Dr. Sum Tran MD - Surgery List: Botox

What is Botox?

BOTOX® is a therapeutic muscle-relaxing agent that works at motor nerve endings (nerves that lead to muscles). It is in a class of drugs called neurotoxins. When considering neurotoxin therapy, it is important to understand how the product works, the history of its use in patients, its protein content, and possible side effects. This page is designed to help you understand more about BOTOX®: what it is, how it works, and how it can help you. Refer to this page in the future should you have further questions about BOTOX® treatment.

BOTOX® is indicated for the treatment of cervical dystonia in adults to decrease the severity of abnormal head position and neck pain associated with cervical dystonia.

BOTOX® is indicated for the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and above.

BOTOX® is a novel therapeutic agent derived from the bacterium, Clostridium Botulinum. Also known as Botulinum Toxin Type A, the brand BOTOX® is produced in controlled laboratory conditions and given in extremely small therapeutic doses.

Botulinum Toxin Type A is the most studied of the seven different serotypes of botulinum toxin (A, B, C1, D, E, F, G). Each serotype has different properties and actions. No two are exactly alike.

How does Botox work?

Normally your brain sends electrical messages to your muscles so that they can contract and move. The electrical message is transmitted to the muscle by a substance called acetylcholine. BOTOX® works to block the release of acetylcholine and, as a result, the muscle doesn't receive the message to contract. This means that the muscle spasms stop or are greatly reduced after using BOTOX®, providing reliable relief from symptoms.

BOTOX® is not a cure. For many patients, however, its therapeutic effects have been dramatic - symptoms usually begin to dissipate within three to fourteen days and the effects can last for approximately three months. See Mechanism of Action for more information.

What Characterizes Hyperactive Muscle Contraction?

At a normal neuromuscular junction, a nerve impulse triggers the release of acetylcholine, which causes the muscle to contract. Hyperactive muscle contraction, regardless of the underlying cause, is characterized by excessive release of acetylcholine at the neuromuscular junction. The use of BOTOX® can be effective in reducing this excessive activity.

How is Botox administered?

BOTOX® is injected into the muscle. Your doctor will determine the muscle(s) in need of treatment.

Does the treameant hurt?

A very fine needle is used for the injection. Some patients report minor and temporary discomfort from the injection.

When does Botox start to work?

For blepharospasm, the initial effect of the injection is seen within three days and reaches a peak at one to two weeks post-treatment. When you are being treated for cervical dystonia, clinical improvement generally begins within the first two weeks after injection, with maximum clinical benefit at approximately six weeks post-injection.

How long does the effects last?

The relief you will feel from a single treatment of BOTOX® will normally be sustained for approximately three months. You will notice a gradual fading of its effects. At this point you will return to your doctor for your next treatment.

Usually, BOTOX® treatment is required only three or four times a year. Symptoms may vary throughout the course of the condition, and so the degree of relief and duration of effect varies from person to person. Consult your doctor, who has special knowledge about how to achieve the best possible results with BOTOX® for your individual case.

How long can I be treated with Botox?

Treatment with BOTOX® can typically be repeated as long as the patient continues to respond and does not have a serious allergic reaction. BOTOX® has been used for over 10 years commercially worldwide. Acceptable safety in long-term treatment has been well established. However, formal clinical evaluations of long-term treatment have not been conducted.

There are a number of factors that can impact the long-term usage of BOTOX®. These include:

Setting appropriate expectations - Changes occurring with subsequent BOTOX® injections may be less dramatic than the first injection.
Appropriate muscle selection - Identifying and injecting the affected muscle can be difficult, complicated by the changing pattern of muscle involvement and progression of the disorder.
Adequate dosing - Changes in response may require dose adjustment.
Minimizing exposure to neurotoxin complex proteins1 - Botulinum toxins contain proteins.

In certain circumstances, when foreign proteins enter the body, the natural response is to form antibodies to the protein. When antibodies are formed, the effect may be that one is no longer able to respond to the therapy. Formation of neutralizing antibodies to botulinum toxin type A may reduce the effectiveness of BOTOX®. The rate of formation of neutralizing antibodies in patients receiving BOTOX® has not been well studied. The critical factors for neurtalizaing antibody formation have not been well characterized. The results from some studies suggest that BOTOX® injections at more frequent intervals or at higher doses may lead to greater incidence of antibody formation. The potenial for antibody formation may be minimized by injecting with the lowest effective dose given at the longest feasible intervals between injections. Well-controlled studies designed to determine the rate formation of neutralizing antibodies in patients receiving BOTOX® have yet to be conducted.

Is Botox a new treatment?

No. BOTOX® has been used commercially for over 10 years in thousands of patients worldwide. The American Academy of Neurology, American Academy of Ophthalmology, and National Institutes of Health have endorsed BOTOX® (Botulinum Toxin Type A) as a valuable treatment.

Is Botox right for me?

Ask your doctor if BOTOX® is the right treatment for you. BOTOX® should not be used during pregnancy, if you are nursing, or if you are taking certain medications. Only your physician can determine the best course of therapy.

The effects of BOTOX® may be increased with the use of certain antibiotics or other drugs that interfere with neuromuscular transmission. Ensure that your doctor is aware of any current medications you are taking. If you have any questions regarding the use of BOTOX® treatment, please consult your doctor.

What side effects may I expect from Botox?

Patients with neuromuscular disorders may be at increased risk of clinically significant systemic effects including severe dysphagia and respiratory compromise from typical doses of BOTOX®. The effects of therapy may be increased with the use of aminoglycoside antibiotics or with other drugs that interfere with neuromuscular transmission. There have been rare spontaneous reports of death, sometimes associated with dysphagia, pneumonia, and/or other significant debility, after treatment with botulinum toxin.

There have also been rare reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including cardiovascular disease. The exact relationship of these events to the botulinum toxin injection has not been established.

In general, adverse events occur within the first week following injection of BOTOX® and while generally transient may have a duration of several months. Localized pain, tenderness and/or bruising may be associated with the injection. Local weakness of the injected muscle(s) represents the expected pharmacological action of botulinum toxin. However, weakness of adjacent muscles may also occur due to spread of toxin.

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