Botox or Botulinum toxin is a potent poison that inhibits the signal transmission at the neuromuscular junction. Thus the release of the neurotransmitter acetylcholine is prevented. Result is an application for a restriction in the face of the mimic muscles. This existing wrinkles are removed by muscle relaxation.
Especially in the past there was often a dreaded severe poisoning from the toxin that was often acquired by eating spoiled food. In this context one also speaks of botulism (first described Justinus Kerner 1817). If no treatment was carried out, was a poisoning (intoxication) have a respiratory paralysis leading to death.
Today, Botox can be used for therapy in modern medicine. In addition to the treatment of neurological diseases, it is particularly used in aesthetic medicine. Especially in the wrinkle treatment it is paralyzed by hyperactive facial muscles widely used.
Botulinum toxin is a polypeptide zweikettiges and can be serologically divided into seven distinct subgroups, types A - G,. The various sub-groups differ in their duration of action and potency, and provide the type A, the strongest and longest duration of effect.
Mechanism of action of Botox
Botulinum toxin acts at the neuromuscular junction, inhibiting the release of a messenger here (Acethylcholin). This leads to paralysis of the muscles and thus to the corresponding relaxation of the muscle as a result, the overlying skin is smooth and relaxed.
The inclusion of the neurotoxin into the nerve cell is through a receptor endocytosis. The result is an endosome, inside which the neurotoxin changes its conformity. In this acidic environment is the cleavage of the disulfide bridge and the light chain of botulinum toxin acts as zinkabhängige endopeptidase with proteolytic activity. It splits in the cytosol a protein of the SNARE complex (soluble N-ethylmaleimide-sensitive factor
attachment receptor), which is responsible for the exocytosis of Acethylcholinvesikel. The SNARE complex is a fusion complex composed of three proteins:
1) the synaptobrevin
2) the SNAP 25
3) the syntaxin
Inactivation of only one protein leads to inoperability of the SNARE complex. The excitation transfer is barred by that so that it results in a flaccid paralysis of striated muscle and has the smooth muscle atony a result. Ten to twelve weeks after an injection is the formation of new SNARE complexes.
Duration of action
The first effect occurs earlier than 24-48 hours after injection. After about two weeks then the maximum effect is achieved. After formation of the SNARE complex can be the effect gradually decreases. Thus, the effect of approximately 3 months. However, there are certain variations in the duration of action.
Preparations and dosage
On the German market, the botulinum toxin A is marketed under various trade names:
Botox ®
Vistabel ®
Dysport ®
Azzalure ®
Xeomin ®
Bocouture ®
Regarding the dosage of the drugs individually, make sure that the biological activity of the serotype.
Contraindications
- Hypersensitivity to the drug botulinum toxin A or other components
- Myasthenia gravis, Lambert-Eaton syndrome (neuromuscular diseases)
- Allergy to the drug or the additives
- Infections in the treatment area
- Coagulopathy
- Treatment with anticoagulants (eg warfarin, aspirin ....)
- Pregnancy and lactation because of inadequate experience
Excessive expectations of the treatment
Interaction
Certain drugs can affect the action of botulinum toxin. Therefore, the doctor is essential to learn about the use of certain drugs.
These include:
- Drugs such as aminoglycoside antibiotics (gentamicin, spectinomycin, tobramycin, netilmicin, amikacin)
- Muscle relaxants of the tubocurarine type can increase the effect
Side effects
The use of botulinum toxin complications is the rule. It can lead to local pain associated with redness and swelling. Hematoma and infection can occur. You may also paralysis (paresis) of the adjacent muscles. The extent and frequency of adverse effects are very different depending on the location. Unwanted side effects are just as irreversible (reversible) as desired.
Treatment Failure
In the application of botulinum toxin is the possibility of antibody formation, which may lead to therapy failure. Risk factors for antibody production are high dose and low time intervals between treatments or injections. A minimum interval of two months should be followed.
Antidote - Antidote
As an antidote for botulinum toxin a polyvalent botulism antitoxin is available from the horse. Only in the blood circulating toxin can be neutralized.
Off-label use
The medical use of approved finished outside of the approved use in the authorization is known as off-label use.
In aesthetic medicine can mimic facial wrinkles by injecting botulinum toxin A are smoothed. In Germany, only the preparations Bocouture ® and Azzalure ® for the treatment of glabellar lines are allowed.
