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Use of Botulinum Toxin A in Adult Neurological Disorders

Efficacy, Tolerability and Safety

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Abstract

The protein botulinum neurotoxin A (BoNT/A) is one of seven distinct neurotoxins produced by Clostridium botulinum. BoNT/A blocks cholinergic synapses with an extremely high specificity and potency. Appropriately purified and diluted, BoNT/A serves as a reliable and well tolerated drug that is applied by local injection.

The efficacy of BoNT/A is evident in the symptomatic therapy of disorders in which muscular hyperactivity plays a prominent role, such as focal dystonias and hemifacial spasm; in these disorders, BoNT/A is considered first-line therapy. BoNT/A is also beneficial in the treatment of both adults and children with spasticity of various causes. The pain that frequently accompanies these conditions is effectively reduced by BoNT/A. A genuine analgesic effect for BoNT/A unrelated to skeletal muscle spasmolysis has been suggested on the basis of in vitro and in vivo (animal) data. However, studies in humans designed to detect such an effect were negative, as were controlled studies of BoNT/A in patients with primary headache disorders.

BoNT/A also acts on cholinergic synapses of the autonomic nervous system, and injection of BoNT/A into salivary glands significantly decreases the production of saliva. This may be beneficial for patients with Parkinson’s disease, in whom the excessive production of saliva may be problematic.

Overall, BoNT/A has been confirmed as an efficacious, predictable and well tolerated drug in an ever-increasing number of neurological disorders.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. Dr Schulte-Mattler was an investigator in clinical trials sponsored by Allergan and Ipsen, and was a speaker at symposia promoted by Allergan, Ipsen and Merz.

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  1. Department of Neurology, University of Regensburg, Regensburg, Germany

    Wilhelm J. Schulte-Mattler

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  1. Wilhelm J. Schulte-Mattler
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Correspondence to Wilhelm J. Schulte-Mattler.

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Schulte-Mattler, W.J. Use of Botulinum Toxin A in Adult Neurological Disorders. CNS Drugs 22, 725–738 (2008). https://doi.org/10.2165/00023210-200822090-00002

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