참크리닉의 이규래선생님이 올리신글입니다. I. General Introduction 1. History * Botulinum toxin type A as a therapeutic agent to treat human disease in the late 1960s through the collaboration of Alan B Scott,MD * considered not as an agent of human sickness and disease but as a powerful therapeutic agent to treat symptoms of neurological disorders * In 1989, commercialized under the trade name BOTOX by Allergan Inc. * Approved for use in strabismus and blepharospasm associated with dystonia in patients 12 years of age and above * The alternatives to Face Lift 2. Mode of Action (1) Neuromuscular Transmission a. Action Potential release Ach b. Ach locks in receptors and cause muscle depolarization c. Depolarization leads into muscle contraction (2) Botulism toxin Type A Potent neurotoxins Clostridium botulinum produces 8 distinct toxins, types A through G Botulinum toxin type A is the most potent of the 8 serotypes produced by the anerobic bacterium Clostridium botulinum (3) Action Mechanism of Botox Block of neurotransmission of the motor end plate Toxin mediated paralysis -Internalization - Disulfide reduction & translocation -Inhibition of neuromuscular release by interference with the uptake of cytoplasmic Ach (4) Onset within 3 days 3. Indication Treatment of certain neuromuscular disorders characterized by involuntary muscle contractions or spasms blepharospasm, strabismus over 12 years old migraine and tension headache (phase 2) cervical dystonia, juvenile cerebral palsy (phase 3) hyperfunctional facial lines(cosmetic brow furrows) (phase 3) adult spasticity postroke (phase 2) 4. Contraindication Any individual who has a preexisting autoimmune motor endplate disease such as ALS, multiple sclerosis, or myathenia gravis 6. Precautions 1) Ig G Neutralizing Antibody 2) Pregnancy(?) 7. Complications 1) Upper eyelid ptosis : most common 2) diplopia, dry eye 3) Skin rash 4) localized : pain, swelling, bruising, headaches, numbness, hematoma II. Practical Application 1. Appointment of schedule - supplied sterile in grass vials, each containing 100 units - should be diluted with sterile, nonpreserved saline immediately prior to its injection 2. Marking in surface anatomy - 1 cm above the bony orbital margin - 1.5 cm from external canthus or 1.0 cm from lateral orbital margin 3. Decision of dosing - Crow"s feet : 2.5 U X 4 - Glabella frown lines : 2.5 U X 5 - Forehead wrinkles : 2 U X 10 - Mentalis hyperactivity: 5 U 4. Dilution - should be kept freeze, dried at -4■■■o - Denatured by bubbling or similar violent agitation - Administered within 4 hours after reconstitution - 10 Unit/0.1 cc or 4 Unit/0.1 cc 5. Injection techniques -30 Gauze insulin syringe - Less than 25 units in each muscle is recommended - The risk is increased with the use of more than 300 unit within a month 6. Interaction with Botox - Enhancing : Penicillamine , Amycoglycoside, Quinidine, CCBs(Calcium Channel Blockers) - Reducing : Captopril 7. Follow up - revisit in a week - 24 weeks later & booster - observe the long-term sequele References 1.http://www.allergan.com/protpath/neuro/botox/content/index.htm 2. Garcia A, Fulton JE. Cosmetic denervation of the muscles of facial expression with botulinum toxin. Dermatol Surg 1996;22:39-43. 3. Carruthers JDA, Carruthers JA. Botulinum A exotoxin in clinical ophthalmology. Can J Ophthalmolo 1996; 31: 389-400.