Botulinum toxin is a protein produced by a bacterium called Clostridium botulinum. It works by preventing the release of a molecule called acetylcholine, which carries the signal for muscle contraction, at the neuromuscular junction. By interrupting the transmission from the nerve to the muscle, it temporarily weakens the injected muscles. This toxin, secreted by the bacterium Clostridium botulinum, has been used in the treatment of various diseases since 1980. When used in the correct doses, it is an effective and safe medication.

Both type A and type B botulinum toxins are used in treatment. In Turkey, there are two drugs that contain type A botulinum toxin, and they can be obtained from hospital pharmacies. Botulinum toxin is transported to the clinic with a cold chain and can be stored in the inner part of a refrigerator. These medications are in the form of vials and are diluted with a certain amount of sterile saline solution (0.9% NaCl) before use. Once diluted, they should be consumed within 24 hours.

Botulinum toxin should be applied to the muscles or glands associated with the disease by trained and experienced physicians in the correct doses and forms. Performing the injections with the guidance of electromyography (EMG) examination in specific body areas increases the success rate. When applied to the appropriate areas in the right doses, it is safe and effective. The medication takes about two weeks to show full effect and then gradually decreases. A recovery rate of 50-90% can be expected for at least 2-3 months. Since the effect is temporary, Botulinum Toxin injections need to be repeated approximately every 3-6 months. There should be at least a 3-month interval between injections to prevent the body from rejecting the treatment.

Firstly, it was used by ophthalmologists for the treatment of strabismus. Later, neurologists started using Botulinum toxin in patients with movement disorders characterized by excessive muscle contractions, such as dystonia.

1. Dystonia is a condition characterized by involuntary muscle contractions or muscle spasms that can cause twisting and jerky movements or unusual body postures.

• • Cervical dystonia (torticollis): Involuntary muscle contractions in the neck that cause abnormal head or twisting.
  • Blepharospasm: Spasms that cause excessive blinking or involuntary eyelid closure.
  • Oromandibular dystonia: Abnormal movements in the jaw and mouth that can hinder speech and eating.
  • Laryngeal dystonia (spasmodic dysphonia): Spasms of the vocal cords.
  • Hand or arm dystonia, such as writer’s cramp.

2. Hemifacial spasm: Muscle spasms that occur around the eyes or half of the face.
3. Spasticity is a condition characterized by the excessive activation and inability of specific muscles to relax, resulting in severe muscle stiffness and rigidity. It leads to significant limitations in movement. It can occur due to various causes such as cerebral palsy, stroke, spinal cord injury, or multiple sclerosis.
4. Excessive sweating or hyperhidrosis: Excessive sweating in the palms or armpits,
5. Other situations:

• • Tremor in head, hands, or voice
  • Tics
  • Increased salivary secretion (sialorrhea) observed in Parkinson’s patients
  • Chronic migraine headache

Although rare, there are side effects associated with Botulinum toxin treatment, and all of them are temporary. The most common side effect is eyelid drooping in periorbital injections and mild muscle weakness in the vicinity of the injection site, rarely resulting in double vision. Other possible side effects include pain, bruising, or bleeding at the injection site. Botulinum toxin injections should be performed by experienced and trained doctors.