Use of Botulinum Toxin in Neurology

Botulinum toxin is one of the strongest natural toxins. The toxin is produced by anaerobic bacteria Clostridium botulinum. The substance causes a block of acetylcholine release on the neuromuscular endplate with subsequent disruption of impulse transmission on the muscle. At the same time, botulinum toxin causes denervation syndrome of the muscle into which it was administered. There are seven types of botulinum toxin with effects on various proteins in presynaptic ending. In contemporary clinical practice, botulinum toxin has been used for more than 30 years and drugs with botulinum toxin A and B are available. At present, two medicinal products containing botulinum toxin A (Botox and Dysport) and one with botulinum toxin B (NeuroBloc) are available. Botulinum toxin is a highly effective drug used in many clinical conditions associated with increased skeletal muscle activity and increased activity of autonomic system. Botulinum toxin is indicated and reimbursed by insurance companies for cervical dystonia, other dystonias, blepharospasm, hemifacialis spasm, upper limb spasticity after stroke, and upper and lower limb spasticity in cerebral palsy. It also has proven efficacy in chronic headache, sfincter-detrusor dyssynergia of urine bladder, hyperhidrosis, sialorhoea, in gastroenterologic disorders (achalasia, anal fissure), cosmetic indications and in a number of other conditions. Contraindications include pregnancy, lactation, some neuromuscular diseases, haemocoagulation disorders including anticoagulation therapy (INR > 2.8) and inflammatory changes of the skin at the administration site. Adverse events include intensive muscle weakness, pain, hemorrhage into the muscle or subcutaneous tissue, headache as well as flu-like symptoms. Botulinum toxin is injected into muscles or subcutaneous tissue either directly "from hand", guided by EMG signal with a support of hollow monopolar EMG needle electrode, by direct stimulation of the muscle with hollow EMG needle electrode, guided by ultrasonography (position of the needle and the belly of a muscle) or CT.