Botox Bonuses

by Barbara C. Neff

As a board-certified dermatologist who treats cosmetic conditions, Dr. Jeffrey Hsu has injected his patients with Botox for years. But while the drug is probably most commonly associated with battling wrinkles, Hsu says it also is effective for treating excessive sweating and other medical issues.

Hsu should know—he doesn't just administer Botox to others to counter excessive sweating, he also uses it himself for the condition.

"I personally advocate Botox because it's made such a big difference in my life," he says. "As a surgeon, I couldn't even work if my hands were sweating." And this novel use is only one of the many therapeutic applications doctors have found for Botox.

Botox is a purified form of botulinum toxin that prevents muscles from contracting. "Your nerves talk to your muscles via neurotransmitters," Hsu explains. "Botox blocks that connection, so the muscles don't work as well as before."

The U.S. Food and Drug Administration (FDA) first approved the prescription-only drug in 1989 for treating crossed eyes and uncontrollable eye blinking. The FDA has since approved Botox for the treatment of cervical dystonia (the involuntary contracting of neck muscles) in adults, excessive sweating, and, most famously, furrows between the eyebrows.

Like other FDA-approved drugs, physicians can prescribe Botox for "off-label" uses. Doctors have reportedly used Botox to treat upper limb spasticity in post-stroke adults, chewing and swallowing problems, overactive bladders, pelvic muscle spasms, enlarged prostates, and other conditions. According to Allergan, the drug's manufacturer, therapeutic sales accounted for about half of Botox sales in 2008.

Dr. Andrew Celmer, a board-certified otolarynologist, says Botox also has some applications for vocal cord problems: "The main one is treatment of spasmodic dystonia, which is when the muscles that control the vocal cords contract uncontrollably, making it difficult to talk and sometimes to breathe." Sufferers usually have very strangled speech.

"There's no cure," Celmer says, "but you can stop the contractions for three to six months by injecting Botox into the muscles adjacent to the vocal cords. It relaxes the muscles, so patients can have fluent speech again."

Dr. Alan Summers, a board-certified clinical neurologist, calls Botox a miracle drug. "Neurologists started using it in the late ‘80s for diseases there was no treatment for," Summers says. "We've gone from virtually no treatment to an excellent cure in some cases."

For example, Summers injects certain muscles in the neck to treat cervical dystonia. Weakening those muscles allows patients to hold their heads straight. He also injects Botox for facial and eye spasms and tics, as well as for migranes.

"Botox was found to be effective for headaches serendipitously," Summers says. "People who had facial wrinkles started reporting fewer headaches and that led to some small studies." While it hasn't been definitively determined how Botox alleviates migraines, Summers suggests the drug may go beyond reducing muscle spasm to also interfere with the mechanism of migraines.

Summers cautions that Botox is not for every migraine patient and is not a first-line treatment. "Sometimes it helps, sometimes it doesn't," he says. "You consider it for patients who aren't responding to any other treatment. I definitely have some patients who can't be treated in any other way."

What about the risks? Earlier this year, the FDA began requiring the makers of Botox and similar products to add new warnings to their labels. The labels now state that the effects of botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms that include potentially life-threatening swallowing and breathing difficulties and even death.

Summers says he has been injecting Botox for 15 years and never encountered a problem. Hsu, the dermatologist who uses Botox therapeutically himself, agrees. "If you use a huge amount of any medicine, it can be toxic, but, if you use a small quantity in a doctor's office, it's going to be safe."