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Botox: beyond frown line filler

The popularity of Botox (botulinum toxin type A) is largely attributed to its use as a cosmetic treatment that decreases the appearance of wrinkles, frown lines, crow’s feet and other “imperfections.” In recent years, the drug’s use by Hollywood celebrities has propelled it into stardom, making botulinum injections the most popular non−surgical cosmetic procedure performed by plastic surgeons in the United States.

However, many Americans are unaware of Botox’s other medical uses. In fact, a recent article in the New York Times mentioned that only five percent of stroke patients who could benefit from the drug know about it. The drug was first approved by the Food and Drug Administration in 1989 for medical use to treat eye muscle disorders. Since then, physicians have used the drug for “off label” purposes. Off label use of the drug is widely accepted and many insurance companies will reimburse for its usage.

At New York Methodist Hospital, 506 Sixth Street between Seventh & Eighth avenues, experienced neurologists use botulinum toxin type A for the treatment of spasticity, which is characterized by severe muscle stiffness, involuntary jerking and contractions of all or part of a muscle or group of muscles. This condition occurs when the normal messaging between the spinal cord and the reflex center of the brain is interrupted through injury or disease. Spasticity is often the result of stroke, brain trauma, spinal cord injury and other neuromuscular diseases, such as multiple sclerosis and cerebral palsy.

“In addition, the drug is also used at the Hospital to treat other movement disorders such as cervical dystonia (involuntary contracting of the neck muscles, causing abnormal movements and awkward posture of the head and neck), hemifacial spasms and blepharospasms (a condition marked by increased blinking and involuntary eye closure),” said Miran Salgado, MD, chairman of neurosciences. “We also use the drug to treat hyperhidrosis (excessive sweating) and excessive drooling.”

Botulinum toxin works by blocking the release of acetylcholine, a substance that transmits signals from the nerves to the muscles and can cause the muscles to overreact and tense up if present in large amounts. Once the drug is injected into the affected area, muscle spasms may stop or become greatly reduced. The use of the drug has very few risks. However, the effects of Botox are not permanent and generally wear off in three to four months, at which time the injection is repeated.

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