Botulinum toxin treatment over the last 25 years has changed dramatically the prognosis of neurological conditions such as focal dystonia, spasticity, and hyperhidrosis. Botulinum toxin treatment has become the first line treatment for these conditions.

The image of Botulinum toxin ( BoNT-A)  in neurology has been distorted by the cosmetic use of this treatment and the numerous articles in woman’s magazine telling story about how “magic” or “dangerous” it can be. It’s usually of poor medical quality and has given a feeling to the public of Botox as a beauty cream or a poison, very far from what it is: an efficient medical treatment which requires being administered by doctors, specialist nurses or physiotherapists trained in this technique.

The name BOTOX is a brand name for a botulinum toxin type A, commercialised by Allergan. It’s used commonly to name Botulinum toxin type A as Kleenex to name disposable tissues.

There are 3 types of BoNT-A, available in the UK: Botox, Dysport and Xeomin and 1 type of BoNT-B called Neurobloc or Myobloc. The 3 BoNT-A are licensed for Blepharospasm, cervical dystonia and glabellar lines.In addition, BOTOX and Dysport are licensed also for hemifacial spasm and feet and upper arm spasticity ( in conjunction with physiotherapy). BOTOX is also licensed for severe axillae hyperhydrosis and chronic migraines. Neurobloc, the BoNT-B  is licensed for the treatment of cervical dystonia

In matter of fact, over the last 25 years, BoNT-A has been studied and showed its efficacy in all types of focal dystonia in particular writer’s cramp, musician’s cramp, jaw dystonia, laryngeal dystonia and also in palmar hyperhidrosis with publications of the results in scientific journals but the drug companies have chosen to not ask for the license of these indications which represent a “small market” ( small doses, rare conditions)

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