BOTOX (Botulinum Toxin) is a toxin produced by an anaerobic bacteria Clostridium botulinum. (Abbreviated as BTX or BoNT or BOTOX)

BOTOX is therapeutically used for:

• Hemi facial spasm - recurrent twitching of facial muscles
• Blepharospasm - involuntary and repeated closure of eyelids
• Cervical dystonia - involuntary turning of neck due to muscle spasm.
• Hyper hydrosis -  excessive sweating.
• Sialhoerhea - excessive salivation.
• Spastic Cerebral palsy – inability to walk due to brain damage at birth.

The Botox clinic in the Department serves for the treatment of the above conditions.

Mode of Action

Botulinum toxin acts by binding presynaptically to high-affinity recognition sites on the cholinergic nerve terminals and decreasing the release of acetylcholine, causing a neuromuscular blocking effect. In short, BOTOX blocks the unwanted release of Acetyl Choline from nerve terminals and thereby inhibit the unwanted involuntary movements. Use of BOTOX in different types of focal dystonias has been well studied and has proven to be very effective. 

Goals of treatment with botulinum toxin

The ideal of BOTOX treatment is to achieve a balance between weakness sufficient to reduce spasm but insufficient to interfere with function. The best combination of reduction in dystonia and pain with optimization of function is aimed.

Procedure

Injections are performed with a Teflon-coated, 24-gauge needle connected to an electromyographic (EMG) machine. Those muscles with highest clinical and EMG activity are injected. Usually, 2-4 separate muscles are injected in 1 session and, in larger muscles, 2-4 sites per muscle are injected. Identifying the specific muscles involved in cervical dystonia prior to the injection is important. Beneficial effect from toxin injection usually is apparent in 7-10 days. Maximum response from the toxin is reached in approximately 4-6 weeks and lasts for an average of 12 weeks.