Botulism: Killer or Wonder Drug?
What do wrinkles and muscle tics have in common? Both are caused by repeated or inappropriate muscle activity and both can be treated using the same drug, Botox.
With such wide-ranging effects, Botox may sound like a wonder drug. But it's actually short for ]]>botulinum toxin]]>—one of the deadliest food poisons known to humankind. Some may remember the infamous Bon Vivant soup incident, in which cans of vichyssoise infected with the botulinum toxin killed unsuspecting soup lovers. But the same quality that can make ]]>botulism]]> lethal—its ability to paralyze muscles—makes it therapeutic when used in carefully controlled doses.
All Kinds of Relief
Botox is used to treat a variety of muscular disorders. It is the drug of choice for the neuromuscular condition, dystonia. In dystonia, particular muscles contract inappropriately. The classic form of dystonia involves the neck, and is called ]]>torticollis]]>. Other common forms involve spasms of the eyelids (blepharospasm), half of the face (]]>hemifacial spasm]]>), and vocal cords (spasmodic dysphonia).
Unlike muscle strain or ]]>tendonitis]]>, dystonia is a neurologic disorder in which the brain incorrectly signals muscles to go into an abnormal contraction.
"Strain is where you get an achiness in the forearms [for example] but you don't get a change in the position of the muscle. With dystonia, the hand or limb or neck changes position creating an imbalance in the muscles so that the normal position gets tighter and tighter," says George Plotkin, MD, former acting director of neurophysiology at Brigham & Women's Hospital in Boston.
When Botox is injected directly into a contracted muscle, it is weakened and cannot contract, restoring balance to the group of muscles involved in a particular movement.
"Even though the signal coming from the brain is that the muscle should contract to a certain point, it can't," Plotkin explains.
Doctors have used Botox to correct a variety of conditions involving inappropriate muscle and gland activity with varying degrees of success. They include:
- Eye muscle spasms—Patients with limited eye closure and spasms that prevented them from driving (blepharospasm) have been very successfully treated with Botox.
- Spasticity—Botox can be helpful in controlling spasticity due to ]]>stroke]]>, head injury, ]]>multiple sclerosis]]>, or congenital ]]>cerebral palsy]]>.
- Esophageal disorders—When the lower sphincter muscle of the esophagus fails to relax and allow food to pass into the stomach, Botox can be an effective treatment.
- Excess sweating—Botox injected into the skin can control overactive sweat glands, but it can be difficult to treat a widespread area.
- Neurological bladder dysfunction—Botox may be helpful for bladder problems caused by nerve dysfunction.
- Headaches—Botox may be useful for treatment of a variety of headache disorders including ]]>migraines]]>, ]]>tension-type headaches]]>, and chronic daily headaches.
Frown. Smile. Grimace. Grin. Every facial expression forms a crease that will someday be etched in the skin as a wrinkle. You can't stop moving your face, but you can limit movement in key places using Botox. As a result of its successful use with facial tics, plastic surgeons discovered that Botox can smooth out wrinkles in places where muscle activity has a particularly noticeable effect. ]]>Botox is used to treat wrinkles in two places: frown lines between the eyebrows, where it is most effective, and crow's feet.]]> As Botox restricts muscle movement, it creates a smoother appearance even if it doesn't remove all traces of the wrinkle.
"There is certainly a component of wrinkles that's dynamic and caused by overactivity of the muscles; that component will be eliminated by Botox," says David Wainwright, MD, associate professor in the division of plastic surgery at the University of Texas-Houston Medical School.
How Does It Work?
Tiny quantities of the toxin are injected directly into the muscles of facial expression. It takes three small injections between the eyebrows to treat the frown line. The treated muscles weaken over the following week or so and the person is no longer able to contract the frown muscles. They can still lift their eyebrows normally and blink without problems. The injection is almost painless. It is important to remain upright for four hours after the injection and not touch the treated area.
Not surprisingly, younger patients—whose lines are not as deep—experience the greatest improvements. The effect lasts between 4-6 months, and treatments are generally repeated in nine months to a year. Ongoing treatments have the added benefit of preventing further wrinkling.
Side Effects Are Uncommon
Side effects have not been a problem in using Botox for treating wrinkles or other conditions, aside from the occasional allergic reaction or temporary excessive muscle weakness. Some people have a slight headache for several hours after treatment. The most common significant complication, which is rare, is ptosis. This is a drooping of the eyelid caused by the Botox tracking into the eyelid muscle. It generally lasts just a few days, but more prolonged weakness is possible. Botox injections cannot be used during pregnancy or when breastfeeding.
If you decide to undergo Botox treatment, be sure that you receive your care from a reputable physician highly experienced in the use of this substance. From quelling muscle spasms to smoothing out skin, Botox can be an effective treatment for many people if used properly.
American Society of Plastic Surgeons
United States Food and Drug Administration
The Canadian Society for Aesthetic Plastic Surgery
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Last reviewed March 2010 by ]]>Brian Randall, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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