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Botox not just for wrinkles

By: Loyola University Health System

Botox is best known as a cosmetic treatment for frown lines, but the drug also effectively treats the after effects of Bell's palsy and other serious facial nerve problems.

28Bell's palsy results from damage to the facial nerve that controls muscles on one side of the face. Ear-nose-throat surgeon Dr. Matthew Kircher of Loyola University Medical Center is giving patients Botox injections to treat facial nerve disorders that sometimes occur after Bell's palsy, including unwanted facial movements known as synkinesis.

Botox injections work by weakening or paralyzing certain muscles or by temporarily blocking the nerve input into the muscles.

Facial synkinesis is the involuntary movement of one set of muscles when the patient tries to move another set of muscles. For example, when the patient blinks, the mouth smiles or grimaces.

Botox can improve the symmetry of the face and reduce muscle contractures and spasms. Botox also is effective for platysmal banding -- verticle lines that develop in the neck as a result of muscle contractions.

Kircher said he starts out conservatively, treating patients with dilute doses. After seeing how well the patient does, Kircher adjusts the dose if necessary.

Botox is not a cure. The drug wears off after three or four months, so patients need repeat injections.

"While we can never make the face perfect, we have found Botox to be extremely effective," Kircher said. "It can make a huge difference in patients' lives."

Kircher is an assistant professor in the Department of Otolaryngology of Loyola University Chicago Stritch School of Medicine.

Botox injections reduce chronic neck and cervical muscle pain

By: merican Society of Anesthesiologists (ASA)
Source: Science Daily

A study presented at the Anesthesiology 2012™ annual meeting revealed Botulinum toxin type A (BOTOX) injections significantly improve pain and quality of life in people with chronic bilateral posterior neck and shoulder myofascial pain syndrome.

Traditional therapies for the treatment of myofascial pain syndrome include medications such as anti-inflammatory drugs (such as ibuprofen or naproxen), steroids and muscle relaxants, physical therapy and behavioral modification.

"At best, long-term benefit with traditional therapies is transient and unpredictable," said Andrea L. Nicol, M.D., M.S., Director of Research -- UCLA Pain Management Center, Assistant Clinical Professor, Department of Anesthesiology -- Division of Pain Management, David Geffen School of Medicine at UCLA. "Even with these treatments, some people with myofascial pain syndrome get incomplete benefit or no benefit at all."

BOTOX is used commercially to treat multiple painful medical conditions, including migraine headaches, spasticity and cervical dystonia. It is also used cosmetically as a means of reducing the appearance of frown lines and wrinkles.

"BOTOX is in a class of medications called neurotoxins and when injected into muscles, blocks the nerve signals that cause the tightening of muscle, leading to muscle relaxation. Thus, BOTOX may offer advantages over traditional therapies for myofascial pain syndrome due to its prolonged and sustained effects," Dr. Nicol confirmed.

About the Study

The study was conducted at the University of California, Los Angeles by Chronic Pain Management Specialists F. Michael Ferrante, M.D. and Andrea Nicol, M.D. All subjects who enbotox injection gtarolled in the study were given injections of BOTOX into the painful muscles of the neck and shoulder area during the first phase of the study. Subjects with significant improvement to BOTOX treatment moved on to the second phase of the study and were randomized into two groups. Subjects in the treatment group had BOTOX injections into the painful muscles of the neck and shoulder area. Subjects in the control group received a placebo injection (salt water) into the painful muscles of the neck and shoulder.

Those enrolled in the study were monitored intermittently to assess their response to the injections. Pain scales and questionnaires were administered to document response and perform data analysis.

Analysis of the results revealed subjects who received BOTOX injections had:

A significantly greater reduction of their pain scores compared to those subjects who had received placebo injections.
A significant reduction in the number of headaches they experienced on a weekly basis.
The severity of the subjects' headaches (numerical pain score rating) was reduced.
A significant reduction in the interference of their pain with regards to general activity, sleep and enjoyment, indicating an overall improved quality of life.

Given the findings of this study, BOTOX may be an option for those who have been suffering with myofascial pain syndrome and have yet to find relief with traditional therapies.

Facial exercise speeds Botox's wrinkle-reducing effects Simple facial exercises shortly after injection get quicker results by one day

By: Northwestern University
Source: Northwestern University

For people who can't wait the three or four days for the wrinkle smoothing effects of botulinum toxin (Botox) injections to kick in, a new Northwestern Medicine study shows facial exercise after the injections speeds the change in appearance by about one day. Botox can reduce forehead frown lines and crows' feet wrinkles, giving people a more relaxed and youthful appearance that lasts for several months. But the effects take time to kick in.

"Patients often leave getting their Botox to the last minute," said lead study author Dr. Murad Alam, professor of dermatology at Northwestern University Fe26inberg School of Medicine and a Northwestern Medicine physician. "If people get their botulinum toxin right before a social engagement or important work event, they may worry it won't start working in time. Speeding up the effects could be important to people."

In addition, it's helpful to be able to tell patients facial exercise is truly evidence based, Alam said.

The paper will be published Oct. 25 in the Journal of the American Academy of Dermatology.

Conventional wisdom in the medical community used to be exercising the treated muscles would make Botox work sooner. Then, some doctors suggested it didn't seem to make much of a difference, and it fell out of favor, Alam said.

"But we wondered who was right," Alam said. "Since there had not been any well-designed randomized studies comparing exercise and no exercise side-by-side, we decided to do one."

In the study, 22 adult women with forehead wrinkles were treated with botulinum toxin. Half were then asked to exercise their facial muscles over four hours after the injections; the other half were not. The exercises included raised motions of the forehead and scowls (i.e., knitting the brows) in three sets of 40 repetitions separated by 10 minutes. Six months later, after the treatments' effects had worn off, participants were retreated. This time, the experiment was reversed, with those who had exercised last time now avoiding facial exercise, and the others performing exercises.

Both dermatologists and participants rated forehead wrinkles to be better in two to three days after treatment when injections were followed by facial exercise, compared to three to four days without exercise. By two weeks, there was no difference in effect between exercise and non-exercise participants. There also was no difference in how long the treatments kept working before wearing off. Sixty-eight percent of participants believed exercising made muscle relaxation and wrinkle reduction occur faster. Fifty-nine percent found the facial exercises very easy to do.

The results show post-treatment facial exercise after botulinum toxin injections can make wrinkle reduction occur one day sooner.

"Botox binds to receptors on nerve cells to relax muscles, and it is possible that exercise speeds this binding process," Alam said. "For patients who need quick results, the exercise may be worth the effort. Patients appreciate having more control over their care."

Botox Injections Effective For Treating Stroke Spasticity

By: Wake Forest University Baptist Medical Center

New research shows that repeated treatments of botulinum toxin type A (BoNTA) over one year after a stroke can improve muscle tone and reduce pain in the arms and hands, making it easier for patients to dress themselves and perform personal hygiene.

"The treatment resulted in sustained and meaningful functional improvement that makes a difference in the daily lives of stroke patients and the people who care for them," said Allison Brashear, M.D., professor and chairman of neurology at Wake Forest University Baptist Medical Center.

The findings were presented today at the 2005 Annual Meeting of the American Association of Physical Medicine and Rehabilitation (AAPM&R) in Philadelphia. The study was co27nducted by Brashear and colleagues while she was at Indiana University School of Medicine.

This was the first long-term study to evaluate repeated treatment with BoNTA for post-stroke spasticity, a muscle tightness that inhibits movement. Brashear and colleagues had previously reported (New England Journal of Medicine, August 2002) that one-time injections of BoNTA are safe and effective in people with wrist and finger spasticity after a stroke.

The study reported on today involved 35 centers and included 279 stroke patients with wrist, hand or elbow spasticity. Disabling spasticity affects between 17 percent and 30 percent of stroke survivors and can lead to functional limitations, discomfort and pain. Upper limb spasticity can interfere with patients' mobility, comfort and their ability to dress, wash or feed themselves and perform other activities of daily living.

During the year-long study, all study participants received up to five treatments with BoNTA, which is sold under the trade name BOTOX®. For the study, the BoNTA injections were given at the wrist, thumbs, fingers and elbows to block overactive nerve impulses that trigger excessive muscle contractions.

Researchers found that at week six of the study, muscle tone in the wrist, fingers, thumb, and elbow was markedly improved from baseline, and was sustained throughout the study. The study also measured functional disability in four areas: hygiene, dressing, limb posture and pain. Before the first treatment, patients selected an area that was most important to them. On a four-point scale that ranged from "no disability" to "severe disability," at least 50 percent of patients achieved a 1-point or greater improvement in the area they targeted.

"If it isn't managed effectively, post-stroke spasticity can result in very disabling complications such as contractures, a condition that leaves the muscles and tendons permanently shortened," said Brashear. "Early intervention with effective therapies is absolutely vital to prevent the profound disability that afflicts many stroke patients, and to lessen the emotional and financial toll on caregivers and the health care system as a whole."

The study found that adverse events related to treatment, such as headache, pain in the arm, or an influenza-like illness, were reported in 7 percent of patients. Brashear said these results show that the treatment is safe and well-tolerated in post-stroke patients and may represent a significant advantage over many oral anti-spasticity medications.

"Such drugs are associated with a high incidence of systemic effects such as sedation, mental confusion, dizziness and muscle weakness, all of which can seriously hinder rehabilitation after a stroke," she said.

Every year, about 700,000 Americans suffer a new or recurring stroke. Stroke is a leading cause of serious, long-term disability in the United States, and it is estimated that the costs associated with lost productivity due to stroke-related disability will total $21.8 billion in 2005.


The research was funded by Allergan Inc., the pharmaceutical company that developed BoNTA. Brashear's co-researchers were Elie Elovic, M.D., of Kessler Medical Rehabilitation Research and Education Corporation and New Jersey Medical School, Darryl Kaelin, M.D., of the Shepherd Center, Atlanta, and Robin McIntosh, Jingyu Liu, Ph.D., and Catherine Turkel, PharmD., M.B.A., all with Allergan Inc.

Botox Cosmetics increase overall quality of life and self-esteem

By: Dr. Steven Dayan
Source: News Medical life Scinces

Chicago Facial Plastic Surgeon, Steven H. Dayan, MD, FACS, publishes a study in the November 2010 issue of Dermatologic Surgery, a prominent Dermatology journal, demonstrating that increases in overall quality of life and self-esteem were observed in participants treated with Botulinum Toxin Type A or Botox Cosmetic. In this double-blind randomized placebo-controlled survey, Dr. Dayan and DeNova research worked with one hundred participants who were treated with either Botox Cosmetic or a saline placebo for facial wrinkles.25

Study participants were photographed and randomized to receive injections of Botox Cosmetic to the glabellar area (between the eyebrows), forehead, and crow's feet or injections of a saline solution. It is not uncommon after treatment with Botox for patients to report an increase in satisfaction with their appearance. Many individuals recently treated with Botox report an elevation in mood, claiming to be happier. All participants in this study finished a health outcomes survey consisting of quality of life enjoyment and satisfaction questionnaire, before injections and two weeks and three months after injections.

Statistically significant improvements in participants treated with Botox Cosmetic were observed in answers to quality of life questions pertaining to physical health, mood, household activities, overall life satisfaction, body satisfaction, self-consciousness, intellect, self-worth, appearance, comprehension, weight satisfaction, attractiveness, and sense of well-being. Increases in overall self-esteem and appearance-,social-, and performance-related self-esteem were observed in participants treated with Botox Cosmetic.

Findings revealed that Botox injections result in improvements in quality of life and self-esteem. In addition, Botox-naive participants (participants who never received injections before) demonstrated a greater improvement in quality of life and self-esteem when compared to participants previously exposed to Botox. Moreover, Botox-familiar participants demonstrated sustained improvement in quality of life and self-esteem relative to Botox-naive participants, even when injected with placebo.
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"The findings in this study ask us to think much differently about Cosmetic Botox treatments," says, lead investigator Steven H. Dayan, MD, FACS, Chicago Center for Facial Plastic Surgery, Clinical Assistant Professor of Otolaryngology at University of Illinois at Chicago, Adjunct Professor at DePaul University. "We have long known the physically enhancing benefits of Botox treatments, but to now have data that indicates Botox also improves one psyche, self-esteem and quality of life is very significant. This probably contributes to the widespread popularity of the product. The question now has to be asked is if getting Botox makes people feel better about themselves, could this translate into them being more productive in their professional lives and happier in their personal lives?"

Findings demonstrated that individuals who received Botox had significantly greater satisfaction with household activities, performance-related self-esteem, and social-related self-esteem. Others have shown that those who have and feel more positive about themselves are more productive in the workplace and in their personal relationships. The data shows that Botox has the potential for transformative results that significantly boost self-esteem and quality of life.

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