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 poisoning. However, when carefully measured doses of pure toxin are injected into muscle or skin, they can safely decrease muscle over activity or eliminate excess sweating. Electrical impulses for muscle function are generated in the brain, brain stem and spinal cord, which then travel into peripheral nerves. At the end of the nerves there is a chemical transmitter substance called acetylcholine. Normally the electrical impulse is carried by the acetylcholine to the muscles or gland receptors. However, when Botulinum toxin is injected into muscle or skin, it creates a blockade against the release of acetylcholine, resulting in no transmission of the electrical signal and therefore no muscular contraction, or sweat excretion.
The over 20 years use of this toxin has proven it to be extremely safe and there have been no persistent side effects apart from local muscle weakness, which is temporary and dose related. When injected for therapy, only several billionths of a gram of toxin are used, and the toxin largely remains at the point of injection. 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 months, and then the injection has to be repeated.
There are currently two FDA approved versions of Botulinum toxin A: Botox® and Reloxin®. Botulinum toxin has been FDA approved as safe and effective treatment for cosmetic improvement of furrows in the mid forehead, and treatment of blepharospasm, strabismus, hemifacial spasm, and spasticity. The FDA has also approved Botolinum toxin injections for treatment of excessive sweating. 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: cosmetic treatment of crow’s feet (around the eyes), cosmetic treatment of neck bands and vertical lip lines, 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) 25 years ago, and has helped pioneer the use of toxin for other indications including oromandibular dystonia; temporomandibular disease and jaw spasms; swallowing disorders; recurrent 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.