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13 - Clinical uses of botulinum toxin

Published online by Cambridge University Press:  02 December 2009

By
John Elston
Edited by
Anthony B. Ward  and
Michael P. Barnes
John Elston
Affiliation:
Oxford Eye Infirmary, Radcliffe Infirmary, Oxford, UK
Anthony B. Ward
Affiliation:
University Hospital of North Staffordshire
Michael P. Barnes
Affiliation:
Hunters Moor Regional Neurological Rehabilitation Centre
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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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Chapter
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Clinical Uses of Botulinum Toxins , pp. 262 - 281
Publisher: Cambridge University Press
Print publication year: 2007

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References

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