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BOTOX – Not Just for Wrinkles, Anymore

BOTOX – Not Just for Wrinkles, Anymore Staff Report
Medically Reviewed by Jeffrey Raval, M.D.

December is the 17th anniversary of Botox’s chance discovery; the substance is currently the most popular non-surgical cosmetic procedure used by plastic surgeons in the U.S. with almost three million uses for 2004. Either you, or somebody you know, have probably had a Botox injection to erase facial wrinkles. But most people do not know that Botox has many more uses in medicine. From treating overactive bladders to controlling pain in breast reconstructions to helping children with cerebral palsy, Botox is helping more people overcome more ailments.

Jean Carruthers, a Canadian ophthalmologist, was treating a patient in 1987 for a rare eye disorder known as blepharospasm. The off-the-wall disorder causes excessive blinking of the eyes and, in some, causes the eyelids to slam shut.

Dr. Carruthers treated the woman with Botox, a then largely unknown substance which reduces activity in overactive muscles by blocking nerve impulses. It was a seemingly unlikely use of the botulinium toxin, which -- in its purest form -- is the deadliest poison known.

Wrinkles Disappear

However, tiny amounts worked well and halted the Carruthers patient’s debilitating eye disorder. But, even with no symptoms, the patient kept coming back, telling the doctor that each time she received a Botox injection, the wrinkles between her brows seemed to disappear, leaving a relaxed, untroubled expression.

Jean’s husband, Alastair, a dermatologist, found the story of the blepharospasm patient intriguing and looked further into how Botox could be used to enhance people’s appearance.

It was there, over pillow talk, that one of the world’s most popular drugs came into wide usage. The rest, as they say, is history.

“When we tried Botox, we never expected it would be the most sought after cosmetic procedure among men and women today,” says Alastair Carruthers. “It is gratifying to know this safe and effective medicine continues to make people look more natural, relaxed and feel better about themselves.”

this safe and effective medicine... According to the American Society for Aesthetic Plastic Surgeons, Botox is approaching three million uses in 2004 and is the number one non-surgical procedure used in the U.S. The substance is also used by plastic surgeons to remove deep smile lines around the mouth, neck band wrinkles and crow’s feet.

But Botox is not only for smoothing wrinkles anymore. As time goes on, more and more medical uses – other than plastic surgery -- are turning up. The substance has so many applications because many medical woes are caused by muscles that contract when they should not. Botox performs its magic by halting nerve impulses that fire the muscle into action.

No Migraines

Yet another case of serendipity later turned up another use for Botox. An Atlanta plastic surgeon noticed many of his patients reporting back to him that Botox had indeed removed facial wrinkles – along with their migraine headaches. Word spread and soon, doctors began using Botox “off-label,” meaning a medical use that seems to work but one for which the drug was not originally approved. Eventually, headache studies were organized at institutions like the Mayo Clinic and the Baylor College of Medicine which found around 80 percent of subjects get do indeed fast, fast migraine relief with Botox. Researchers are not exactly sure how Botox curbs headache pain and stiffness. They think the substance blocks sensory nerves that relay pain messages to the brain while relaxing facial muscles.

Current approved Botox uses in the U.S. include fighting cervical dystonia, a condition that causes the neck to twitch, twist, go through repetitive movements and carry the head in abnormal postures. It happens because involuntary muscle contractions hinder normal movements and cause severe, chronic neck pain.

One of the latest approved uses for Botox is halting severe underarm sweating, an embarrassing condition doctors know as axillary hyperhydrosis. The disorder releases such a flood of perspiration; some sufferers are forced to carry with them several changes of clothing to make it through the day. The excessive sweating is caused by over stimulation of sweat glands in the autonomic system. Botox interferes with the nerves responsible for the drenching. In Canada, the substance is used to combat sweaty palms.

But many other uses for Botox are still out on the medical horizon – but have been showing up more frequently on doctors’ radar screens.

Helps Children

Recently, medical researchers have found that Botox can help treat overactive bladders, control pain during some operations, help children with cerebral palsy, prevent ringing in the ears, assist diabetics with weight gain and control drooling in some cerebral palsy patients.

Overactive bladder is caused by spasms of the muscles that control the organ; the syndrome gives sufferers the urgent feeling they have to go to the bathroom so often even short car trips are difficult. Most patients have tried various medications but end up in adult diapers anyhow. But Botox injected directly into the bladder (through an endoscope) solves the problem and only requires about ten minutes in the doctor’s office. The injection works for about six months to give the person more control over the constant helps children urge to void. For instance, in one study at the University of Pittsburg, 41 of 50 incontinence patients reported a decrease or absence of the disorder after the injections. In a related study, Botox overcame incontinence caused by a bladder which contracts inappropriately and squeezes out urine involuntarily.

A study on pain control with Botox examined women who had mastectomies, followed by breast reconstruction. In those operations, surgeons use a balloon device known as a tissue expander to create a pocket in the woman’s chest to make room for a breast implant. But the expanders cause muscle spasm and additional pain. To better cope, Julio Hochberg, MD, professor and chief of plastic and reconstructive surgery at West Virgina University found patients who received Botox injections for pain control in the operations used 89 percent less morphine in the first 24 hours after surgery, had a shorter hospital stay and required three fewer physician visits than a control group. After the study was released, according to Dr. Hockberg, many general surgeons began using Botox to help manage pain after some surgeries.

Botox also put the kibosh on pain Down Under. Researchers at the Royal Hospital for Women in Sydney, Australia, found in two studies of 63 women that a single injection of Botox can stop chronic pelvic pain that makes it almost impossible for some women to have sexual intercourse, pass urine or undergo a pap smear test. The pelvis pain is caused by tight, over-contracted pelvic muscles.

In the U.S., Botox can help children with cerebral palsy (CP) because the substance relaxes muscles and allows for improved limb function and less pain. Hallmarks of CP are stiff, spastic arms and legs caused by abnormal signals sent from the brain to muscles in the limbs, causing them to stiffen and contract. But Botox interrupts the communication between the nerves and the spinal cord, which then allows the muscles to relax.

In a study at Walter Reed Army Medical Center, 250 children between the ages of one and 16 with CP received at least one treatment of Botox. Significant improvement was seen in 86 percent. A separate study in Europe revealed that Botox may help reduce drooling in patients suffering from cerebral palsy.

People with tinnitus hear ringing, hissing and roaring sounds in one or both ears. It afflicts an estimated ten to 20 percent of the general population and can hinder work, social life and ruin sleep. Scientists think the bugbear in tinnitus is continuous activation of a nerve within the ear, which transmits sounds. Researchers at the California Ear Institute at San Ramon, tried Botox on 26 adults with tinnitus. Eight percent of the placebo group had less ringing in the ear but the Botox group improved by 25 percent.

When people develop type I diabetes, they frequently have another condition known as diabetic gastroparesis which causes nausea, vomiting and weight loss because the contents of the stomach can’t pass through to the colon due to spasms in a tiny valve – the pylorus – at the bottom of the stomach. But Botox injections, given through an endoscopic tube, help the pylorus work more normally, according to a study done at Johns Hopkins Medical Center.

Additional studies are being done on using Botox to combat cerebral palsy, low back pain and other conditions brought on by muscles spasms.

Whether people use the substance as a fountain of youth or to combat more serious medical woes, the many faces of Botox are becoming even more of a household word.

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