Botox's less glam avatar treats spasm, incontinence

Botox reaches the brain but does not cause side effects, which shows its use is safe. But at the end of the day, it is a neurotoxin. When given in wrong doses by untrained hands, Botox can play havoc with your nerves.
Hindustan Times | By Sanchita Sharma, New Delhi
UPDATED ON APR 18, 2015 06:57 PM IST

Everyone knows of Botox as the wonder wrinkle-buster that is used and abused more than illicit drugs by the rich and the famous desperately-seeking eternal youth.

But apart from its impressive cosmetic applications, Botox is medially used to treat an array of distressing nerve and muscle-related disorders that make it impossible for millions to be physically mobile or survive the day without social embarrassment.

First approved for treating two eye muscle disorders - uncontrollable eye spasm (blepharospasm) and eye misalignment (strabismus) -- in 1989, botulinum toxin type A, better known by its brandname Botox, is now approved for treating eight conditions, ranging from abnormal head position and neck pain (cervical dystonia) to excessive underarm sweating and spasticity.

It's not a cure but just a therapy that provides temporary relief. Since the injection eases contractions for three to four months, botox injections shots have to be given every four months for continued relief, which can cost up to Rs 20,000 per sitting. Once injected, the toxin is broken down by enzymes in the body and eliminated slowly over three to four months.

With a 100-unit vial priced at Rs 18,900, and each patient needing 50 to 400 units for one session every four months, depending on the condition, the cost can go through the roof.

*Rehab:Many people in pain are willing to pay. Muscle stiffness in the elbow, wrist and finger muscles in people with upper limb spasticity (ULS), for example, is reduced by injecting Botox into muscles. In people with ULS, the brain sends continuous messages to the muscles telling them to contract because of damage to parts of the brain controlling voluntary movements. Botox freezes the nerve pathways that do the messaging, making the muscles relax and increasing the range of movement. Off label use for similar conditions under the discretion of the physician is not unusual. Some rehab centres, for example, use it to treat paralysis after stoke or accidents. The therapy works at three basic levels: it eases involuntary muscle movement; reduces excessive glandular secretions, and relieves pain by blocking the transmission of the pain sensation to the brain.

*Migraine: For people with chronic migraine that last for four or more hours a day for 15 or more days a month, Botox is a lifesaver. Madhuri Munjal, 45 started getting migraines when she was expecting her daughter 19 years ago. Her daughter grew up and left home to study in the UK last year, but the migraines remained. Over the years, the frequency of Munjal's migraine attacks went up from half a dozen episodes lasting 24 hours during her pregnancy to mind-atrophying pain every other week lasting for three days at a stretch. Though Munjal heard about Botox getting approved for treating migraine in 2010, she chose to be cautious and waited for two years before opting for treatment. Over the past two years, getting Botox shots two to three times a year has helped, with the frequency of attacks and the intensity of pain going down.

*Dribble, drabble uses:It's also being used to treat drooling and dribbling, medically referred to as ptyalism, associated with Parkinson's or other neurological disease such as pseudobulbar palsy. It works by blocking the neuromuscular junction that controls facial muscles.
The last group of conditions that Botox got approval for treatment is urinary incontinence due to neurologic disorders such as spinal cord injury and multiple sclerosis; and overactive bladder (OAB) not responding to anti-cholinergic medicines used to treat it.

*Side effects:Its effects are temporary and so are its side effects. Temporary side effects include mild headache lasting for a day or two, droopy eyelids, weakening of the group of injected muscles and generalised flu-like symptoms. Users must, however, inform their physician if they develop problems swallowing, speaking or breathing, which may be due to weakening of the associated muscles. If injected incorrectly, the toxin may spread and affect areas away from the injection site and cause overall muscle weakness, double or blurred vision and droopy eyelids or hoarseness or slurring, but this has not been found when the toxin is used in recommended doses for approved treatments such as chronic migraine, underarm sweating and cosmetic uses such as treating frown lies and crow's feet.

Overall, more than 60 reviews have found Botox to be safe. On Friday, Australian researchers reported in the Journal of Neuroscience that Botox reaches the brain but does not cause side effects, which shows its use is safe ( But at the end of the day, it is a neurotoxin. When given in wrong doses by untrained hands, Botox can play havoc with your nerves.

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