Botox® Isn’t Just For Frowns

Over 3 million Botox® Cosmetic treatments were carried out in the US in 2006 alone, according to The American Society for Aesthetic Plastic Surgery (ASAPS).  This cosmetic procedure to eliminate brow creases and the wrinkles caused by frowning or squinting is the single most popular non-surgical cosmetic procedure in the US year after year. 

For anyone who still hasn’t heard of this internationally famous procedure, Botox® Cosmetic is a drug prepared from the purified protein toxin produced by the clostridium botulinum bacteria (Botulinum Toxin A) which, when injected into the muscles adjacent to creases or wrinkles, causes a temporary paralysis.  In 2002 the FDA approved Botox® Cosmetic to temporarily improve the appearance of moderate to severe frown lines between the eyebrows.

The results are almost instant and the smoothing effect lasts for months.  When properly administered, it’s safe, quick and effective.  Compared to many other surgical and non-surgical cosmetic procedures Botox® treatments are also relatively inexpensive.

Perhaps because of the immense popularity of Botulinum Toxin A in its Botox® Cosmetic formulation for cosmetic wrinkle control, some of the more amazing clinical and therapeutic uses of one or more of the seven distinct botulinum neurotoxin serotypes of Botox® (A,B,C,D,E,F and G) are often overlooked. 

By the time Botox® received US FDA approval in 2002 as a cosmetic wrinkle relaxant it had already previously been approved and had been in use for some years to treat the symptoms of several medical conditions.  Clinical studies and trials are currently ongoing to obtain FDA approval for the use of Botox for many more medical uses.

Treating Sweating Disorders with Botox 

Hyperhidrosis is a physical condition manifesting itself in the production of four or five times the normal amount of sweat. Traditional treatments include powerful antiperspirants, drugs to prevent sweat gland stimulation, and even surgery on the sweat glands.  

A 2005 survey estimated that 2.8 percent in the US population suffers from primary hyperhidrosis, .4 percent have excessive sweating in the underarms (axillary hyperhidrosis), and one-sixth are believed to suffer sweating that is intolerable or interferes with daily activities.

In 2004 in a placebo-controlled, double-blind study was carried out at the St. Louis University School of Medicine on 322 patients suffering from primary hyperhidrosis. Half the subjects were given injections of Botox® and the other of half salt water.  73% of the subjects who received Botox® injections in the unarm areas reported a significant reduction in sweating, and 43% of those were still enjoying the effects a year later. 

Botox® is effective in treating excessive sweating because it seems to stop the release of the chemical messenger acetylcholine, temporarily paralyzing the nerves in the underarm that stimulate sweat glands to produce sweat.

In July 2004, following further studies and testing, the US FDA approved Botulinum Toxin Type A (Botox®) specifically to treat the severe underarm sweating known as “primary axillary hyperhidrosis” that cannot be managed by topical agents such as prescription antiperspirants. 

This approval allowed Allergan, Inc. Irvine, California, to market Botulinum Toxin Type A for this new application.  Although the FDA approval is only for use in the armpit areas, licensed physicians under the “off label” rules may also exercise their own judgment in applying Botox® to other skin areas.

Because Botox® is a prescription drug, it must be used under careful medical supervision.  Any patient being treated for primary axillary hyperhidrosis should first be evaluated for other potential causes to avoid symptomatic treatment of hyperhidrosis with Botox® without addressing a potentially serious underlying disease, such as hyperthyroidism, low blood sugar, or anxiety.

Treating Migraine Headaches with Botox

Botox is currently being extensively studied for use in preventing migraine headaches. Many board certified plastic surgeons and neurologists have used Botox® on an “off label” application to treat patients suffering from the debilitating pain of frequent and severe headaches.  In certain types of migraine remarkable results have been obtained in eliminating pain and lessening the frequency and severity of migraine attacks.

Treating Crossed Eyes and Eye Tics

In 1980 an ophthalmologist, Dr. Alan Scott (then a Senior Research member at the Smith-Kettlewell Eye Research Institute), first described the use of botulinum toxin in the treatment of eye muscle disorders. He found that he could bring crossed eyes into parallel alignment by injecting the neurotoxin into eye muscles causing them to relax enough for the eyes to uncross. Dr. Scott named his drug Oculinum and later sold it to the pharmaceutical company, Allergan.  

Allergan received FDS approval of Botox® in December 1989 to treat two eye muscle disorders, lepharospasm (uncontrollable blinking) and strabismus (crossed eyes). These are still the most common and widely used medical uses for the toxin.

For further information, see this article.

Treating Neck and Shoulder Muscle Contractions 

During the early nineties the high media visibility of Botox® triggered further clinical studies and further uses followed.  Various formulations of the neurotoxin were used  to treat cervical dystonia, a neurological movement disorder causing severe neck and shoulder muscle contractions.

More recently, the FDA approved a BTX-B complex preparation (Myobloc™, Elan Corporation, Dublin, Ireland) for clinical use in cervical dystonia patients. 

Treating Lower Back Pain

Many clinical studies are currently being carried out on the use of Botulinum Toxin A (Botox®) and Botulinum Toxin B (Myobloc®) in the reduction of pain and disability in subjects suffering from acute low back pain due to an identifiable muscle strain or back trauma.

For further details and a list of publications detailing these clinical studies, see this government study on the effectiveness of Botox® on low back pain.

Treating Urinary Incontinence and Cystitis

About ten percent of the current population has an overactive bladder, and almost a third of the current population will experience urinary retention dysfunction at some time in their lives 

Clinical trials in the UK have reported an 80% relief rate when Botulium toxin (Botox®) was injected into the bladder linings of patients suffering from urine retention disorders.  Botox® blocks the release of nerve transmitter substances and sensory nerves, which means that the patient doesn't feel the urge to urinate constantly. The injection treatment lasts between three and six months, and can be administered to outpatients under local anesthetic.  

Further long-term studies are being made, with results due next year in this very promising treatment. Botox® therapy could greatly improve the quality of life of people suffering bladder storage or sensation problems without resorting to intensive drug therapy or invasive surgery. 

For further details on how Botox® works in treating urinary and bladder disorders, see this study from the National Institutes of Health.

Toxin or Wonder Drug? 

Studies on safe and effective applications of the Botox group of neurotoxins are ongoing also in many other fields.  Advances are being made in everything from writer’s cramp and difficulty swallowing to treatments for spasticity, a condition that occurs after a stroke, in multiple sclerosis and cerebral palsy patients or those suffering from traumatic brain injuries.  There are now several hundred medical uses for this wonder drug.

The botulinum toxins may be deadly poisons under certain conditions, but like many other organic poisons, they have been harnessed by medical research and human ingenuity to serve humanity by alleviating pain and improving the quality of life.