Botox uses in Neurology

botox uses tables

In 1980, an ophtalmologist was the first to use it in humans. Botulinum toxin type A (BoNT-A) has been first studied by Alan Scott, an ophtalomologist from San Franscisco who was looking for a neurotoxin able to weaken the oculomotor muscles to avoid  surgery in infants with strabismus. He published the first paper of the use of BoNT-A as a treatment in human in 1980.Scott A, Botulinum toxin injection into extraocular muscles as an alternative to  strabismsus surgery. Ophthalmology 1980;87:1044-1049.

The neurologists started to use it in 1985 for the treatment of blepharospasm and then hemifacial spasm which are both movement disorders of the face. Over the last 25 years, the indications of the BoNT-A inneurology has expanded from the treatment of movement disorders (dystonia) to  spasticity and then to the treatment of excessive glandular function ( hyperhydrosis, drooling, gustatory sweating). The most recent licensed indications in neurology are the chronic migraines. Pain is a new era of research for BoNT-A in neurology.

Other specialties have also developed new indications for BoNT-A: Injection of the sphincters such as the lower oesophageal sphincter for achalasia, the upper oesophageal sphincter for dyphagia, the anal sphincter for anal fissure or for anismus. Injections into the masticatory muscles for bruxism. Injections into the detrusor muscle  for hyperactive bladder.  Injections into  the prostate gland for prostatic adenoma are studied.

Botulinum toxin uses in neurology:
Focal Dystonia: Blepharospasm, Cervical dystonia, Jaw and tongue dystonia, Writer’s cramp, Musician’s Cramp, Foot Dystonia, Laryngeal dystonia ( spasmodic dysphonia, dystonic stridor)
Facial nerve pathology: Hemifacial spasm, facial plasy complications (facial asymmetry, synkinesias, induced-ptosis for exposure keratitis)
Other Movement Disorders: Tics, Tremor (Head tremor, Voice tremor, Writing tremor), Parkinsonian foot dystonia, Bruxism, Masticatory spasm following radiotherapy.
Excessive secretion: axillae sweating, hands sweating, facial sweating, gustatory sweating, Frey’s syndrome, drooling (Parkinson’s disease), crocodile tears ( after facial palsy).
Post stroke spasticity: arm, hand spasticity, equinovarus foot deformity
Pain: Chronic migraines, neuropathic pain(?)