Botulism Toxin: Killer or Wonder Drug?
by Elaine Gottlieb
What do wrinkles and muscle spasms have in common? Both are caused by repeated or inappropriate muscle activity and both can be treated using the same drug, Botox.
With such wide-ranging effects, Botox may sound like a wonder drug. Nevertheless, it is actually short for botulinum toxin—one of the deadliest food poisons known to humankind. Although rare, it is not hard to find news stories about groups of people who died from food poisoning caused by the toxin. However, the same quality that can make botulism lethal—its ability to paralyze muscles—makes it therapeutic when used in carefully controlled doses.
All Kinds of Relief
Botox is used to treat a variety of muscular disorders. It is the drug of choice for the neuromuscular condition, dystonia. In dystonia, particular muscles contract inappropriately. A common form of dystonia involves the neck, and is called torticollis. Other forms involve spasms of the eyelids (blepharospasm), half of the face ( hemifacial spasm), and vocal cords (spasmodic dysphonia). Dystonia is also common in some neurologic diseases, such as cerebral palsy
Unlike muscle strain or tendinitis, dystonia is a neurologic disorder in which the brain incorrectly signals muscles to contract, which can result in muscle pain and spasm.
When Botox is injected directly into a contracted muscle, it is weakened and cannot contract as strongly, restoring balance to the group of muscles involved in a particular movement and relieving symptoms for a period of months.
Doctors have used Botox to correct a variety of conditions involving inappropriate muscle and gland activity with varying degrees of success. They include:
Frown. Smile. Grimace. Grin. Every facial expression forms a crease that will someday be etched into your skin as a wrinkle. You can't stop moving your face, but you can limit movement in key places using Botox. As a result of its successful use with facial tics, plastic surgeons discovered that Botox can smooth out wrinkles in places where muscle activity has a particularly noticeable effect. Botox is used to treat wrinkles in 2 places: frown lines between the eyebrows, where it is most effective, and crow's feet. As Botox restricts muscle movement, it creates a smoother appearance, even if it does not remove all traces of the wrinkle.
How It Works
Tiny quantities of the toxin are injected directly into the muscles of facial expression. The treated muscles weaken over the course of 2 weeks and the person is no longer able to contract the frown muscles. They can still lift their eyebrows normally and blink without problems. The injection is almost painless.
Not surprisingly, younger people—whose lines are not as deep—experience the greatest improvements. Results last up to 4 months. You can receive injections every 3–4 months to maintain the results.
Side Effects Are Uncommon
Side effects have not been a problem in using Botox for treating wrinkles or other conditions, aside from the occasional allergic reaction or temporary excessive muscle weakness. Some people have a slight headache for several hours after treatment. The most common significant complication, which is rare, is ptosis. This is a drooping of the eyelid caused by the Botox tracking into the eyelid muscle. It generally lasts just a few days, but more prolonged weakness is possible. Botox injections cannot be used during pregnancy or when breastfeeding.
If you decide to undergo Botox treatment, be sure that you receive your care from a reputable physician highly experienced in the use of this substance. From quelling muscle spasms to smoothing out skin, Botox can be an effective treatment for many people if used properly.
American Society of Plastic Surgeons
Food and Drug Administration
Canadian Society for Aesthetic Plastic Surgery
AbobotulinumtoxinA. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T907386/AbobotulinumtoxinA. Updated August 7, 2017. Accessed October 19, 2017.
Cervical dystonia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T132176/Cervical-dystonia. Updated April 13, 2017. Accessed October 19, 2017.
Charles PD. Botulinum neurotoxin serotype A: a clinical update on non-cosmetic uses. Am J Health Syst Pharm. 2004;61(22 Suppl 6):S11-S23.
Continuing treatment. Botox Cosmetic website.
...(Click grey area to select URL)
Accessed October 19, 2017.
Evers S, Vollmer-Haase J, Schwaag S, et al. Botulinum toxin A in the prophylactic treatment of migraine—a randomized, double-blind, placebo-controlled study. Cephalalgia. 2004;24(10):838-843.
IncobotulinumtoxinA. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T907772/IncobotulinumtoxinA. Updated August 7, 2017. Accessed October 19, 2017.
Relja M, Poole AC, Schoenen J, et al. A multicentre, double-blind, randomized, placebo-controlled, parallel group study of multiple treatments of botulinum toxin type A (BoNTA) for the prophylaxis of episodic migraine headaches. Cephalalgia. 2007;27(6):492-503.
Report blames Florida botulism cases on misused toxins. Center for Infectious Disease Research and Policy website. Available at:
...(Click grey area to select URL)
Published December 15, 2004. Accessed October 19, 2017.
Shukla HD, Sharma SK. Clostridium botulinum: a bug with beauty and weapon. Crit Rev Microbiol. 2005;31(1):11-18.
Silberstein S, Mathew N, Saper J, Jenkins S. Botulinum toxin type A as a migraine preventive treatment. For the BOTOX Migraine Clinical Research Group. Headache. 2000;40(6):445-450.
Troost BT. Botulinum toxin type A (Botox) in the treatment of migraine and other headaches. Expert Rev Neurother. 2004;4(1):27-31.
Wheeler AH. Botulinum toxin A: adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache. 1998;38(6):468-471.
Last reviewed October 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 12/4/2015
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