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  • Review Article
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Use of botulinum toxin in the neurology clinic

Nature Reviews Neurology volume 6, pages 624–636 (2010)Cite this article

Subjects

Abstract

Botulinum neurotoxin (BoNT) is an effective treatment for conditions associated with overactivity of glandular, smooth or skeletal muscle, and this toxin can also ameliorate certain painful conditions. Electromyography, endoscopy and imaging techniques such as ultrasonography and fluoroscopy have been used to increase the accuracy of BoNT injections. This Review assesses the mechanisms of action of BoNT, and examines the use of BoNT injections in numerous neurological conditions, including dystonia, spasticity, headaches and other painful disorders, hemifacial spasm, essential tremor, motor tics, hyperhidrosis, and sialorrhea and drooling. Important practical aspects, such as the reconstitution of BoNT, dosing, and methods of administration, are also addressed.

Key Points

  • Seven serotypes of botulinum neurotoxin (BoNT)—BoNT/A–G—have been identified, but only BoNT/A and BoNT/B are used in clinical practice

  • BoNT is used to treat conditions associated with overactivity of glandular, smooth or skeletal muscle, and to ameliorate some painful conditions

  • BoNT is probably an effective treatment for focal and segmental dystonia; spasticity; back, joint, neuropathic and pelvic pain; hemifacial spasm; essential tremor; motor tics; and palmar and axillary hyperhidrosis

  • Electromyography, endoscopy and imaging techniques have been used to increase the accuracy of BoNT injections

  • A lack of controlled or comparative studies prevents assessment of the effectiveness of electromyography, endoscopy and imaging techniques over other localization techniques

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Figure 1: Decision tree to aid identification of the most appropriate technique for injecting botulinum toxin.
Figure 2: Typical equipment required for the injection of botulinum toxin.

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Acknowledgements

The authors would like to thank Dr. Andy Pickett (Biologicals Science and Technology, Ipsen Biopharm Limited) for invaluable help with the Mechanisms of action section of the article.

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  1. Division of Neurology, National University Health System, National University of Singapore, 1E, NUHS Tower Block, Kent Ridge Road, 119228, Singapore

    Erle C. H. Lim & Raymond C. S. Seet

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Contributions

E. C. H. Lim researched the data and wrote the article, and provided substantial contributions to discussions of the content, reviewing and editing of the manuscript. R. C. S. Seet researched the data for the article and provided substantial contributions to discussions of the content, and contributed to the reviewing and editing of the manuscript.

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Correspondence to Erle C. H. Lim.

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Lim, E., Seet, R. Use of botulinum toxin in the neurology clinic. Nat Rev Neurol 6, 624–636 (2010). https://doi.org/10.1038/nrneurol.2010.149

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