The therapeutic potential of botulinum toxin

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Abstract from Dermatol Surg. 2004 Mar;30(3):452-5. Links

The therapeutic potential of botulinum toxin.

Klein AW.

Department of Dermatology/Medicine at the Geffen School of

Medicine at UCLA and the American Foundation for Aids Research, Beverly

Hills, California.

BACKGROUND: Botulinum toxin type A (BTX-A; commercial preparation BOTOX)

is most well known for its effect on muscle contraction because of the

BTX binding to the presynaptic nerve terminal, inhibiting the release of

acetylcholine (ACH). The therapeutic benefit of BTX-A, however, can also

be isolated to pain relief alone, suggesting that BTX-A also works

through additional modes of action.

OBJECTIVE: This article provides insight by an experienced physician

into four different case reports. Each case demonstrates the therapeutic

potential of BTX-A and the possibility of a different mechanism of

action for BTX other than the inhibition of ACH release.

RESULTS: Four patients, each with different symptoms such as

relapsing-remitting multiple sclerosis, postherpetic neuralgia,

peripheral neuropathy, and severe tingling caused by herniation of

cervical vertebrae at the level of C8, were treated with BOTOX, and

their symptoms were alleviated.

CONCLUSIONS: The BTX-A mechanism providing pain relief is hypothesized

to be something other than muscle relaxation by inhibiting the release

of ACH at the neuromuscular juncture, such as inhibition of the release

of substance P or the blocking of autonomic pathways, etc. This article

is intended to continue to keep physicians using this substance for

dermatologic indications aware of the potential unsuspected effects.