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Related Concept Videos

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin01:26

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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
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Skeletal Muscle Relaxants: Therapeutic Uses01:31

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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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Depolarizing Blockers: Mechanism of Action01:28

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Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
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Depolarizing Blockers: Pharmocokinetics01:19

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Classification of Skeletal Muscle Relaxants01:28

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Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
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Skeletal muscle relaxants can target the central nervous system [CNS] to reduce muscle tension or act directly at the neuromuscular junction to induce temporary paralysis. These two classes of muscle relaxants are called centrally acting muscle relaxants and peripherally acting muscle relaxants. They differ in their action, mechanism, administration route, and clinical uses.
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Updated: Jun 23, 2025

Targeting Neuronal Fiber Tracts for Deep Brain Stimulation Therapy Using Interactive, Patient-Specific Models
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Botulinum Toxin and Deep Brain Stimulation in Dystonia.

Julia Carvalhinho Carlos de Souza1, Ananda Carolina Moraes Falcone1, Renata Montes Garcia Barbosa1

  • 1Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil.

Toxins
|June 26, 2024
PubMed
Summary

Deep Brain Stimulation (DBS) significantly reduces the need for Botulinum Toxin (BoNT) treatments in dystonia patients. This study shows a notable decrease in BoNT dosage after DBS surgery, improving patient management.

Keywords:
Deep Brain Stimulationabobotulinum toxinAbotulinum toxindystoniaonabotulinum toxinA

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Area of Science:

  • Neurology
  • Neurosurgery

Background:

  • Deep Brain Stimulation (DBS) is an FDA-approved treatment for dystonia since 2003.
  • DBS is recommended for dystonia unresponsive to treatments like botulinum toxin (BoNT).
  • Long-term studies confirm DBS efficacy in improving motor function and quality of life.

Purpose of the Study:

  • To evaluate the impact of DBS surgery on botulinum toxin (BoNT) dosage in dystonia patients.
  • To determine if DBS reduces the overall BoNT treatment burden.

Main Methods:

  • Retrospective multicenter chart-review of 23 dystonia patients.
  • Analysis of botulinum toxin (BoNT) total dosage and per-muscle dosage before and after DBS surgery.

Main Results:

  • A significant reduction in the median total dose of BoNT was observed post-DBS surgery (from 800 to 700 units).
  • This reduction represents a 12.5% decrease in median BoNT dosage.
  • Mean BoNT dosage differences between baseline and post-surgery were consistent across follow-up periods.

Conclusions:

  • DBS surgery leads to a significant reduction in botulinum toxin (BoNT) doses for generalized dystonia patients.
  • The findings suggest a decreased reliance on BoNT following successful DBS implantation.