Butyrylcholinesterase is a serine hydrolase related to acetylcholinesterase that catalyses the hydrolysis of esters of choline, including acetylcholine. Butyrylcholinesterase has unique enzymatic properties and is widely distributed in the nervous system, pointing to its possible involvement in neural function. Here, we summarize the biochemical properties of butyrylcholinesterase and review the evidence that this enzyme has important roles in cholinergic neurotransmission and could be involved in other nervous system functions and in neurodegenerative diseases.