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The Beauty of Botox May Be Its Other Uses

2008-06-30 15:05:57

Botox, the popular poison most often used to smooth out facial wrinkles, is becoming something of a cure-all.

Developed initially by ophthalmologists for the treatment of crossed eyes and uncontrollable blinking, Botox injections are the most popular cosmetic treatment in the United States, with 2.8 million procedures to get rid of crow's feet, frown lines and forehead furrows in 2007, according to the American Society for Aesthetic Plastic Surgery.

But, that's not nearly all. Physicians are using tiny injections of purified botulinum toxin to fight a variety of afflictions, including:

Excessive sweating

Neck and shoulder pain

Migraine headaches

Benign prostate disease

Bladder pain

Spasticity caused by cerebral palsy, and

Spasmodic dysphonia (involuntary muscle spasms that interfere with speech).

Studies are under way to determine its effectiveness in treating alopecia (a form of balding), hot flashes and shingles, and to help identify specific nerves causing diabetic neuropathy.

Brad Getz, a Fort Worth landscape architect, is among patients who have sought help to stop muscle spasms. He first noticed the twitch in his right eye last August.

"It doesn't hurt. It's just annoying, and it's been going on a long time. I never know when it's going to just start jerking," said Getz, 21. "It's kinda weird."

He hasn't felt the elusive twitch since June 13, when Dr. Sam Abdul-Rahim, a neuro-ophthalmologist at Ophthalmology Associates in Fort Worth, gave him two "almost painless" injections into the muscles that control blinking.

"An involuntary eye tic is a really common and often severe problem in older people, who tend to get bilateral eye twitches that can be almost nonstop," Abdul-Rahim says. "It is usually less severe in young people. One little shot of Botox will often eliminate the problem."

Some older patients with more severe muscle spasms around their eyes come in every three or four months for injections, said Abdul- Rahim, who treats 12 to 14 patients for blepharospasms (uncontrollable eye blinking) the second Friday of each month.

Botox neurotoxin therapy was first approved by the U.S. Food and Drug Administration in 1989 for the treatment of strabismus (crossed eyes) and blepharospasm. It received FDA approval in 2000 to decrease the severity of abnormal head position and neck pain associated with cervical dystonia (sudden involuntary contraction or spasm of the neck muscles), and in 2002 to improve the appearance of the vertical frown lines between the eyebrows in adult men and women age 65 and younger, under the name Botox Cosmetic.

Dr. Erin Welch, a cosmetic dermatologist and associate professor at the University of Texas Southwestern Medical Center at Dallas, uses Botox on patients suffering from excessive sweating, and Dr. Sharon Gibbs, a physical medicine rehabilitation specialist at the Texas Back Institute, uses it to treat muscle-based neck, shoulder and lower back pain.

"It is becoming common for treating spastic muscles," Gibbs said. "It seems to impact pain beyond the muscle spasticity. . . . I haven't used it for cerebral palsy for years, but we did when I was at Southwestern Medical Center. We would get kids whose hands were in such tight little fists you couldn't wash them, and when we released those muscles, you could. We also used it for patients who could not relax their muscles, post-stroke. I use it now for taut spastic muscles, especially in the upper back, neck and shoulders."

A Dallas-area patient was at the Texas Back Institute in Plano recently for a shoulder injection to ease lingering pain from an accident several years ago.

"I had tried chiropractic treatments, a lot of pain medications, muscle relaxers and steroid injections once a month for four months, and I had gotten some relief, but this is working better for me. I still take several pain medications, but I can take a lot less the first couple of months after I have had a Botox shot," said the woman, who declined to give her name. "I start taking more when it starts wearing off."

Botox therapy, which normally wears off in three to four months, costs between $300 and $1,000, depending on the area treated and the number of injections required. Biofeedback breathing techniques, ice packs and topical lidocaine are sometimes used to lessen pain, especially if numerous injections are needed or treatment requires multiple deep injections into large muscles.

In July 2004, the FDA sanctioned Botox for the relief of severe underarm sweating that is inadequately managed by topical agents, but doctors also use it to control excessive sweating in the palms and feet.

"People who truly sweat a lot ruin their clothes, smudge papers and don't want to shake hands. That can be a real handicap in business," said Welch. "There is a lot of social embarrassment associated with excessive sweating. Young teens sweat through their clothes and are embarrassed at school. Sweating can cause shoe odors and fungal infections. We have them try prescription strength antiperspirants and iontophoresis[a treatment in which hands and feet are submerged in saltwater with a low electrical current] but that's a problem for underarms, and Botox works well. It's expensive, but it works."

She uses ice to blunt the pain and said she usually gives 20 to 25 injections in each underarm. The cost is $900, and the treatment, which blocks the nerve endings that send messages to the glands to produce sweat, lasts about six months.

"We are collecting data right now on the use of Botox to stave off hot flashes in menopausal women. The study is still very preliminary, but it's interesting," Welch said.

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