Relevant conflicts of interest/financial disclosures: Nothing to report.
Diffusion, spread, and migration of botulinum toxin
Article first published online: 18 JUL 2013
© 2013 Movement Disorder Society
Volume 28, Issue 13, pages 1775–1783, November 2013
How to Cite
Ramirez-Castaneda, J., Jankovic, J., Comella, C., Dashtipour, K., Fernandez, H. H. and Mari, Z. (2013), Diffusion, spread, and migration of botulinum toxin. Mov. Disord., 28: 1775–1783. doi: 10.1002/mds.25582
Full financial disclosures and author roles may be found in the online version of this article.
- Issue published online: 13 NOV 2013
- Article first published online: 18 JUL 2013
- Manuscript Accepted: 23 MAY 2013
- Manuscript Revised: 17 APR 2013
- Manuscript Received: 8 FEB 2013
- botulinum toxin;
Botulinum toxin (BoNT) is an acetylcholine release inhibitor and a neuromuscular blocking agent used for the treatment of a variety of neurologic and medical conditions. The efficacy and safety of BoNT depends on accurate selection and identification of intended targets but also may be determined by other factors, including physical spread of the molecule from the injection site, passive diffusion, and migration to distal sites via axonal or hematogenous transport. The passive kinetic dispersion of the toxin away from the injection site in a gradient-dependent manner may also play a role in toxin spread. In addition to unique properties of the various BoNT products, volume and dilution may also influence local and systemic distribution of BoNT. Most of the local and remote complications of BoNT injections are thought to be due to unwanted spread or diffusion of the toxin's biologic activity into adjacent and distal muscles. Despite widespread therapeutic and cosmetic use of BoNT over more than three decades, there is a remarkable paucity of published data on the mechanisms of distribution and its effects on clinical outcomes. The primary aim of this article is to critically review the available experimental and clinical literature and place it in the practical context. © 2013 International Parkinson and Movement Disorder Society