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Central effects of botulinum toxin type A: Evidence and supposition

✍ Scribed by Antonio Currà; Carlo Trompetto; Giovanni Abbruzzese; Alfredo Berardelli

Publisher
John Wiley and Sons
Year
2004
Tongue
English
Weight
58 KB
Volume
19
Category
Article
ISSN
0885-3185

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✦ Synopsis

No convincing evidence exists that botulinum toxin type A (BT-A) injected intramuscularly at therapeutic doses in humans acts directly on central nervous system (CNS) structures. Nevertheless, several studies, using various approaches, strongly suggest that BT-A affects the functional organization of the CNS indirectly through peripheral mechanisms. By acting at alpha as well as gamma motor endings, BT-A could alter spindle afferent inflow directed to spinal motoneurons or to the various cortical areas, thereby altering spinal as well as cortical mechanisms. Muscle afferent input is tightly coupled to motor cortical output, so that the afferents from a stretched muscle go to cortical areas where they can excite neurons capable of contracting the same muscle. The BT-A-induced reduction in spindle signals could, therefore, alter the balance between afferent input and motor output, thereby changing cortical excitability.

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