1 Therapeutic uses of the botulinum toxins
Summary and Key Features
• Botulinum toxins exzymatically affect the SNARE proteins in neural endings
• Botulinum toxins will reduce and prevent the release of substances exocytosed by SNARE proteins
• Reduction of SNARE function may have therapeutic implications for autonomic, sensory and motor parts of the nervous system
• Reduction of acetyl choline neurotransmitter can reduce the hyperfunction of muscles in various dystonias
• Reduction of acetyl choline neurotransmitter can reduce autonomic nervous system hyperfunction such as hyperhidrosis and sialorrhea
• Reduction of SNARE function can also reduce the release of inflammatory mediators such as substance P, CGRP, glutamate and others
• Reduction of inflammatory mediators can have an affect on pain syndromes
• Pain syndromes such as post-herpetic neuralgia, migraine headaches, TMD can be improved with botulinum toxin
• Inflammatory conditions such as rheumatoid arthritis may be improved with intra-articular injections of botulinum toxin
• Bioengineered toxins may allow precise localization and decrease of exocytosed proteins such as hormones
Introduction
The following material will in greater depth describe the use of botulinum toxins for the management of disorders of efferent nerves and muscular hyperfunction; afferent nerves, pain disorders, and inflammatory conditions; autonomic nervous system disorders; and glandular hypersecretion. (See Box 1.1.)