Editorials

The changed image of botulinum toxin

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7374.1188 (Published 23 November 2002) Cite this as: BMJ 2002;325:1188

Its unlicensed use is increasing dramatically, ahead of robust evidence

  1. V Peter Misra (peter.misra@uclh.org), consultant clinical neurophysiologist
  1. National Hospital for Neurology and Neurosurgery, London WC1N 3BG

    Over the past decade botulinum toxin has had a makeover. Earlier it was known as one of the most potent biological neurotoxins—in botulism it blocks the release of acetylcholine at the neuromuscular junction and can cause fatal muscular paralysis. Today botulinum toxin is widely known as a pharmaceutical agent with multiple uses and has been propelled into the public eye after it was widely reported in the lay press as an antiwrinkle drug for facial cosmetic enhancement. This has established its new image as a glamour drug. Botulinum toxin is reported to be useful in more than 50 conditions, with indications spanning many specialties.1 But the toxin is licensed for only a few specific conditions, based on clear scientific evidence of its efficacy and safety. Some “off licence” indications are substantiated by some evidence, but its efficacy in several other conditions is based on anecdote …

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