Paging Dr. Frischer - Botulinum

The most lethal toxin known to humans is botulinum. If injected into muscles or veins, or inhaled, it can be deadly. Do you find it surprising that a large and expanding industry has grown around injecting it into people’s faces? Of course, most of us would recognize the cosmetic and medical uses of botulinum toxin by its product name: BOTOX. Food-borne botulism is a disease caused by bacterial spores. Contamination can occur if food hasn’t been heated properly prior to being canned, or if food was improperly cooked after the can was opened. Its enemies are proper refrigeration, high amounts of salt, high oxygen, and low pH levels, and the heat of cooking can destroy it.

The botulinun toxin is also found in soil and dust. Most infant botulism cases are caused by bacteria found inside the home on floors, carpet, and countertops - even after cleaning. Honey can contain the bacteria as well, and consequently babies should not have honey until they are at least one year old.

Despite these dangers, scientists have found many uses for the botulinum toxin. It prevents the release of a neurotransmitter (acetylcholine), and as a result, nerve impulses are inhibited and muscles are paralyzed. In the 1950s, researchers discovered that injecting overactive muscles with tiny quantities resulted in decreased muscle activity. In 1989 Botox was approved by the FDA for the treatment of crossed eyes (strabismus), uncontrollable blinking (blepharospasm), and facial spasm.

BOTOX got major attention in 1989, when a plastic surgeon published a study on wrinkles in a prominent medical journal. In 2002, the FDA approved its use to temporarily improve the appearance of frown lines between the eyebrows, and as time has passed, more and more uses for Botox have been developed:

• An injection of a very small dose can erase wrinkles by paralyzing the facial muscles. Last year, there were 6.4 million procedures in the United States alone, making it the most common cosmetic operation. Qualifications needed to provide this service vary by county and state. Practitioners include dermatologists, plastic surgeons, aesthetic spa physicians, dentists, nurse practitioners, nurses and physician assistants. The injection needs to be repeated every three to six months.

• Botox has FDA approval for treatment of excessive sweating (hyperhydrosis). This was the first example of a nonmuscular use for Botox.

•Botox is commonly used for severe spasms of the muscles of the neck (cervical dystonia).

•Botox has been approved for injections into the head and neck to treat chronic migraine headaches.

•The FDA has approved the use of Botox for the clenching of the jaw muscles (bruxism). This condition can lead to tooth and jaw damage, TMJ syndrome, and headaches.

•Another FDA approved use is for a condition that prevents the lower esophageal spincter from relaxing (achalasia).

•Botox is used for many conditions that don’t yet have FDA approval.  They include bladder overactivity; pediatric incontinence; anal fissures; spasms of the vaginal muscles (vaginismus); movement disorders related to trauma, stroke, multiple sclerosis, Parkinson’s disease and cerebral palsy; TMJ syndrome; diabetic neuropathy; excessive salivation; vocal cord dysfunction; and painful bladder syndrome.

Serious side effects from Botox are rare. There have been deaths, although none from cosmetic procedures. Botox has been linked to conditions such as botulism-like symptoms, muscle weakness, swallowing difficulties, pneumonia, speech disorders and breathing problems.

However, most side effects are relatively minor and temporary. In cosmetic use, unintended muscle paralysis can result in drooping eyelid, double vision, uneven smile, or loss of the ability to close the eyes. These types of side effects wear off within about six weeks. There can be bruising from the needle at the injection site. Other minor side effects can include headaches, flu-like syndromes, blurred vision, dry mouth, fatigue, allergic reactions, and swelling or redness at the injection site. It is not recommended for those who are pregnant, have egg allergies, or suffer from neuromuscular disease.

Psychologists have found one more interesting potential side effect of using Botox for cosmetic treatment. Studies of facial feedback suggest that preventing frowning leads to greater happiness! Those receiving botulinum toxin treatment for frown lines were significantly happier than those who had received other kinds of cosmetic treatment. It’s also been shown that treating crow’s feet (laughter lines), making it difficult to express a true smile, may have the opposite effect.

Note that Botox is costly, and the effect is temporary. The average cost for a Botox cometic treatment is over $300. Cosmetic procedures are not covered by insurance (although therapeutic treatments may be). If you are considering Botox, ask questions, weigh the pros and cons, and proceed with care.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.



Published: Dec. 11, 2014 - Volume 13 - Issue 35