Exploring the role of botulinum toxin in critical care

ABSTRACT

Introduction

Botulinum neurotoxin (BoNT) is one of the most potent and extensively studied neurotoxins with clinical applications across several different medical specialties. This review article explores the latest evidence for therapeutic applications of BoNT in patients receiving critical management in an intensive care unit (ICU).

Areas Covered

The authors did a literature search in PubMed, Google Scholar, and Texas Medical Center Library database for studies describing the use of BoNT in a critical care setting. They extracted information on study design, patient selection, methodology, and results of relevant studies. Based on initial identification of 85 studies and after conducting screening, the authors identified 61 studies to be included in this review. In an ICU setting, BoNT has been used for several neurological and non-neurological indications. However, the supporting evidence is mostly limited to small observational studies.

Expert Opinion

The use of BoNT in this setting is largely underutilized due to paucity of well-designed clinical trials and financial barriers. Further research is needed to provide evidence for the safety and efficacy of BoNT and to optimize the dosing and injection techniques for various conditions encountered in this setting.

KEYWORDS:

• Botulinum toxin
• critical care medicine
• intensive care unit
• Iatrogenic botulism
• botox

Article highlights

• Botulinum neurotoxin (BoNT) is one of the most potent and extensively studied neurotoxins with clinical applications across several different medical specialties.

• The article explores its role in management of conditions like trismus, acute dystonic reactions, vocal cord motility disorders, epilepsia partialis continua, sialorrhea, dysphagia, vocal cord disorders, post-operative atrial fibrillation, sphincter of Odi dysfunction, spinal cord injury, and traumatic or surgical wounds which can all be encountered in a critical care setting.

• The severe adverse events are rare when administered by an experienced practitioner.

• BoNT is under-utilized in acute setting due to lack of well-designed clinical trials, delayed onset of action, and lack of available expertise.

• Further research is needed to provide evidence for its safety and efficacy in this setting.

Acknowledgments

The authors wish to thank Dr. Ibrahim Noorbhai for his useful suggestions.

Declaration of interest

J Jankovic has received research/training funding from AbbVie Inc; Allergan, Inc; Dystonia Coalition; Merz Pharmaceuticals; and Revance Therapeutics, Inc. He has served as a consultant to Aeon BioPharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has been paid an honorarium by Allegan, Ipsen and Merz. In addition they have had unconditional research support from Allergan. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.