SlideShare a Scribd company logo
1 of 38
Download to read offline
INTRODUCTION TO THE COSMETIC
USES OF DYSPORT
by Dr. Patrick Treacy
Medical Director
Ailesbury Clinic
Dublin Ireland
Dr. Patrick Treacy discusses the origins of Dysport BTX-A
COSMETIC USES OF BOTULINUM-A
TOXIN AS DYSPORT
1. Short history of the development of BTX-A
2. Uses of BTX-A in conventional medicine
3. Mechanism of action of BTX-A at the NMJ
Cosmetic Use of Dysport
1.Horizontal forehead lines
2. Glabellar frown lines
3. Lateral canthal lines
4. Temporal brow lift
5. Upper lips
6. Nasolabial folds
7. Horizontal neck lines
8. Vertical neck lines
Botulinum neurotoxin
Botulinum toxin (BTX) is produced by a gram-positive
anaerobic bacterium Clostridium botulinum,
The clinical syndrome of botulism can occur following
ingestion of contaminated food, from colonisation of
the infant gastrointestinal tract, or from a wound
infection.
Botulinum toxin is broken into 7 neurotoxins
(types A, B, C [C1, C2], D, E, F, and G),
which are antigenically and serologically distinct but
structurally similar.
Human botulism is mainly due to types A, B, E,
and, rarely, F,G. Types C and D cause toxicity only in
animals.
Botulinum Toxin Molecule
The botulinum toxin molecule is
synthesized as a single chain (150 kDa)
It is cleaved to form a dichain molecule
with a disulfide bridge.
The light chain (~50 kDa) acts as a zinc
(Zn2+) endopeptidase similar to tetanus
toxin
The heavy chain (~100 kDa) provides
cholinergic specificity and binding of the
toxin to presynaptic receptors,
19th
Century History of BTX-A toxin
•1822 The German physician and poet Justinus Kerner
published in a medical journal clinical symptoms of
"sausage poison" in about 200 cases of gastroenteritis
in Stuttgart
•1822 Kerner noted the neurological symptoms and
suggested the idea of a possible therapeutic use of
“sausage poison“ in St. Vitus dance
•1870, Muller (German physician) coined the name
botulism for the symptoms. The Latin form is botulus,
which means sausage.
1895, Microbiologist Emile Van Ermengem investigated
three deaths after food poisoning outbreak in Ellezelles
and isolated the bacterium Clostridium botulinum.
New Century 1900
Chemical warfare brought new means of killing people
Ypres April 22nd
1915
5,000 died on the first day and another 5,000 on the second
1916 British chemical warfare complex
7000 acres of scrubland in Porton Down Wiltshire
Dublin 1916
Porton Down Research Centre
Research experiments on Botulinum by Dr. Paul Fides gave
rise to DysPORT
Porton Down is still active today
First victim of experiments
Aircraftman Ronald Madison died in May 1953
Reinhard Heydrich
Assassinated by Czech agents in Prague on 27th
May 1942
1953 US built Fort Detrick
Experiments by Edward Schantz gave rise to Botox
20th
century History of BTX-A toxin
•1944, Edward Schantz cultured Clostridium botulinum
and isolated the toxin (BTX-A) .
•1949, Burgen et al discovered that botulinum toxin
blocks neuromuscular transmission.
.
20th
century History of BTX-A toxin
•1973, Alan B Scott, MD, of Smith-Kettlewell Eye
Research Institute used (BTX-A) in monkey
experiments
•1980, Scott suggested and used BTX-A for the first
time in humans to treat strabismus.
•I989, BTX-A approved by the FDA for treatment of
strabismus, blepharospasm, and hemifacial spasm in
patients aged younger than 12 years.
Late 20th
century History of BTX-A toxin
•1987, Canadian ophthalmologist Jean Carruthers
noted that vertical glabellar creases (frown lines)
disappeared following the use of Botox to treat
patients for blepharospasm. She informed her
dermatologist husband Alastair Carruthers
1990, The Carruthers presented their findings in a
seminal paper entitled ’ The treatment of glabellar
furrows with botulinum A exotoxin’
Carruthers JDA, Carruthers JA. J Dermatol Surg
Oncol. 1990;
THE ROLE OF THE CARRUTHERS
Late 20th
century History of BTX-A toxin
•1991, The Carruthers resented their findings at the
annual meeting of the American Society for
Dermatologic Surgery, Orlando, Florida on March 13-
17, 1991.
•1992 The doctors continued research into the
cosmetic effect of botulism toxin. It was their
article in J Dermatol Surg Oncol.1992;18:17-21
that set the stage for the FDA to finally approve
botulinum toxin A for use in cosmetic medicine.
USE OF DYSPORT COSMETICALLY
PATIENT FIVE DAYS LATER
FDA approved uses of BTX-A
1. Cervical dystonia
2. Blepharospasm
3. Cranial nerve 11 disorders
4. Facial spasm
5. Glabellar frown lines
‘Extralabel’ use of BTX-A
•Focal dystonias - Involuntary, sustained, or spasmodic
patterned muscle activity
•Cervical dystonia (spasmodic torticollis)
•Blepharospasm (eyelid closure)
•Laryngeal dystonia (spasmodic dysphonia)
•Limb dystonia (writer's cramp)
•Oromandibular dystonia
•Orolingual dystonia
•Truncal dystonia
      •Sweating disorders
•Axillary and palmar hyperhidrosis
•Frey syndrome, also known as
auriculotemporal syndrome
‘Extralabel’ use of BTX-A
•Disorders of localized muscle spasms and pain
•Chronic low back pain
•Myofascial pain syndrome
•Temporomandibular joint disorders associated with
increased muscle activity
•Tension headache
•Migraine headache
•Cervicogenic headache
     
A  Smooth muscle hyperactive disorders
• Detrusor-sphincter dyssynergia
• Achalasia cardia
• Hirschsprung disease
• Sphincter of Oddi dysfunctions
• Chronic anal fissures
‘Extralabel’ use of BTX-A
•Spasticity - Velocity-dependent increase in muscle tone
•Stroke
•Traumatic brain injury
•Cerebral palsy
•Multiple sclerosis
•Spinal cord injury
     
A    Achalasia (oesophageal)
Ø Chronic anal fissures
Ø Migraine and tension headaches
Ø Hyperhidrosis
Ø Cerebral Palsy
Ø Low back pain
Ø Myofascial pain syndrome
Ø Tics
Ø Spastic bladder and urinary sphincters
How muscles contract
At a normal neuromuscular
junction, a nerve impulse
triggers the release of
acetylcholine, which
causes the muscles to
contract. Excessive release
of acetylcholine at the
neuromuscular junction
causes overactive
contraction of corrugator
and procerus muscle,
which over time can cause
wrinkles to form.
Mechanism of action of BTX-A
Botulinum toxin acts by binding
presynaptically to high-affinity
recognition sites on the
cholinergic nerve terminals and
decreasing the release of
acetylcholine, causing a
neuromuscular blocking effect.
This mechanism laid the
foundation for the development
of the toxin as a therapeutic
tool.
Dr. Patrick Treacy discusses the origins of Dysport BTX-A
BINDING, INTERNALISATION,
TRANSLOCATION and BLOCKING
•Binding of BTX-A to receptors
on presynaptic cell membrane.
•Internalisation of Receptor/
BTA-X complex as toxin vesicle
by membrane into nerve cell
•Translocation S-S cleaved and
50Ka released to cytoplasm
•Blocking 50Ka chain cleaves
SynNptosome-Associated
Protein (SNAP-25), required for
docking of neurotransmitter-
containing vesicles.
Mechanism of BLOCKING of BTX-A
The 50-kDa light chain of
BTX-A inhibits acetylcholine
release by cleaving SNAP-2
(a cytoplasmic protein)
SNAP-2 is required for the
docking of acetylcholine
vesicles on the inner side of
the nerve terminal plasma
membrane.
How muscles contract
Dr. Patrick Treacy discusses the origins of Dysport BTX-A
Mechanism of unBLOCKING of BTX-A
The clinical effect
of botulinum
toxin injections
lasts 2-6 months
and then resolves
After several months, the
inactivated terminals
slowly recover function,
and the new sprouts
and end plates regress
RESOLUTION of the CLINCIAL EFFECT
of BTX-A
Clinical effect lasts about
2-6 months and then
resolves
Recovery occurs through
proximal axonal sprouting
and muscle reinnervation
by formation of new
neuromuscular junction.
A recent study by De Paiva
suggests that, eventually,
regeneration of the original
neuromuscular junction
takes place.
BOTULINUM-A TOXIN formulations
Dysport ® is another formulation
of BTX-A made in England and
available in Europe.
It is distributed in 500-unit vials
that can be stored at room
temperature
Dysport ® is produced by Speywood Pharmaceuticals in
England (Dysport)
DYSPORT ®
The relative potency of Botox® units
to Dysport ® units is approximately 1:4.
Contraindications to Dysport injections
Treat patients with
diseases of the
neuromuscular junction
(eg, myasthenia gravis)
cautiously because
underlying generalized
weakness can be
exacerbated, and local
weakness at injection sites
can occur more than
otherwise expected
Dr. Patrick Treacy discusses the origins of Dysport BTX-A

More Related Content

Similar to Dr. Patrick Treacy discusses the origins of Dysport BTX-A

Botox:use in facial plastics
Botox:use in facial plasticsBotox:use in facial plastics
Botox:use in facial plasticsKhairallah Aoucar
 
Costridial toxins botulinum toxin
Costridial toxins   botulinum toxinCostridial toxins   botulinum toxin
Costridial toxins botulinum toxinRavi Kant Agrawal
 
Clinical use of botulinum toxins in oral and maxillofacial surgery
Clinical use of botulinum toxins in oral and maxillofacial surgeryClinical use of botulinum toxins in oral and maxillofacial surgery
Clinical use of botulinum toxins in oral and maxillofacial surgeryDrKamini Dadsena
 
Botulinum toxin in ophthalmology
Botulinum toxin in ophthalmologyBotulinum toxin in ophthalmology
Botulinum toxin in ophthalmologySSSIHMS-PG
 
Botulinum toxin in Urology
Botulinum toxin in UrologyBotulinum toxin in Urology
Botulinum toxin in UrologyApollo Hospitals
 
Botulism; Toxicology - February 2017
Botulism; Toxicology - February 2017Botulism; Toxicology - February 2017
Botulism; Toxicology - February 2017Kareem Alnakeeb
 
Botulinum toxin in dermatology ppt
Botulinum toxin in dermatology pptBotulinum toxin in dermatology ppt
Botulinum toxin in dermatology pptDr Daulatram Dhaked
 
Botulinum toxin
Botulinum toxinBotulinum toxin
Botulinum toxininasoto
 
Ernst Von Bergmann
Ernst Von BergmannErnst Von Bergmann
Ernst Von BergmannMarcy Gilman
 
Botulinum toxin in urology2
Botulinum toxin in urology2Botulinum toxin in urology2
Botulinum toxin in urology2anchal8203
 
Clinical use of botulinum toxins in omfs
Clinical use of botulinum toxins in omfsClinical use of botulinum toxins in omfs
Clinical use of botulinum toxins in omfsSanchit Goyal
 

Similar to Dr. Patrick Treacy discusses the origins of Dysport BTX-A (20)

Dysport Lecture London 2004
Dysport Lecture London 2004Dysport Lecture London 2004
Dysport Lecture London 2004
 
The Action of Botox on Migraine
The Action of Botox on Migraine The Action of Botox on Migraine
The Action of Botox on Migraine
 
Botox:use in facial plastics
Botox:use in facial plasticsBotox:use in facial plastics
Botox:use in facial plastics
 
Costridial toxins botulinum toxin
Costridial toxins   botulinum toxinCostridial toxins   botulinum toxin
Costridial toxins botulinum toxin
 
Clinical use of botulinum toxins in oral and maxillofacial surgery
Clinical use of botulinum toxins in oral and maxillofacial surgeryClinical use of botulinum toxins in oral and maxillofacial surgery
Clinical use of botulinum toxins in oral and maxillofacial surgery
 
Neurotoxins in Food
Neurotoxins in FoodNeurotoxins in Food
Neurotoxins in Food
 
Botox1.ppt
Botox1.pptBotox1.ppt
Botox1.ppt
 
Botulinum toxin in ophthalmology
Botulinum toxin in ophthalmologyBotulinum toxin in ophthalmology
Botulinum toxin in ophthalmology
 
Innovation of botox cosmetic
Innovation of botox cosmeticInnovation of botox cosmetic
Innovation of botox cosmetic
 
Botulinum toxin in Urology
Botulinum toxin in UrologyBotulinum toxin in Urology
Botulinum toxin in Urology
 
Botulism; Toxicology - February 2017
Botulism; Toxicology - February 2017Botulism; Toxicology - February 2017
Botulism; Toxicology - February 2017
 
Botulinum toxin in dermatology ppt
Botulinum toxin in dermatology pptBotulinum toxin in dermatology ppt
Botulinum toxin in dermatology ppt
 
Botox
BotoxBotox
Botox
 
Botulinum toxin
Botulinum toxinBotulinum toxin
Botulinum toxin
 
Slides Test
Slides TestSlides Test
Slides Test
 
Ernst Von Bergmann
Ernst Von BergmannErnst Von Bergmann
Ernst Von Bergmann
 
Botulism2
Botulism2Botulism2
Botulism2
 
Botulinum toxin in urology2
Botulinum toxin in urology2Botulinum toxin in urology2
Botulinum toxin in urology2
 
Lecture 01.2014
Lecture 01.2014Lecture 01.2014
Lecture 01.2014
 
Clinical use of botulinum toxins in omfs
Clinical use of botulinum toxins in omfsClinical use of botulinum toxins in omfs
Clinical use of botulinum toxins in omfs
 

More from Dr. Patrick J. Treacy

South African interview with Dr. Patrick Treacy
South African interview with Dr. Patrick TreacySouth African interview with Dr. Patrick Treacy
South African interview with Dr. Patrick TreacyDr. Patrick J. Treacy
 
Using Botox for trigeminal neuralgia
Using Botox for trigeminal neuralgia Using Botox for trigeminal neuralgia
Using Botox for trigeminal neuralgia Dr. Patrick J. Treacy
 
'Facial Disfigurement' by Dr. Patrick Treacy
'Facial Disfigurement' by Dr. Patrick Treacy'Facial Disfigurement' by Dr. Patrick Treacy
'Facial Disfigurement' by Dr. Patrick TreacyDr. Patrick J. Treacy
 
Dr Patrick Treacy treating pulled earlobes
Dr Patrick Treacy treating pulled earlobesDr Patrick Treacy treating pulled earlobes
Dr Patrick Treacy treating pulled earlobesDr. Patrick J. Treacy
 
Dr Patrick Treacy shares some of his most challenging cases. This month he ta...
Dr Patrick Treacy shares some of his most challenging cases. This month he ta...Dr Patrick Treacy shares some of his most challenging cases. This month he ta...
Dr Patrick Treacy shares some of his most challenging cases. This month he ta...Dr. Patrick J. Treacy
 
Dr Patrick Treacy treating Cutaneous Malignant Melanoma
Dr Patrick Treacy treating Cutaneous Malignant MelanomaDr Patrick Treacy treating Cutaneous Malignant Melanoma
Dr Patrick Treacy treating Cutaneous Malignant MelanomaDr. Patrick J. Treacy
 
Dr Patrick Treacy treating cutaneous warts
Dr Patrick Treacy treating cutaneous wartsDr Patrick Treacy treating cutaneous warts
Dr Patrick Treacy treating cutaneous wartsDr. Patrick J. Treacy
 
Dr Patrick Treacy on devices for dealing with post-pregnancy baby weight
Dr Patrick Treacy on devices for  dealing with post-pregnancy baby weightDr Patrick Treacy on devices for  dealing with post-pregnancy baby weight
Dr Patrick Treacy on devices for dealing with post-pregnancy baby weightDr. Patrick J. Treacy
 
Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...
Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...
Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...Dr. Patrick J. Treacy
 
Dr Treacy’s treating facial popular sebaceous hyperplasia
Dr Treacy’s treating facial popular sebaceous hyperplasiaDr Treacy’s treating facial popular sebaceous hyperplasia
Dr Treacy’s treating facial popular sebaceous hyperplasiaDr. Patrick J. Treacy
 
Dr Patrick Treacy discusses dermal filler complications and how to deal with ...
Dr Patrick Treacy discusses dermal filler complications and how to deal with ...Dr Patrick Treacy discusses dermal filler complications and how to deal with ...
Dr Patrick Treacy discusses dermal filler complications and how to deal with ...Dr. Patrick J. Treacy
 
Speakers medical agenda 2015 (patrick)
Speakers medical agenda 2015 (patrick)Speakers medical agenda 2015 (patrick)
Speakers medical agenda 2015 (patrick)Dr. Patrick J. Treacy
 
Dr Treacy's casebook - FUE Hair Transplantation
Dr Treacy's casebook - FUE Hair Transplantation  Dr Treacy's casebook - FUE Hair Transplantation
Dr Treacy's casebook - FUE Hair Transplantation Dr. Patrick J. Treacy
 
‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...
‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...
‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...Dr. Patrick J. Treacy
 
Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma
Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma
Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma Dr. Patrick J. Treacy
 

More from Dr. Patrick J. Treacy (20)

South African interview with Dr. Patrick Treacy
South African interview with Dr. Patrick TreacySouth African interview with Dr. Patrick Treacy
South African interview with Dr. Patrick Treacy
 
Using Botox for trigeminal neuralgia
Using Botox for trigeminal neuralgia Using Botox for trigeminal neuralgia
Using Botox for trigeminal neuralgia
 
The Irishman Behind the Mask
The Irishman Behind the MaskThe Irishman Behind the Mask
The Irishman Behind the Mask
 
'Facial Disfigurement' by Dr. Patrick Treacy
'Facial Disfigurement' by Dr. Patrick Treacy'Facial Disfigurement' by Dr. Patrick Treacy
'Facial Disfigurement' by Dr. Patrick Treacy
 
Dr Patrick Treacy treating pulled earlobes
Dr Patrick Treacy treating pulled earlobesDr Patrick Treacy treating pulled earlobes
Dr Patrick Treacy treating pulled earlobes
 
Dr Patrick Treacy shares some of his most challenging cases. This month he ta...
Dr Patrick Treacy shares some of his most challenging cases. This month he ta...Dr Patrick Treacy shares some of his most challenging cases. This month he ta...
Dr Patrick Treacy shares some of his most challenging cases. This month he ta...
 
Dr Patrick Treacy treating Cutaneous Malignant Melanoma
Dr Patrick Treacy treating Cutaneous Malignant MelanomaDr Patrick Treacy treating Cutaneous Malignant Melanoma
Dr Patrick Treacy treating Cutaneous Malignant Melanoma
 
Dr Patrick Treacy treating cutaneous warts
Dr Patrick Treacy treating cutaneous wartsDr Patrick Treacy treating cutaneous warts
Dr Patrick Treacy treating cutaneous warts
 
Dr Patrick Treacy on devices for dealing with post-pregnancy baby weight
Dr Patrick Treacy on devices for  dealing with post-pregnancy baby weightDr Patrick Treacy on devices for  dealing with post-pregnancy baby weight
Dr Patrick Treacy on devices for dealing with post-pregnancy baby weight
 
Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...
Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...
Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...
 
Dr Treacy’s treating facial popular sebaceous hyperplasia
Dr Treacy’s treating facial popular sebaceous hyperplasiaDr Treacy’s treating facial popular sebaceous hyperplasia
Dr Treacy’s treating facial popular sebaceous hyperplasia
 
Dr Patrick Treacy discusses dermal filler complications and how to deal with ...
Dr Patrick Treacy discusses dermal filler complications and how to deal with ...Dr Patrick Treacy discusses dermal filler complications and how to deal with ...
Dr Patrick Treacy discusses dermal filler complications and how to deal with ...
 
Treating Cutaneous Warts
Treating Cutaneous WartsTreating Cutaneous Warts
Treating Cutaneous Warts
 
Speakers medical agenda 2015 (patrick)
Speakers medical agenda 2015 (patrick)Speakers medical agenda 2015 (patrick)
Speakers medical agenda 2015 (patrick)
 
Behind The Mask
Behind The Mask Behind The Mask
Behind The Mask
 
Dr Treacy's casebook - FUE Hair Transplantation
Dr Treacy's casebook - FUE Hair Transplantation  Dr Treacy's casebook - FUE Hair Transplantation
Dr Treacy's casebook - FUE Hair Transplantation
 
‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...
‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...
‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...
 
Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma
Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma
Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma
 
Dr Treacy's Casebook
Dr Treacy's Casebook Dr Treacy's Casebook
Dr Treacy's Casebook
 
PRIME International Supplement
PRIME International SupplementPRIME International Supplement
PRIME International Supplement
 

Recently uploaded

CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)MedicoseAcademics
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)1922Jaygohel
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthArthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthGokuldas Hospital
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Cure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfCure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfrg0000009
 

Recently uploaded (20)

CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthArthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Cure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfCure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdf
 

Dr. Patrick Treacy discusses the origins of Dysport BTX-A

  • 1. INTRODUCTION TO THE COSMETIC USES OF DYSPORT by Dr. Patrick Treacy Medical Director Ailesbury Clinic Dublin Ireland
  • 3. COSMETIC USES OF BOTULINUM-A TOXIN AS DYSPORT 1. Short history of the development of BTX-A 2. Uses of BTX-A in conventional medicine 3. Mechanism of action of BTX-A at the NMJ
  • 4. Cosmetic Use of Dysport 1.Horizontal forehead lines 2. Glabellar frown lines 3. Lateral canthal lines 4. Temporal brow lift 5. Upper lips 6. Nasolabial folds 7. Horizontal neck lines 8. Vertical neck lines
  • 5. Botulinum neurotoxin Botulinum toxin (BTX) is produced by a gram-positive anaerobic bacterium Clostridium botulinum, The clinical syndrome of botulism can occur following ingestion of contaminated food, from colonisation of the infant gastrointestinal tract, or from a wound infection. Botulinum toxin is broken into 7 neurotoxins (types A, B, C [C1, C2], D, E, F, and G), which are antigenically and serologically distinct but structurally similar. Human botulism is mainly due to types A, B, E, and, rarely, F,G. Types C and D cause toxicity only in animals.
  • 6. Botulinum Toxin Molecule The botulinum toxin molecule is synthesized as a single chain (150 kDa) It is cleaved to form a dichain molecule with a disulfide bridge. The light chain (~50 kDa) acts as a zinc (Zn2+) endopeptidase similar to tetanus toxin The heavy chain (~100 kDa) provides cholinergic specificity and binding of the toxin to presynaptic receptors,
  • 7. 19th Century History of BTX-A toxin •1822 The German physician and poet Justinus Kerner published in a medical journal clinical symptoms of "sausage poison" in about 200 cases of gastroenteritis in Stuttgart •1822 Kerner noted the neurological symptoms and suggested the idea of a possible therapeutic use of “sausage poison“ in St. Vitus dance •1870, Muller (German physician) coined the name botulism for the symptoms. The Latin form is botulus, which means sausage. 1895, Microbiologist Emile Van Ermengem investigated three deaths after food poisoning outbreak in Ellezelles and isolated the bacterium Clostridium botulinum.
  • 8. New Century 1900 Chemical warfare brought new means of killing people
  • 9. Ypres April 22nd 1915 5,000 died on the first day and another 5,000 on the second
  • 10. 1916 British chemical warfare complex 7000 acres of scrubland in Porton Down Wiltshire
  • 12. Porton Down Research Centre Research experiments on Botulinum by Dr. Paul Fides gave rise to DysPORT
  • 13. Porton Down is still active today
  • 14. First victim of experiments Aircraftman Ronald Madison died in May 1953
  • 15. Reinhard Heydrich Assassinated by Czech agents in Prague on 27th May 1942
  • 16. 1953 US built Fort Detrick Experiments by Edward Schantz gave rise to Botox
  • 17. 20th century History of BTX-A toxin •1944, Edward Schantz cultured Clostridium botulinum and isolated the toxin (BTX-A) . •1949, Burgen et al discovered that botulinum toxin blocks neuromuscular transmission. .
  • 18. 20th century History of BTX-A toxin •1973, Alan B Scott, MD, of Smith-Kettlewell Eye Research Institute used (BTX-A) in monkey experiments •1980, Scott suggested and used BTX-A for the first time in humans to treat strabismus. •I989, BTX-A approved by the FDA for treatment of strabismus, blepharospasm, and hemifacial spasm in patients aged younger than 12 years.
  • 19. Late 20th century History of BTX-A toxin •1987, Canadian ophthalmologist Jean Carruthers noted that vertical glabellar creases (frown lines) disappeared following the use of Botox to treat patients for blepharospasm. She informed her dermatologist husband Alastair Carruthers 1990, The Carruthers presented their findings in a seminal paper entitled ’ The treatment of glabellar furrows with botulinum A exotoxin’ Carruthers JDA, Carruthers JA. J Dermatol Surg Oncol. 1990; THE ROLE OF THE CARRUTHERS
  • 20. Late 20th century History of BTX-A toxin •1991, The Carruthers resented their findings at the annual meeting of the American Society for Dermatologic Surgery, Orlando, Florida on March 13- 17, 1991. •1992 The doctors continued research into the cosmetic effect of botulism toxin. It was their article in J Dermatol Surg Oncol.1992;18:17-21 that set the stage for the FDA to finally approve botulinum toxin A for use in cosmetic medicine.
  • 21. USE OF DYSPORT COSMETICALLY
  • 23. FDA approved uses of BTX-A 1. Cervical dystonia 2. Blepharospasm 3. Cranial nerve 11 disorders 4. Facial spasm 5. Glabellar frown lines
  • 24. ‘Extralabel’ use of BTX-A •Focal dystonias - Involuntary, sustained, or spasmodic patterned muscle activity •Cervical dystonia (spasmodic torticollis) •Blepharospasm (eyelid closure) •Laryngeal dystonia (spasmodic dysphonia) •Limb dystonia (writer's cramp) •Oromandibular dystonia •Orolingual dystonia •Truncal dystonia       •Sweating disorders •Axillary and palmar hyperhidrosis •Frey syndrome, also known as auriculotemporal syndrome
  • 25. ‘Extralabel’ use of BTX-A •Disorders of localized muscle spasms and pain •Chronic low back pain •Myofascial pain syndrome •Temporomandibular joint disorders associated with increased muscle activity •Tension headache •Migraine headache •Cervicogenic headache       A  Smooth muscle hyperactive disorders • Detrusor-sphincter dyssynergia • Achalasia cardia • Hirschsprung disease • Sphincter of Oddi dysfunctions • Chronic anal fissures
  • 26. ‘Extralabel’ use of BTX-A •Spasticity - Velocity-dependent increase in muscle tone •Stroke •Traumatic brain injury •Cerebral palsy •Multiple sclerosis •Spinal cord injury       A    Achalasia (oesophageal) Ø Chronic anal fissures Ø Migraine and tension headaches Ø Hyperhidrosis Ø Cerebral Palsy Ø Low back pain Ø Myofascial pain syndrome Ø Tics Ø Spastic bladder and urinary sphincters
  • 27. How muscles contract At a normal neuromuscular junction, a nerve impulse triggers the release of acetylcholine, which causes the muscles to contract. Excessive release of acetylcholine at the neuromuscular junction causes overactive contraction of corrugator and procerus muscle, which over time can cause wrinkles to form.
  • 28. Mechanism of action of BTX-A Botulinum toxin acts by binding presynaptically to high-affinity recognition sites on the cholinergic nerve terminals and decreasing the release of acetylcholine, causing a neuromuscular blocking effect. This mechanism laid the foundation for the development of the toxin as a therapeutic tool.
  • 30. BINDING, INTERNALISATION, TRANSLOCATION and BLOCKING •Binding of BTX-A to receptors on presynaptic cell membrane. •Internalisation of Receptor/ BTA-X complex as toxin vesicle by membrane into nerve cell •Translocation S-S cleaved and 50Ka released to cytoplasm •Blocking 50Ka chain cleaves SynNptosome-Associated Protein (SNAP-25), required for docking of neurotransmitter- containing vesicles.
  • 31. Mechanism of BLOCKING of BTX-A The 50-kDa light chain of BTX-A inhibits acetylcholine release by cleaving SNAP-2 (a cytoplasmic protein) SNAP-2 is required for the docking of acetylcholine vesicles on the inner side of the nerve terminal plasma membrane.
  • 34. Mechanism of unBLOCKING of BTX-A The clinical effect of botulinum toxin injections lasts 2-6 months and then resolves After several months, the inactivated terminals slowly recover function, and the new sprouts and end plates regress
  • 35. RESOLUTION of the CLINCIAL EFFECT of BTX-A Clinical effect lasts about 2-6 months and then resolves Recovery occurs through proximal axonal sprouting and muscle reinnervation by formation of new neuromuscular junction. A recent study by De Paiva suggests that, eventually, regeneration of the original neuromuscular junction takes place.
  • 36. BOTULINUM-A TOXIN formulations Dysport ® is another formulation of BTX-A made in England and available in Europe. It is distributed in 500-unit vials that can be stored at room temperature Dysport ® is produced by Speywood Pharmaceuticals in England (Dysport) DYSPORT ® The relative potency of Botox® units to Dysport ® units is approximately 1:4.
  • 37. Contraindications to Dysport injections Treat patients with diseases of the neuromuscular junction (eg, myasthenia gravis) cautiously because underlying generalized weakness can be exacerbated, and local weakness at injection sites can occur more than otherwise expected