The History of Botulinum Toxins in Medicine: A Thousand Year Journey

Botulinum toxin is one of the most potent and deadliest substances on earth. Because of its unique mechanism of action at the synaptic junction and the ability to precisely deliver the toxin locally to where it is needed, botulinum toxin has been used as an effective treatment for a plethora of diseases from head to foot, from chronic migraine to ankle spasticity. Unlike systemic drugs, botulinum toxin is delivered by injection to the site of disease. As we will see from the history of botulinum toxin, the ability to deliver the drug locally to minimize the amount of botulinum toxin needed and thereby minimizing systemic exposure has been key to its medical utility. Botulinum toxin was first approved by the US Food and Drug Administration in 1989 for the treatment of blepharospasm and strabismus, but the history starts long before this, with outbreaks of food poisoning in the tenth century. Importantly, the development of botulinum toxins for medical use continues today with the engineering of novel toxins to treat disease.