• Botulinum Toxin Injections—Medical

    (Botulinum Toxin Type A; Botulinum Toxin Type B; Botox Injections)

    Definition

    Botulinum toxin is made from a type of bacteria. It is toxic to the nerves. Another name for it is bacterial neurotoxin. An injection puts this toxin into muscle. There, it blocks the chemical signal from the nerves to muscles. This will decrease the muscle contraction (tightening).
    There are several types and brands of this toxin. Examples include Botox, Dysport, and Reloxin, which are formulations of botulinum toxin type A. Myobloc is another brand, but it is a formulation of botulinum toxin type B. These products are used for cosmetic and medical reasons.
    This injection process is often called botox injection , although any brand of the botulinum toxin may be used.

    Reasons for Procedure

    The injection is FDA-approved to treat:
    • Cervical dystonia (abnormal spasms of neck muscles)
    • Blepharospasm (spasm of eyelid muscles)
    • Strabismus (crossed eyes)
    • Hyperhydrosis (excessive sweating)
    The injection has also been used to treat other conditions, such as:
    Strabismus
    Lazy eye
    Copyright © Nucleus Medical Media, Inc.

    Possible Complications

    Complications are rare. When they occur, they are temporary and mild. Side effects are related to the site of injection. For example, if injections take place near the eyes, there may be complications with eyelids or brow line.
    Temporary issues may include:
    • Redness
    • Bruising
    • Stinging around the injection sites
    The following are less common reactions. They are generally mild and do not last long.
    • Nausea
    • Fatigue
    • Flu -like symptoms
    • Headache
    Other complications that may occur include:
    • Excessive weakness of the muscle around the eyes—can cause drooping of the eyelids or obstruction of vision
    • Difficulty swallowing—can occur in patients receiving injections in their neck
    • Compensatory hyperhidrosis—people being treated for hyperhidrosis may develop increased sweat production at another area of the body
    • Excessive weakness or atrophy (wasting) in chosen muscles—the injection may slow any improvement in the muscle
    • Neck weakness in people with long, thin necks
    • Risk of the botulinum toxin spreading beyond the injection area—may cause botulism symptoms, including difficulty breathing and death in severe cases (Children with cerebral palsy may be at a higher risk for this side effect.)
    The toxin can also interact with medicines, such as antibiotics. Tell your doctor about all of the medicines that you are taking.
    You should not have botox if you:
    • Have an infection or inflammation in the area where botox will be injected
    • Are sensitive to the ingredients in botox
    • Are pregnant or breastfeeding

    What to Expect

    Anesthesia

    Most often, none is given. Some patients may prefer to have the area numbed for comfort. In this case, a topical anesthetic may be used.

    Description of the Procedure

    A thin needle will be used. The doctor will inject the toxin through the skin into the targeted muscle. You will often need several injections in a small area.

    After Procedure

    There is very little recovery needed, but remember to:
    • Remain upright for several hours
    • Avoid alcohol

    How Long Will It Take?

    The length will depend on the number of sites involved. It is often less than 20 minutes.

    Will It Hurt?

    You may have some minimal discomfort.

    Post-procedure Care

    Normal activities may be resumed after the procedure. For the best recovery, follow your doctor's instructions .
    The toxin temporarily weakens targeted muscles. The treatment lasts up to four months. With repeated use, the effects may last longer.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Difficulty breathing
    • Difficulty swallowing
    • Difficulty speaking
    • Severe lower eyelid droop or obstructed vision
    • Excessive weakness around the injection site
    • Rash or any other sign of an allergic reaction
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Society for Dermatologic Surgery http://www.asds.net/

    American Society of Plastic Surgeons http://www.plasticsurgery.org/

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca/

    Health Canada http://www.hc-sc.gc.ca/

    References

    Allergan Physician Production Information. Botox cosmetic (botulinum toxin type A). Published April 2008.

    Baran R, Maibach H. Textbook of Cosmetic Dermatology . 3rd ed. New York, NY: Taylor and Francis; 2004.

    Conn HF, Rakel R. Conn’s Current Therapy . 54th ed. Philadelphia, PA: WB Saunders Company; 2002.

    Habif T. Clinical Dermatology . 4th ed. St. Louis, MO: Mosby; 2004.

    Ondo WG, Gollomp S, Galvez-Jimenez N. A pilot study of botulinum toxin A for headache in cervical dystonia. Headache . 2005;45(8):1073-1077.

    Ward A, Roberts G, Warner J, et al. Cost-effectiveness of botulinum toxin type A in the treatment of post-stroke spasticity. J Rehabil Med . 2005;37(4):252-257.

    11/4/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA gives update on botulinum toxin safety warnings. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm . Updated August 3, 2009. Accessed November 4, 2009.

    3/19/2010 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA approves Botox to treat spasticity in flexor muscles of the elbow, wrist and fingers. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm203776.htm . Updated March 9, 2010. Accessed March 19, 2010.

    5/17/2012 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA. 2012;307(16):1736-1745.

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