First, it was infamous as a deadly form of food poison. Then, fame came as a temporary remedy for wrinkles. Now, botulinum toxin is considered the \"miracle poison\" and used for an increasing number of medical conditions.

The December issue of Mayo Clinic Health Letter covers how this drug works and its multiple and emerging applications.

Botulinum toxin blocks communication between nerves and muscles. Food poisoning occurs when large quantities are ingested, causing paralysis of the muscles that control breathing.

About 30 years ago, doctors found that injecting small amounts could safely immobilize muscle movements for as long as several months. The Food and Drug Administration has approved botulinum toxin to minimize fine facial wrinkles and to treat involuntary eyelid twitching and muscle contractions associated with crossed eyes. It can offer relief from sweating of the hands, feet and underarms and can help manage painful neck spasms (dystonia).

Other clinical uses include treating muscle conditions associated with cerebral palsy, multiple sclerosis, stroke and Parkinson\'s; and improving swallowing and speaking problems for people with vocal cord disorders.

Newer applications include facial scar healing and treatment for types of impaired bladder control. And the list goes on.

Results are mixed on whether botulinum toxin should have a role in headache management. For now, it isn\'t a first-line therapy for migraine but it may be a consideration for those who haven\'t had success with other treatment.

If you\'re considering a treatment that involves botulinum toxin, check to see that your doctor has considerable experience using the drug. Also check with your insurance company about coverage. The injections are costly and may not be covered.

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