Botulinium Toxin (Botox®) Therapy

Botulinum toxin (Botox®) is a potent neural toxin produced by the bacterium Clostridium Botulinum. When the bacterium is eaten, it causes food poisening. However, when pure toxin is injected into muscle, the toxin has been found to be a safe and very effective method of decreasing muscle overactivity and spasm.

Botulinum toxin works by decreasing of blocking the neural transmission from nerve to muscle. Electrical impulses for muscle function are generated in the brain, brain stem and spinal cord. From there these impulses travel into peripheral nerves. At the end of the nerves there is a storage of a chemical transmitter substance called acetylcholine. Normally, when an electrical impulse reaches the storage point, acetylcholine is release and comes in contact with muscle receptors. However, when Botulinum toxin is injected into muscle, there is a blockade of the release of acetylcholine, and so there is no transmission of the electrical signal and therefore no muscular contraction. To obtain the optimal result from Botulinum toxin therapy, it is necessary to identify the overactive muscles generating the clinical symptomatology and to decide on the appropriate dose to normalize the activity. The use of this toxin has been found to be extremely safe in over 20 years of use. When injected for therapy, only several billionths of a gram of toxin are used, and the toxin largely remains at the point of injection. There have been no persistent side effects. The major side effect has been local muscle weakness that is temporary and dose related. The toxin takes 24 to 72 hours to have an effect with the maximum effect about 7 to 10 days. The effect of the toxin lasts 3 to 4 months, and then the injection has to be repeated.

Botulinum toxin has been FDA approved as safe and effective treatment for blepharospasm, strabismus, hemifacial spasm, and spasticity. The American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Neurology, and the NIH Concensus Conference on Botulinum toxin have recognized other "off-label" uses including torticollis, occupational writer's cramp, oromandibular dystonia, spasmodic dysphonia and Meige syndrome. Dr. Andrew Blitzer gave the world's first laryngeal injection of botulinum toxin for laryngeal dystonia (spasmodic dysphonia) 14 years ago, and has helped pioneer the use of toxin for other indications including oromandibular dystonia; temporomandibular disease and jaw spasms; swallowing disorders; recurrent muscular tension headache; Frey's syndrome or gustatory sweating; and palatal myoclonus. Dr. Blitzer also helped pioneer the use of Botox® for hyperfunctional facial lines and wrinkles. Dr. Blitzer is currently an investigator for adding some of these other uses to the FDA on-label indications.

Dr. Maurice M. Khosh offers the use of Botox® for cosmetic improvement of facial wrinkles.