Botulinum Neurotoxin Type A in Neurology: Update.
This paper reviews the current and most neurological (central nervous system, CNS) uses of the botulinum neurotoxin type A. The effect of these toxins at neuromuscular junction lends themselves to neurological diseases of muscle overactivity, particularly abnormalities of muscle control. There are seven serotypes of the toxin, each with a specific activity at the molecular level. Currently, serotypes A (in two preparations) and B are available for clinical purpose, and they have proved to be safe and effective for the treatment of dystonia, spasticity, headache, and other CNS disorders in which muscle hyperactivity gives rise to symptoms. Although initially thought to inhibit acetylcholine release only at the neuromuscular junction, botulinum toxins are now recognized to inhibit acetylcholine release at autonomic cholinergic nerve terminals, as well as peripheral release of neuro-transmitters involved in pain regulation. Its effects are transient and nondestructive, and largely limited to the area in which it is administered. These effects are also graded according to the dose, allowing individualized treatment of patients and disorders. It may also prove to be useful in the control of autonomic dysfunction and sialorrhea. In over 20 years of use in humans, botulinum toxin has accumulated a considerable safety record, and in many cases represents relief for thousands of patients unaided by other therapy.
Centro Universitário Augusto Motta, Bonsucesso , Rio de Janeiro, Brasil ; Universidade Federal Fluminense, Departamento de Neurologia, Niterói , Rio de Janeiro, Brasil.
Marco
M
Orsini
Universidade Federal Fluminense, Departamento de Neurologia, Niterói , Rio de Janeiro, Brasil.
Marco Antonio Araujo
MA
Leite
Universidade de São Paulo - USP , São Paulo, Brasil.
Tae Mo
TM
Chung
Universidade Federal de São Paulo - UNIFESP , São Paulo, Brasil.
Wladimir
W
Bocca
Universidade de São Paulo - USP , São Paulo, Brasil.
Jano Alves
JA
de Souza
Universidade de São Paulo - USP , São Paulo, Brasil.
Olivia Gameiro
OG
de Souza
Universidade Federal do Piaui , Parnaíba, Brasil.
Rayele Priscila
RP
Moreira
Universidade Federal do Piaui , Parnaíba, Brasil.
Victor Hugo
VH
Bastos
Universidade Federal do Piaui , Parnaíba, Brasil.
Silmar
S
Teixeira
Universidade Federal de São Paulo - UNIFESP , São Paulo, Brasil.
Acary Bulle
AB
Oliveira
Centro Universitário Augusto Motta, Bonsucesso , Rio de Janeiro, Brasil.
Bruno da Silva
Bda S
Moraes
Universidade Federal Fluminense, Departamento de Neurologia, Niterói , Rio de Janeiro, Brasil.
André Palma
AP
Matta
Universidade Federal do Piaui , Parnaíba, Brasil.
Luis Jorge
LJ
Jacinto
botulinum toxin; neurology; rehabilitation