The following discussion is for general informational purposes only and is not meant to provide the reader with specific medical advice. Please consult with your personal physician or neurologist, for specific advice, guidance and information regarding your particular circumstances.

What is Botulinum toxin (Botox®)?

Botulinum toxin is a potent neurotoxin produced by the bacterium, Clostridium botulinum. When purified and delivered exactly where needed, it becomes a powerful therapeutic agent. There are seven known types of C. botulinum toxin, but only types A (Botox® onabotulinumtoxinA), Dysport® abobotulinumtoxinA) and B (Myobloc®) are used as medical treatments.

What is Botox® used for?

The U.S. Food and Drug Administration first approved the neurotoxin in 1989. It was approved for chronic migraine treatment in 2010. It has since been increasingly used in Neurology practice. In addition to its popular role for cosmetic purpose, it has been used in multiple neurological conditions such as:

  • Chronic migraine
  • Cervical dystonia or torticollis (tilted neck)
  • Blepharospasm (eye lid twitches/spasms)
  • Hemifacial spasm (facial twitches)
  • Upper and lower limb spasticity following stroke, cerebral palsy, multiple sclerosis, brain or spinal cord injuries
  • Primary Axillary Hyperhidrosis (excessive sweating in arm pits)
  • In addition it is also used to various focal dystonias and oro-facial dyskinesia, facial pain (trigeminal neuralgia) temple-mandibular joint dysfunction (TMJ) and tremors.

How does Botox® work?

Botox works by blocking the neurotransmitter (acetylcholine) release from nerve endings to muscle that are involved in muscle contraction.  As a result, abnormal movements or muscle spasms are decreased. The goal of the therapy is to reduce muscle spasm and pain, and restore more useful function. A very small dose of botulinum toxin is injected into a muscle to block some of the messages that are sent from the nerves to the muscles, help an overactive muscle relax, reducing spasms. Treatment does not permanently deactivate muscles. The peak effect of Botox® occurs at roughly the 7-10 day mark. Neurons generate new nerve endings that reactivate the muscle contracture. Hence improvement is time limited. Repeat treatments are needed at approximately three-month intervals.

Individual response to Botox treatment varies. Overall the treatment success rate is very high and majority of patients who receive this treatment are pleased with the benefit.  Physical or occupational therapy occasionally helps restore normal muscle function.

How is Botox® administered?

Botox® is injected under the skin or into the muscle using small needles. Depending on the particular indication, sometimes electromyography (EMG) guidance is needed. Patient discomfort is usually mild, in most cases. Some people opt to take Tylenol or a mild sedative prior to the procedure. Injections are performed in the office and the patient can go home afterward. A follow-up visit (in person or by telephone) is usually set up within two to three weeks to evaluate to results of the injection and discuss any side effects or concerns.

What are the side effects?

Botulinum toxin therapy is a safe and effective treatment when given in appropriate amounts by a qualified neurologist. Some patients experience temporary weakness in the group of muscles being treated, or those nearby. For example, ptosis (drooping eyelid) can develop after treating blepherospasm. Flu-like symptoms develop in some patients, but rarely. Patients with certain other neuromuscular diseases, such as amyotrophic lateral sclerosis or myasthenia gravis, may not be appropriate candidates for botulinum toxin therapy. Infrequently, some patients develop antibodies to the medication over time, rendering the treatment ineffective.

Am I a candidate for Botox?

An initial consultation with a doctor determines whether Botox® is an appropriate treatment. If so, a treatment appointment will be scheduled during which the procedure will be re-explained and questions/concerns addressed. For torticollis, spasticity, and other dystonias, most insurances including Medicare cover the treatment. For other indications, it varies and frequently a pre-authorization from the insurance company is needed. This question can be addressed during consultation in our Botox Clinic.

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