Botox: you put it where?

A popular cosmetic procedure is now being used to treat various debilitating medical problems. Larraine Sathicq discovers how a cure is just an injection away.

We all know Botox is widely used as a beauty treatment. For years, there's been a worldwide trend to inject this toxin into areas of the face to reduce wrinkles. But did you know that it can help with a wide range of health problems? Here, we look at how the medical world is putting this ingredient to good use.

What is Botox?
You probably know it as the anti-wrinkle treatment called Botox. But, if ingested, Botox's active ingredient, clostridium botulinum can kill you, as it causes botulism — a rare, but serious, paralytic illness. People who consume the botulinum toxin often die because their chest muscles become paralysed and they are unable to breathe. This ability to block nerves and paralyse muscles, however, is precisely what makes Botox an effective treatment for a variety of conditions.

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What can Botox help?

Incontinence
An overactive bladder often means having the need to pass urine urgently — dashing to the toilet and sometimes not making it in time. The first line of treatment for this condition is pelvic-floor strengthening, exercising and/or medication. But these strategies don't always work for everyone, points out urogynaecologist Professor Ajay Rane.

Botox can turn an overactive bladder into an active bladder, but it's important to make sure that the initial diagnosis is correct to avoid paralysing muscles in a normal bladder. "The effects of botulinum toxin on an overactive bladder initially last for six to 12 months, but some studies show that subsequent injections last longer," he explains.

The procedure to treat an overactive bladder involves injections into about 30 sites around the bladder area and is performed under a general anaesthetic.

Sweat glands
Botox can also be used in the treatment of hyperhidrosis (excessive sweating). Dr Bhagyesh Patel, from the Sydney's Hyperhidrosis Institute, says this embarrassing condition responds well to Botox treatment and only needs to be carried out once or twice a year.

"This treatment works by blocking neurotransmitters which tell the body to produce more sweat," he explains. "We place the injection just under the skin of the problem area, which may include armpits, forehead, hands, feet, under the breasts or even the groin."

Stroke
Botox has recently been approved for the Pharmaceutical Benefits Scheme (PBS) to aid the recovery of stroke victims who have permanently tightened arm muscles, says associate professor John Olver from Epworth Rehabilitation in Victoria. Survivors of stroke often experience muscle spasticity, which leaves them with tight, stiff muscles in an arm or leg.

"Botulinum toxin relaxes the muscles and improves the patient's movement," Professor Olver says. "In turn, this makes it much easier for physiotherapy and stretching exercises to work." For the time being, however, Botox is only PBS-listed for use on the upper limbs of stroke patients.

Voice box
Ear, nose and throat surgeon Dr Matthew Broadhurst uses Botox to help patients with spasmodic dysphonia. This condition is caused by involuntary contractions of the larynx (voice box) muscles. Sufferers may have difficulty speaking fluently and their voices may break or have a tight, strained or strangled quality.

Dr Broadhurst uses a fibre-optic camera device called an electromyogram (EMG) and a fine needle to inject Botox through the front of the neck into precisely the right spot on the muscles either side of the vocal cords. "It paralyses the muscles, stopping the spasms and, as the Botox wears off, the patient becomes more fluent," he says. "The effects last longer than they do for wrinkles — with most people only requiring about two injections a year for dysphonia."

Throat
Dr Broadhurst says Botox is also valuable in treating swallowing disorders. "A tight muscle valve at the top of the oesophagus can be relaxed with Botox via EMG to provide significant improvement in swallowing," he adds.

Eyes
If the eyes are looking every which way — in, out, up or down — instead of straight ahead, this is usually caused by tightness in one of the muscles that controls eye movement. It can result in misalignment problems such as crossed eyes and a condition that is known as strabismus.

Dr Lionel Kowal from the Royal Victorian Eye and Ear Hospital treats strabismus patients with EMG-guided Botox injections. When the appropriate muscle relaxes after a Botox injection, the other muscles work harder, causing an overcompensation for the six weeks it takes for the Botox to wear off, Dr Kowal says. After that, the tight muscle is much stronger and the improvement in eye alignment often lasts long-term.

Cerebral palsy
Botox has been useful in treating children with cerebral palsy who are forced to walk on their toes because of stiffness in the calf muscles which prevents them from putting their heels flat on the ground. A 2006 study found a similar benefit in treating spasticity of the upper limbs. A trial involving 42 children with cerebral palsy reported low-dose Botox injections improved their arm function, allowing them to perform movements such as picking up toys or hugging their parents.

Botox and obesity
A 2007 Italian study looked at the weight-loss effect of Botox on 30 obese participants. It was found that, when injected into two gastric regions, Botox made weight loss easier by increasing the length of time food stayed in the stomach and reducing the amount of solid food the stomach could hold.