Diffusion, spread, and migration of botulinum toxin

Juan Ramirez-Castaneda, Joseph Jankovic, Cynthia Comella, Khashayar Dashtipour, Hubert H. Fernandez, Zoltan Mari

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


Botulinum toxin (BoNT) is an acetylcholine release inhibitor and a neuromuscular blocking agent used for the treatment of a variety of neurologic and medical conditions. The efficacy and safety of BoNT depends on accurate selection and identification of intended targets but also may be determined by other factors, including physical spread of the molecule from the injection site, passive diffusion, and migration to distal sites via axonal or hematogenous transport. The passive kinetic dispersion of the toxin away from the injection site in a gradient-dependent manner may also play a role in toxin spread. In addition to unique properties of the various BoNT products, volume and dilution may also influence local and systemic distribution of BoNT. Most of the local and remote complications of BoNT injections are thought to be due to unwanted spread or diffusion of the toxin's biologic activity into adjacent and distal muscles. Despite widespread therapeutic and cosmetic use of BoNT over more than three decades, there is a remarkable paucity of published data on the mechanisms of distribution and its effects on clinical outcomes. The primary aim of this article is to critically review the available experimental and clinical literature and place it in the practical context.

Original languageEnglish (US)
Pages (from-to)1775-1783
Number of pages9
JournalMovement disorders : official journal of the Movement Disorder Society
Issue number13
StatePublished - Nov 2013


  • Botulinum toxin
  • Diffusion
  • Dystonia
  • Migration
  • Spread

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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