Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Mov Disord. 2013 Nov;28(13):1775-83. doi: 10.1002/mds.25582. Epub 2013 Jul 18.
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.
肉毒毒素（BoNT）是一种乙酰胆碱释放抑制剂和神经肌肉阻滞剂，用于治疗多种神经和医学病症。BoNT 的疗效和安全性取决于对预期目标的准确选择和识别，但也可能由其他因素决定，包括分子从注射部位的被动扩散、物理扩散、通过轴突或血源性运输迁移到远端部位。毒素以梯度依赖的方式从注射部位被动扩散可能也在毒素扩散中起作用。除了各种 BoNT 产品的独特性质外，体积和稀释度也可能影响 BoNT 的局部和全身分布。BoNT 注射的大多数局部和远处并发症被认为是由于毒素的生物活性意外扩散或扩散到相邻和远端肌肉。尽管 BoNT 在过去三十多年中得到了广泛的治疗和美容应用，但关于其分布机制及其对临床结果影响的发表数据却非常有限。本文的主要目的是批判性地回顾现有的实验和临床文献，并将其置于实际背景中。
