Botulinum toxin is a medication and a neurotoxic protein produced by the bacterium Clostridium botulinum. It is the most toxic protein known with an LD50 of roughly 0.005-0.05 µg/kg. Despite this, it is used in minute doses, in some parts of the world, to treat muscle spasms. It is sold commercially under the brand names Botox, Dysport, Myobloc, Neurobloc and Xeomin for this purpose. Botox Cosmetic and Vistabel are available for cosmetic treatment. The terms Botox (Cosmetic), Vistabel, Dysport, Myobloc, Neurobloc and Xeomin are trade names and are not used generically to describe the neurotoxins produced by C. botulinum.

The cosmetic effect of BTX-A was initially described by ophthalmologist Jean Carruthers and dermatologist Alastair Carruthers, a husband-and-wife team working in Vancouver, Canada, although the effect had been observed by a number of independent groups (Brin, and the Columbia University group). On April 15, 2002, the FDA announced the approval of botulinum toxin type A (BOTOX Cosmetic) to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). BTX-A has also been approved for the treatment of excessive underarm sweating. The acceptance of BTX-A use for the treatment of spasticity and muscle pain disorders is growing, with approvals pending in many European countries and studies on headaches (including migraine), prostatic symptoms, asthma, obesity and many other possible indications are ongoing.

Botox is manufactured by Allergan Inc (U.S.) for both therapeutic as well as cosmetic use. The formulation is best stored at cold temperature of 2-8 degrees Celsius. Dysport is a therapeutic formulation of the type A toxin developed and manufactured in Ireland and which is licenced for the treatment of focal dystonias and certain cosmetic uses in many territories world wide. Neuronox is a new type A toxin manufactured by Medy-Tox Inc (South Korea).

Despite Botulinum toxin being one of the most lethal naturally occurring substances known to science, it is still widely used for cosmetic purposes in a purified and isolated form.

* Cervical dystonia (spasmodic torticollis) (a neuromuscular disorder involving the head and neck)

* Blepharospasm (excessive blinking)

* Severe primary axillary hyperhidrosis (excessive sweating)

* Achalasia (failure of the lower oesophageal sphincter to relax)

* Local intradermal injection of BTX-A is helpful in chronic focal painful neuropathies. The analgesic effects are not dependent on changes in muscle tone.

* Migraine and other headache disorders, although the evidence is conflicting in this indication

* Pediatric incontinence, incontinence due to overactive bladder, and incontinence due to neurogenic bladder.

* Anal fissure

* Spastic disorders associated with injury or disease of the central nervous system including trauma, stroke, multiple sclerosis, Parkinson’s disease, or cerebral palsy

* Focal dystonias affecting the limbs, face, jaw, or vocal cords

* TMJ pain disorders

* Diabetic neuropathy

* Wound healing

* Excessive salivation

* VCD Vocal cord dysfunction a spasming of the vocal cords

* Reduction of the Masseter muscle for decreasing the size of the lower jaw

Treatment and prevention of chronic headache and chronic musculoskeletal pain are emerging uses for botulinum toxin type A. In addition, there is evidence that Botox may aid in weight loss by increasing the gastric emptying time.

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