Botulinumtoxin (BTX) is actually one of the most potent natural neurotoxins. It is produced by an (anaerobic) species of bacteria called Clostridium Botulinum. It used to be quite well known being the agent causing botulism, a kind of food poisening after consuming infected tinned food. One of the initial signs for this potentially deadly condition is double vision (because of plegic eye muscles) followed by respiratory failure due to weakness of the respiratory muscles. The neurotoxin acts by paralysing the so called motor endplates. As it is blocking those endplates permanently, only after the endplates are reformed normal muscle function comes back.This shows the substance is exceptionally long acting - in fact several months. In the right hands, this substance can be a blessing for certain patients though.
Most people usually think of wrinkles and their removal if they hear the word Botulinum. much more important though is the possibility to treat severe spasticity and certain other very disabling neurological conditions like dystonia.
The underlying principle of action using botulinum toxin is a long acting inhibition of local muscle contraction in the treated muscles.
This is the same whether we are treating wrinkles or spasticity. Wrinkles are caused by repeated contraction of the small muscles in the skin that are responsible i.e. for facial expression. Over the years the skin is loosing elasticity and the wrinkles stay permanent.
Botulinum toxin reduces the wrinkles by relaxation of the treated muscles.
The same principles apply when using Botulinum toxin for spasticity. The often very painful muscle spasms are inhibited and physiotherapy will be possible.
Dystonic patients get rid of involuntary movements and can carry out a normal social life again.
It should be clear that such a powerful drug should only be used by doctors who understand the mechanisms of action and therefore can avoid or at least treat possible side effects. The result of a botulinum toxin treatment can be very disappointing, in fact dangerous if not carried out by a professional with experience in the use of the drug.
Botulinum toxin is successfully used in the following conditions:
We are most experienced using botulinum toxin to treat spasticity or dystonia and in cosmetic medicine.
The other fields of use are more or less new treatment areas and scientific proof of efficiency has to be provided. So be critical if you suffer from a condition for which botulinum is not the first line of treatment and also if miraculous effects are promised.
A typical treatment includes a proper physical examination as well as a detailed explanation of possibilities and limitations of the method. Then a consent form should be signed and the painless injections are carried out.
The effect of the treatment starts after three to six days. It should last about three to four months (but sometimes even longer)
The different brands available vary in dosage. This means that i.e. 10 units of one product are not the same as 10 units of a different brand.
Which brand should be used and which dosage will be discussed with your doctor.
Dosage: varies and depends on localisation and reason for treatment (i.e. low dose for cosmetics, high dose for spasticity)
Safety and Side Effects:
The therapy is not dangerous in experienced hands. A potentially dangerous dose for humans would be in an area about 1000 times higher than the therapeutic dose. Possible side effects are discussed in advance and can usually be avoided.
mechanism of action
