The neurologists started to use it in 1985 for the treatment of blepharospasm and then hemifacial spasm which are both movement disorders of the face. Over the last 25 years, the indications of the BoNT-A in neurology has expanded from the treatment of movement disorders (dystonia) to spasticity and then to the treatment of excessive glandular function ( hyperhydrosis, drooling, gustatory sweating). The most recent licensed indications in neurology are the chronic migraines. Botuliunm toxin is more recently used in the treatmnet of neuropathic pain , such as burning pain following Zoster infection, trigeminal neuralgia, pain in neuropathy.

Other specialties have also developed new indications for BoNT-A: Injection of the sphincters such as the lower oesophageal sphincter for achalasia, the upper oesophageal sphincter for dyphagia, the anal sphincter for anal fissure or for anismus. Injections into the masticatory muscles for bruxism. Injections into the detrusor muscle for hyperactive bladder. Injections into the prostate gland for prostatic adenoma are studied.

Botulinum toxin uses in neurology:

Focal Dystonia: Blepharospasm, Cervical dystonia, Jaw and tongue dystonia, Writer’s cramp, Musician’s Cramp, Foot Dystonia, Laryngeal dystonia ( spasmodic dysphonia, dystonic stridor)
Facial nerve pathology: Hemifacial spasm, facial plasy complications (facial asymmetry, synkinesias, induced-ptosis for exposure keratitis)

Other Movement Disorders: Tics, Tremor (Head tremor, Voice tremor, Writing tremor), Parkinsonian foot dystonia, Bruxism,
Masticatory spasm following radiotherapy.
Excessive secretion: axillae sweating, hands sweating, facial sweating, gustatory sweating, Frey’s syndrome, drooling
(Parkinson’s disease), crocodile tears ( after facial palsy).
Post stroke spasticity: arm, hand spasticity, equinovarus foot deformity
Pain: Chronic migraines, neuropathic pain.

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