<P> Nerve gases and liquor damage this area . </P> <P> Botulinum toxin (aka botulinum neurotoxin, BoNT, and sold under the trade name Botox) inhibits the release of acetylcholine at the neuromuscular junction by interfering with SNARE proteins . This toxin crosses into the nerve terminal through the process of endocytosis and subsequently interferes with SNARE proteins, which are necessary for ACh release . By doing so, it induces a transient flaccid paralysis and chemical denervation localized to the striated muscle that it has affected . The inhibition of the ACh release does not set in until approximately two weeks after the injection is made . Three months after the inhibition occurs, neuronal activity begins to regain partial function, and six months, complete neuronal function is regained . </P> <P> Tetanus toxin, also known as tetanospasmin is a potent neurotoxin produced by Clostridium tetani and causes the disease state, tetanus . The LD of this toxin has been measured to be approximately 1 ng / kg, making it second only to Botulinum toxin D as the deadliest toxin in the world . It functions very similarly to botunlinum neurotoxin (BoNT) by attaching and endocytosing into the presynaptic nerve terminal and interfering with SNARE protein complexes . It differs from BoNT in a few ways, most apparently in its end state, wherein tetanospasmin demonstrates a rigid / spastic paralysis as opposed to the flaccid paralysis demonstrated with BoNT . </P> <P> Latrotoxin (α - Latrotoxin) found in venom of widow spiders also affects the neuromuscular junction by causing the release of acetylcholine from the presynaptic cell . Mechanisms of action include binding to receptors on the presynaptic cell activating the IP3 / DAG pathway and release of calcium from intracellular stores and pore formation resulting in influx of calcium ions directly . Either mechanism causes increased calcium in presynaptic cell, which then leads to release of synaptic vesicles of acetylcholine . Latrotoxin causes pain, muscle contraction and if untreated potentially paralysis and death . </P>

At the neuromuscular junction acetylcholine is released as the result of