Botulinum neurotoxins clinical

The botulinum neurotoxins and the snake presynaptic PLA2 neurotoxins share three levels of interest (1) they are pathogenic to humans and animals, (2) they contribute to the understanding of the molecular steps of neurotransmission, and (3) their present and future clinical applications. In this chapter, these neurotoxins are considered in terms of mode of action and in relation to their potential use in cell biology and neuroscience research as well as therapeutics in some human neurodisorders. 

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Chemical Abstracts Service Registry Number CAS 93384-43-1. Botulinum toxins comprise a series of seven related protein neurotoxins that prevent fusion of synaptic vesicles with the presynaptic membrane and thus prevent release of acetylcholine. Exposure in a battlefield or terrorist setting would most likely be to inhaled aerosolized toxin. The clinical presentation is that of classical botulism, with descending skeletal muscle weakness (with an intact sensorium) progressing to respiratory paralysis. A toxoid vaccine is available for prophylaxis, and a pentavalent toxoid can be used following exposure its effectiveness wanes rapidly, however, after the end of the clinically asymptomatic latent period. Because treatment is supportive and intensive (involving long-term ventilatory support), the use of botulinum toxin has the potential to overwhelm medical resources especially at forward echelons of care. 

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