Facts on Botulinum toxin

Miracle poison, another name for Botulinum toxin, is known to be one of the most poisonous substances which is a neurotoxin produced by bacterium Clostridium botulinum, an anaerobic, a spore forming rod commonly found on plants, in water, soil and in the intestinal tracts of animals. AB Scott tried his first demonstration of botulinum toxin, type A, for management of strabismus in human beings which was then approved for various treatments of spasticiy and numerous other ailments. It is presently being used for sub specialty medicine. Botulinum toxin A (Botox) has been approved by FDA in the year 2002, for cosmetic purpose of temporarily reducing forehead glabeller frown line. Botulinum toxin A was first commercially available in the United States which was considered safe for medical use. The only drawback was that the vial gets dissolved and the reconstituted product loses its potency. Hence dermatologists were in favor of using the entire contents of the vial, the same day on several patients. Botulinum toxin is injected using a 30 gauge one inch needle into the affected muscle or glands with the doses depending on the mass of muscle being injected with individual patient’s treatment. For large muscle mass, higher the dose, though lower doses may be needed for patients with weakness and in felinum males.

This toxin injection is administered through hollow coated needles directly into the affected muscles and in delicate places like strabismus, the injections are guided by electromyography. The precautions needed to be maintained after botulinum toxin injections are by returning home immediately and resting. Patients should avoid strenuous work for a couple of days and refrain from IPL laser treatment, facial massage or facials for one to two weeks after the administration of the injection. This precaution is to minimize toxins traveling and dislodging in the surrounding muscles which may be due to direct pressure or increased blood circulation. Patients may tend to feel some weakness by the injection which normally lasts for about three months and further injections at regular intervals may be needed depending on the dose and the individual’s susceptibility. Follow up monitoring by way of assessments should be done on the subjective and objective measures after the injection. Many a times, patients treated with toxin may need the injections after many years. Some patients, who respond favorably initially, may develop tolerance to the injections because of the development of neutralizing antibodies to the toxin. Patients receiving higher individual dose have a higher risk of antibodies and hence injections should be given at the lowest effective dose less frequently as possible due to several antibodies that are available. Botulinum toxin has been used for treatment of various ophthalmic spastic ailments, facial dystonias and periocular wrinkles and the correct use of botulinum toxin in clinical practice is absolutely necessary.



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