Book contents
- Frontmatter
- Contents
- List of Contributors
- 1 Introduction
- 2 Mechanistic basis for the therapeutic effectiveness of botulinum toxin A on over-active cholinergic nerves
- 3 Botulinum toxin: from menace to medicine
- 4 Botulinum toxin: primary and secondary resistance
- 5 Introduction to botulinum toxin in clinical practice
- 6 Cervical dystonia
- 7 The use of botulinum toxin in otolaryngology
- 8 Spasticity
- 9 Hyperhidrosis
- 10 Hypersalivation
- 11 Botulinum toxin type A for the prophylactic treatment of primary headache disorders
- 12 Botulinum toxin in the management of back and neck pain
- 13 Clinical uses of botulinum toxin
- 14 Bladder and bowel indications
- 15 Cosmetic uses of botulinum toxin A
- 16 Other clinical neurological uses of botulinum toxin
- Index
- Plate section
- References
13 - Clinical uses of botulinum toxin
Published online by Cambridge University Press: 02 December 2009
- Frontmatter
- Contents
- List of Contributors
- 1 Introduction
- 2 Mechanistic basis for the therapeutic effectiveness of botulinum toxin A on over-active cholinergic nerves
- 3 Botulinum toxin: from menace to medicine
- 4 Botulinum toxin: primary and secondary resistance
- 5 Introduction to botulinum toxin in clinical practice
- 6 Cervical dystonia
- 7 The use of botulinum toxin in otolaryngology
- 8 Spasticity
- 9 Hyperhidrosis
- 10 Hypersalivation
- 11 Botulinum toxin type A for the prophylactic treatment of primary headache disorders
- 12 Botulinum toxin in the management of back and neck pain
- 13 Clinical uses of botulinum toxin
- 14 Bladder and bowel indications
- 15 Cosmetic uses of botulinum toxin A
- 16 Other clinical neurological uses of botulinum toxin
- Index
- Plate section
- References
Summary
Ophthalmological uses
Introduction
Botulinum toxin targets the cholinergic neuromuscular complex with exquisite precision producing dose dependent muscle weakness. The concept of using this property therapeutically was an ingenious and bold one, and it came from a thoughtful and innovative ophthalmologist over 30 years ago. Working at the time on extraocular muscle electromyography (EMG) Alan Scott of the Smith Kettlewell Eye Research Foundation was exploring the treatment potential of the ability to locate a needle tip at or near the motor point of extraocular muscles. Using an EMG guided injection technique could enable focal delivery of a drug – for example local anaesthetic – to modify muscle function. The ideal drug would need to remain localized at the injection point and have an effect on muscle function only, without inducing inflammation or scarring, either temporarily enhancing or more probably reducing function, over a predictable time frame. Full recovery of extraocular muscle function would be necessary to restore normal eye movement. During the period of induced muscle underactivity it was hypothesized that the balance between two opposing extraocular muscles (agonist: antagonist balance) would be altered in such a way that a permanent change in the relative position of the two eyes would be achieved after the effect of the drug had worn off. This created the possibility of treating misalignment of the eyes (strabismus or squint) by non-surgical means.
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- Information
- Clinical Uses of Botulinum Toxins , pp. 262 - 281Publisher: Cambridge University PressPrint publication year: 2007