intramuscular injections of botulinum toxin block pre-synaptic cholinergic release at neuromuscular junctions producing a temporary paralysis of affected motor units. There is increasing evidence, however, that the effects are not restricted to the periphery and can alter the central excitability of the motoneurones at the spinal level. This includes increases in input resistance, decreases in rheobase currents for action potentials and prolongations of the post-spike after-hyperpolarization. the aim of our experiments was to investigate possible anatomical explanations for these changes. Unilateral injections of Botulinum toxin A mixed with a tracer were made into the gastrocnemius muscle of adult rats and contralateral tracer only injections provided controls. immunohistochemistry for Ankyrin G and the vesicular acetylcholine transporter labelled axon initial segments and cholinergic c-boutons on traced motoneurones at 2 weeks post-injection. Soma size was not affected by the toxin; however, axon initial segments were 5.1% longer and 13.6% further from the soma which could explain reductions in rheobase. Finally, there was a reduction in surface area (18.6%) and volume (12.8%) but not frequency of c-boutons on treated motoneurones potentially explaining prolongations of the afterhyperpolarization. Botulinum Toxin A therefore affects central anatomical structures controlling or modulating motoneurone excitability explaining previously observed excitability changes. Botulinum neurotoxin type-A (BoNT/A) is one of the most dangerous toxins known to man, yet it is being increasingly used, both cosmetically and clinically, to produce long lasting paralysis of specific muscles. After intramuscular injection, the toxin enters the synaptic vesicles of motor axon terminals by endocytosis. From here it silences synaptic transmission via specific proteolytic cleavage of SNAP-25 which prevents the release of acetylcholine from the motoneurone terminal resulting in flaccid paralysis 1. There is increasing evidence, however, that the effects may not be restricted to the periphery. Studies show that BoNT/A, injected intramuscularly, is transported both anterogradely along sensory axons and retrogradely along motoneurone axons to the motoneurone soma in the spinal cord 2-5. Furthermore, there is now also evidence that BoNT/A can spread between networks of cells 6 , although this claim has been questioned by other studies and would appear to be dose dependent 7,8. This raises the question as to what central effects BoNT/A may have on the motoneurone itself or on central cholinergic synapses contacting the motoneurone. Electrophysiological studies suggest changes in spinal motoneurone excitability after intramuscular BoNT/A injections of the gastrocnemius muscle. Increased stretch reflexes are seen at two weeks post-injection in rats 9. This increased reflex was also seen when tested as simple monosynaptic responses to dorsal root stimulation suggesting the enhanced reflexes may be due to an increase in motoneurone excitability 1...