Botulinum toxin (BT) – a natural protein produced by clostridium botulinum – acts on the connections between nerves and muscles by disrupting the transmission of nerve impulses; at high doses can cause paralysis of all muscles. Decades ago, however, it was discovered that extremely low doses of BT, prepared under controlled laboratory conditions, produced only mild weakness when selectively injected into muscle; it can be dosed as needed, depending on the type and severity of involuntary movements that you want to control, and lasts for several months and gradually disappears. In addition to its effect on the neuromuscular link, BT also acts on the nerve fibers that mediate the transmission of painful impulses, which forms the basis of the analgesic action of this preparation.
INDICATIONS
Due to its efficiency and reliability, BT has become the main therapeutic tool in the last two decades for the treatment of all conditions in which involuntary movements or pathologically elevated muscle activity occur: dystonia (torticollis, blepharospasm, hemifacial spasm, tremor); spasticity in multiple sclerosis, or after cerebrovascular stroke (stroke); headaches and other chronic pain conditions; hyperhidrosis (excessive sweating).
Diseases of involuntary movements
For dystonia – neurological disorders that manifest themselves with involuntarily increased muscle activity and cause altered and deformed postures and impaired movement of parts or the whole body – Botulinum toxin therapy is practically the only widely available and effective therapy. The most common dystonias in which BT has been effectively administered for almost two decades are torticollis (head tilt to one side and face to the other), blepharospasm (eyelid cramp) and hemifacial spasm (half face spasm). It is also effective in other significantly less frequent dystonias, and has been successfully used in the treatment of tremors (involuntary shaking of hands) of various causes.
Pathologically elevated muscle tension
After cerebrovascular stroke (stroke), in the affected arm and / or leg, in addition to weakness, almost necessarily retains spasticity (increased muscle tension), and similarly occurs in patients with multiple sclerosis. Spasticity fixes an arm or a leg in an unnatural and often painful position, so it can be a bigger problem than the disease itself. Such problems are successfully eliminated by BT therapy combined with physiotherapy.
Chronic pain conditions
Chronic headaches are typically associated with more or less elevated tension in the muscles of the head, face and neck, and similarly occurs in other chronic pain conditions – muscle tension increases around the painful area, exacerbating the pain. Due to its relaxing effect on the muscles and the additional effect on the nerve fibers for pain, BT has proven to be a successful tool in the treatment of chronic pain conditions, especially in situations where standard drug therapy cannot be applied (due to side effects, allergies, other diseases … ) or is not effective enough.
Hyperhidrosis
Botulinum toxin also acts on the nerve fibers that control the functioning of the sweat glands, and is also used in the treatment of hyperhidrosis – pathologically increased sweating in certain parts of the body or face.
SIDE EFFECTS
The main side effect of BT is the ability to cause muscle weakness greater than necessary, or to extend its effect to adjacent muscles, those not affected by involuntary movements and pathological tension. This phenomenon is relatively rare, usually weak and lasts for several days. Sometimes, BT can cause dry mouth, which is typically mild. There are no other side effects.
METHOD OF ADMINISTRATION
Botulinum toxin is given in an outpatient setting without specific patient preparation. A thin needle is injected into the muscles, which are found by examination to be the most tense, or most responsible for certain problems. The first administration of BT gives the least amount of doses that are expected to work (based on muscle size, strength of involuntary tension …). It takes several days for the preparation to take effect, and the effects can be evaluated after two weeks. The full effect of BT reaches four weeks from administration, lasts about two months, and then weakens. In order to control the symptoms successfully, the next and every subsequent administration of BT is usually scheduled every three to four months, and in some cases half a year. At Tesla Medical, BT therapy can be combined with targeted physiotherapy treatment.