In Neurology Botox Injections Are Doing Great!

In the realm of Neurology Botox Injections appear to have achieved a comfortable therapeutic niche of their own.

Botox (trade name for botulinum toxin), although a toxin by nature but when used in extremely minute quantity has been found to have therapeutic value.

This toxin is obtained from a bacteria called as Clostridium botulinum. It can bother human beings in 3 different ways; food poisoning, wound botulism and infant botulism. If prompt therapeutic intervention is not done then many patients succumb to the disease.

The toxin causes skeletal muscle paralysis including the breathing and throat muscles. There is a microscopic area called NMJ (neuromuscular junction) where the nerve fibers contact the muscle fiber and transmit the nerve signals (electric impulses) coming from the brain & spinal cord.

A chemical called Acetylcholine (Ach) acts as a neurotransmitter at NMJ. As the nerve impulse reaches the so called pre-synaptic area of NMJ Ach is liberated. It travels to the so called post-synaptic area and attachés to Ach receptors and initiates certain ionic movements which in turn activates the muscle and induces contraction

So if Ach is not liberated properly then muscle will fail to get activated. The botulinum toxin does exactly that. It hinders the liberation of Ach from the pre-synaptic area of NMJ.

The same action of, this one of the most potent toxin known to humankind is exploited for treating certain neurological conditions. There are varieties of neuro conditions where skeletal muscles are contracting unnecessarily and excessively causing pain, spasms/cramps, abnormal movements like dystonia etc. By injecting a very small amount of this toxin to the abnormally excited muscle we can relax those muscles and relieve the uncomfortable symptoms.

• Hemifacial spasm (dystonia of one side of the face)
• Blepharospasm (dystonia of the eyelids)
• Writer’s cramps (hand/finger dystonia while writing)
• Wry neck (Spasmodic torticollis)- neck dystonia
• Spasmodic dysphonia (dystonia of larynyx)
• Oromandibular dystonia
• Refractory severe migraine headache
• Spasticity of the extremities (due to stroke etc)

Although when injected in the prescribed concentration, by an experienced physician like a neurologist,cosmetic surgeon, pain expert or other specialists, side effects and complication are extremely minimal. However if inadvertently the toxin enters the blood stream then serious hypotension and shock can occur. Sometimes this toxin can induce hypertension too. A temporary weakness of the injected muscles also may occur (e.g. eye lid drooping). Some other adverse effects include (dysphagia) difficulty in swallowing, headache etc.

An EMG guided botox injecion procedure helps in delivering this toxin more accurately to the target muscle and reduces the complications as well as increases the success rate of this procedure.

It is not a curative treatment. Its effect generally lasts for few weeks to few months and repeat injections are usually necessary.

Botox is actually an expensive therapy but the good news is that many of the US insurance companies approve this injection provided there is a genuine medical indication.

To Summarize, in the field of Neurology Botox Injections seem to be doing a wonderful job! There are myriad indications, and many satisfied patients too.