Botulinum Toxin Therapy

Botulinum toxin injection therapy is used to treat some types of movement disorders (e.g., spasmodic torticollis, blepharospasm, myoclonus, tremor). In this treatment, a potent neurotoxin (produced by the bacterium Clostridium botulinum) is injected into a muscle to inhibit the release of neurotransmitters that cause muscle contraction. When the botulinum toxin blocks its release, the messages are not delivered. As a result, muscle contractions and associated pain are reduced.

Minute amounts of the toxin are injected directly into the muscle responsible for the spasms. The toxin weakens the muscle, but does not paralyze it, and allows the affected area to resume a more normal position. Pain from prolonged muscle contractions is eased. The treatments can be used in the eyelid to treat blepharospams, and in muscles elsewhere in the body, such as the arm or leg. A very fine needle is used for the one to three injections that are normally given per muscle. Discomfort from the injections, if any, is usually minor and temporary.

Patients receiving botulinum toxin injection therapy should call our office at (415)-353-2311 approximately two weeks to report the results.

Because symptoms vary during the course of dystonia, the treatment's effectiveness and duration vary from patient to patient. Subsequent injections may produce results that are less dramatic than the first, and doses may have to be adjusted. Identifying and injecting the affected muscle is not always easy.

Botulinum toxin treatments should not be used by pregnant or nursing women or by people taking certain medications. Side effects to the treatment include a temporary muscle weakness and discomfort at the injection site.

Botulinum toxin injections are not a cure, but they usually ease symptoms in the injected muscle in seven to 10 days. Patients usually receive maximum benefit one to two weeks after the injections. The effects can last several months, and the treatments can be repeated, often indefinitely.

In some cases, patients may develop antibodies to the toxin over time, causing treatment to become ineffective. Side effects include temporary weakness in the group of muscles being treated and rarely, flu-like symptoms.

When medication is ineffective, severe movement disorders may require surgery. In deep brain stimulation (DBS), a surgically implanted, battery-operated medical device (neurostimulator) is used to deliver electrical stimulation to areas of the brain that control movement. The electrical charge blocks nerve signals that trigger abnormal movement.