DR. BRIAN DOWDELL: Botulinum Toxin, or ‘Botox’ Is Not Just For Wrinkles
By Dr. Brian Dowdell • SOAR Spine, Orthopedics and Rehabilitation // August 11, 2015
Spine, Orthopedics and Rehabilitation
ABOVE VIDEO: SOAR – Spine, Orthopedics and Rehabilitation – was founded by Dr. Brian Dowdell in 2003. From its inception, the practice has focused on a multidisciplinary approach to treating people with orthopedic and pain disorders through the application of advanced minimally invasive interventional pain therapy, physical therapy, medication optimization,diagnostic testing and laboratory testing.
Most people are familiar with Botulinum toxin used in cosmetic medicine with the purpose of reducing facial wrinkles.
When a small amount of botulinum toxin is injected into a muscle, it blocks nerve signals that tell your muscles to contract.
The effect is that it temporarily weakens or paralyzes the facial muscles and smooths or eliminates wrinkles in the skin for a few months. However, this incredible medication has been used for years for several other medical conditions.
Before discussing the other uses for botulinum toxin, it’s important to understand the origin of the medication. Botulinum toxin is actually a poison produced by Clostridium Botulinum bacteria.
The toxin was discovered several years ago as the cause of a serious medical condition know as botulism. Botulism is a rare but serious illness caused by the bacterium which occurs in soil. It produces a toxin that affects your nerves.
Foodborne botulism comes from eating foods contaminated with the toxin. They can include but are not limited to foods such as honey, home-canned vegetables and fruits, corn syrup, improperly canned commercial foods, home-canned or fermented fish, herb-infused oils, baked potatoes in aluminum foil, cheese sauce, bottled garlic, and foods kept warm for extended periods of time.
There is a 3 to 30 days incubation period in infants and a 12 to 72 hours in children and adults, Symptoms of botulism in infant include lethargy, weakness, poor feeding, constipation, poor head control and poor gag and sucking reflexes.
Symptoms commonly found in children and adults include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth and muscle weakness.
Believe it or not, the first strains of Botulinum toxin were discovered by a scientist trying to understand food poisoning. In the 1820’s a German scientist, Dr. Kerner, determined that there was a toxin in spoiled sausages that were making people ill.
Seventy years later, another doctor, also investigating food poisoning, would expand on Dr. Kerner’s discovery, and find seven strains of Botulinum toxin – four of which were harmful to humans.
In the 1940’s, Botulinum toxin almost became a weapon of war! However, before the pills containing the toxin could be produced to poison high-ranking officials on the opposite side, the project was abandoned.
FIRST APPROVED BY FDA IN 1989
Throughout the first 130 years since its discovery, Botulinum toxin had a very unfavorable reputation. That being said, it seems unconscionable that someone could ever consider using this poison for medical purposes. But that’s exactly what happened.
Throughout the first 130 years since its discovery, Botulinum toxin had a very unfavorable reputation. That being said, it seems unconscionable that someone could ever consider using this poison for medical purposes. But that’s exactly what happened.
In the 1950’s, researchers discovered that injecting small amounts of Botulinum toxin type A into hyperactive muscles relaxed them. Today research is carried out on hundreds of toxins, ranging from sea snail toxins to snake venoms, with the hope of finding the next medical miracle.
Botulinum toxin was first approved by the FDA in 1989 for therapeutic use in Blepharospasm and Strabismus. Over the last 20 years, the use of Botulinum toxin in the medical field has continued to expand.
Currently, Botulinum toxin has a total of eight indications approved for use in the United States. Since 1989, Botulinum toxin has gained FDA approval for seven different medical conditions.
In addition to Blepharospasm and Strabismus, other conditions such as cervical dystonia (tonic neck spasm), severe primary axillary hyperhidrosis (excessive sweating under the armpits), upper limb spasticity (spasms in the arms from stroke, Multiple Sclerosis, spinal cord injury and other neurological disorders), chronic migraine headaches, detrusor overactivity (muscle of urinary bladder) and overactive bladder have gained FDA approval for use in patients.
In the 1990’s there was a massive movement to utilize Botox to reduce frown lines. In fact there was a shortage of Botulinum toxin in 1997.
INSTRUMENTAL IN OFFERING PAIN RELIEF
Cervical dystonia, also known as spasmodic torticollis, is a focal dystonia characterized by neck muscles contracting involuntarily, causing abnormal movements and awkward posture of the head and neck. The movements may be sustained (‘tonic’), jerky (‘clonic’), or a combination.
Spasms in the muscles or pinched nerves in the neck can result in considerable pain and discomfort. In our clinic, we see patients with severe neck pain due to cervical dystonia. Botulinum toxin chemodenervation has been instrumental in offering relief for these patients.
It relieves the constant tension that pulls their neck allowing them to hold their head in a neutral position, thus reducing the pain associated with the spasms.
Migraine headache is a complex disorder characterized by recurrent episodes of headaches, most often unilateral and in some cases associated with visual or sensory symptoms—collectively known as an aura—that arise most often before the head pain but that may occur during or afterward (see the image below). Migraine is most common in women and has a strong genetic component.
A patient may be considered for prophylactic migraine therapy if the frequency of migraine attacks is greater than 2 per month, the duration of individual attacks is longer than 24 hours, the headaches cause major disruptions in the patient’s lifestyle, with significant disability that lasts 3 or more days or abortive (short acting medication) therapy fails or is overused.
In these patients, Botulinum toxin has been shown to offer significant extended pain relief from attacks.
NO SERIOUS SIDE EFFECTS
Two Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials recruited 1,384 patients with chronic migraine, and randomized them to treatment with Botulinum toxin or placebo.
These patients were suffering on average 20 days of headache each month, of which 18 were moderate or severe.
While Botulinum toxin has gained great notoriety in the world of cosmetic medicine for making us look wrinkle free, its utility goes far beyond its good looks. Botulinum toxin has restored people’s lives who suffer from severe pain and complications of neurological disorders. Dr. Kerner would have been astounded to learn that his discovery would have such a profound effect on so many peoples lives. With Botulinum toxin, now you can look good and feel great.
Those randomized to Botulinum toxin received fixed-site, fixed dose injections every 12 weeks over 56 weeks. These injections covered seven specific areas of the head and neck, with a total dose of between 155-195 units.
At six months, after two cycles of treatment, those treated with Botulinum toxin had on average eight less days of headache each month.
After 12 months, 70% of those treated had ≤50% the number of headaches that they had done originally. Botulinum toxin was well-tolerated, the commonest side effects being neck pain (6.7%), muscular weakness (5.5%), and drooping of the eyelid (3.3%).
No serious irreversible side effects have ever been reported in trials of Botulinum toxin in headache.
Upper limb spasticity is seen in patients who suffer neurological disorders such as spinal cord injury, stroke, traumatic brain injury, Multiple Sclerosis, and Cerebral Palsy among other degenerative diseases. The arms and hands are usually contracting involuntarily causing abnormal postures.
These contractions can be tonic or jerky and can cause severe pain.
If left untreated, spastic muscles in the upper extremities can lead to permanent contractures. Botulinum toxin has been used to temporarily paralyze the muscles and allow the extremity to rest in a neutral position.
This allows the individual to position his or her extremity in a comfortable manner, and perform activities of daily living and hygiene with less restriction.
RESTORING PEOPLE’S LIVES
While Botulinum toxin has gained great notoriety in the world of cosmetic medicine for making us look wrinkle free, its utility goes far beyond its good looks.
Botulinum toxin has restored people’s lives who suffer from severe pain and complications of neurological disorders. Dr. Kerner would have been astounded to learn that his discovery would have such a profound effect on so many peoples lives.
With Botulinum toxin, now you can look good and feel great.
For more information contact SOAR Spine, Orthopedics and Rehabilitation at 321-733-0064 or log on to SoarFlorida.com
ABOUT THE AUTHOR
• DR. BRIAN DOWDELL completed his medical degree and master’s degree at the University of Buffalo. In addition to his medical studies, he successfully completed his Master’s Thesis in cancer research at Roswell Park Cancer Institute.
He finished his internship in Internal Medicine at the University of Buffalo and his residency in Physical Medicine and Rehabilitation and Pain Medicine at Stanford University.
Moreover, Dr. Dowdell served as assistant clinical professor at Stanford University Medical Center where he published research and lectured nationally to other doctors in his field.
He is a past president of the Brevard County Medical Society and served as a delegate for the Florida Medical Association. Dr. Dowdell has been in private practice since 1998 and is the founder of SOAR.
