Botulinum toxin, also known as botox, is mainly associated by most patients with wrinkle smoothing treatments. But it is not the only function of botox in medicine. Botulinum toxin is a toxic substance which, thanks to its properties, has found its place in therapeutic curings. When used in small doses, botulinum toxin in certain conditions may contribute to the recovery. It is the first-line treatment for many conditions. The therapy is quite effective.
Botulinum toxin is a drug that, when applied locally, inhibits the release of acetylcholine in the neuromuscular junction – thus reducing muscle tension in the injected muscle, reducing excessive muscle activity, and influencing the secretion of substances involved in the transmission of pain sensations – it has an analgesic effect. This treatment is more effective than “pill” prophylactic treatment. Currently, treatment with botulinum toxin covers a wide spectrum of neurological disorders. The mechanism of action of this substance is based on blocking neurotransmission in the neuromuscular junctions and in the postganglionic autonomic fibers innervating the glands. The treatment is effective in people suffering from chronic migraines, it also works well in the treatment of dystonia (torticollis, blepharospasm), hemifacial spasm, spasticity, and others.
What is botulinum toxin?
Botulinum is produced by the anaerobic bacteria Clostridium botulinum. Despite its strong poisonous properties, it has been used in aesthetic medicine and neurology. The mechanism of action of this substance is based on a permanent connection with the neuromuscular plate, which leads to paralysis of the overactive muscle.
The substance used in medicine is botulinum toxin type A. It is available in pharmacies upon presentation of a prescription. The form of the drug used is an intramuscular injection with botulinum toxin. The first effects of the toxin’s action are visible after 2-3 days, and the maximum effect appears after 2-6 weeks and may last up to 3-6 months. Unfortunately, the effect is only temporary. Therapeutically, low doses of botulinum toxin are used, and its action is limited only to the injection site, which reduces the risk of serious side effects. Botulinum toxin is reimbursed only in the treatment of certain diseases.
Thanks to its properties, the substance can be used in diseases with a significant increase in neuromuscular tension. Botulinum toxin is administered in the form of intramuscular or subcutaneous injections, and the therapeutic effect depends on the dose used. Currently, four preparations of botulinum toxin are available on the international market.
Treatment with botulinum toxin injection in neurology is applicable in:
- dynamic equine foot caused by spasticity in children older than 2 years of age with cerebral palsy,
- facial cramp,
- eyelid spasm,
- spasmodic torticollis,
- upper limb spasticity after stroke,
- primary excessive sweating of the armpits,
- prophylaxis of migraine headaches with chronic migraine when headaches occur more than 15 days a month.
BTX-A as a drug for different neurological ailments
It is one of the most potent biological toxins, but the doses used in medicine are many times lower than the doses toxic to the human body. The action of botulinum toxin is limited to the muscle to which it was injected and does not affect the activity of other, also healthy muscles. Botulinum toxin is used in curing:
- focal dystonia – blepharospasm, facial spasm, torticollis, writer’s cramp, musicians spasm,
- dystonic tremor,
- chronic migraine,
- increased muscle tone (spasticity),
- underarms, hands and feet hyperhidrosis
Limb spasticity is a form of increased muscle tone. In a clinical trial, it is characterized by resistance to passive movement in the joint. It can significantly limit the performance of active movements, reduce their range and be a source of pain. It is also associated with the limitation of the patient’s rehabilitation options. Patients with post-stroke spasticity of the limbs can be treated with botulinum toxin.
Focal dystonias and hemifacial spasms are movement disorders characterized by involuntary muscle contractions that cause involuntary, uncontrolled movements and positions of various parts of the body. In many cases, the cause of the ailments remains unknown, and some of them are genetic or are the result of organic changes in the central nervous system.
We divide dystonias into focal, segmental, and generalized. Focal dystonias are confined to one area of the body and only occupy one group of striated muscles. The factors that aggravate dystonic symptoms include, among others fatigue, stressful situations, fever. In some patients, the so-called sensory tricks, like a temporary reduction in dystonia symptoms when touched.
These type of dystonias include:
- eyelid spasm (blepharospasm) consists of involuntary contractions of the circular muscles of the eyes causing the eyelid to tighten, sometimes so strong that it becomes impossible to open the eyes – the so-called functional blindness.
- cervical dystonia (torticollis) is caused by increased activity of several muscles in the neck, usually acting synergistically during torsional movements of the head, resulting in a forced tilt of the head and neck to the side, back, or forward.
- laryngeal dystonia affects the muscles of the larynx, resulting in difficulty speaking and voice output. Treatment of patients with this form of dystonia is carried out only in highly specialized centers.
BTX-A and serious neurological diseases
Botulinum toxin has been used with great success for years in the treatment of Parkinson’s disease. The doses administered intramuscularly are adjusted on a case-by-case basis. The therapy has an analgesic effect and allows patients to move better by reducing tremors and muscle tension, and significantly improves their quality of life. The effects of treatment last for several months.
Bruxism is the involuntary rubbing of the teeth of the mandible against the teeth of the maxilla, which is the most frequent friction during sleep. Patients sometimes remain unaware of their condition for many years. Bruxism can cause cracking of the enamel, abrasion of the teeth, and degenerative changes in the articular and mandibular joints. Treating bruxism consists of injecting excessively tense muscles. The effects of treatment appear a few days after the application of the toxin and last for 4 to 6 months. After this time, botox should be reintroduced to maintain the effects.
Treatment of spasticity with botulinum toxin results in gradual muscle relaxation and improvement of the patient’s quality of life. In rehabilitation, botulinum toxin is used, among others, after a stroke. It facilitates physical therapy exercises, reducing pain and allowing you to perform daily activities. On the other hand, botulin injection in children suffering from cerebral palsy at an early stage of development gives a chance to improve movement patterns and perform activities such as walking and gripping.
Botulinum toxin (botox) – side effects
The main complication of botulinum toxin treatment is local reactions to the injection – the formation of hemorrhages. Less frequent tremors are observed in the muscles distant from the botulin injection site. As a result of the treatment of eyelid and facial spasms, visual disturbances, drooping eyelids, paralysis of the middle muscles of the face, photophobia, lacrimation, dry eyes, and bruising may appear. In the treatment of cervical dystonia, difficulty swallowing and dry mouth appear. In very rare cases, there are allergic reactions in the form of rashes and swelling.
Botulinum toxin is a protein that can produce an immune response in the body. Large doses of the drug and more frequent injections with botox increase the risk of antibody formation and reduce the clinical effectiveness of the preparation. Remember to take the exact dose of botulinum toxin prescribed by your doctor. Exceeding the recommended amount may lead to distant and severe paralysis of neuromuscular groups.