As compared to standard-size injections, Baby Botox lowers the risk of your features appearing to be frozen. Take the forehead, for example: "The risk is that you weaken your frontalis muscle, which causes your eyebrows to drop," Darren Smith, a board-certified plastic surgeon in New York City, tells Allure. "If you're getting micro doses of Botox, that's a lot less likely to happen."
Sedation is not often used because the injection time is so short. A local numbing cream (anesthetic) is used instead. Young children often behave as if no numbing cream was used. This may be due to not fully understanding what is being done and having a fear of "shots." In these cases, gentle holding (restraint) is done to keep the area of the shot still. Two staff members sometimes give the injections at the same time to decrease the time of the session.

In May, hedge fund Appaloosa Management, run by David Tepper, received antitrust clearance from the Federal Trade Commission to potentially increase its stake in the Botox-maker. This means that Appaloosa now has more flexibility to push for further changes at Allergan. It remains to be seen if that happens, but if so, it could mean more changes are ahead for the drugmaker.
Forehead – The horizontal lines and furrows on your forehead will not magically disappear. Which is why you should consider getting a Botox injection before they start to set in permanently. These lines will become more excessive with age, and will age to your appearance.Over time by repeatedly injecting these lines the deeply etched lines will become progressively improved
I always tell my patients that you get what you pay for. However, you need to advocate for yourself and understand what you are getting for your dollars. Ensure that your injector is experienced and properly trained; that you are getting FDA approved Botox Cosmetic from Allergan; and know how many units you receive. As well, a physician's office should maintain a medical record of your treatments so you can optimize and customize your Botox to achieve the best effect and value. Good Luck!

Migraine is not a synonym for just a really bad headache, Galli says, which is one of the biggest misconceptions of this disease. It’s a full-body experience that affects your daily life. Being able to break that stigma and, instead, making migraine a synonym of the “this huge debilitating monster of a disease” is one way to change that. Knowledge is a powerful tool for migraine management. The American Migraine Foundation maintains a comprehensive resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists. Visit AMF’s website to learn more and to find a headache doctor near you.
Other than that, there don’t seem to be any specific groups of people or health conditions that are contraindicated for Botox injections. As with all treatments, general health guidelines apply. People with a healthy body-mass index who are non-smokers, moderate or non-drinkers, and physically active will nearly always tolerate any type of medical treatment well.
There’s a wide variety of factors that influence the total cost: the number of units required to effectively limit facial movement in the forehead, the areas in the upper face you wish to treat, the experience level of your injector, and finally, the location of the clinic where you undergo the procedure. Botox is usually charged per unit, with a unit priced from $10 to $20. The final price can also be determined per area treated, with the forehead and frown lines charged as two seperate areas.
Since then, several randomized control trials have shown botulinum toxin type A to improve headache symptoms and quality of life when used prophylactically for patients with chronic migraine[88] who exhibit headache characteristics consistent with: pressure perceived from outside source, shorter total duration of chronic migraines (<30 years), "detoxification" of patients with coexisting chronic daily headache due to medication overuse, and no current history of other preventive headache medications.[89]
According to Ravitz, it's very effective among a large sampling of her patients and is usually very well tolerated. She says some of her patients find that it even eliminates the need for medication, which is a huge deal. However, she also says, "About 7 to 10 percent of my patients find that it’s not effective and they actually feel worse during that time." As with any medical procedure, everybody (and everyone's actual body) is different and will respond to treatment differently, and it's best to do a healthy amount of research and thoroughly talk to your doctor about your body and medical history before making a decision.

I’ve had migraine since I was 5 and have learned a lot over the years about how to manage it. I’m aware of the foods that trigger my migraine attacks, and I try to eat consistently and drink a lot of water. My children and I eat as healthy as possible throughout the day to keep energy up, knowing skipped meals are a trigger for both tantrums and migraine attacks. Staying on a schedule allows my body to stay stable and helps me identify triggers. The same goes for my children. Maintaining their energy and providing them with good food and water prevents them from getting “hangry” later. We all want to avoid a food meltdown. I know that I am triggered by weather, hormones, stress, diet, hydration, light, sound, heat, sleep and more. I try to be prepared for as many of these situations as I can, but some are easier to avoid than others. If you’re unaware of your triggers, keep a log. There are migraine apps that can help you track your symptoms and identify what’s causing your attacks. Finding patterns in how you react may help with identifying effective medications or alternative treatments.


I’ve had migraine since I was 5 and have learned a lot over the years about how to manage it. I’m aware of the foods that trigger my migraine attacks, and I try to eat consistently and drink a lot of water. My children and I eat as healthy as possible throughout the day to keep energy up, knowing skipped meals are a trigger for both tantrums and migraine attacks. Staying on a schedule allows my body to stay stable and helps me identify triggers. The same goes for my children. Maintaining their energy and providing them with good food and water prevents them from getting “hangry” later. We all want to avoid a food meltdown. I know that I am triggered by weather, hormones, stress, diet, hydration, light, sound, heat, sleep and more. I try to be prepared for as many of these situations as I can, but some are easier to avoid than others. If you’re unaware of your triggers, keep a log. There are migraine apps that can help you track your symptoms and identify what’s causing your attacks. Finding patterns in how you react may help with identifying effective medications or alternative treatments.
I had no idea my health insurance could take Botox away from me. I checked Cigna’s policy and found out that in order to continue receiving Botox coverage after one year, I need to get at least seven fewer migraine days — or at least 100 fewer migraine hours — per month compared to pre-Botox treatments. (I keep a diary to record when I have migraines.) Worse still, if I were to change my job — and therefore change my health insurance — my new insurance could ask me to run through the cheap medication gauntlet again before covering Botox.
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The procerus is a small triangular-shaped muscle that intermingles with the inferior aspect of the frontalis muscle. The muscle runs from the aponeurotic fascia on the nasal bones and inserts into the skin of the inferior forehead. The medial portion of the eyebrow and the skin of the lower forehead are drawn down by the procerus muscle, producing transverse wrinkle lines over the bridge of the nose.

Bronchitis was reported more frequently as an adverse reaction in patients treated for upper limb spasticity with BOTOX® (3% at 251 Units to 360 Units total dose) compared to placebo (1%). In patients with reduced lung function treated for upper limb spasticity, upper respiratory tract infections were also reported more frequently as adverse reactions in patients treated with BOTOX® (11% at 360 Units total dose; 8% at 240 Units total dose) compared to placebo (6%). In adult patients treated for lower limb spasticity, upper respiratory tract infections were reported more frequently as an adverse event in patients treated with BOTOX® (2% at 300 Units to 400 Units total dose), compared to placebo (1%).
It is not always clear what is causing chronic migraines. BOTOX is a viable option for treating migraines, and it may be the most effective treatment for you. Migraines lead to extreme pain that impacts every aspect of life, from personal to professional. Migraines are debilitating and for some who suffer from the condition, bedrest is the only option. A BOTOX treatment for migraines is a simple procedure but could vastly improve your quality of life.
"I have treated people with profound migraine headaches and it turns them right off," says Dr. Matarasso. "If you feel it coming on, it stops it, reducing the severity as well as the duration. I had a patient [who was] in college who had unremitting migraine headaches. She changed her diet, she changed her birth-control pill, she had acupuncture. I finally said to the mother, 'We need to try Botox,' and it has been a complete life-changing event for this woman."
Still, there have been enough concerns that the FDA instituted a REMS (Risk Evaluation and Mitigation Strategy) requirement for all botulinum toxin preparations that specifically addresses the issues of distant spread of the toxin and the risk of problems, leading to death, from swallowing or breathing issues in certain patients who may be susceptible after botulinum toxin treatment. All products, including Dysport, Myobloc, Xeomin, and Botox, are monitored via this strategy. This is specifically aimed at a certain population of patients receiving more than the usual doses of botulinum toxin and not aimed at the casual user of Botox, per se.
One glaring example took place over the weekend, when someone on Twitter (TWTR) posted a photograph of an injured police officer, with a caption that he’d been “brutalized” by the migrant caravan on its way to the United States. “These pictures do not capture police officers who were brutalized by members of the immigrant caravan making its way toward the U.S. in October 2018,” Snopes explained.

Severe side effects are very rare but can happen if the botulinum toxin unexpectedly spreads throughout the body from the site of the shots. This can cause muscle weakness, hoarseness or trouble talking, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing, double vision, blurred vision and drooping eyelids. The breathing and swallowing problems can be life-threatening. If this happens, seek medical attention right away.
The efficacy and safety of BOTOX for the treatment of lower limb spasticity was evaluated in Study 6, a randomized, multi-center, double-blind, placebo-controlled study. Study 6 included 468 post-stroke patients (233 BOTOX and 235 placebo) with ankle spasticity (modified Ashworth Scale ankle score of at least 3) who were at least 3 months post-stroke. A total dose of 300 Units of BOTOX or placebo were injected intramuscularly and divided between the gastrocnemius, soleus, and tibialis posterior, with optional injection into the flexor hallucis longus, flexor digitorum longus, flexor digitorum brevis, extensor hallucis, and rectus femoris (see Table 33) with up to an additional 100 Units (400 Units total dose). The use of electromyographic guidance or nerve stimulation was required to assist in proper muscle localization for injections. Patients were followed for 12 weeks.
In many children, there are a few muscle groups that can have very active spasticity. A more focal approach to these muscles would be better than a widespread approach. In this case a doctor may advise a nerve block to interrupt the signal to the muscle that is spastic. Once the signal that is carried to the muscle by the nerve is interrupted, the spasticity will decrease.
According to the PREEMPT paradigm, one injection of 5 units of onabotulinumtoxinA into four sites (total 20 units) into the frontalis muscle is done. The injection points are located by visually drawing a line up from the medial edge of the supraorbital rim. Patients will be injected into the muscle in the upper third of the forehead at least 1 to 2 fingerbreadths above the corrugator injection site. The lateral muscle injection areas are parallel and approximately 1 fingerbreadth lateral to the medial injection site, which is roughly in line with either the midpupillary line or the lateral edge of the cornea, which is the limbus line. In cases in which I am worried about ptosis, I inject the frontalis close to the hairline. In order to reduce the risk of these unwanted effects, injections should be administered in the upper third of the forehead only. The needle should be inserted at a 45° angle superiorly. Because the frontalis is an elevator muscle, weakening can cause brow ptosis or exacerbate preexisting brow ptosis.
I had a consult and the doctor quickly realized that I was a candidate for Botox. He ordered an MRI and doppler of my brain to make sure everything else was A-OK, and then the rest was just waiting on my insurance company. With Botox (I’m not sure if it’s all Botox or just prescription), the insurance company orders it from a pharmacy and sends it to the doctor.
Of 1242 overactive bladder patients in placebo-controlled clinical studies of BOTOX, 41.4% (n=514) were 65 years of age or older, and 14.7% (n=182) were 75 years of age or older. Adverse reactions of UTI and urinary retention were more common in patients 65 years of age or older in both placebo and BOTOX groups compared to younger patients (see Table 18). Otherwise, there were no overall differences in the safety profile following BOTOX treatment between patients aged 65 years and older compared to youn ger patients in these studies.
At Allergan, you will have the opportunity to thrive in a fast-paced, strategic environment where bold thinking isn’t just welcomed, it’s encouraged. Allergan is a bold, global pharmaceutical company and a leader in a new industry model – Growth Pharma. Our world-class team develops, manufactures and commercializes innovative branded pharmaceuticals, devices, biologic and tissue products for patients around the world.

So people told me I looked tired, overlooking the grape-size purple bruise smack dab in the center of my forehead. As one RealSelf reviewer wrote: “My head feels too tight, my eyebrow position has dropped enough to lose my nice pretty arch and my eyelids seem hooded. My eyes look smaller.” Now, if it works, looking a bit tired is a small price to pay for a few more days each month of migraine freedom and function. And bruises can be covered with makeup.
Patients with smaller neck muscle mass and patients who require bilateral injections into the sternocleidomastoid muscle for the treatment of cervical dystonia have been reported to be at greater risk for dysphagia. Limiting the dose injected into the sternocleidomastoid muscle may reduce the occurrence of dysphagia. Injections into the levator scapulae may be associated wit h an increased risk of upper respiratory infection and dysphagia.

Other than that, there don’t seem to be any specific groups of people or health conditions that are contraindicated for Botox injections. As with all treatments, general health guidelines apply. People with a healthy body-mass index who are non-smokers, moderate or non-drinkers, and physically active will nearly always tolerate any type of medical treatment well.


Key secondary endpoints included Physician Global Assessment, finger flexors muscle tone, and thumb flexors tone at Week 6. The Physician Global Assessment evaluated the response to treatment in terms of how the patient was doing in his/her life using a scale from -4 = very marked worsening to +4 = very marked improvement. Study 1 results on the primary endpoint and the key secondary endpoints are shown in Table 26.

Before using this medication, tell your doctor your medical history, especially of: bleeding problems, eye surgery, certain eye problem (glaucoma), heart disease, diabetes, signs of infection near the injection site, urinary tract infection, inability to urinate, muscle/nerve disorders (such as Lou Gehrig's disease-ALS, myasthenia gravis), seizures, trouble swallowing (dysphagia), breathing problems (such as asthma, emphysema, aspiration-type pneumonia), treatment with any botulinum toxin product (especially in the last 4 months).
The last thing I've found to be a little frustrating is that my body tends to metabolize the Botox a bit faster than I can get it. While Ravitz tells me I can't get the treatment any more frequently than every three months, because that's the rate at which the body can develop antibodies against it, I find my migraines amping up in frequency again about two to two and a half months after I get the shots. However, given the fact that with the Botox, my migraines have gone down from about four a week to one or two at most, it's absolutely increased my quality of life, and I'm glad I gave it a shot...or 40.
The co-primary endpoints were the average of the change from baseline in modified Ashworth Scale (MAS) ankle score at Week 4 and Week 6, and the average of the Physician Global Assessment of Response (CGI) at Week 4 and Week 6. The CGI evaluated the response to treatment in terms of how the patient was doing in his/her life using a 9-point scale from -4=very marked worsening to +4=very marked improvement).
Postmarketing reports indicate that the effects of BOTOX and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, general ized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have an underlying condition that would predispose them to these symptoms. In unapproved uses, including spasticity in children, and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and spasticity and at lower doses. [See WARNINGS AND PRECAUTIONS]
Though there's still more research to be done on Botox for migraines and doctors aren't yet completely sure why the procedure is effective, they have some ideas. Ravitz tells me, "What [Botox] does is paralyze nerve terminals. Essentially, nerve terminals transmit pain, but they also produce pain substances while they’re doing that, and it completely paralyzes that process." She says that it stops the process of pain patterning and it also relaxes the muscles.

Baby Botox can also be used as an upkeep strategy. "I really think of it as small maintenance doses of Botox over time instead of standard doses given at three- to six-month intervals," says Smith. "The other term that describes this well is 'tweakment' — subtle changes done over a longer period of time using lower doses of product at each treatment."


The safe and effective use of BOTOX depends upon proper storage of the product, selection of the correct dose, and proper reconstitution and administration techniques. An understanding of standard electromyographic techniques is also required for treatment of strabismus, upper or lower limb spasticity, and may be useful for the treatment of cervical dystonia. Physicians administering BOTOX must understand the relevant neuromuscular and structural anatomy of the area involved and any alterations to the anatomy due to prior surgical procedures and disease, especially when injecting near the lungs.

Table 14 presents the most frequently reported adverse reactions in a placebo-controlled, double-blind post-approval 52 week study with BOTOX 100 Units (Study NDO-3) conducted in MS patients with urinary incontinence due to detrusor overactivity associated with a neurologic condition. These patients were not adequately managed with at least one anticholinergic agent and not catheterized at baseline. The table below presents the most frequently reported adverse reactions within 12 weeks of injection.

The studies using Botox for depression, like other research into Botox's off-label potential, were so encouraging that they caught the attention of Allergan. In Rosenthal and Finzi's research, 74 people with major depressive disorder were randomly assigned to receive Botox injections or a placebo. Six weeks later, 52% of the people who received Botox experienced a drop in reported symptoms, compared with 15% of the people given a placebo. "Over 50% of people responding is a high number," says Finzi. "These are people who have already tried other treatments, and they are significantly depressed."


Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing.
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Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junction disorders (eg, myasthenia gravis or Lambert-Eaton syndrome) should be monitored when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects including generalized muscle weakness, diplopia, ptosis, dysphonia, dysarthria, severe dysphagia, and respiratory compromise from onabotulinumtoxinA (see Warnings and Precautions).

Ophthalmologists specializing in eye muscle disorders (strabismus) had developed the method of EMG-guided injection (using the electromyogram, the electrical signal from an activated muscle, to guide injection) of local anesthetics as a diagnostic technique for evaluating an individual muscle’s contribution to an eye movement.[44] Because strabismus surgery frequently needed repeating, a search was undertaken for non-surgical, injection treatments using various anesthetics, alcohols, enzymes, enzyme blockers, and snake neurotoxins. Finally, inspired by Daniel Drachman’s work with chicks at Johns Hopkins,[45] Alan B Scott and colleagues injected botulinum toxin into monkey extraocular muscles.[46] The result was remarkable: a few picograms induced paralysis that was confined to the target muscle, long in duration, and without side-effects.
In her talk, Lalvani expressed her intent to drive AMF’s mission forward by leveraging the expertise of the American Headache Society and incorporating more patient voices. The Move Against Migraine support community is essential to that goal, and AMF strives to be a trusted partner for support, resources and credible information for everyone in the community. The Move Against Migraine campaign was launched to raise awareness of migraine, but that’s only the beginning. Lalvani pointed to AMF’s advocacy and community-building efforts, specifically the response to Elle’s “Migraine Pose” article and robust partnership program. Whatever the platform and audience, AMF works to ensure the patient voice is always included and heard. Lalvani concluded her talk by stressing that patients have an important role to play as “drivers of change” and encouraged listeners to continue connecting with AMF. Check out our full library of Facebook Live recaps with some of the leading headache specialists and patient advocates in the country, and visit our resource library for more information on how you can better advocate for yourself and the migraine community.
Sometimes, because of these policies, patients are put on meds that are not approved by the FDA for the treatment of migraines, like the antidepressant amitriptyline and the high blood pressure drug verapamil. “In my experience, [verapamil is] not very effective,” says Elizabeth Loder, chief of the headache division at Brigham and Women’s Hospital in Boston and the former president of the American Headache Society. For the insurance companies, that doesn’t seem to matter. “It’s frustrating to patients, especially when it seems like some of the treatments that they’re required to try have a lot of side effects and haven’t really been tested that carefully for migraines.”
Remember that the skill of the injector is extremely important when considering Botox injections. Because Botox can have some very obvious and embarrassing side effects like drooping eyelids, blurry vision, and excessive bruising around the injection site, it's important to consult with an experienced injector. Unlike dermal fillers which can be melted away with a follow-up injection of hyaluronidase, there's not much you can do about a bad Botox experience other than wait it out.
Botox must be used only under a doctor's care. It's important that injections be placed precisely in order to avoid side effects. Botox therapy can be dangerous if it's administered incorrectly. Ask for a referral from your primary care doctor or look for a doctor who specializes in your condition and who has experience in administering Botox treatments.
Each patient has their own goals for treatment of muscle spasticity made in our clinic. These goals can include decreasing pain from muscle spasms. This can be done by reducing both how often and how intense the spasms are. It can also be done by increasing the range of motion of joints to allow improved function. Improvement of range of motion can help to:

According to the PREEMPT injection paradigm, one injection of 5 units of onabotulinumtoxinA is administered to one site in the procerus muscle. The procerus injection site is approximately midway between the two corrugator injections. In order to confirm the location of the procerus muscle, the patient is asked to furrow the brow, which will activate the belly of the muscle causing the medial furrowing to occur. Once identified, 5 units of onabotulinumtoxinA is injected superficially into the belly of the muscle at a 90° angle to ensure the injection is administered into the procerus rather than the frontalis. Injections placed too superiorly may inadvertently lead to penetration of the frontalis muscle.
Treatment with BOTOX and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a conseq uence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing [see Spread Of Toxin Effect].
That’s enough to generate buzz on the patient forums like RealSelf among those who have tried it: “My neck is killing me” wrote one user;  I’ve got “Stiffness, pain in the neck, headache and can’t look down” reported another. Like anything, results vary widely. “I have since felt nauseous and dizzy on and off every day, as well as have blurry vision.

The Company is developing a number of products, some of which utilize drug delivery systems, through a combination of internal and collaborative programs, such as Esmya, Sarecycline, Ubrogepant, Abicipar, Bimatoprost SR, Relamorelin, Rapastinel, Cenicriviroc and Atogepant. The Company's portfolio of branded pharmaceutical products within the US Specialized Therapeutics, US General Medicine and International segments includes Alphagan/Combigan, which is used for the treatment of selective alpha2 agonist; Armour Thyroid, which is used for the treatment of Underactive thyroid; Asacol/Delzicol, which is used for the treatment of ulcerative colitis; Botox, which is used for the treatment of acetylcholine release inhibitor; Bystolic, which is used for the treatment of hypertension; Carafate/Sulcrate, which is used for the treatment of ulcerative colitis, and Dalvance, which is used for the treatment of acute bacterial skin infections. It also offers Estrace Cream, which is used for the treatment of hormone therapy; Linzess/Constella, which is used for the treatment of irritable bowel syndrome; Lo Loestrin which is an oral contraceptive; Lumigan/Ganfort, which is used for the treatment of prostaglandin analogue; Minastrin 24, which is an oral contraceptive; Namenda IR, Namenda XR and Namzaric, which are used for the treatment of Dementia; Restasis, which is used for the treatment of topical immunomodulator; Saphris, which is used for the treatment of schizophrenia, bipolar mania; Teflaro, which is used for the treatment of acute bacterial skin infections, community-acquired bacterial pneumonia; Viberzi, which is used for the treatment of irritable bowel syndrome; Viibryd/Fetzima, which is used for the treatment of depressive disorders, and Zenpep, which is used for the treatment of exocrine pancreatic insufficiency. The Company also offers CoolSculpting, which is a controlled-cooling fat reducing system.
I asked this question as Ravitz was putting the first needles in my face, which was probably a mistake as I get anxious easily. However, she assured me that the side effects of Botox typically don't happen at the doses prescribed for migraines, and even if the scary-sounding side effects you read about online do occur (such as one-side paralysis and eye droops), they aren't particularly dangerous and last four to six weeks.
There’s a wide variety of factors that influence the total cost: the number of units required to effectively limit facial movement in the forehead, the areas in the upper face you wish to treat, the experience level of your injector, and finally, the location of the clinic where you undergo the procedure. Botox is usually charged per unit, with a unit priced from $10 to $20. The final price can also be determined per area treated, with the forehead and frown lines charged as two seperate areas.
Launched in 2002, Practical Neurology is a publication uniquely dedicated to presenting current approaches to patient management, synthesis of emerging research and data, and analysis of industry news with a goal to facilitate practical application and improved clinical practice for all neurologists. Our straightforward articles give neurologists tools they can immediately put into practice.
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With the outbreak of World War II, weaponization of botulinum toxin was investigated at Fort Detrick in Maryland. Carl Lamanna and James Duff[42] developed the concentration and crystallization techniques that Edward J. Schantz used to create the first clinical product. When the Army’s Chemical Corps was disbanded, Schantz moved to the Food Research Institute in Wisconsin, where he manufactured toxin for experimental use and generously provided it to the academic community.
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