![]() Pain relief was reported that did not coincide in proportion with its activity on muscle locally. In the early years of clinical use, physicians and patients experienced effects that could not easily be explained by the then accepted model of action. This activity results in the well-established effect of muscle paresis, often explained as “three days to take effect, three weeks to maximal and three-six months duration.” Complete recovery and original neuromuscular junction regeneration has been demonstrated. Essentially, BTX is shown to work through inclusion in the cholinergic nerve endings, cleavage and binding to SNARE (soluble NSF attachment receptor) protein receptors thus preventing acetylcholine release into the synaptic cleft. The molecule is further characterized by its light (50kDa) and heavy (100kDa) chains. The BTX molecule is synthesized as a single 150kD (kilodalton, a measure of atomic mass) chain formed in two parts connected by a disulfide chain. Botox and Botox Cosmetic ® are identified as onabotulinumtoxinA, Myobloc as rimabotulinumtoxinB and Dysport as abobotulinumtoxinA. In July of 2009, new drug names were established for various marketed forms of botulinum toxin. Myobloc ® was approved in for cervical dystonia in December 2000 and Dysport ® was approved in April 2009. Allergan ® purchased the rights to the “A” serotype (BTX-A) and, by 1989, Botox ® was approved by the FDA. The toxin was first used clinically in the 1950s but a useful presence to the medical community became apparent when Alan Scott 2 utilized it in clinical trials in the 1970s. Today we know of seven distinct and separate serotypes (collectively BTX) with varying potency, species specificity and target receptors which result in neuromuscular blocking effect. ![]() In the past several decades, the pace of investigating this unusual toxin has blossomed exponentially. Ever since German physician Justinus Kerner first described possible therapeutic applications of clostri-dium botulinum toxin in 1822, 1 there has been an increasing interest in pursuit of new treatment with this toxin. ![]()
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