BOTULINUM TOXIN (BOTOX) INJECTIONS IN NEUROLOGY
Botulinum toxin (popularly sold in the brand name Botox by Allergan company) is one of the commonly used treatment methods in cosmetology. Many actors and models take botox therapy to look young and hide away all facial and forehead wrinkles. Very few people know that Botox has wide applications in the field of neurology and patients with several neurological disorders can benefit from botox therapy. In this post, I would list out all the conditions where I give botox injections and would share my experiences in treating them.
1. POST-STROKE SPASTICITY
Stroke is a common disease leading to paralysis of muscles on one side of the body, due to reduced blood flow to the brain. Patients who survive stroke are left with severe disabilities. Spasticity- increased stiffness and tone of weak muscles- is a common cause of disability in stroke survivors. There are several medications (oral tablets) available for reducing the spasticity, but they have limited efficacy and significant side effects such as drowsiness. Botox injection therapy is a very effective method of treating post-stroke spasticity. Botox is injected in the spastic muscles. In the past 10 years, I have treated more than 100 patients with this condition and most of them do well. One of my recent patients was an ex-army person from Baghdad (Iraq), who was wheel-chair bound for five years due to a stroke. I gave him botox treatment, and referred him for physiotherapy. After a week, he came walking to my office. Patient and his wife were so thrilled! Reduction in spasticity also helps in doing better physiotherapy.
2. CHRONIC MIGRAINE
Migraine is the commonest cause of headache, affecting about 10-15% of women and 5-8% of men. In many cases, migraine becomes chronic and leads to frequent headaches. Frequent, severe headaches adversely affects the patients' quality of life, studies, employment and family life. Oral preventive therapies for migraine are available, but are ineffective in some and lead to adverse events in others. In these patients, botox therapy has a great role to play.
Botox is injected in scalp and neck muscles (frontalis, temporalis, occipitalis, cervical, trapezius, etc) using a very thin needle. The procedure can be done in the office, with little discomfort to the patient, and is completed within 15-20 minutes. In the past two years, I have treated about 30 patients with chronic migraine with botox. 29 of them showed good improvement in pain and quality of life. One patient who did not improve had various stressors in personal and professional life, leading to super-added tension headache. One patient, who I distinctly remember was a 35-year-old woman from Dubai, who came to me with 5 year duration of chronic migraine (20 headache days per month). She returned 3 months after botox injection therapy for review, and reported almost complete improvement in pain. However, she requested me for one more botox shot. I was surprised, as she was pain-free. Then she disclosed to me that her husband had started showing more interest in her now that she looked much younger and prettier (after botox shot to frontalis muscles) and she wanted to maintain the youthfulness of her face. I suggested to her that she consult a cosmetologist, but she insisted on me doing it. So, I along with my cosmetologist, gave her the second botox shot!
3. WRITER'S CRAMP
It is a condition, where patients find it difficult to write. They are able to perform all other activities normally, including lifting heavy weights with hands. Handwriting becomes poorer and illegible. Cheques signed by the patients start bouncing, as the signature on the cheque does not match that of bank records. Another feature of the disease is that writing becomes worse in front of others and when tensed.
Botox is very effective for treating writer's cramp. Injection is given in forearm muscles. Most patients improve very well.
4. SPASTICITY OF LIMBS IN CHILDREN WITH CEREBRAL PALSY
Cerebral palsy (CP) is a condition affecting children, characterized by developmental delay (delayed motor and speech milestones). Other features may include fits, deafness, squint, learning disability, etc. Cerebral palsy results due to a lack of oxygen or blood supply to the brain during peri-natal period (immediately before, during or immediately after birth). Many children with CP have spasticity of legs and hands. Spasticity of legs hamper in their standing and walking. Botox injections given in adducor and hamstring muscles of thighs reduce the spasticity, and improve walking. Today, I treated a 5-year old child from Bidar (Karnataka) with this condition.
5. Other dystonias- such as hemi-facial spasm, blepharospasm, cervical dystonia- are also very well treated with botox injections.
6. Hyperhidrosis- increased sweating over palms and feet, which can be embarrassing and cumbersome- responds well to botox treatment.
In general, all botox injection therapies are done on an out-patient basis. Patients can come after eating (fasting is not necessary). It is done without any anaesthesia, in the office setting. The entire procedure is completed in less than 30 minutes and patients are free to return home immediately after the procedure. No leave from work is required and they can join work the next day. Depending on the condition, 100 to 200 units (1-2 vials) of botox is required for the procedure, and the approximate cost could be Rs 25, 000- 50, 000 (USD 1000-2000). Botox treatment is safe and I have not seen any complication in more than 250 botox procedures that I have done in the past 10 years.
DR SUDHIR KUMAR MD (MEDICINE), DM (NEUROLOGY)
CONSULTANT NEUROLOGIST
APOLLO HOSPITALS, JUBILEE HILLS
HYDERABAD, INDIA.
Phone: 0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com
