Article Text

PDF

Botulinum Toxin for Focal Dystonia
  1. Nigel Hyman
  1. Department of Neurology, Radcliffe Infirmary, Woodstock Road, Oxford; E-mail: nigel.hyman{at}orh.nhs.uk

    Abstract

    It is a truth universally acknowledged that neurology outpatients are stimulating, challenging and varied. It is a truth less universally acknowledged that patients with severe epilepsy continue to have severe epilepsy, advanced Parkinson’s disease patients get worse, and patients with chronic daily headaches are untreatable. In contrast, patients who attend botulinum toxin clinics demonstrably improve with successive treatments. In addition, their complaints are unusual and fascinating – a perfect clinic for the general neurologist!

    WHY DOES BOTULINUM TOXIN WORK SO WELL?

    The primary action of botulinum toxin is to block acetylcholine release at the neuromuscular junction and so produce muscle weakness. However, the therapeutic effect is often greater than predicted, suggesting additional mechanisms. The drug is taken up preferentially by the most active nerve terminals and so the actively contracting muscle fibres are weakened while the strength in other fibres in the same muscle is preserved. Indeed patients commonly notice that

    Statistics from Altmetric.com

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.