h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Entry: Botulinum Toxin, AKA BoTox, Treatment - A3903095
Author: Friar, the BigDawg, returing from a life of crime with all the spoils - U158503

Botox as cosmetic therapy and as medicine for the treatment of debilitating spacticity.

I'll return to this at some point as, a few years ago, I used to extract and purify botulinal toxins for use in medicine (treatment for blepharospasm of the eye, preparation of anti-toxins for detection of food spoilage)

Worth noting that botulinum toxin is THE most potent poison known to Man (1 microgram is a lethal dose if I recall correctly). During my first few weeks of working with it I used to come home from work with imaginary muscle aches and pains.

Can I suggest you proofread this or run it through a spellchecker. 'Cosmetics' is incorrectly spelt in the first line and there are one or two others I spotted but can't recall.

... also you need to italicise Clostridium botulinum.

they would not conract or contract improperly. > contract

Is 'medical cosmesis' an accepted term, or should it be 'medical cosmetics'? I ask because I notice you've mentioned 'medical cosmesis' at least twice in the Entry.

Just wondered if you might add specific examples to your description of how botulinum toxin can be used to treat spastic conditions. I know it is used in cases of spasmodic dysphonia - as far as I am aware it is injected at 3 month intervals into the vocal folds. It restores vocal fold function.

AM

A bacteria called Clostridium botulinum produces a seven forms of neurotoxin > A bacterium called Clostridium botulinum produces seven forms of neurotoxin

This can happen from poorly canned foods or poorly smokked meats or fish. Tragically, this can also affect infants (but not older children or adults) who ingest tainted honey4. > smoked meats.

Probably worth saying that this happens because the foodstuffs concerned become contaminated with Cl botulinum (e.g. spores enter the honey and develop into the organism. n.b. this form of botulism is known as 'infant botulism'.

Must and have my breakfast now. Only popped into hootoo to see what was going on, and got 'sucked in'

Hi Dr Friar,
This is a very informative piece and obviously well researched. I think it will be quite frightening, however, to the layman/woman; especially the latter, who as we all know are Botox mad at the moment to try to get rid of their ageing effects, lines, etc. I understand that the treatments have to be repeated fairly frequently to maintain their effect.
I have always understood that doctors, especially those in the UK, prefer to keep their more dramatic medical symptom knowledge to themselves as caring professionals. GPs in this country tend to protect their patients from such scary scenarios! Is this not the case in the US?
I have no uses for the toxin myself, but perhaps a few on h2g2 will: The symptoms described are, however, a little disturbing to read.
Otherwise the paper is, as I have said, most informative and learned.

Ron

Just been thinking about this a bit more. I think probably you should expand slightly the early para about Cl. botulinum organism itself, to explain that it is common in the soil and produces spores. This is how it comes to contaminate foodstuffs.

Just Googled 'cosmesis' and discovered that it is an acceptable word. Perhaps you need to add a footnote about this.

"cause" -> caused or cause by -> due to
" mot " -> not

2nd line of (approx) 8th para



concerns:allergy needs a space concerns: allergy

2nd line of approx 9th para



contiune -> continue

from next para


practicle -> practical









brilliant!

Thanks all for the feedback!

The typos I'll try to address sometime today.

As far as the content stuff:

1) Cosmesis is the preffered term, but you're absolutely correct, I'll certainly footnote it. One of those pieces of jargon that you use frequently and forget that it's jargon. . .

2) I had thought that the toxin was the most potent as well, but I don't have any data that specifically SAYS that; I left it out as I did not want to be too grandiose. Still thinking about a mention of it though. . .

3)I will now and forever put C. bot. in italics.

4)Thoug I mention specific examples towards the end, I will make sure that the specific examples of botox use are more clear.

5)Regarding botulism, I didn't want to get too specific here. I wanted to stay a little more on point. Thus I consedered, but ultimately left out the mechansism by which people get exposed to toxin or colonized by C. Bot.. I still think it was the right decision to leave that discussion out. It's a little too specific for this article, but I see what you mean entirely and had thought the same myself.

6)Re: ronbloggs comments about frightening our lay public. Well, yes, this may do that. Yes, yes it might.

"GPs in this country tend to protect their patients from such scary scenarios"

However, the adverse effects I mention in this entry are those that shold be mentioned to any patient recieving the toxin. The scariest adverse effect, death due to respiratory paralysis I made very clear does not really happen. The other effects all happen and to not know them because they might be scary is incredibly irresponible. Patients must be told of the benefits and risks of any procedure and allowed to decide for themselves what to do.

7)I will mention the common nature of C. bot. and its presence in the soil.

8) thank you all for your attention, it really helps. Please, if spelling issues arise, left me know where in the entry they occur.

Friar

Re: ronbloggs comments about frightening our lay public: Well, it is the duty of h2g2 to present balanced arguments, so one has to present the bad with the good.

Ref bot. toxin nbeing the most poisonous substance known, GOTO:

http://jama.ama-assn.org/cgi/content/full/285/8/1059

and read the second para.

... of the Introduction, that is

Good overview.

In the potential uses section, you might like to add that it is sometimes used to treat squinting eyes (strabismus) in adults.

Hi radioactiveBIGALI,
You take the supposed authority of h2g2 too far.
This site only has its own BBC and 'internal' rules and procedures to answer for, or to control its own correspondents. It cannot decide for the whole UK or world's good or bad attitudes or feelings, nor what they should be told generally.
We are (supposedly) free agents outside this site and have more freedom of speech outside it than we do inside.
It doesn't even give medical practitioners the right to decide on all political questions, let alone what appears in these pages.

Ronbloggs

Well, the Entries still have to be balanced. If there are inherent dangers then these need to be pointed out, including the level of these dangers (i.e. not very serious to very serious)

It's nothing to do with 'authority'; it's to do with 'balance'.

P.S.

Friar, It's probably worthhile pointing out that, due to the inherent toxicity of botulinal toxin, batched of 'Botox' are VERY carefully Quality Controlled to ensure a safe dose.

Hello Fiar Got some corrections for you to look at.

"Everyone's heard of Botox by now"
I think you need to lose that opening sentence, because everyone hasn't.

"produces a seven forms of neurotoxin"
There's a stray article there. And I think that sentence ought to begin with 'The' rather than 'A'.

"The effect of this neurotoxin is the prevention of muscle contraction"
That was already explained in the last sentence of the previous section.

"There are obviously muscles in our bodies that we benefit from using"
Well, we benefit from the use of *all* muscles in one way or another. The heart muscle for instance, keeps blood moving around the body. The intestinal muscles keep food moving through the gut. The muscles in our stomach help to churn the food up. The muscles in our jaw help to chew to the food. The muscles in our arms and shoulders bring the food to our mouth. The muscles that control our eyes help us to find the food.

I'd suggest rewriting that part something along the lines of 'We benefit from the use of all our muscles, but some could be thought of as more important than others for our survival from moment to moment'.

"This conditions typically cause"
Either 'This condition' or 'These conditions'.

"Diseases of spasticity are fairly common"
How common, exactly? Perhaps 'suprisingly common' would be a more accurate description?

"Excessive glandular secretions specifcally refers to sweating and drooling. Botulinum toxin injections reduce the release and production of secretions from the parotid and axillary glands (which produce saliva and armipt sweat)"
specifcally
I think it needs to be made more clear that 'Excessive glandular secretions' is being used specifically to this entry, because there can certainly be other instances throughout the body of escessive secretion leading to problems of a personal or physiological nature. Is it only the parotid salivary gland that botulinum affects? Or is the parotid salivary gland the only which over-secretes?

are mot affected - most? not?

"infection to the skin"
'of the skin'

"where the needle was injected"
inserted

contiune - continue

smokked -> smoked.

And unfortunately for us all, the word sp****city is not allowed on h2g2, even when used in a completely clinical context.

The title seems to imply that the entry is mostly about treatment, but the entry as a whole seems to focus more on everything else -- I'd suggest expanding to a bit more detail in the treatment section, possibly including more info about what populations it is used in, how the toxin is administered, how long it lasts, how effective it is, etc.