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9 - Spasticity and botulinum toxin

Published online by Cambridge University Press:  22 August 2009

By
Michael P. Barnes  and
Elizabeth C. Davis
Edited by
Michael P. Barnes  and
Garth R. Johnson
Michael P. Barnes
Affiliation:
Professor of Neurological Rehabilitation Walkergate Park International Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
Elizabeth C. Davis
Affiliation:
Consultant in Rehabilitation Medicine Walkergate Park International Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
Michael P. Barnes
Affiliation:
University of Newcastle upon Tyne
Garth R. Johnson
Affiliation:
University of Newcastle upon Tyne
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Summary

Introduction

Botulinum toxin (BoNT) is the most potent neurotoxin known, and its clinical effects have been recognized since the end of the nineteenth century. The toxin is produced by the gram-negative anaerobic bacterium Clostridium botulinum and ingestion can produce botulism, a rare and often fatal paralytic illness.

The paralytic effect of the toxin is due to blockade of neuromuscular transmission (Burgen et al., 1949). Injection of BoNT into a muscle causes irreversible chemodenervation and local paralysis. It was this discovery that led to the development of the toxin as a therapeutic tool. It is now used clinically for a wide range of conditions (Jankovic, 1994).

There has been burgeoning interest in the medical use of BoNT, particularly since its efficacy and safety have been demonstrated. Its use in the management of spasticity is now well established. This chapter reviews its mode of action and current therapeutic use in spasticity.

Clinical pharmacology

There are seven immunologically distinct serotypes of botulinum toxin (labelled A to G); there are two types in routine clinical use – BoNT type A (BoNT-A) and BoNT type B (BoNT-B). Most of the studies with regard to botulinum and spasticity have been conducted using type A toxin, but type B toxin is in commercial use and is also used in the management of spasticity.

Keywords

botulinum toxindysportdystoniamovement disordersspasticityphysiotherapy
Type
Chapter
Information
Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
 , pp. 165 - 180
Publisher: Cambridge University Press
Print publication year: 2008

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References

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  • Spasticity and botulinum toxin
    • By Michael P. Barnes, Professor of Neurological Rehabilitation Walkergate Park International Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK, Elizabeth C. Davis, Consultant in Rehabilitation Medicine Walkergate Park International Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.010
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  • Spasticity and botulinum toxin
    • By Michael P. Barnes, Professor of Neurological Rehabilitation Walkergate Park International Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK, Elizabeth C. Davis, Consultant in Rehabilitation Medicine Walkergate Park International Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.010
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  • Spasticity and botulinum toxin
    • By Michael P. Barnes, Professor of Neurological Rehabilitation Walkergate Park International Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK, Elizabeth C. Davis, Consultant in Rehabilitation Medicine Walkergate Park International Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.010
Available formats
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