Botulinum-Toxin treatment in Neurology - Established and new indications

The exotoxin of Clostridium botulinum has the most toxic potency of all poisonous natural substances. Its anticholinergic mode of action at the synapses of the neuromuscular and the autonomic nervous system is responsible for the symptoms of botulism. Since the first report of successful therapeutic application in humans in 1981, Botulinum toxin meanwhile has gained an important role in the symptomatic treatment of conditions with pathological muscular overcontractions and inadequate glandulary secretion. In neuromuscular indications the clinical effect lasts between 10 and 16 weeks. In most countries, Botulinumtoxin is approved for the treatment of "blepharospasm", "hemifacial spasm", "spasmodic torticollis" and "cerebral palsy". There are other well documented indications, such as task specific dystonias (e.g. writers cramp), limb dystonia, spasmodic dysphonia, oromandibular dystonia and spasticity. In gastrointestinal (e.g. achalasia);and urogenital (detrusor-sphincter dyssynergia) disorders the toxin injections have also shown convincing results. The most recent indications are autonomic disorders of the secretory glands such as gustatory swearing, focal hyperhidrosis and hyperlacrimation after Bell's palsy.