Table 1

 Clinical applications of botulinum toxin

Dystonia
* Blepharospasm and lid apraxia
* Oromandibular-facial-lingual dystonia
* Cervical dystonia (torticollis)
* Laryngeal dystonia (spasmodic dysphonia)
* Limb dystonia
* Task specific dystonia (eg, writer’s or other occupational cramps)
* Other focal/segmental dystonias (primary, secondary)
Other involuntary movements
* Hemifacial spasm
* Limb, head, voice, chin tremor
* Palatal myoclonus
* Motor and phonic tics (including coprolalia)
* Nystagmus and oscillopsia
* Myokymia
Inappropriate muscle contractions
* Spasticity (stroke, cerebral palsy, head injury, multiple sclerosis)
* Painful rigidity
* Strabismus
* Bruxism and temporo-mandibular joint syndrome
* Stuttering
* Chronic tension (muscle contraction) headaches
* Lumbosacral strain and back spasms
* Radiculopathy with secondary muscle spasm
* Myofascial pain syndromes
* Achalasia (lower oesophageal sphincter spasm)
* Spasm of the inferior constrictor of the pharynx
* Spasm of the sphincter of Oddi
* Spastic bladder, detrusor sphincter dyssynergia
* Anismus
* Vaginismus
Other applications
* Protective ptosis
* Hyperlachrymation
* Drooling (sialorrhoea)
* Hyperhidrosis
* Gustatory sweating
* Anal fissure
* Constipation
* Obesity (distal stomach)
* Cosmetic (wrinkles, brow furrows, frown lines, “crow’s feet”, platysma lines, facial asymmetry)
* Tennis elbow and other sports injuries