Botox is approved by the FDA for some painful conditions such as cervical dystonia (muscle spasm), spasticity, excessive sweating (hyperhidrosis), eye muscle problems, involuntary movements and wrinkles (frown lines).
Botox was recently approved by the FDA for the treatment of chronic migraines (15 or greater headache days per month). Most insurances are covering this treatment in the appropriate circumstances. Our patients have had a very good response, with an average benefit of nearly 3 months after each injection.
Botox® is the brand name for purified and crystallized botulinum toxin type A. The toxin is produced by a bacterium called Clostridium botulinum, an organism that normally lives in soil. Although botulinum toxin is one of the most lethal biological chemicals on earth, when it is highly diluted and injected into muscles it is quite safe. Allergan Pharmaceuticals, the company that makes Botox® packages the medication in doses that are far below quantities that would cause serious harmful effects.
Botox® can help many disorders where excessive muscle contraction cause pain, disfigurement, or impairment of movement. The common denominator of all problems helped by Botox® is excessive muscle contraction. Thus, conditions that involve spasticity, excessive muscle movement, or excessive muscle tone may be improved by Botox®.
Botox® is injected through a thin needle directly into muscles or skin. After a few days the muscles relax. The injections are only mildly painful, and the pain can be minimized by the use of anesthetic sprays or pain medicines. The effects last for 10 to 20 weeks in most cases. The treatment can then be repeated as needed.
Botox® is a protein molecule made of amino acids linked together in two chains that are connected. When the toxin is injected into muscles, the molecule is taken up by the nerve ending at the site that the nerve meets the muscle. The toxin then binds to part of the nerve ending, inactivating the nerve by preventing the nerve from releasing a chemical a (neurotransmitter) that normally travels over to the muscle causing the muscle to contract. Under normal conditions, an electrical impulse travels down the nerve to the nerve ending causing the neurotransmitter, acetylcholine, to be released by the nerve ending. The acetylcholine travels across a very small gap and binds to the surface of the muscle. When the binding occurs, certain changes take place in the muscle membrane which lead to the muscle’s contraction. Because Botox® prevents acetylcholine release, the muscle cannot contract, and the cumulative effect is that the muscle belly relaxes.
When they occur, the side effects are usually mild and may include excessive muscle weakness near the are of injection. Because the effects of Botox® always wear off, so do any side effects of muscle weakness. Bleeding and infection are always risks when the skin is punctured, but they are rare. No one has ever died from Botox®. Allergic reactions are rare.
From many of the disorders listed in the previous paragraphs, insurance companies cover the expense of the injection. Botox® is an extremely expensive medication costing the physician more than $500 per vial, and many disorders require two or three vials per injection series. However, because most insurance carriers recognize that many of the disorders listed above are only effectively treatable by Botox®, treatment is covered. Often the treatment must be precertified by your Physician’s Office.
Only a few physicians have a great deal of experience using Botox®. Though the technique is relatively uncomplicated, knowing which muscles to inject and how much Botox® to inject into each requires skill and training. In many regions of the country, university hospitals are the only locations where the treatment is available.
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