Botox – toxin and treatment

In modern times the majority of drug and treatment discoveries are not happy accidents but carefully planned and researched activities. They follow strict and safe protocols fro development, beginning with adaptive phase 1 studies, and if proving safe and effective, progressing through the various other stages eventually to licensing. For more detail about this have a look at

There are, however, many historical tales of how some drugs and treatments came into use, which were far from planned or predicted. Botox is one example of an unlikely treatment.

Botox derives from botulinum toxin, the toxin responsible for botulism. This was an illness first described accurately in 1820 by Justinus Kerner, with the actual bacteria responsible for the toxin finally being discovered much later (1895) by Emile Van Ermengem and Robert Koch. This was named Clostridium botulinum. In the mid 1900’s it was discovered that the mechanism of action of the toxin on the body is to block release of acetylcholine (a neurotransmitter) from nerve endings.

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Botulism is now rare but potentially life threatening. Symptoms include weakness, tiredness, speaking difficulties and blurred vision, ptosis, and breathing difficulties. It is when the effects of the toxin affect the respiration that the illness can prove fatal. According to the NHS this can occur in 5-10% of cases. The patient’s consciousness is not usually affected. There are three main causes of botulism; the first is food-borne. This can occur where food containing the toxin is consumed and this is most likely with improperly cooked or preserved foods. Infant botulism can be seen in children who are usually less than 1 year old as until this age, they have not developed the defences against it. It is for this reason that food such as honey should not be given to infants under 1 year old. Thirdly wound botulism occurs when a wound is infected by clostridium botulinum. This is most commonly seen among those injecting illegal drugs and when it is injected into muscle rather than a vein.

The treatment of botulism can vary depending on the cause but in general the antitoxins aim is to halt the effects of the toxin and therefore prevent worsening paralysis, as well as providing the patient with support for any body systems which are not functioning correctly, such as helping them to breathe. Usually the paralysis then will gradually improve over weeks or months.

Despite the ill effects of the toxin, it has since been discovered to have many therapeutic uses. The most well known is actually for cosmetic reduction of lines and wrinkles on the face. The toxin paralyses the facial muscles. It can also be used to treat conditions such as; cervical dystonia, lazy eye, chronic migraine, eye twitching, muscle contractures and hyperhidrosis, among others.

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