What you need to know about botulinum toxin – Progressive Rehab, LIVING WELL Magazine

Botulinum toxin – more than cosmetic

By Sunny R. Kim, MD, FAAPMR, Progressive Rehab, Linn County LIVING WELL Magazine

Botulinum toxin is the most potent neurotoxin known on earth. It is produced by the bacteria clostridium botulinum. This protein works by inhibiting the transmission of signals between nerve and muscle, thereby causing paralysis. In acute botulism, an overdose of botulinum neurotoxins are ingested from spoiled foods resulting in severe muscle weakness, difficulty breathing and altered vision.

Fortunately, scientists have learned to mass produce this toxin in the laboratory and learned how to control the dose to exact specifications (like a drop in the ocean). Of the seven different serotypes (A – G), botulinum toxin A has been used most frequently in humans. In fact, prior to being used in cosmetics, botulinum toxin A (BOTOX®) had been used to treat strabismus (crossed eyes), blepharospasm (excessive blinking) and hemifacial spasm (excessive facial twitching). The toxin works by decreasing the amount of neuromuscular transmission to select muscles of the eyes or face. Cosmetic uses exploit the toxin’s ability to relax facial muscles causing wrinkles or frowns. Today, the FDA has expanded its list of approved medical conditions to include cervical dystonia (overactive neck muscles), spasticity (overactive limb muscles), hyperhidrosis (excessive sweating) and chronic migraine headaches ( > 15 headache days a month).

Cervical dystonia is a muscle overactivity disorder of the neck associated with pain and abnormal head posturing. If there is significant rotation of the head and neck then it is categorized as spasmodic torticollis. In its early stages, head posturing may not be seen and diagnosis often eludes clinicians, resulting in multiple tests and treatments with minimal results. Precise electrical measurements of specific neck muscles using EMG (electromyogram) can help identify this problem. Botulinum toxins can then be delivered precisely to the specific overactive muscles in the neck affording relief in pain and improvement in range of motion.

It is important to undergo a proper and thorough evaluation for any muscle overactivity problem mentioned above prior to undergoing treatment.

Sunny R. Kim, MD, FAAPMR, is founder and president of Progressive Rehabilitation Medicine. Reach them at 1026 A Avenue – Physician’s Suite 5000, Cedar Rapids, IA, 319-861-6945.