What is Botulinum Toxin (Botox)?

It is a substance obtained for medical purposes from the poison of the bacterium Clostridium Botulinum under laboratory conditions and prevents the impulses coming from the nerves to pass to the muscles.

The force of contraction of a muscle injected with Botulinum Toxin decreases or disappears temporarily and proportionally to the dose of the drug. Due to this feature, Botulinum Toxin is used as a muscle relaxant in involuntary and uncontrolled muscle twitching, dystonia, and also for aesthetic purposes, for wrinkle removal, excessive sweating, and in the treatment of some headaches recently.

In which diseases is it used in neurology?

1- Involuntary Movement Disorders

• Cervicaldystonia (involuntary contraction of neck muscles)
• Blepharospasm (involuntary contraction of the muscles around the eyes)
• Limb dystonias (writer's cramp) (involuntary contraction of arm and leg muscles)
• Oromandibular dystonia (involuntary contraction of the jaw muscles)
• Orolingual dystonia (involuntary contraction of the mouth-tongue muscles)
• Hemifacial spasm (intermittent involuntary contraction of mimic muscles stimulated by the facial nerve)
• tics
• Myokymycinkinesia (involuntary contraction of small muscle fibers in the face area)

2- Spasticity; Spasticity may occur when the centers of movement in the brain and spinal cord are affected. It is manifested by hardening and contraction in the muscles and muscle groups, and voluntary movement becomes difficult. Physiotherapy program should be applied in order to provide more effective treatment together with Botox application.

Diseases accompanied by spasticity: 

• Stroke
• traumatic brain injury
• Cerebral palsy
• Multiple Sclerosis
• spinal cord injury

3- Headaches: Botox treatment can be recommended especially for those who have pain for a long time, do not benefit from various treatment methods, and cannot tolerate the side effects of the drugs they use.

• Migraine
• tension-type headache

4- Bruxism (Teeth Grinding); It is the condition of clenching and clenching the teeth, usually caused by strong jaw movements that occur during sleep. Often individuals with this habit are unaware of the condition as the disturbance occurs during sleep at night. teeth grinding; It can lead to wear on teeth, fractures of teeth and fillings. It can cause pain in the facial muscles and jaw joint, chronic headache.

5- Autonomic Nervous System Disorders

• Axillary, palmar hyperhidrosis (sweating underarms and palms and soles); It is formed by the excessive work of sweat glands. It is a cosmetically disturbing condition. Unlike other applications, it is injected into the skin.
• Sialorrhea (Excessive Salivation)

How Long Does Botulinum Toxin Take?

Although the duration of the effect of botulinum toxin varies from person to person, it can take 3-6 months depending on the use of the person's muscle. As the number of applications increases, the duration of the application may be extended.

Botulinum toxin treatment should be individualized. Depending on the disease causing, gender and examination, which muscle needs to be relaxed and how much is determined. Application points and doses should be adjusted according to the examination findings. For this reason, Botox treatment should be applied by the relevant specialist.

The effect of Botulinum Toxin starts a few days after the injection and usually lasts for about 3-6 months. At the end of this period, the muscle, which begins to receive the impulses from the nerve, gradually regains its former strength. For this reason, the injection should be repeated every 3-6 months for the continuation of the effect. If the effect of the drug has not yet passed at the end of the 3rd month, a longer period of time may be expected for the re-injection. If the injection is repeated in less than 3 months, there is a risk of developing antibodies to the drug and losing the effect of the drug in subsequent injections. Therefore, even if the effect of the drug has passed in less than 3 months, it is necessary to wait at least 3 months for a re-injection.

What are the side effects of Botulinum Toxin injection and who should not be administered?

Weakness and temporary loss of function in the injected muscles and some other muscles adjacent to these muscles are the most common side effects. Among these, depending on the location and function of the injected muscle, drooping of the eyelids and eyebrows, double vision, allergic reactions, and decreased dexterity of hands and arms can be seen. In addition, pain at the injection site lasting for several days may occur. Botulinum Toxin has no permanent side effects.

Botox should not be applied to people with neuromuscular system diseases (such as Eaton-Lambert syndrome, myasthenia gravis), pregnant and breastfeeding women.

Dr. Gülsün Akansoy Üstünel
neurology expert

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