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Botulinum Toxin: Medical Applications
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Botulinum toxin is a peptide produced by anaerobic bacteria Clostridium botulinum. This is one of the most potent neurotoxins in the world. Botulinum intoxication, characterized by severe paralysis that could end up fatally, is known as botulism. Large molecular mass prevents toxin to enter the brain, but it can interrupt synaptic connections in the peripheral nervous system and block acetylcholine (neurotransmitter) release. Despite numerous negative effects associated with botulinum toxin, it can be very useful in treating various medical conditions if applied properly.

Blepharospasm is medical condition characterized by uncontrolled eye blinking; it results from involuntary movement of the muscles around eyes. Disease could be triggered by impaired function of basal ganglia, fast life style and psychophysical stress, or due to dry eyes… Botulinum toxin provides relief by inducing the spasm of the muscles responsible for eye twitching. It needs to be applied every 3 months to maintain ocular muscle “under control”.

Strabismus is diagnosed when eyes are not properly aligned. Disorder results from extraocular muscles dysfunction or due to impaired brain - eyes coordination. Impaired binocular vision and depth perception are common disease attributes. Treatment options are limited to corrective glasses, lenses and patches that could correct the visual image created in the brain. Cosmetically, strabismus can be improved either by botulinum toxin injection or through surgery. Botulin toxin provokes muscle spasm and result in eye alignment. It needs to be injected every couple of months, since paralysis weakens in time.

Upper motor neuron syndrome results from lesion of the motor neurons (which innervate skeletal muscles). It is characterized by decreased muscle control, altered tonus, weakness, mioclonus, spasticity…. Severity of disease depends on the severity of motoneuron lesion and affected muscles. In the most cases, exercise combined with drug treatments could help restore muscle tonus and relief spasticity. Botulinum toxin is applied by direct injection in the muscle to alleviate muscle - neuron signals. There is a story about Australian that had a stroke 20 years ago and managed to leave the wheelchair recently thanks to botulinum applied for hypertonic muscles treatment.

Hyperchydrosis or excessive sweating results from increased activity of sympathetic nervous system; it could be triggered by some type of food, drink and smoking... Whether it is localized (palms, underarms, groins) or widely spread, surgical methods such as removal of the sweat glands or endoscopic thoracic sympathectomy could provide satisfying results. Less aggressive methods such as antiperspirant application could help also. Botulinum toxin can prevent perspiration by blocking neural control over sweat glands. Effects are visible during 3-9 months.

Cervical dystonia known as torticollis is medical condition associated with neck spasticity. Damaged sternocleidomastoid muscle can’t rotate and bend laterally resulting in abnormal head position (tilted in one side). Facial asymmetry can develop also. Disease can be congenital, induced by birth trauma or intrauterine malposition or can be acquired later in life (consequence of tumors, drugs, infectious diseases…). Typical treatments include muscle stretching and strengthening. When applied exercises doesn’t provide expected outcome, surgery could help release tensed muscle. Botulim toxin is often used in torticollis treatment; it effectively inhibits spastic contractions.

Chronic migraine is severe headache that affect one side of the head; it could last between 2 and 72 hours. Genetic predisposition (2/3 of all cases are inherited) and multiple environmental factors are implicated in migraine genesis. Nausea, vomiting, pain, sensitivity toward light and noise… are just few symptoms that typically occur during migraine. Analgesics and antiemetic are used for control of pain and nausea, respectively. Botulin injected in head and neck proved to be efficient in chronic migraine prophylaxis.

Achalasia or esophageal aperistalsis is disorder affecting smooth muscles of esophagus and lower esophageal sphincter. Food can’t pass esophagus normally due to low organ peristalsis and increased muscle tonus of the sphincter. Main symptoms are dysphagia (patients can’t swallow food normally), regurgitation and chest pain. Calcium channel blockers (decrease tonus of the sphincter) and surgical approach (Heller myotomy) are mostly used treatment options. Botulinum toxin induces sphincter paralysis. It can induce scarring of the muscle, so it’s avoided in patients who are planning surgical operation in the future. Botulinum is prescribed only to the patients that are not suitable for surgery.

Cosmetic industry exploits botulinum toxin very much. Most people consider that botulinum is used solely for wrinkle removal. Actually, list of disorders that could be treated with botulinum toxin is long. Unfortunately, effect is time limited and treatments need to be repeated every couple of months.
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