Historical aspects of botulinum toxin

In recent years, the molecular mode of action of the neurotoxins produced by different strains of Clostridium botulinum has been successfully elucidated.1,2 Simultaneously, botulinum toxin type A has proved to be effective and safe in the treatment of conditions caused by focal contractions of skeletal muscles, such as strabismus, hemifacial spasm, focal dystonias, spasticity, and some autonomic disorders.3-11 Therapeutic chemodenervation with botulinum toxin was pioneered by Alan B. Scott in 1973 with monkey experiments10 and in 1980 with human applications.11

The first accurate and complete description of the clinical symptoms of food-borne botulism was published between 1817 and 1822 by the German physician and poet Justinus Kerner (1786–1862) (figure 1), who also developed the idea of a possible therapeutic use of botulinum toxin, which he called “sausage poison.” Kerner’s approach to the problems of food poisoning during the period of enlightenment was a scientific one: after describing and categorizing empirical phenomena, he started animal experiments and clinical experiments on himself, developed hypotheses on the pathophysiology of the toxin, suggested measures for prevention and treatment of botulism, and, finally, developed visions and ideas about future perspectives regarding the toxin, including the idea of its therapeutic use. It is fascinating to see his ideas being validated over the last 20 years.