Botulinum Toxin
What is botulinum toxin?
A Botulinum Toxin is a substance used in the treatment of movement disorders, such as dystonia, tremors, post-stroke spasticity, muscle spasms, hemifacial spasms, blepharospasm, Meige Syndrome, and after peripheral facial paralysis (Bell's palsy ).
Also, a Botulinum Toxin can be used in the treatment of numerous pain syndromes, includingmigraine, tension-type headache, localized pain, trigeminal neuralgia, postherpetic neuralgia, bruxism and myofascial pain.
Is botulinum toxin used in neurology the same as used in dermatology?
Botulinum toxin is the same substance that is applied for aesthetic purposes in general dermatology. But the places, doses and techniques in general are very different, since the indication is different.
Botulinum toxin has many brands, such as Botox®/ Dysport®/ Xeomin®/ Prosigne®).
Where does botulinum toxin come from?
Botulinum toxin is made in the laboratory, from the extraction of a specific type of bacteria, similar to how vaccines are made. But you shouldn't be afraid, the substance goes through a process to have the expected action and diluted to be applied. By going through special processes before being marketed, the substance does not cause any type of infection and the chance of allergy is very low. The procedure is very safe and side effects are rare and when they do occur, they are very mild.
Its main action is to relax the muscle, when applied directly to the muscle group, and to inhibit the painful impulse, when applied to the subcutaneous tissue. Its action depends on the dose, so it is common to adjust the doses according to the patient and the indication throughout the applications.
How Botox® works
Botulinum toxin has several actions in the body.
When injected into the muscle, it relaxes the muscle. So it can be very helpful when there is spasticity or abnormal body movements. It acts on the motor neuron (the nerve that goes to the muscle to make it move), reducing or preventing the vesicles from exocytosis and leaving for the synaptic cleft to release the neurotransmitter.
They also act on sensory neurons, decreasing sensory conduction by the same mechanism, allowing their use in the treatment of many painful syndromes.
Its action depends on the dose, so it is common to adjust the doses according to the patient and the indication throughout the applications.
What is Botox?
The brand Botox® was the first to appear and it was the medication on which studies for migraine were carried out. There are several botulinum toxin brands on the market, such as Botox®, Dysport®, Xeomin®, among others. All have equivalent effectiveness.
Other medications such as Dysport® are used in different dilutions and are widely used in larger body segments, such as spasticity after stroke and dystonia, but all can be used in headaches and other indications.
Botulinum toxin is indicated for patients with migraine or other chronic headaches and may be the first choice of preventive treatment.
Efficacy is great compared to other oral medications and almost no side effects.
When to apply botox?
Botulinum toxin is indicated for patients with migraine or other chronic headache e can be the first choice for preventive treatment, especially when there is contraindication or patient resistance to oral treatment.
The application of botox in Trigeminal neuralgia and postherpetic neuralgia and other pains is very effective. Furthermore, it is widely used in the treatment of Dystonias.
The use in post-stroke spasticity brings great benefit and aid to rehabilitation to the patient. In some cases of cerebral palsy or sequelae of trauma botulinum toxin brings enormous relief of pain symptoms due to limb stiffness, and also help with hygiene and patient care.
A Botulinum Toxin is applied in small doses, in the hypodermic region, or directly to the muscle, depending on the indication. Small bruises, which are tiny "purple" spots at the application sites are common, but are usually very small and disappear after a few days.
When does the botox effect start?
The action of botulinum toxin can take between 5 and 10 days to start, but the peak effectis usually felt after 14 days of the application.
How long does the botox action last?
The effect of the toxin tends to last about 3-4 months. This effect may be greater depending on the area where it was applied or the indication.
After this period, the substance must be reapplied, depending on the response, adverse effects and maintenance of the indication.
What are the risks and side effects of botox?
Adverse effects are usually minimum, such as weakness in the applied muscle, small bruises at the site and in very rare cases, some allergic reaction. Depending on the muscle in which it is applied, very small needles are used, so that it is not necessary to apply anesthesia and the pain in the application is small.
The big problem is when Botox is performed by someone who has not been trained for it.
Indications such as headache, spasticity, dystonia, spasms, should be performed by atrained doctor, in general, the neurologist!
The best procedure, however, is the one performed at the right time and with precise and individualized indication. Minimally invasive procedures represent one of the stages of the patient's rehabilitation program, but not the only one. The treatment has to be discussed with the specialist and the choice of the best option has to be shared between doctor and patient.
Is it worth doing botox?
In the end, this is the main question.
Botulinum toxin is a great weapon in the arsenal against different problems, from headaches to muscle contractions. But, like other treatments, it is not infallible and should not be seen as a miracle cure for problem.
The most important thing is follow-up and follow-up with the neurologist doctor,so that it is possible to discuss the best alternative in each situation.
We must remember that the best procedure, is the one performed at the right time and with the precise indication and individualized. Minimally invasive procedures represent one of the stages of the patient's rehabilitation program, but not the only one.
The treatment has to be discussed with the specialist and the choice of the best option has to be shared between doctor and patient.