Summary: Botolinum toxin is one of the most potent nerve toxins in nature. Harnessing its power has made it possible to use it judiciously at minuscule doses to benefit a number of medical and cosmetic conditions. The effects are very temporary, and benefits in CP usually depend on how intense the long term OT/PT is. Last updated January 21, 2007



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What is it?

Clostridium botulinum is a powerful type of germ that has caused a number of outbreaks of food poisoning, some of which have lead to a fatal outcome. The germ produces 7 serotypes of Botulinum toxin called : A, B. C, D, E, F and G. They exhibit individually characteristic structural and pharmacological properties like site of action, potency and duration of paralysis. The most potent, and medically useful one is the A serotype. Hence, that is the version that is usually preferred by doctors.

It destroys the "plug point" on the nerve fiber just at the point (neuro-muscular junction) where it encounters the muscle cell to be stimulated. This prevents release of stimulation causing chemicals called Acetyl Choline, that are necessary to inform the muscle fiber to contract. Though the main effects of the toxin are at the peripheral muscle level, some blocking actions are also seen at a more central level.

When the drug is medically injected into a specific muscle belly by an experienced doctor, it causes weakness to paralysis of the muscle depending on dose used. The effect starts within 2-3 days and peaks within 10 days. However, since the originating nerve cell of the treated nerve fiber is safely hidden undisturbed within the spinal cord, hence the nerve endings regenerate the junction point within 4 to 6 months in most cases.

Where all is it being tried / used?

Excessive sweating

Some persons have exaggerated sweating on one or more body parts that hamper their life style. Botulinum injection decreases the excessive sweat release by destroying the nerves that cause the problem. relief lasts for some months to a year.

Eye muscle spasm

Eye muscles may go into involuntary spasm to cause rhythmic side to side movements of eyes called Nystagmus. many patients obtain relief with the injection, though there is a risk of too much weakness causing double vision or eye wall inflammation (Keratitis).

Eye Squint 

Squint refers to misalignment of the two eyes due to mismatch of power in eye muscles surrounding an eye (too much or too little power in one or more group of muscles controlling eye movement). The Eye Specialist may inject a minuscule dose of Botulinum into the extra-powerful eye muscle to bring its net power into match with the other  muscles, this restoring alignment. It gives the surgeon some months of time to correct any other medical problem that the patient may have, before a final and permanent surgical correction can be done.

Face muscle Spasms

Excessive muscle spasm may be seen in eye lids or face muscles on one side that are functionally or cosmetically unacceptable. Botulinum injections have proved temporarily or permanently effective in such conditions, in expert hands.

Facial wrinkles

Forehead wrinkles, wrinkles around the eyes, etc. are being treated by cosmetologists with good results. However, it needs an expert hand to determine the correct dose of this ultra-potent toxin.

Jaw muscle spasm

Persistent spasm of upper or lower jaw muscles may make chewing very difficult. early medical intervention with Botulinum injections have been encouraging. However, the results are not consistent, with improvement varying from mild to moderate to marked. It is not yet possible to predict who will benefit how much.

Neck muscle spasm

Neck muscle spasm and headache is common in modern life due to too much computer work, typing, desk jobs, etc. They usually respond to muscle relaxants and anti-inflammatory family of pain killers. Sometimes, these drugs may fail, resulting in a continuous intractable neck spasm, on one side, that we call Torticollis. There are a number of other such abnormal muscle contraction states also. Botulinum has sometimes been used in such cases with gratifying though temporary (few months) benefit.

Spasm and fissures at anus

The stool passage or Anus, may develop cracks called Anal Fissure. It is a painful condition that makes defecation very painful. Injections of Botulinum have reduced pain, spasm and help in faster healing of the fissures. However, some patients may require repeated injections to maintain relief.

Spasm of gullet

The gullet has alkaline juice while the stomach has high acid content. To protect the gullet lining from the stomach acidity that it is not capable of handling, the junction of the gullet to the stomach is guarded by a ring of muscles acting like a one way trap-door (Lower Esophageal Sphincter or LES). Sometimes, the muscles of LES go into an exaggerated persistent spasm, causing pain and difficulty in swallowing (Achalasia cardia). Injections of Botulinum by stomach specialists, using an Endoscope, have yielded good results, lasting from a few months to even more than two years in some.

Spastic paralysis

The limbs are controlled by two sets of muscle command. The main brain for voluntary control sends down orders to relax the muscles (Pyramidal Tracts), while the involuntary brain orders the muscles to contract (Extra Pyramidal Tract). It is the balance of the two commands that allows smooth and efficient limb movement control. In diseases like stroke, Spastic CP, head injury, etc., the main brain is primarily affected, leading to a spastic type of "Upper Motor Neurone" paralysis. A few studies have shown that the use of Botulinum Injection may benefit some of these patients. it is now being increasingly used for relief of intractable muscle spasm in CP. The UDAAN Multimode Therapy for CP makes extensive use of the injection for this condition.


Tremor refers to rapid involuntary to and fro, or up and down movements in hand, limbs face, neck, etc, commonly seen in some elderly persons. The injection has shown only limited benefit in some series, hence it should be tried only in drug failure cases.

Voice Box muscle spasm

Spasmodic conditions of the muscles controlling voice box (larynx) may be due to disease of brain, and hence are associated with spasms of many other facial muscle groups also. Injections of Botuilinum into a group of voice box muscles called Thyro-aretenoid muscle, has been beneficial in many cases, though repeated injections may be needed. Side effects consist of breathlessness, inadvertent ingestion of food into air passage, difficulty in swallowing, voice abnormalities, etc.

Wrist cramp

Wrist / hand cramps often affect writers, and hence it is also called Writer's cramp. Even picking up a pencil may be painful. The condition affects a number of muscle groups, and hence the results of the use of Botulinum have not always been encouraging, with variable relief and worse, weakness of hand making writing / working difficult.

How safe is it?

  1. Accidental overdose causing excessive weakness of the muscle being treated
  2. Allergy, drug fever,
  3. Dryness of mouth or tears, drooping eyelids, double vision (facial injections)
  4. Voice or swallowing abnormalities (neck injections)
  5. Antibody formation, making future use of the injection less effective.

N.B. We at UDAAN rarely now go in for Botox or Phenol Nerve Block. The effect of these injections are magical: the child starts walking near normally within 5 minutes to a day. The doctor is happy, the parents are happy, the child is happy. In all this happiness, intensive Standard Therapy is given the go-by. Result: back to the pavilion within a year and Rs.15000 + gone down the drain.

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