OnabotulinumtoxinA (BT-A) 因其有益作用而被用于不同的医学领域。 BT-A 是一种最初由肉毒杆菌产生的毒素，众所周知，它能够通过阻止乙酰胆碱（一种参与肌肉收缩的神经递质）的释放来暂时麻痹肌肉。文献不断报道关于潜在应用的新假设，这些假设不认为阻断神经肌肉接头处的乙酰胆碱释放是常见途径。在这篇观点文章中，我们的目的是研究 BT-A 在不同医学应用中的不同途径靶点。首先，BT-A的乙酰胆碱作用用于美容目的减少皱纹，治疗泌尿系统问题、出汗过多、颞下颌关节紊乱、肥胖、偏头痛、神经系统疾病的痉挛以及各种肌肉过度活动的情况例如颈部肌张力障碍、眼睑痉挛和特发性头部震颤。在另一个潜在途径中，谷氨酸 A、CGRP 和 P 物质可通过 BT-A 应用来抑制偏头痛、三叉神经痛、神经性疼痛和肌筋膜疼痛综合征等疾病的疼痛。另一方面，作为一种不同于乙酰胆碱和疼痛介质的机制，BT-A通过增加氧合和靶向转化生长因子-β1细胞来治疗脱发。此外，BT-A对癌细胞凋亡的作用也是已知的，并且正在开发中。文献研究显示了不同剂量、不同区域、不同医疗目的使用 BT-A 的益处，这些研究还强调，重复使用可增加长期益处。随着研究人员发现这种多功能毒素的新潜在治疗用途，BT-A 的用途不断扩大。

OnabotulinumtoxinA (BT-A) is used in different medical fields for its beneficial effects. BT-A, a toxin originally produced by the bacterium Clostridium botulinum, is widely known for its ability to temporarily paralyze muscles by blocking the release of acetylcholine, a neurotransmitter involved in muscle contraction. The literature continually reports new hypotheses regarding potential applications that do not consider blockade of acetylcholine release at the neuromuscular junction as a common pathway. In this opinion article, it is our aim to investigate the different pathway targets of BT-A in different medical applications. First of all, the acetylcholine effect of BT-A is used to reduce wrinkles for cosmetic purposes, in the treatment of urological problems, excessive sweating, temporomandibular joint disorders, obesity, migraine, spasticity in neurological diseases, and in various cases of muscle overactivity such as cervical dystonia, blepharospasm, and essential head tremor. In another potential pathway, glutamate A, CGRP, and substance P are targeted for pain inhibition with BT-A application in conditions such as migraine, trigeminal neuralgia, neuropathic pain, and myofascial pain syndrome. On the other hand, as a mechanism different from acetylcholine and pain mediators, BT-A is used in the treatment of hair loss by increasing oxygenation and targeting transforming growth factor-beta 1 cells. In addition, the effect of BT-A on the apoptosis of cancer cells is also known and is being developed. The benefits of BT-A applied in different doses to different regions for different medical purposes are shown in literature studies, and it is also emphasized in those studies that repeating the applications increases the benefits in the long term. The use of BT-A continues to expand as researchers discover new potential therapeutic uses for this versatile toxin.