BOTULISM

The discovery that botulism is caused by a toxin produced by an anaerobic organism was made less than 100 years ago by Professor Emile Van Ermengen. Since that time, our understanding of the disease botulism has expanded with a series of newer discoveries and important revelations that only recently have been elucidated. In the past two decades, the clinical electrophysiologic abnormalities of botulism have been described and new clinical forms - infantile botulism and wound botulism in drug abuse patients - have been defined. In addition, we have witnessed one of science's stranger ironies: the toxin of botulism, one of the most lethal poisons, is now being applied therapeutically in some patients with muscle and movement disorders. In this article, I shall attempt to summarize the following topics pertaining to botulism: (1) the clinical forms of botulism, which now include four categories (Table 1); (2) the diagnostic methods with particular attention to the value of clinical electrophysiologic studies in helping to establish the diagnosis of botulism; and (3) the use of botulinum toxin as a therapeutic agent in some muscle and movement disorders.