Restoring Motor functions in Spinal cord injury, Hemiplegic Cerebral Palsy, and Stroke by Botulinum toxin-induced Synaptic Competitive-Learning Therapy

Botulinum toxin (BoTx) is well known as a popular drug of choice for spasticity relief [1-3]. Recent research shows that BoTx has synaptic competitive-learning (SCL) restoring properties that act at neuromuscular, spinal cord, and central nervous sensory-motor centers [4-6]. Contemporary research in sensory-motor cognitive systems indicate that in SCI, HCP,and stroke the motor paresis/ paralysis, and spasticity is caused by partial/complete disruption of all SCL mechanisms in the injured and denervated target neuron centers synaptic fields [5-7]. In the intact brain-cord, SCL is naturallyendowed, that controls-regulates all sensory-motor learn-registerrecall-(motor) execute functions, and memory storage functions during development and throughout adult life. SCL consists of an initial redundant numbers of synaptic connections, muscles activitydependent, competition-based selection of appropriate connections and pruning of inappropriate ones. Basic science research shows that BoTx has SCL-restoring properties that act transiently (weeks) at neuromuscular synapses, spinal cord motoneuron pools and the motor cortex [4-7]. Until now BoTx use in motor paralytic disorders is limited to spasticity/overactivity relief in isolated limb muscles and in dyssynergic bladder-sphincters. BoTx administration into spastic/ overactive muscle causes transient blockade of Ach release from the motor axon terminals, and extensive sprouting of the terminals; the paralyzing effect lasting 3-5 months [1-3,8,9]. This paper explains the SCL-restoring properties of BoTx acting at neuromuscular synapses, spinal motoneurons-interneurons and at the cerebral motor cortex [5,10,11] and presents a low-dose, multi-muscles, serial/repeat BoTx treatment protocol designed to prolong the SCL duration in the affected neural centers in the above disorders so as to initiate and promote motor recovery. What is Synaptic Competitive-Learning (SCL)?