How Botox Can Be Used to Treat Neurological Conditions

by Arthur I. Neurologist

Long before Botox became a household name for cosmetic use, and later for chronic migraine treatment, neurologic specialists successfully used botulinum toxins for various neurologic conditions.

Botox is a preferred and first line therapy for several neurologic conditions.

Dystonia

Dystonia is an involuntary muscle contraction that can twist the muscle and can be very painful.

Some dystonias can involve the whole body and represent a familial and progressive disease. These so-called generalized dystonias require extensive diagnostic and genetic testing, and can be difficult to control. Fortunately, they are very rare.

Most patients suffer with focal or segmental dystonias, which involve a particular muscle or group of muscles in one segment of the body. In theory, any body part can be involved, but in practice, some segments of the body are affected more than others.

Cervical dystonia, also known as spasmodic dystonia, occurs when specific muscle groups in the neck contract, causing neck pain and spasms. Sometimes, the contraction of the neck can cause the neck to rotate and can lead to abnormal neck posture and pain. This condition is known as torticollis.

Sometimes, cervical dystonia is associated with head tremors or shaking of the head. It is important to understand that patients with cervical dystonia have variable involvement of neck movement, pain or tremor. While severe cases usually get appropriate therapy, milder cases of cervical dystonia can go undiagnosed for years, sometimes being mistaken for spinal problems. If the patient has neck pain and neck muscle contractions without obvious spinal disease and is not responding to spinal therapy, they should be evaluated for cervical dystonia.

Likewise, someone with an isolated head tremor (head shaking) should be evaluated for cervical dystonia. Botulinum toxin therapy is a first line, FDA-approved therapy for cervical dystonia and has been very successful in treating the disease.

Another important group of focal dystonias are limb dystonias. The symptoms include repeated muscle spasms and pain in a particular limb (arm or leg). In the arm, most common dystonias involve a hand. Usually, a patient uses a hand in a repetitive fashion and develops cramps and abnormal hand postures, which cause painful spasms. In the leg, the dystonia usually involves the muscles rotating, flexing and extending the foot and small muscles in the foot. Limb dystonias respond well to botulinum toxin injections by experienced and well-trained specialists.

Focal Spasticity

After a stroke or any other permanent injury to the brain or spinal cord (e.g. spinal trauma, multiple sclerosis, etc.), spasticity can develop in arms or legs. This can cause pain, joint deformity and contractures. Traditionally, we use medicines to reduce spasticity, but those can cause fatigue and generalized weakness. Botulinum Toxin injection in specifically troublesome muscles in spastic patients is FDA approved and can be a very effective treatment, without the side effects of generalized fatigue and drug sedation. Usually, we perform botulinum chemodenervation at regular intervals, in conjunction with physical or occupational therapy.

Botulinum toxin is also used for abnormal spasms of the eye (blepharospasm) or facial muscles (hemifacial spasms). It is also used for abnormal spasms in the jaw (oromandibular dystonia).

Another neurologic use of botulinum is for treatment of excessive salivation (sialorrhea), usually in Parkinson’s patients.

About Dr. Itkin:

Dr. Itkin was one of the clinical pioneers in therapeutic evolution of non-cosmetic Botox use and other therapeutic toxins. In 1993, Dr. Itkin started injecting botulinum toxin for obscure neurologic conditions, and the use has evolved to treat very common neurologic problems. Over decades, Dr. Itkin developed world-class clinical expertise in all forms of neurologic Botox injections. He participated in clinical trials and served as a major injection training center for physicians to learn all aspects of the art of botulinum injection for neurologic conditions.

Over the past 25+ years, Dr. Itkin has developed injection techniques geared to individual patients. Each patient is unique in their expression of dystonia or spasticity and requires an individual injection protocol.