Botulinum Toxin: History and Pharmacology

Botulism was originally called “sausage poisoning” because it occurred following the ingestion of poorly prepared blood sausages in Stuttgart. Justinus Kerner first described the clinical features of botulism in 1822. (Ergbuth). In 1895, Van Ermengem isolated the bacillus from the remains of a meal following which members of a musical party developed symptoms and 3 of them died. This occurred in Ellezelle, Belgium (Sakaguchi 1983). The clinical manifestations include gastrointestinal distress, blurred vision, mydriasis, diplopia, ptosis, dysphagia, loss of sweating and progressive flaccid muscle paralysis leading to respiratory failure and death. There are 5 types of botulism: food borne, wound, infant, hidden and inadvertent botulism (Cherrington). Inadvertent botulism follows therapeutic injections of doses of botulinum toxin causing systemic effects. There are rare reports of generalized weakness following injection with 250 to 900 units of Dysport with electromyographic evidence of systemic botulism (Bhatia 1999, Bakheit 1997). All patients recovered completely.