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Botulism Toxin: 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. Nevertheless, it is actually short for botulinum toxin—one of the deadliest food poisons known to humankind. Although rare, it is not hard to find news stories about groups of people who died from food poisoning caused by the toxin. However, 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 tendinitis, dystonia is a neurologic disorder in which the brain incorrectly signals muscles to contract, which can result in muscle pain and spasm.

When Botox is injected directly into a contracted muscle, it is weakened and cannot contract as strongly, restoring balance to the group of muscles involved in a particular movement and relieving symptoms for a period of months.

Doctors have used Botox to correct a variety of conditions involving inappropriate muscle and gland activity with varying degrees of success. They include:

  • Eyelid muscle spasms—People with limited eye closure and spasms that prevented them from driving (blepharospasm) have been very successfully treated with Botox.
  • Eye crossing— Weaking one of the muscles controlling eye movement with Botox can restore muscle balance and straighten the eyes.
  • 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.
Wrinkle Treatment

Frown. Smile. Grimace. Grin. Every facial expression forms a crease that will someday be etched into your 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 does not remove all traces of the wrinkle.

How Does It Work?

Tiny quantities of the toxin are injected directly into the muscles of facial expression. The treated muscles weaken over the course of two weeks 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.

Not surprisingly, younger people—whose lines are not as deep—experience the greatest improvements. Results last up to 4 months. You can receive injections every 3–4 months to maintain the results.

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.

RESOURCES:

American Society of Plastic Surgeons
http://www.plasticsurgery.org

United States Food and Drug Administration
http://www.fda.gov

CANADIAN RESOURCES:

The Canadian Society for Aesthetic Plastic Surgery
http://www.csaps.ca

Health Canada
http://www.hc-sc.gc.ca

References:

Botulinum toxin type A. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed February 4, 2014.

Cervical dystonia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 29, 2012. Accessed February 4, 2014.

Charles PD. Botulinum neurotoxin serotype A: a clinical update on non-cosmetic uses. Am J Health Syst Pharm. 2004 Nov 15;61(22 Suppl 6):S11-23.

Continuing treatment. Botox Cosmetic website.http://www.botoxcosmetic.com/continuing_treatment.aspx. Accessed February 4, 2014.

Evers S, Vollmer-Haase J, Schwaag S, et al. Botulinum toxin A in the prophylactic treatment of migraine—a randomized, double-blind, placebo-controlled study. Cephalalgia. 2004; 24:838.

Relja M, Poole AC, Schoenen J, et al. A multicentre, double-blind, randomized, placebo-controlled, parallel group study of multiple treatments of botulinum toxin type A (BoNTA) for the prophylaxis of episodic migraine headaches. Cephalalgia. 2007; 27:492.

Report blames Florida botulism cases on misused toxins. Center for Infectious Disease Research and Policy website. Available at: http://www.cidrap.umn.edu/cidrap/content/bt/botulism/news/dec1504botulism.html. Accessed February 4, 2014.

Shukla HD, Sharma SK. Clostridium botulinum: a bug with beauty and weapon. Crit Rev Microbiol. 2005;31(1):11-8.

Silberstein S, Mathew N, Saper J, Jenkins S. Botulinum toxin type A as a migraine preventive treatment. For the BOTOX Migraine Clinical Research Group. Headache. 2000; 40:445.

Troost BT. Botulinum toxin type A (Botox) in the treatment of migraine and other headaches. Expert Rev Neurother. 2004;4(1):27-31.

Wheeler AH. Botulinum toxin A: adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache. 1998; 38:468.



Last reviewed February 2014 by Michael Woods, 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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