Botulism was first described in 1735 as a food-borne illness that occurred after consuming sausage. In the years between 1817 and 1822, Dr. Justinus Kerner began research into deaths of some German citizens following their consumption of sausage. Kerner was a German physician and poet. Because of its association with the ingestion of improperly prepared meats, Kerner referred to the toxin causing the illness as sausage poison and fatty poison.
Following Kerner, research on this food-borne disease continued. A German physician named Müller named the illness botulism in 1870. The term is derived from the Latin word (botulus) for sausage. Emile van Ermengem, in 1897, determined that the botulinum toxin is produced by the Clostridium botulinum bacterium. He also identified the 7 types of botulinum toxin. The toxin was isolated and purified in 1928 by Snipe and Sommer. The mechanism of botulism poisoning was discovered in 1949 by Burgen and colleagues. They discovered that botulism prevents the release of acetylcholine from neurons at neuromuscular junctions. The first investigations of the therapeutic uses for a standardized preparation of botulinum toxin were conducted in the 1960s separately by Scott and Schantz. Scott, of the Smith-Kettlewell Eye Research Institute in San Francisco, conducted research on the effects of botulinum toxin type A on the eye muscles, using monkeys as subjects.
It was Alan Scott who first used small doses of botulinum toxin type A to treat strabismus and blepharspasm. However, he could not obtain regulatory approval alone. In 1988, Allergan, Inc. bought the rights to botulinum toxin type A. Allergan, Inc. named the drug Botox.
After 1980, human research studies to investigate the clinical uses for botulinum toxin were initiated. Botulinum toxin type A (BTX-A) was used on human subjects for the first time in 1980. The toxin was used to treat strabismus. The United States FDA (Food and Drug Administration) approved the use of botulinum toxin type A to treat strabismus and blepharospasm. Botox’s cosmetic effects were soon noted by a number of researchers and physicians. Jean Carruthers and Alastair Carruthers, an ophthalmologist and dermatologist, respectively, were the first to record these effects. Researchers found Botox to be useful in decreasing the appearance of facial wrinkles. The drug was used off-label for this purpose for a number of years. The drug was approved for cosmetic purposes in April 2002. Initially, the drug was approved to improve the appearance of moderate to severe glabellar lines. Glabellar lines are the frown lines that form above the nose between the eyebrows. Botox improves these lines on a temporary basis.
Since its initial approval for the treatment of glabellar lines, Botox has been approved for other purposes. The drug was approved in 2004 for the treatment of hyperhidrosis, which is excessive sweating under the arms. Botox is currently being used to treat a number of other conditions, although the FDA has not approved the drug for these purposes. For example, Botox is being used to treat migraines, backaches, muscle spasms, excessive salivation, some types of incontinence, spastic disorders resulting from central nervous system disorders or injuries, temporomandibular joint dysfunction (TJM), and vocal cord dysfunction due to spasms. There is also some indication that the drug may be useful in improving the appearance of scars if used on a long-term basis. This work is still experimental. Other possible indications for Botox are being researched.