Article

Botulinum neurotoxin is commonly utilized in neurorehabilitation as a
treatment for focal spasticity. Clinical experience has yielded observations of
late motor recovery after intramuscular injection of botulinum neurotoxin, that
are not readily explained by the classical mechanism of action of the neurotoxin
in controlling spasticity.
These findings have triggered speculation regarding a
botulinum neurotoxin mediated effect at the central level after peripheral
intervention. METHODS: A review of current literature reveals evidence of distant
action after peripheral botulinum neurotoxin injection in affected muscles, be it
in other muscles, nerves, spinal cord or the cortex. RESULTS: Plausible
explanations for a centrally mediated late motor recovery after botulinum
neurotoxin injection include: (i) direct action of botulinum neurotoxin at
distant sites in the central nervous system, mediated by retrograde transport of
the neurotoxin into the spinal cord, and (ii) cortical reorganization due to
botulinum neurotoxin-induced decrease in peripheral sensory input at the local
injection site. CONCLUSION: Additional research is required to further elucidate
these hypotheses, as well as providing specific dosing specifications, patient
selection criteria and the interplay with other therapeutic modalities necessary
to promote late motor recovery.

Langue : ANGLAIS