J Neurol Neurosurg Psychiatry 75:951-957 doi:10.1136/jnnp.2003.034702
  • Review

Botulinum toxin in clinical practice

  1. J Jankovic
  1. Correspondence to:
 Dr J Jankovic
 Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, Texas 77030, USA;
  • Received 17 December 2003
  • Accepted 25 February 2004
  • Revised 24 February 2004


Botulinum toxin, the most potent biological toxin, has become a powerful therapeutic tool for a growing number of clinical applications. This review draws attention to new findings about the mechanism of action of botulinum toxin and briefly reviews some of its most frequent uses, focusing on evidence based data. Double blind, placebo controlled studies, as well as open label clinical trials, provide evidence that, when appropriate targets and doses are selected, botulinum toxin temporarily ameliorates disorders associated with excessive muscle contraction or autonomic dysfunction. When injected not more often than every three months, the risk of blocking antibodies is slight. Long term experience with this agent suggests that it is an effective and safe treatment not only for approved indications but also for an increasing number of off-label indications.


  • Competing interests: Dr Jankovic has received grants from Allergan Pharmaceuticals, Elan Pharmaceuticals, and Ipsen Ltd.

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