Botulinum toxin: historical perspective and treatment of neurogenic and idiopathic overactive bladder

Daniel Mulligan and Raymond Bologna

Overactive bladder (OAB) affl icts nearly 17% of the population, causing frequent urgent dashes to the bathroom, sometimes with leakage along the way. This causes diffi culties with employment, as well as social and even sexual relationships. The costs of consultations, medications, physiotherapy, surgery, pads, undergarments, cleaners for carpet or furniture, catheters and the treatment of skin and bladder infections has been estimated to be US$32 billion. OAB is not a fatal disease like botulism, but those who suffer from OAB can feel as if their lives have been paralyzed by their bladders. Botulinum toxin can paralyze the bladder in turn, and has emerged as a possible treatment of this epidemic. How botulism was discovered is a testament to early scientist–physicians. The story is fascinating, and how different militaries purifi ed the toxin, a possible weapon of mass destruction, is equally frightening. The medical potential of the toxin was predicted by the very physician who discovered botulism, and the 175 clinical trials currently listed at clinicaltrials.gov attest to the conversion of this substance from killer to healer.