (strabismus) and 'uncontrollable blinking' (blepharospasm), but needed a partner to gain regulatory approval to market his discovery as a drug. Allergan, Inc., a pharmaceutical company that focused on prescription eye therapies and contact lens products, bought the rights to the drug in 1988 and received FDA approval in 1989. Allergan renamed the drug Botox.

Cosmetically desirable effects of Botox were quickly discovered thereafter when the frown lines between the eyebrows were observed to soften following treatment for eye muscle disorders, leading to clinical trials and subsequent FDA approval for cosmetic use in April 2002. As of 2006, Botox injection is the most common cosmetic operation in the United States.

Besides its cosmetic application, Botox is used in the treatment of

• migraine headaches

• cervical dystonia (spasmodic torticollis) (a neuromuscular disorder involving the head and neck)^[2]

• blepharospasm (involuntary blinking)^[3]

• severe primary axillary hyperhidrosis (excessive sweating)^[4]

• achalasia (failure of the lower esophageal sphincter to relax)

Other uses of botulinum toxin type A that are widely known but not specifically approved by FDA include treatment of:

• involuntary microexpression facial triggers (concealing a lie)^{[citation needed]}

• pediatric incontinence^[5], incontinence due to overactive bladder,^[6] and incontinence due to neurogenic bladder.^[7]

• anal fissure^[8]

• spastic disorders associated with injury or disease of the central nervous system including trauma, stroke, multiple sclerosis, Parkinson's disease, or cerebral palsy

• focal dystonias affecting the limbs, face, jaw, or vocal cords

• TMJ pain disorders

• diabetic neuropathy

• wound healing

• excessive salivation

• Reduction of the Masseter muscle for decreasing the size of the lower jaw

In the Journal of Dermatologic Surgery, Eric Finzi claims to have treated clinically depressed patients with botox. On Good Morning America, he claimed that by taking away the ability to frown, he was somehow taking away the ability to feel depressed.^[9]

Treatment and prevention of chronic headache^[10] and chronic musculoskeletal pain^[11] are emerging uses for botulinum toxin type A. In addition, there is evidence that Botox may aid in weight loss by increasing the gastric emptying time.^[12]

Side effects

Side effects can be predicted from the mode of action (muscle paralysis) and chemical structure (protein) of the molecule, resulting broadly speaking in two major areas of side effects: paralysis of the wrong muscle group and allergic reaction. Bruising at the site of injection is a side effect not of the toxin, but rather the mode of administration. In cosmetic use, this means that the client will complain of inappropriate facial expression such as drooping eyelid, uneven smile, loss of ability to close the eye. This will wear off in around 6 weeks. Bruising is prevented by the clinician applying pressure to the injection site, but may still occur, and will last around 7 - 10 days. When injecting the masseter muscle of the jaw, loss of muscle function will result in a loss or reduction of power to chew solid foods. All cosmetic treatments are of limited duration, and can be as short a period as six weeks, but usually one reckons with an effective period of between 3 and 8 months. At the extremely low doses used medicinally, botulinum toxin has a very low degree of toxicity.

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