Botulinumtoxin

Botulinum toxin is deemed to be the strongest poison (toxin) in existence. When treating various types of excess sweating (hyperhidrosis), we use billionths of a gram. There are three commercially available botulinum toxins that have been approved for medical use: Botox®, Dysport® and Neurobloc®. The sweat clinic currently uses Dysport ®because it is cheapest.

 
It started out as food poisoning:

Justinus Kerner, a German poet and scientist, was the first to make a clinical description of botulism in three publications around 1820. Apart from traditional food poisoning, the patients succumbed to symptoms from both the sympathetic and parasympathetic nervous systems. Justinus Kerner writes: ”The flow of tears vanished….the secretions stood still in all openings of the body….there was no saliva….urination was only possible with difficulty, and standing up….there was extreme dehydration of palms of hands and soles of feet." The symptoms of paralysis could in the worst cases affect the respiratory muscles and lead to death. The food that had caused all the patients to fall ill, according to Justinus Kerner, was sausage, called botulus in Latin. Today, we know that all types of food that have been incorrectly preserved can in rare cases lead to the growth of the Clostridiumbotulinum bacterium which produces botulinum toxin.
The most remarkable fact about the botulinum toxin is that the complicated process for the manufacture of pure toxin was financed by the US military with the intention of creating an effective biological weapon. Instead of being used as a weapon of mass destruction, the toxin has been able to be used to treat a number of diseases. We in Uppsala have been involved in developing treatment for hyperhidrosis.

Image 4. Justinus Kerner understood early that the botulinum toxin (“sausage poison”) could be used in the treatment of  a number of conditions. Almost 200 years before the discovery of the new treatment method at the University Hospital, Justinus Kerner predicted that botulinum toxin could be used for hyperhidrosis.

How does botulinum toxin work?
The toxin is absorbed into the outer parts of the nerve endings and prevents the release of neurotransmitters. No nerve stimuli are then able to reach the sweat glands, and the patient stops sweating. The effect of botulinum toxin is temporary and when the nerve endings are repaired after a few months, sweating returns.

Is botulinum toxin dangerous?
Botulinum toxin has few side-effects as medicines go. In Uppsala, we have been using the toxin in the treatment of some muscular cramping disorders since the 1980s and in the treatment of hyperhidrosis since 1996. Thousands of patients have been treated with the toxin at the University Hospital without any serious side-effects. In the treatment of underarm sweat, there are almost no side-effects, although some patients can experience pronounced dryness. In the treatment of hand sweat, some patients experience a temporary weakness in the pincer grip between the thumb and forefinger for a couple of weeks. The side-effect appears when the preparation shifts from the skin into the underlying muscles. The loss of power can make itself felt when opening a jam jar or a milk carton, or when using clothes pegs. It is important not to treat patients who have unusual muscle diseases, or women who are pregnant or breastfeeding.. Even if the treatment with botulinum toxin is relatively safe, those using the preparation must be experienced in its use.