Botox (Botulinum Toxin) & Neurological Conditions

Botox

Summary

Botulinum toxin is a synthetic chemical that can be used to treat various nervous system (neurological) disorders. When used in small doses, the toxin also can help stop muscle spasms in certain body areas. In addition, it is more commonly recognized as a cosmetic treatment to reduce furrows and lines in a person’s face.

During botulinum toxin treatments, a tiny amount of the toxin is mixed with saline and injected into a muscle to prevent it from contracting unnecessarily. Usually, between one and 10 injections of botulinum toxin are necessary during a single treatment session.

There are two major forms of botulinum toxin medication:

  • Botulinum toxin type A. Commonly known as Botox, it is used to treat various eye conditions (e.g., blepharospasm) and spasms that may be caused by multiple sclerosis, stroke, brain injury or spinal cord injury. It is also used to treat cervical dystonia (muscle spasms in the neck) and severe sweating of the armpits (hyperhidrosis). Botox is perhaps best known for its role in cosmetic procedures designed to smooth out facial wrinkles.

  • Botulinum toxin type B. Commonly known as Myobloc, it is used to treat patients with cervical dystonia who develop an abnormal head position (spasmodic torticollis) and neck pain.

Patients who receive botulinum toxin treatments often experience the greatest benefit during the first two to six weeks following the injection. Effects often begin to fade around three to six months after the injection as the nerve regenerates. Patients require regular follow-up treatments to receive continued benefit of the toxin.

Certain people may not be good candidates for botulinum toxin treatments, including patients who previously have been infected with clostridium botulinum toxin (botulism) and those with a history of swallowing problems. In addition, people with certain medical conditions have a greater risk of developing severe swallowing or breathing problems following botulinum toxin treatment.

Some patients who undergo treatment with botulinum toxin may experience certain side effects, but these are not typically considered to be severe. Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Patients who have an overdose of botulinum toxin may develop botulism, a potentially life-threatening illness.

Patients who receive botulinum toxin type A for an eye problem may have the urge to become more active with the improvement in vision. However, patients are urged to consult a physician before increasing their level of activity. There is limited data on the effects of botulinum toxin on pregnant or breastfeeding women, children and the elderly. Therefore, people in these populations are urged to consult their physician about the benefits and potential risks of botulinum toxin treatments.

About botulinum toxin

Botulinum toxin is a chemical substance used to treat various neurological disorders. Many people are familiar with this substance as a cosmetic treatment to reduce furrows and wrinkles in a person’s face. However, when used in small doses, the toxin can also help stop muscle spasms in the head, neck, face, hands, arms and legs.

When muscle contraction is physically necessary (e.g., when lifting a heavy object), the nerves send chemical messages to the muscles, instructing them to contract. When people experience muscle spasms, their nerves send those same signals to the muscles, even though there is no physical reason for such contraction.

Botulinum toxin is sometimes used to prevent the spastic muscles from receiving these abnormal contraction signals from nerves. This toxin is a synthetic version of clostridium botulinum, the same toxin produced by the bacterium responsible for botulism food poisoning.

Scientists do not completely understand how botulinum toxin treatments work. It is known that the toxin hinders the ability of nerves to release the neurotransmitter acetylcholine into muscle, thereby weakening muscle contractions. However, experts also believe that the toxin also may help prevent contraction by decreasing signals sent from stretch receptors in muscles to the spinal cord.

During botulinum toxin treatments, a tiny amount of the toxin is mixed with saline and injected into the appropriate muscle to prevent it from contracting unnecessarily. Usually, between one and 10 injections of botulinum toxin are necessary during a single treatment session. In some cases, more than one session is required for the patient to obtain the full benefit from treatment. It may also take a couple of weeks before patients begin to notice the effects of the toxin on muscle spasms. Electromyography (EMG) may be necessary to help identify the correct locations for injecting the toxin.  

Patients who receive botulinum toxin treatments often experience the greatest benefit during the first two to six weeks following the injection. Effects often begin to fade around three to six months after the injection as the nerve regenerates. Patients require regular follow-up treatments to receive continued benefits from the toxin.

Botulinum toxin treatments are not always effective for all patients. Some people treated with botulinum toxin may develop antibodies that bind to the toxin and inactivate it, thereby rendering the treatment ineffective for reducing muscle contractions.

There must be at least three months between treatments to help avoid the development of antibodies to the toxin. In addition, physicians use the smallest amount of toxin necessary to help reduce the chance of developing antibodies to the toxin. Botulinum toxin treatments are safe when administered by a trained medical professional. However, some people have begun to host parties where untrained people inject themselves or others with botulinum toxin type A (Botox) in an attempt to smooth out wrinkles. These “Botox parties” are potentially very dangerous, because administering too much botulinum toxin can cause people to become sick with botulism, and possibly lose the ability to move their arms or legs, or to breathe. In some cases, such overdoses may result in coma or death.

Types and differences of botulinum toxin

There are two major forms of botulinum toxin medication. Both work in the same way but are slightly different in chemical structure. Each toxin may have different levels of effectiveness and produce different side effects from patient to patient:

  • Botulinum toxin type A. Commonly known as Botox, it is used to treat eye conditions such as blepharospasm (muscle spasm that prevents eyelid from staying open), amblyopia (sometimes known as “lazy eye”) and strabismus (eyes do not line up properly). Botulinum toxin type A also is used to treat many different types of spasms and conditions that cause these spasms, such as multiple sclerosis. Some types of spasms treated with this toxin include the following:
    • Spasms of the arms, feet, hands or legs resulting from brain injury, multiple sclerosis, spinal cord injury or stroke
    • Spasms of the face (e.g., hemifacial spasm)
    • Spasms of the hand (e.g., writer’s cramp)
    • Spasms of the vocal cords

Botulinum toxin type A also may be used to improve facial symmetry in patients with Bell’s palsy. In addition, botulinum toxin type A also is used to treat cervical dystonia and severe sweating of the armpits (hyperhidrosis). Studies continue to investigate the effectiveness of botulinum toxin type A as a treatment for fibromyalgia. Botox is perhaps best known for its role in cosmetic procedures designed to smooth out wrinkles resulting from the natural aging process.

  • Botulinum toxin type B. Commonly known as Myobloc, it is used to treated patients with cervical dystonia who experience abnormal head position (spasmodic torticollis) and neck pain. It may be used as second line therapy in patients who have developed antibodies to botulinum toxin type A.

Conditions of concern with botulinum toxin

Patients are urged to notify their physician if they have any allergies, especially if they have ever experienced an allergic reaction to any previous injections of botulinum toxin or to other substances such as foods, preservatives or dyes.

Certain people may not be good candidates for botulinum toxin treatments. For example, patients who have previously been infected with clostridium botulinum toxin (botulism) may carry antibodies that can reduce the effectiveness of botulinum toxin type A therapy.

Botulinum toxin also should not be injected into infected or swollen areas of the body. Muscles should not be treated with the toxin if they are in a weakened state.

People who have a history of swallowing problems may find the condition worsened after botulinum toxin treatment. In addition, people with certain medical conditions are at higher risk of developing severe swallowing or breathing problems and may not be good candidates for botulinum toxin treatment. Such conditions include:

  • Amyotrophic lateral sclerosis (ALS)
  • Lambert-Eaton myasthenic syndrome
  • Motor neuropathy
  • Myasthenia gravis

Potential side effects of botulinum toxin

Some patients who undergo treatment with botulinum toxin may experience certain side effects, but typically these are not considered to be severe. Depending on the type of treatment used, side effects may include (but are not limited to):

  • Body aches or pain
  • Difficulty swallowing
  • Dizziness
  • Eye dryness
  • Headache
  • Infection
  • Skin rash
  • Unusual tiredness

Some patients may experience unusual weakness in the muscle that has been treated, but this usually wears off. Allergic reactions to the toxin are also possible. In addition, some patients may experience bruising or soreness at the injection site. Soreness can typically be relieved by an over-the-counter pain reliever medication. However, people are urged not to take any medication without first consulting a physician.

Drug or other interactions with botulinum toxin

Patients should consult their physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Ophthalmic medications (prescription and nonprescription), anticoagulants (drugs that prevent blood clots) and certain antibiotics may interact poorly when taken with botulinum toxin. However, most patients who take skeletal muscle relaxants can continue to do so during botulinum toxin treatments.

Lifestyle considerations with botulinum toxin

Patients who receive botulinum toxin type A for an eye problem often have the urge to become extremely active once their vision improves. However, such patients are urged to consult a physician before increasing their activity level. This gives the heart and body a chance to more gradually adapt to the new level of activity.

Symptoms of botulinum toxin overdose

Patients who receive botulinum toxin type A for an eye problem often have the urge to become extremely active once their vision improves. However, such patients are urged to consult a physician before increasing their activity level. This gives the heart and body a chance to more gradually adapt to the new level of activity.

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Patients who have an overdose of botulinum toxin may develop botulism, a potentially life-threatening illness. Patients exhibiting any of the following symptoms associated with botulism should contact their physician immediately:

  • Abdominal cramps

  • Breathing difficulties

  • Difficulty swallowing and speaking

  • Double vision

  • Dry mouth

  • Nausea and vomiting

  • Progressive weakness with paralysis

Pregnancy use issues with botulinum toxin

Studies have not been conducted on the effects of botulinum toxin on pregnant women. Women who are pregnant or thinking of becoming pregnant are urged to inform their physician of this fact before undergoing treatment.

It is not known whether botulinum toxin passes into breast milk. Women who are breastfeeding are urged not to undergo botulinum toxin treatments without first talking with their physician about the benefits and potential risks of botulinum toxin treatments.

Child use issues with botulinum toxin

There are limited studies regarding the effect of botulinum toxin on children. As a result, parents and caregivers are urged to consult with a physician about the benefits and potential risks of botulinum toxin treatments for their children.

Elderly use issues with botulinum toxin

Experts are not sure if side effects from botulinum toxin are likely to be different in older adults than they are in younger adults. However, older adults are often especially sensitive to the effects of some medications and may be more likely to experience side effects. As a result, elderly people are urged to consult a physician about the benefits and potential risks of botulinum toxin treatments.

Questions for your doctor on botulinum toxin

Preparing questions in advance can help patients to have more meaningful discussions with healthcare professionals regarding their condition. Patients may wish to ask their doctor the following questions related to botulinum toxin:

  1. How many patients have you treated with botulinum toxin?
  2. Why are you recommending I undergo this procedure?
  3. What are my treatment alternatives?
  4. Will you use type A or type B botulinum toxin? Why?
  5. Can you explain the procedure to me in detail?
  6. What results can I expect from the injections?
  7. How many injections will I require?
  8. Will I experience pain during the procedure? What about afterward?
  9. What risks do I face by undergoing this procedure?
  10. What is the recovery time for the procedure?
  11. When can I expect to see an improvement?
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