Botulinum Toxin (Fundamentals Before Practice): Review

Very few pharmaceutical preperations share an evolutionary development as remarkable as that of botulinum neurotoxin, the most potent biological toxin ever known and first microbial protein administered to be used therapeutically in humans. After irreversibly binding to presynaptic cholinergic nerve terminals, botulinum toxin pevents the release of acetylcholine, resulting in sustained muscle relaxation, which lasts until regeneration of the nerve terminals is accomplished. Botulinum toxin, the most potent biological toxin ever known, use has started as a therapeutic agent after the demonstration of its neuromuscular blocking effect and dissapereance of glabellar frown lines in a patient who was treated for strabismus. Although it has been popular in recent years because of its successful cosmetic use, it has been used also for a number of disorders believed to be due to overactive striated or smooth muscles. The non-cosmetic therapeutic uses of the toxin includes neuromuscular, gastrointestinal, genitourinary, ophtalmological, laryngeal, oromandibular disorders and pain syndromes. Toxin received Food and Drug Administration (FDA) approval for treatment of blepbarospasm, strabismus, primary axillary hyperhidrosis, cervical dystonia and glabellar wrinkles and brow furrows. Detailed information about the toxin is needed to achieve cosmetic and therapeutic aimed effective and safe benefits from its effects. For this reason this review discusses through the the latest related literature according to the historical development of botlinum toxin, its structure, mechanism of action and use as an biological warfare agent, preperations, dilution and storage, toxicity, contraindications, antibody formation, the condition of treated muscles and advers effects.