Botulinum neurotoxin is produced by Clostridium botulinum, an anaerobic bacterium, and causes paralysis of striated muscles, causing a disease called botulismus, which can be serious enough to lead to death. While this toxin can be taken with food, it can colonize especially in the intestines of infants. It may also develop as a result of injuries. When contaminated food is consumed, it enters the systemic circulation via the gastrointestinal tract and binds to cholinergic motor neurons, inhibiting the release of atylcholine. Thus, striated muscles cannot contract, paralysis occurs, and damage to the diaphragm can affect breathing and lead to death.
Botulinum neurotoxin has been used for treatment purposes for more than 20 years. It is used in neurological, otolaryngological, ophthalmological, urological gastrointestinal diseases, cosmetic purposes and pain treatment.
It is used in the treatment of hyperkinetic, that is, movement disorders that occur with increased muscle contractions than normal, among neurological diseases. These diseases are cervical dystonia, oromandibular dystonia, blepharospasm, hemifacial spasm, dystonic and spastic contractions of arms and legs, laryngeal (larynx) dystonias, tremors, myoclonus and tic disorders.
After botulinum toxin is injected into the muscle, the nerve It prevents the release of a substance called acetylcholine to the neuromuscular junction by being taken to its terminal via endocytosis. If this substance is not released to the neuromuscular junction, the muscle cannot contract and a kind of paralysis occurs. This plays a therapeutic role for a muscle that already has abnormal contractions. The effect of the drug becomes effective within 1-2 weeks, the abnormal, involuntary contraction of the muscles decreases, disappears and returns to normal. The effect of botulinum toxin lasts for 3-6 months, it is not permanent, the injection must be repeated when the drug is ineffective and involuntary contractions start again.
Cervical Dystonia:
Cervical dystonia is one of the most common primary dystonias. It often begins in adulthood and can also be seen in childhood. There are involuntary contractions in the neck muscles, causing disorder in head and neck posture, often accompanied by pain, and tremors may also occur in the head. Head torticollis8 Turned to the side), laterocollis (turned towards the shoulder), anterocollis (leaning forward) or retrocollis (arched Oromandibular dystonia (OMD) is one of the focal dystonias. It affects the facial, chewing and tongue muscles. The mandibular component of OMD may cause repetitive jaw opening, closing, and shifting. These movements may cause involuntary tongue, cheek and lip biting, difficulty in speaking and chewing. It causes very significant problems in social life and quality of life.
BLEPHAROSPASM AND HEMIFACIAL SPASM
Blepharospasm is characterized by increased contractions that cause the eyelids to close, it affects both eyes together, sometimes it starts unilaterally.
While usually only the muscles around the eyes are affected, rarely the eyebrows, lips, chewing, tongue, pharynx and larynx muscles may also be affected. Initially, there is increased blinking and eye discomfort against bright light. There is depression, anxiety, social isolation, and 12% of cases can be considered blind. In most cases, there is no obvious cause.
Hemifacial spasm is characterized by irregular, repetitive, involuntary tonic-clonic muscle contractions in one half of the face. It is seen in adults, affects vision by causing eye closure, and reduces the quality of life by affecting the person socially.
It is thought to be due to the compression of the arteries, especially the anterior inferior cerebellar artery or posterior inferior cerebellar artery, in the exit zone of the facial nerve in the brainstem. Acoustic neuroma, facial nerve neuroma and adenoid cystic tumors may also cause it.
FOCAL ARM AND LEG DYstonia
Writer's cramp is the most common form. It has been known since the 18th century. While doing work with the hand, there is a contraction in the internal and forward flexor muscles, and this contraction does not allow the work to be done.
Contractions seen in the foot are rarer and can be seen as a complication of l-dopa treatment in the early or late stages of Parkinson's disease.
>OTHER MOVEMENT DISORDERS
It may be effective in tremor (tremor), especially in hands, arms and head tremors. It is effective in idiopathic, Parkinson's or cerebellar tremor. It is also effective in jaw and voice tremor and plate tremor. Rigid akinetics should also be used in Parkinson's patients, in contractions that cause a fist position in the hands.
In the treatment of vocal and motor tics, myoclonus and It is also effective in stiff-person patients.
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