BOTULINUM TOXIN: INJECTION TECHNIQUES AND TOXIN CHOICES

PRESENTED BY JOHAN SAMANTA, MD | REPORTED BY TISHANA CUNDIFF

Dr. Johan Samanta, MD came to us with his approximately 25 years of experience as an injecting Movement Disorder

Specialist to share on the topic, “Botulinum Toxin: Injection Techniques and Toxin Choices.”

In a brief review of the history of botulinum toxin, he explained that, “botulinum toxins have been around well, honestly, for millennia,... described as far back as the middle ages.” Experimentation with “therapeutic use of botulinum toxins really began with the Cold War” in attempts to develop defenses for a potential attack. Shortly after, during the ‘60s and ‘70s, scientists began research on isolating proteins and toxins to find therapeutic benefits of using a small dose of a purified toxin. In 1978, Dr. Alan Scott, an ophthalmologist, began human trials of what he called “oculinum toxin” for treatment of patients with strabismus (“lazy eye”), hemifacial spasm, and blepharospasm*. Dr. Samanta then shared the slide below and outlined the medical advances that have brought us to the current FDA approved uses of botulinum toxins of Botox ® (Type A) in 1989 for blepharospasm, strabismus, and hemifacial spasm; Myobloc ® (Type B) in 2000 for cervical dystonia; Dysport ® (Type A) in 2009 for cervical dystonia; and Xeomin ® in 2010 for cervical dystonia and blepharospasm.

Dr. Samanta further explained the difference between the medical FDA approvals and “on-label” versus “offlabel” uses based upon the initial research. He gave the example of the decade-long “off-label” use of aspirin to effectively prevent heart attacks although that was not its original indication. Currently, while only two of the four toxins are officially indicated for Blepharospasm, this does