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Botulinum Neurotoxin as a Therapeutic Modality in Orthopaedic Surgery: More Than Twenty Years of Experience
Thorsten M. Seyler, MD1; Beth P. Smith, PhD1; David R. Marker, BS2; Jianjun Ma, MD, PhD1; Jian Shen, MD, PhD1; Tom L. Smith, PhD1; Michael A. Mont, MD2; Kat Kolaski, MD1; L. Andrew Koman, MD1
1 Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070. E-mail address for B.P. Smith: bpsmith@wfubmc.edu
2 Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401West Belvedere Avenue, Baltimore, MD 21215
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Allergan, Inc. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Allergan, Inc.) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2008 Nov 01;90(Supplement 4):133-145. doi: 10.2106/JBJS.H.00901
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Botulinum neurotoxins are among the most potent toxins found in nature, and are produced by Clostridium botulinum, an anaerobic, gram-positive, spore-forming rod-shaped bacterium1. There are seven known serotypes of botulinum neurotoxins (termed A, B, C1, D, E, F, G) that cleave soluble N-ethyl-maleimide-sensitive factor attachment receptor (SNARE) proteins, preventing effective release of neurotransmitters across specialized synaptic junctions. Blocking SNARE protein function within neuromuscular junctions produces flaccid paralysis, results in anhidrosis within sweat glands, and increases nutritional blood flow in vascular beds. On the basis of these findings, it was hypothesized that controlled injections of botulinum neurotoxins could be used to treat neuromuscular disorders. The benefits of botulinum neurotoxin injections in the treatment of various neurological disorders have captured the attention of physicians from multiple specialties and have contributed to the widespread use of botulinum neurotoxins in modern medicine2.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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