Botulinum danger of toxin
June 7 2016 by
Ray Sahelian, M.D.


Botulinum toxin is the most poisonous substance known. A single gram of botulinum toxin, evenly dispersed and inhaled, would kill more than 1 million people. The botulinum toxin is a zinc proteinase that cleaves one or more of the fusion proteins by which neuronal vesicles release acetylcholine into the neuromuscular (between nerve and muscle) junction. Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the Clostridium botulinum bacteria.

Botulinum as medicine and treatment

Botulinum is the first biological toxin to become licensed for treatment of human disease. In the United States, botulinum toxin is currently licensed for treatment of cervical torticollis, strabismus, and blepharospasm associated with dystonia. It is also used "off label" for a variety of more prevalent conditions that include migraine headache, chronic low back pain, stroke, traumatic brain injury, cerebral palsy, achalasia, and various dystonias.


Botulinum toxin danger, side effect
2008 - The popular anti-wrinkle drug Botox and a competitor Myobloc have been linked to some deaths and other severe side effects suggestive of botulism. The drugs use botulinum toxin, which blocks nerve impulses to muscles, causing them to relax. But in rare cases, the toxin may have spread beyond the injection site to other parts of the body, resulting in such problems as paralysis of respiratory muscles and difficulty swallowing.


Botulinum for Wrinkle Reduction

Management of the ageing eyebrow and forehead: an objective dose-response study with botulinum toxin.
J Eur Acad Dermatol Venereol. 2006. Centre Laser Dermatologique, Marseille, France.
Objective To determine if clinical use of two different doses of botulinum exotoxin A (BTX-A) injections to the forehead area result in wrinkle reduction and modifications of eyebrow position. Design Prospective study. Setting Private practice, Dermatologic Laser Centre, Marseille, France. Subjects Twenty-four adult patients treated with BTX-A (Vistabel(R)) injections for forehead rhytides. Intervention Of the 24 patients, 12 received BTX-A injections of 5 U only and 12 received injections of 10 U into the forehead, with or without treatment of the lateral forehead. The eyebrow position, forehead height and number of forehead lines determine the number of injection points. Patients were evaluated before injection and every 2 months after treatment during next 8 months. Results In the two groups of 12 patients, we found no significant change between the two doses. At each time after injections (every 2 months until 8 months), both groups showed a statistically significant improvement except at 8 months. Both groups exhibited the same results on standardized photos and on 3D skin profilometry. Conclusions The two doses of BTX-A injections into the forehead gave the same results. The duration of the effect is similar along 8 months. This study emphasizes the role of low doses of BTX-A injections to obtain good clinical results without freezing aspect.


2011 - Preliminary industry-funded research suggests that a gel based on the active ingredient of the injectable Botox wrinkle treatment could help reduce the lines around the eyes known as crow's feet -- without the pain of needles. The effects of the gel, which uses botulinum toxin, last for about four months, comparable to that produced by Botox injections.


Plast Reconstr Surg. 2015. The Efficacy and Safety of Liquid-Type Botulinum Toxin Type A for the Management of Moderate to Severe Glabellar Frown Lines. Botulinum toxin type A has been widely used to correct unwanted hyperfunctional facial lines. Most forms of botulinum toxin type A currently used require reconstitution, which is very inconvenient for users. The authors compared the efficacy and safety of a newly developed liquid-type botulinum toxin type A (MT10109L) and onabotulinumtoxinA (Botox) for moderate to severe glabellar lines. The efficacy and safety of MT10109L were comparable to those of Botox for the management of glabellar frown lines.


Botulinum for Depression

Treatment of depression with botulinum toxin A: a case series.
Dermatol Surg. 2006.
Dermatology and Cosmetic Surgery Associates, Greenbelt, Maryland
Major depression is a common and serious disease that may be resistant to routine pharmacologic and psychotherapeutic treatment approaches. To evaluate the efficacy of botulinum toxin A treatment of glabellar frown lines in treating patients with major depression, using a small open pilot trial. Patients who met DSM-IV criteria for ongoing major depression in spite of pharmacologic or psychotherapeutic treatment were evaluated with the Beck Depression Inventory II (BDI-II) before receiving botulinum toxin A to their glabellar frown lines. Two months later, all patients were re-evaluated clinically and with the BDI-II. Ten depressed patients were treated with botulinum toxin A, and 9 of 10 patients were no longer depressed 2 months after treatment. The tenth patient had an improvement in mood. To our knowledge, these are the first reported cases of depression treated with botulinum toxin A.


Botulinum for Urinary Incontinence, overactive bladder

Injections of Botox, or botulinum toxin-type A, appear useful in the treatment of drug-resistant urinary incontinence due to traumatic spinal cord injury. Thirty seven patients with drug-resistant urinary incontinence received botulinum injections into the detrusor muscle, which controls bladder function. Overall, incontinence was abolished in 82 percent of patients and detrusor overactivity was stopped in 76 percent. In all, 86 percent of patients were able to stop or reduce drug therapy and a similar proportion showed an increase in quality-of-life scores. The mean duration of symptomatic improvement was 9 months, and 12 patients had a mean of 14 months of improvement. BJU International July 2006.


Botox injections may be best known for smoothing facial lines, but they may also help soothe an overactive bladder. Dr. Arun Sahai at Guy's Hospital and King's College London found that among 34 patients with stubborn overactive bladder symptoms, those treated with Botox showed improvements in symptoms and quality of life that lasted up to six months. Botox, which is derived from botulinum toxin, works by interfering with nerve signals in the treated muscle, essentially paralyzing it. Administered to the muscles of the bladder, Botox is believed to prevent the spasms that create the symptoms of overactive bladder -- a strong, frequent urge to urinate, sometimes accompanied by leakage. Dr. Arun Sahai randomly assigned the 34 patients to receive either Botox injections or a placebo for comparison. All of the men and women had tried oral medication for their symptoms but failed to improve. The Botox treatment was delivered via a thin, flexible tube called a cystoscope. Each patient received 20 injections through the bladder wall to various sites on the bladder muscles. BJU International, June 2009.


Botulinum for BPH
Intraprostatic injection of botulinum toxin type A (BoNT-A) may be an effective treatment for symptomatic benign prostatic hyperplasia (BPH), with benefits lasting at least 12 months. BoNT-A ( Botox ) injections into the bladder and urethra have been tested against various voiding dysfunctions. Recent reports also suggest that the agent affects neurotransmitters that could help alleviate the symptoms of BPH. Dr. Michael B. Chancellor, from the University of Pittsburgh School of Medicine, and colleagues tested 41 men with drug-refractory BPH that were treated with BoNT-A at Chang Gung Memorial Hospital Kaohsiung in Taiwan. The agent, which was administered transperineally under transrectal ultrasound guidance, was given at a dose of 100 U for prostate volumes <30 mL and at a dose of 200 U for volumes >30 mL. No side effects were noted. Thirty-one men experienced improvements in lower urinary tract symptoms and quality of life of greater than 30%. Moreover, BoNT-A treatment led to spontaneous voiding in four of five men with urinary retention. Interestingly, the findings suggest that the benefit of BoNT-A was not solely due to its ability to shrink the prostate. Seven of 12 men who had no change in prostate size still experienced marked improvements in flow rate, lower urinary tract symptoms, and quality of life. BJU Int 2006;98:1033-1037.


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