Wednesday, June 25, 2003

Botox is more than meets the eye

The toxin has been gaining popularity as a way to reduce eye-area wrinkles, but it is used to treat much more

By Peggy O'Farrell
The Cincinnati Enquirer

Botox injections let Ken Lazarus move his hands enough to work a computer keyboard, grasp a paintbrush or turn the page of a book.

The injections help Andy MacWilliams speak without sounding like he's gasping for air.

Though it's best known for eliminating those little lines between the eyes, there's another wrinkle to Botox therapy: The toxin is used to treat migraines, excessive sweating, voice disorders, chronic pain and neurological and muscle disorders.

"There are very few side effects. The Botox goes right into the muscle. It's great stuff," says Stephen Page, director of research for physical medicine and rehabilitation at the University of Cincinnati.

Botox, or botulinum toxin type A, made headlines last year when the Food and Drug Administration approved it to improve the appearance of frown lines.

But the FDA originally approved it in 1989 to treat two eye conditions - strabismus, or crossed eyes, and blepharospasm, or uncontrollable blinking. In 2000, Botox was approved for the treatment of pain associated with cervical dystonia, or spasms of the neck muscles.

Botox improves flexibility

Lazarus, 75, of Anderson Township gets Botox injections every three months in his arms to help ease the pain, muscle spasms and paralysis he suffers as the result of a car accident five years ago.

Nerve damage keeps his arm and chest muscles constantly contracted, which limited the amount of physical therapy and rehabilitation Lazarus could do before Botox therapy.

Injecting Botox into his arms paralyzed the muscles, which caused them to relax, and now Lazarus can work with physical therapists on exercises to strengthen and tone the muscles in his arms and hands.

He uses a wheelchair and his movements are still limited, but the injections have made "a huge difference," he says.

"It relieves all the muscle tightness and pain, and I'm able to bend my arms and use them a little bit more. It helps me be able to reach for things. I can't lift or pick anything up because of the tightness in the tendons of my hands," Lazarus says.

But he can use his left hand to operate a computer or hold a paintbrush or read a book, he says. "I have a little rubber tip that I put on my fingers so I can turn the pages," he says.

Had to get new career

Spasmodic dysphonia - spasms of the vocal cords - forced Andy MacWilliams to find a new career.

MacWilliams, 54, of Delhi Township was a longtime radio announcer, and still announces the football games for Elder High School.

But the spasms affecting his vocal cords got worse over the years. Now, sometimes in mid-word, his voice drops to a whisper, almost like he's run out of air.

"It's sort of a breathy break," MacWilliams says. "The voice just drops out completely."

He started getting Botox injections in 1989.

The injections stop the spasms, allowing his voice to return to normal.

But the injections have become less effective in recent years, and he'll be consulting a specialist to see if a combination of Botox and surgery on the nerves controlling his vocal cords will be helpful.

He left radio in 1997 and now works as a financial consultant.

Sometimes it's bad

"I have good days, bad days, good months, bad months," MacWilliams says. "It's sort of like a moving target."

"Most folks have pretty dramatic results," says Dr. Keith Wilson, an ear, nose and throat specialist with the University of Cincinnati. "They're able to talk freely, and they're more fluent."

Most patients need injections every three to four months; Botox is temporary, and its paralytic effect wears off with time.

Help for headaches?

At the Cincinnati Headache Clinic, doctors are trying to determine if Botox is effective for treating chronic headaches.

Dr. Joseph Nicolas, who's heading up the local branch of the North American study, says patients in the trial either get injections of Botox or a placebo.

"We're just seeing if they get relief when they get Botox," he says.

Botox isn't approved for treating headaches, but some doctors use it to treat migraines and other recurring headaches.

Early research is inconclusive, but doctors say the drug seems to work well for some - but not all - patients.

They're not sure why it seems to work, though.

"One theory is that it reduces the sensory input into the brain, so in that way, there's less pain," Nicolas says. "That could be one explanation."

Still, Nicolas says he doesn't think there's enough data to recommend Botox for migraine treatment.

At the Drake Center, Dr. Susan Pierson and colleagues are testing whether it's safe for stroke patients to get repeated doses - three or four over a 12-month period - of Botox.

Patients who get Botox are often able to get more physical therapy and recover more physical function, says Pierson, a neurologist.

"I've been using it for a long time. It's probably one of the oldest injectable" therapies, she says.

And Botox is widely used to treat muscle spasms in people with cerebral palsy and similar disorders, says Dr. Doug Kinnett, a physical medicine and rehabilitation specialist at Cincinnati Children's Hospital Medical Center.

Kinnett has been using Botox on patients with cerebral palsy since the mid 1990s.

The drug can be injected directly into the affected muscle, and there are few, if any, side effects.

The toxin that Botox is made from can be deadly if ingested, but the injected drug doesn't circulate throughout the body; it stays in the muscle where it's injected, Kinnett says.

"When you get botulism the disease, you've ingested a ton of the toxin and it circulates throughout your system and you get paralyzed," he says. "This stays put."

Lazarus isn't afraid that he'll end up poisoned by the injections. "I'm not worried; I look forward to the shots," he says.

How Botox works

Botox is derived from botulinum toxin Type A - the same bacterial toxin that causes botulism, a severe and sometimes fatal form of food poisoning. Botox works by paralyzing muscles that cause spasms, tics and, most popularly, wrinkles. When Botox is injected into a muscle, it blocks the action of a protein (acetylcholine) that transmits nerve impulses, so the muscle never gets the message from the brain to move. The effects are temporary.

Botox is used to treat the following conditions:

• Blepharospasm (forceful spasms of the eyelids), strabismus (crossed or crooked eyes) and spastic entropion (inward turning of the lower eyelid).

• Hemifacial spasm, or painful, uncontrollable spasms of one side of the face.

• Hyperhidrosis, or chronic excessive sweating.

• Cervical dystonia, or painful spasms of the neck muscles.

• Chronic headaches and migraines.

• Glabellar lines, or vertical lines between the eyebrows.

• Spasmodic dysphonia, or spasms of the vocal cord that disrupt speech.

• Oromandibular dystonia, or spasms involving both sides of the face, jaw, neck, tongue, larynx and respiratory system.

• Muscle spasms and contractions associated with stroke, cerebral palsy and similar neurological disorders.

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