David Simpson from Mount Sinai Hospital: Botulinum Toxin Past, Present, Future

The history of botulinum toxins dates back hundreds of years. What it can mean for the future of medicine and what conditions it can help in the future remains to be seen.

When the American Academy of Neurology held its annual meeting in Vancouver, David M. Simpson, MD, of Mount Sinai Hospital, discussed the Academy's recommendations on botulinum toxin, as well as the history of the toxin and where current research might further progress its use.

As an example, Simpson noted that currently botulinum is injected as a treatment for various conditions: in migraine headache, the injections are in the face and the head; around the neck area to treat cervical dystonia; around the eyelids to treat blepharospasm; and in the limbs to treat spasticity.

Simpson said studies are currently investigating how doses higher than FDA-approved levels perform, and with shorter duration between injections. He also said studies and trials are exploring botulinum toxin as a potential to treat focal dystonia, writer’s cramp, and urological conditions.

“Future research could include more diseases to treat,” Simpson said, adding that the use of botulinum has expanded since initial research by ophthalmologists in the 1970s, and goes beyond today’s name-brand recognition for Botox botulinum toxin for cosmetic dermatology."

Simpson said that as a toxin, botulinum and botulism goes back hundreds of years, with a poison linked to poorly produced foods. Eventually in the 20th-century there was a discovery of its potential as a treatment. “Fast forward, from then to now ‑‑ no one could predict how it is being used,” he said.

While there are known benefits to using this as a treatment option, Simpson said doctors and patients also need to be aware of other factors as well. “There are still safety concerns, like any drug; there is efficacy and toxicity.”