Mukai Yohei, Kaji Ryuji
Department of Neurology, Tokushima University, Tokushima, Japan.
Brain Nerve. 2011 Jul;63(7):775-84.
Botulinum neurotoxins (BoNTs), produced by the gram-positive anaerobic bacterium Clostridium botulinum, act on motor nerve endings and induce muscle relaxation. BoNT type A and B are used as therapeutic agents. Several preparations of BoNT type A are commercially available; Botox®, Dysport®, and Xeomin® are popular. They differ in the manufacturing method used, for example, BoNT consists of neurotoxin and a complex protein, Botox® and Dysport® contain a complex protein, whereas Xeomin® is free from the protein. However, when applied clinically, there is no significant difference in the efficacy and adverse effects between these BoNT products. Intramuscular BoNT injection is widely recognized as a safe and effective treatment for blepharospasm, hemifacial spasm, cervical dystonia, spasticity, squint, migraine, hyperhidrosis, wrinkles (cosmetic purpose), achalasia, hyperactive bladder, etc. BoNT preparations are used in more than 70 countries. In Japan, BoNT is used to treat blepharospasm, hemifacial spasm, cervical dystonia, and spasticity in addition to being used to treat wrinkles. However, its use is not yet widespread in Japan. This article reviews the structure and characteristics of BoNT, and throws light upon the technique of injecting BoNT.
肉毒杆菌神经毒素（BoNTs）由革兰氏阳性厌氧菌肉毒梭菌产生，作用于运动神经末梢并引起肌肉松弛。A型和B型肉毒杆菌神经毒素用作治疗剂。有几种A型肉毒杆菌神经毒素制剂可供商业使用；保妥适（Botox®）、迪帕德（Dysport®）和泽明（Xeomin®）很受欢迎。它们在使用的制造方法上有所不同，例如，肉毒杆菌神经毒素由神经毒素和一种复合蛋白组成，保妥适（Botox®）和迪帕德（Dysport®）含有一种复合蛋白，而泽明（Xeomin®）不含该蛋白。然而，在临床应用时，这些肉毒杆菌神经毒素产品在疗效和不良反应方面没有显著差异。肌肉注射肉毒杆菌神经毒素被广泛认为是治疗眼睑痉挛、面肌痉挛、颈部肌张力障碍、痉挛、斜视、偏头痛、多汗症、皱纹（美容用途）、贲门失弛缓症、膀胱过度活动症等疾病的安全有效方法。肉毒杆菌神经毒素制剂在70多个国家使用。在日本，肉毒杆菌神经毒素除了用于治疗皱纹外，还用于治疗眼睑痉挛、面肌痉挛、颈部肌张力障碍和痉挛。然而，其在日本的使用尚未广泛普及。本文综述了肉毒杆菌神经毒素的结构和特性，并阐述了肉毒杆菌神经毒素的注射技术。
