Botulinum Toxin Clinic

Overview

Botox® is one of the most well-known botulinum toxin injectable brands. Botulinum toxins are neurotoxins that weaken muscles and damage neurons. A botulinum toxin injection may be administered for aesthetic or medical reasons. Small quantities of Botox are injected into particular muscles by healthcare experts to smooth wrinkles, prevent migraine headaches, and treat a variety of other health concerns.

Botulinum toxin treatment has been used to treat a variety of neurologic problems, including blinking or twitching of one side of the face, dystonias, spasticity from strokes, multiple sclerosis, brain traumas, pathologically abnormal sweating and drooling, headache, and other painful conditions.

 

What is Botox Made of?

The neurotoxins utilized in Botox are produced by a bacteria called Clostridium botulinum. For medical injections, healthcare practitioners utilize a specific strain of bacteria (type A).

Botulinum toxins are found in soil and contaminated foods. Botulism can occur if high levels of botulinum toxins are consumed or the germs enter a wound. This significant nerve system condition has an impact on respiration. Botox is manufactured in a laboratory for maximum safety and efficacy. Botulinum toxins are diluted and sterilized so that they do not induce botulism.

 

When Should I Call My Healthcare Provider?

Botox is a common procedure that’s rarely accompanied by serious side effects. However, you should call your healthcare provider immediately if you experience:

• Vision problems, including blurred vision or drooping eyelids.
• Signs of urinary tract infection, such as blood in your urine (hematuria).
• Shortness of breath (dyspnea).
• Trouble swallowing.
• Slurred speech.
• Numbness or paralysis in an untreated area.
• Severe stomach upset.

 

What’s the Difference Between Botox & Dermal fillers?

Botox and dermal fillers provide comparable cosmetic outcomes. Both aid in the reduction of the appearance of face lines and wrinkles. Botox is derived from botulinum toxin, whereas dermal fillers are derived from natural or synthetic materials such as collagen, hyaluronic acid, or calcium hydroxylapatite. Botox injections temporarily block muscles, reducing wrinkles, whilst dermal fillers provide volume and aid with moisture retention. Your healthcare professional can explain the benefits and drawbacks of each therapy and assist you in deciding which choice is best for you.

 

Is it Safe to Get Botox & the COVID-19 Vaccine?

Yes. There have been no reported incidences of Botox and COVID-19 vaccination responses. Whether or whether you've had Botox, healthcare specialists highly advise you to obtain the COVID-19 vaccination as soon as you're eligible.

There have been sporadic incidences of edema in persons who got the Moderna and Pfizer vaccinations while using dermal fillers. To begin, keep in mind that Botox injections and dermal fillers are not the same thing. Second, persons who encountered these uncommon side effects stated that their symptoms subsided promptly. Furthermore, the transient swelling had no long-term health consequences. For these reasons, the American Academy of Plastic Surgeons recommends that persons who have had dermal fillers not avoid taking the COVID-19 vaccination.

 

Uses of Botulinum Toxins in Neurology

Dystonia & Related Movement Disorders

Botulinum toxin originally gained clinical acceptance as a consequence of the significant advantages it generated in patients suffering from dystonia, a neurological disease characterized by repeated and stereotyped muscular contractions that result in aberrant movements and postures. While levodopa, anticholinergic medications, baclofen, and muscle relaxants help some people with primary or secondary dystonia, botulinum toxin injections are currently regarded the therapy of choice in the majority of patients with focal or segmental dystonia.

Several controlled and open label trials have demonstrated the effectiveness and safety of botulinum toxin in a range of dystonic illnesses since the first double-blind, placebo-controlled experiment in patients with cranial-cervical dystonia, including blepharospasm, which was reported in 1987.

More than 90% of patients with blepharospasm who were injected into the orbicularis oculi of the upper and lower eyelids improved moderately or significantly. The average period between the injection and the commencement of improvement is three to five days, and the effect lasts three to four months.

The most frequent side effects, occurring in fewer than 10% of treated patients, include ptosis, blurring of vision, diplopia, tearing, and local hematoma. All these side effects usually resolve in less than two weeks.

Oromandibular dystonia, which is characterized by involuntary jaw closure and bruxism, jaw opening, or jaw deviation, is one of the most difficult kinds of focal dystonia to treat. It rarely improves with medications, and there are no surgical options. In patients with dystonic jaw closure, an injection of botulinum toxin into the masseter and temporalis muscles, or the submental muscle complex and lateral pterygoid muscles in patients with dystonic jaw opening, often significantly improves symptoms of temporomandibular joint syndrome and other oral and dental problems, as well as dysarthria and chewing difficulties.

A temporary swallowing problem, noted in fewer than 20% of all treatment sessions, was the most common complication.

Another reason for botulinum toxin therapy is hemifacial spasm. In contrast to blepharospasm, a kind of facial dystonia, hemifacial spasm is always unilateral and is generally caused by an anomalous artery or faulty vasculature surrounding the brain stem or some other local anatomical abnormality. In a study of 110 individuals with hemifacial spasm, 95% improved in severity and function after receiving botulinum toxin therapy. This is consistent with a 10-year experience in four Italian centers with botulinum toxin therapy in 65 individuals with hemifacial spasm. Side effects were minor in both investigations, consisting mostly of temporary facial weakness.

Cervical dystonia, often known as torticollis, is a common primary dystonia. More open and controlled studies have been conducted for this indication than for any other indication for botulinum toxin therapy. Only the relevant muscles are injected with an adequate dosage when a detailed neurological examination is performed. Permanent neck contractures are now uncommon as a consequence of early management with botulinum toxin in individuals with cervical dystonia, and surgical therapy, such as selective peripheral denervation, is seldom required.

Several studies have established the efficacy and safety of botulinum toxin in the treatment of laryngeal dystonia, manifested by spasmodic dysphonia, an effortful and strained voice interrupted by frequent breaks in phonation and voiceless pauses (adductor spasmodic dysphonia), or a breathy, whispering voice (abductor spasmodic dysphonia). Botulinum toxin is now considered to be the treatment of choice for this disorder.

Other movement disorders reported to benefit from botulinum toxin injections include task specific focal dystonias, such as writer’s or musician’s cramps and other occupational dystonias. Important insights into the pathophysiology of dystonia and the effects of treatment have been gained from various physiological studies that have shown reorganisational changes in the primary motor cortex in patients with dystonic writer’s cramp receiving botulinum toxin injections.

Botulinum toxin injections have also been proven to be beneficial in individuals suffering from Parkinson's disease and other neurodegenerative disorders, as well as stroke-related hemiplegia, who occasionally experience secondary "dystonic clenched fist." Many of these illnesses are linked to foot dystonia, and botulinum toxin injections into the foot-toe flexors or extensors may not only relieve the impairment, pain, and discomfort associated with such dystonia, but may also improve gait. Botulinum toxin injections have yet to be shown effective in the treatment of repeated unpleasant physiological foot and calf cramps.

In addition to dystonia, botulinum toxin injections can help with various hyperkinetic movement disorders. Several open label and double blind, placebo controlled studies have also demonstrated the efficacy of botulinum toxin in the treatment of hand and head tremors. Although antidopaminergic medicines frequently relieve tics associated with Tourette syndrome, their treatment is restricted due to potential adverse effects. Botulinum toxin injections have been demonstrated in several trials to alleviate not just the motor component of focal tics but also the premonitory feelings that precede both motor and phonic tics.

 

Spasticity & Other Hypertonic Disorders

Botulinum toxin has been used successfully to treat muscular tone problems, such as spasticity associated with cerebral palsy, strokes, brain trauma, and multiple sclerosis, in addition to involuntary movement disorders. While botulinum toxin therapy is obviously beneficial, it is frequently accompanied by additional medical therapies (such as tizanidine and other muscle relaxants, as well as oral or intrathecal baclofen and phenol injections) and an intense physical treatment program. Children with cerebral palsy may change from toe walking to normal flat footed gait as a consequence of botulinum toxin therapy of leg stiffness, avoiding surgical extension of the heel chord. Furthermore, early botulinum toxin therapy in young children may help them avoid musculoskeletal abnormalities and other orthopaedic issues later in life.

Several studies have shown meaningful functional improvement and relief of associated pain following botulinum toxin in patients with hip adductor spasticity in multiple sclerosis, rigidity associated with a variety of parkinsonian disorders, and stiff person syndrome. When used early on, botulinum toxin may prevent complications of spasticity such as contractures.

 

Muscle Spasms & Other Painful Disorder

Fibromyalgia-myofascial pain, temporomandibular joint and orofacial pain (frequently linked with bruxism), and other musculoskeletal pain and spasm syndromes have all been found to benefit from botulinum toxin injections.

Botulinum toxin is increasingly being used to treat muscular contraction headaches and migraines, however there is an alarming lack of well-designed controlled research. While some placebo-controlled trials with botulinum toxin found treatment to be beneficial in individuals suffering from persistent daily headaches and chronic tension or "cervicogenic" headaches, others found conflicting results.

Quantitative sensory testing and measurements of pain thresholds in response to local electrical stimulation showed no statistically significant differences between normal subjects pretreated with subcutaneous injection of botulinum toxin A or placebo. This suggests that the efficacy of botulinum toxin in various pain syndromes is a result of mechanisms other than a reduction in muscle tone. Other mechanisms proposed to explain the analgesic effects of botulinum toxin include:

• inhibition of release of substances that sensitize muscle nociceptors.
• an effect on spindle afferents favorably altering the firing pattern of supraspinal projections and changing the central sensory processing.
• suppression of neurogenic inflammation.
• inhibition of substance P, glutamate, and other peptides and neurotransmitters involved in mediating pain.

 

 Autonomic Nervous System Disorders

Botulinum toxin disrupts transmission not just at the neuromuscular junction, but also in the cholinergic, autonomic, parasympathetic, and postganglionic sympathetic nervous systems. As a result, it is becoming more beneficial in the treatment of many autonomic nervous system problems. About 0.5% of the population suffers with essential focal hyperhidrosis, which is characterized as excessive sweating of the palms, feet, or axillae. It is thought to be caused by hypothalamic dysfunction, however it seldom responds to medical therapy, and sympathectomy can be dangerous. A botulinum toxin intradermal injection has proven to be a highly successful therapy for focal hyperhidrosis, significantly enhancing the quality of life of those affected.

In a multicentre placebo controlled trial, axillary injections of botulinum toxin (100 to 200 units of Botox®) in 145 patients with hyperhidrosis reduced axillary sweat production sixfold. In contrast to other conditions treated with botulinum toxin, the duration of benefit in patients treated for hyperhidrosis may last up to one to two years. Botulinum toxin injections into the axillae have been associated with a marked reduction in secretion from the apocrine axillary sweat glands that normally produce a pungent smell when degraded by certain local microbes, and this treatment has led to a reduction in body odour.

The relatively high frequency of dry mouth following botulinum toxin injection into the cervical muscles, particularly botulinum toxin B, implies an anticholinergic action on the salivary glands. Indeed, botulinum toxin injections have successfully cured sialorrhoea associated with amyotrophic lateral sclerosis, Parkinson's disease, and other neurodegenerative illnesses. The mechanism behind the reported differential effect of botulinum toxin serotypes on cholinergic function is unclear, however toxin B may have a higher affinity for autonomic nerve terminals than toxin A, as seen by more prominent pupillary involvement with toxin B botulism.

 

Gastrointestinal, Genitourinary & Sphincter Disorder

Local botulinum toxin injections have also been used successfully to treat gastrointestinal diseases such as dysphagia caused by spasm of the cricopharyngeal component of the inferior constrictor of the pharynx, achalasia and other oesophageal spasms, and spasm of the sphincter of Oddi. Botulinum toxin has been proven to be useful in the treatment of anismus induced by spasm of the rectal sphincter or related with Parkinson's disease. Chronic anal fissure, a painful disorder characterized by a split in the bottom half of the anal canal, spasm of the internal anal sphincter, and constipation, has been reported to be effectively treated with rectal injections of 15 to 20 units of Botox®.

Botulinum toxin is also being increasingly used in the treatment of bladder and other genitourinary disorders. Using a transperineal needle with EMG monitoring, botulinum toxin injection is minimally invasive and an effective method of managing voiding in patients with spastic bladders. In one study of 21 patients with neurogenic incontinence caused by detrusor hyperreflexia, an overall dose of 200 to 300 units of botulinum toxin A was injected at 20 to 30 different sites in the detrusor muscle, sparing the trigone, under cystoscopic and ultrasonographic guidance. At six weeks all but two patients were fully continent and the maximum bladder capacity increased from a mean of 286 ml to 458 ml. Other genitourinary indications for botulinum toxin treatment include voiding dysfunction from prostatitis, prostatic pain, and vaginismus.

 

Other Indications

The use of botulinum toxin is continuously expanding as clinicians are becoming more familiar with its therapeutic potential. In addition to disorders already mentioned, others successfully treated with botulinum toxin include nystagmus, palatal myoclonus, and stridor. Botulinum toxin also has been found effective in the treatment of co-contractions after birth related brachial plexus lesions, scoliosis, and freezing associated with parkinsonian gait. Botulinum toxin is also increasingly used to reduce unwanted muscle contractions during the perioperative period and to reduce EMG artefacts in the frontotemporal muscles while attempting to localize a seizure discharge on an electroencephalogram.

There is growing interest in the use of botulinum toxin in cosmetic and dermatological applications, such as the correction of wrinkles and frown lines. Injections into the corrugator and the procerus muscles bilaterally have been found to be effective for the treatment of vertical glabellar eyebrow furrows (“frown lines”). Injections at multiple sites in the frontalis muscle eliminate horizontal lines in the forehead, injections into the lateral orbicularis oculi are very effective in treating lateral canthal wrinkles (“crow’s feet”), and injections into the platysma muscles often result in marked improvement in the appearance of the age related platysma muscle bands. 

Inappropriate placement or dose of botulinum toxin, however, may result in loss of facial expression and disfiguring complications. Botulinum toxin has been found useful in correcting facial asymmetry after injection for hemifacial spasm, and in patients who developed synkinesia and hyperlacrimation after facial palsy.

 

Conclusion

The bacteria Clostridium botulinum produces botulinum toxin, a powerful neurotoxin. It becomes a potent therapeutic agent when purified and given precisely where it is required. Although there are seven forms of C. botulinum toxin, only kinds A (Botox®) and B (Myobloc®) are employed as medical therapies.

The therapy's purpose is to lessen muscular spasms and discomfort while also restoring more usable function. A very small amount of botulinum toxin is injected into a muscle to prevent spasms by blocking part of the impulses delivered from the nerves to the muscles.

Because neurons develop new nerve ends that reactivate muscular contracture, recovery is time-limited, and therapy is often repeated every 3 to 4 months. Occasionally, physical or occupational therapy might help restore normal muscular function.

Botulinum toxin therapy is a safe and effective treatment when administered correctly by a skilled neurologist. Some patients suffer transient weakening in the muscles being treated or in neighboring muscles. After treating blepharospasm, for example, ptosis (drooping eyelid) may occur. Flu-like symptoms appear in a small number of people.

 Botulinum toxin treatment may not be appropriate for patients with some other neuromuscular diseases, such as amyotrophic lateral sclerosis or myasthenia gravis. Some individuals, on rare occasions, acquire antibodies to the medicine over time, rendering the treatment useless.