What Is Botox™?
Botulinum NeuroToxin (BoNT) is a naturally occurring protein and a poison that has been transformed over the last 40 years into a safe and effective drug to treat a number of different medical conditions, including some movement disorders.
The most familiar brand name for botulinum toxin is clearly Botox™, even though Botox™ is primarily known for its cosmetic benefits as opposed to as an effective treatment for movement disorders.
Botox™ is made by Allergan which first won approval for it from the FDA in 1989. Botox is botulinum toxin type A, one of two different serotypes that have been approved for human use. Other brand names for botulinum toxin type A include Dysport™ which is manufactured by Medicis Aesthetics, and Xeomin™ from Merz Pharmaceuticals GmbH (Germany). Myobloc™ which is now owned by US WorldMeds is a brand name for the other botulinum toxin serotype — type B.
Botox™ as a brand name is in the same category as Google is for internet searches, Kleenex is for tissues, and Xerox is for copy machines — the name has become synonymous with the entire category even though there are many other competitors in the marketplace. For our purposes here, when we say “Botox™,“ we are referring to the entire category of botulinum toxin.
Which Movement Disorders Can Be Treated With Botulinum Toxin?
There are a number of movement disorders that can be treated with botulinum toxin. Some of these include tics, essential tremor, TMD/bruxism, and many types of dystonias, including blepharospasm and hemifacial spasm.
For patients with essential tremor or dystonia, Botox® injections can be used effectively to relax excessive muscle contraction in individuals with movement disorders — the botulinum toxin calms muscles and helps reduce or halt muscle activity and control motor symptoms.
For TMD patients, Botox therapy may be a suggested treatment to help ease the tension in the jaw. This quick treatment can provide months of relief from a painful jaw and headaches.
In bruxism patients, the botulinum toxin is directly injected into the targeted area, where it relaxes the jaw muscle just enough to reduce grinding and clenching without affecting other actions such as talking or chewing. This is particularly helpful for people with intense sleep bruxism that they can’t otherwise control.
How Does Botox™ Work?
Botulinum toxin works by blocking a neurotransmitter (acetylcholine) involved in muscle contraction. Botox calms the affected muscles and allows for a more natural and neutral positioning.
Botulinum toxin is injected by a hypodermic EMG needle directly into the muscles blocking the connection between nerves and muscles. This relieves spasms and other conditions associated with muscle overactivity.
Once the physician is ready to administer the appropriate toxin injection, he will select the muscles either by observing the abnormal postures or movements and feeling for the muscle spasm or by using an ultrasound. The number of injections will depend on the size of the muscle, though a typical treatment consists of five to 10 injections.
The actual injection procedure will take just a few minutes and is typically repeated every three to six months. The treatment can be continued indefinitely as long as you continue to respond and do not have a serious allergic reaction.
How Effective Are Botox™ Treatments for Movement Disorders?
Botox therapy is not a cure, it is an ongoing treatment used to manage your symptoms. But as a movement disorder treatment, Botox has proven to be very effective.
Botox therapy can significantly relieve muscle spasms and other conditions associated with muscle overactivity. Approximately 80% of patients treated with Botox to manage their neuromuscular disorder experience relief in their symptoms following their injection.
Botox therapy treatment is typically effective within three days but may take 2 weeks to reach maximum potency. The reduction in symptoms from a round of Botox treatment is generally sustained for approximately 3 to 6 months. When the effects of the injection seem to diminish, you will return to your physician for additional evaluation and treatment.
Injections can be repeated no sooner than three months, and treatment can be repeated indefinitely as long as there is no allergic reaction.
Keep in mind that botox treatments are most effective when used in combination with physical therapy such as stretching and strengthening exercises. Without daily physical activity, your muscles will remain contracted and joints will become immobile, making it difficult to manage everyday tasks such as sitting, walking, and eating.
Are There Any Potential Side Effects with Botox™ Treatments?
As a general rule, patients should go home and rest immediately following the injection of Botox and refrain from strenuous activity for 2 to 3 days.
Side effects of Botox therapy are generally mild and wear off quickly. For example, because the drug makes the targeted muscles weaken, patients may notice a new pain that arises from the shrinkage of the affected muscle or the other muscles trying to compensate.
According to the FDA warning on this class of drugs, the risk of symptoms is greatest in children with cerebral palsy treated for spasticity.
The most common side effects of Botulinum toxin are:
- temporary general weakness
- soreness at the injection site or affecting your whole body
- weakness in muscles that have been injected
- trouble swallowing, particularly for patients treated for cervical dystonia
- a red rash
- an infection at the injection site
What Can I Expect With Botulinum Toxin Treatments?
Botulinum toxin has proven to be a very safe and effective drug, including when it’s used to treat movement disorders. Patients receiving botulinum treatment often see a 50%-90% improvement in their symptoms that can be expected to last 2-3 months, and even longer in some cases. Because the benefits of botulinum injections wear off, successful botulinum treatment requires that patients get injections 2-4 times per year.
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