Botox Blog

Botox May Cut Knee Osteoarthritis Pain

2007-07-26T05:52:00.000-07:00

Study Shows Injecting Botox May End or Delay Need for Joint Replacement Surgery

By Denise Mann
WebMD Medical News

Reviewed By Louise Chang, MD
on Tuesday, November 14, 2006

Nov. 14, 2006 (Washington) -- Botox shots may do more than get rid of wrinkles. A new study shows Botox may decrease the pain of knee osteoarthritis (OA) and potentially prevent or forestall the need for knee replacement surgery.

The preliminary research was presented at the 2006 annual meeting of the American College of Rheumatology.

Injecting Botox directly into the knee joint relieved pain and improved function among people with severe knee osteoarthritis after one month, says researcher Maren Mahowald, MD. She is the rheumatology section chief at the Minneapolis Veteran's Affairs Medical Center and professor of medicine at the University of Minnesota in Minneapolis. Mahowald now plans to evaluate the participants after three and six months.

Botox is a purified form of botulinum toxin type A and has been used to treat wrinkles and creases on the face. It is currently FDA-approved to treat other conditions including excessive sweating, eye disorders, and certain neurologic conditions. Botox is being studied for treatment of headache, ringing in the ears, overactive bladder, diabetic nerve pain, and more.

Pain Reduction

The new study comprised 37 people with moderate and severe knee osteoarthritis. Participants received 100 units of Botox with the anesthetic lidocaine or a dummy injection with lidocaine directly into their knee joints.

After one month, people with severe pain showed a 28% decrease in pain and a 25% improvement in function. By contrast, people with severe knee pain who received a placebo did not show a significant decrease in pain.

Botox injections had almost no effect among people with moderate pain, the study found.

But it's still early, Mahowald points out. "Patients often have continued decreases in pain and improvements in function after one to two months. And I think there will be more improvements at the three-month evaluation."

Exactly how long the effect lasts will be determined at the six-month evaluation, she says. "People may require one to three injections per year to control knee pain, but these injections may obviate the need for knee surgery."

The new findings came about when researchers noticed that people with limb weakness from a stroke or polio did not develop arthritis.

They also noticed that when people with cervical dystonia -- neck muscle stiffness and spasms -- received shots of Botox, their pain improved before their muscle contractions stopped, suggesting that Botox may have a soothing effect on pain nerves.

How Safe Is Botox?

Safe treatments are desperately needed for people with knee osteoarthritis.

"This is an exciting new approach to knee pain due to OA," she says. "Total joint replacement has been the single greatest advance for relieving the pain of OA, but not all patients are candidates."

Some people with knee osteoarthritis are too young for the surgery and others are too old. In addition, nonsteroidal anti-inflammatory drugs, which are commonly taken to relieve the pain of knee osteoarthritis, are not without risks, such as gastrointestinal problems and increased risk of heart attack or stroke. There are also risks from long-term use of opioid pain killers, including risk of addiction.

The Botox treatment seems to be extremely safe, she says.

Muscle weakness can occur when Botox shots are used to treat cervical dystonia, but such effects were not seen when the toxin was injected into the knee joint. "Since we are not injecting it into the muscle, we do not see any weakness to the limb," she says. "We use a very small dose and there are no significant adverse effects due to injection."

'Intriguing Finding'

Shreyasee Amin, MD, an assistant professor of medicine at the Mayo Clinic in Rochester, Minn., tells WebMD that "this is an intriguing finding and Botox could have a role in patients who have risk factors or contraindications to knee surgery. And if it doesn't have side effects to knee strength, it would be very helpful."

Robert L. Wortmann, MD, professor and chairman of the department of rheumatology at the University of Oklahoma in Tulsa, agrees. "It's too early to say for sure what role injections of Botox may play in knee OA," he says. "But having the possibility of something that may alter the course or pain levels for a disease to which there is no known cure is really exciting."

He adds that "if it does have a positive effect in knee OA, it will likely have an effect in hip OA as well."

Botox Into the Jaw Can Help Relieve Grinding Tension

2007-07-26T05:49:00.000-07:00

Botox to the rescue

Yes, the drug smooths wrinkles, but it also treats several medical conditions

Kimberly Hayes Taylor / The Detroit News

Most patients get Botox to smooth facial wrinkles. See full image

What is Botox?

Botox, produced by Irvine, Calif.-based Allergan, is a purified protein that temporarily reduces the activity of muscles. Medical sales of the drug will top $500 million this year.
More than lip service

Before it became a popular anti-wrinkle treatment, Botox was used to treat crossed eyes and eyelid spasms. Today it's being used to help many other conditions.
HEADACHES
Botox is injected into the affected muscles of the head and neck to help people with migraines, post-traumatic headaches and tension headaches.
NECK PAIN
It is believed that Botox blocks the transmission of nerve impulses, permitting injected muscles to relax, diminishing transmission of pain signals in people suffering from dystonia torticollis, whiplash and disc degenerative disease causing muscle spasms.
HYPERHIDROSIS
Excessive sweating, even when temperatures are cold or the person is resting. Botox stops the nerve impulse from reaching the sweat gland, effectively stopping sweat production.
DYSTONIA
A neurological disorder leading to involuntary muscle contractions that cause abnormal movements or postures.
OVERACTIVE BLADDER
Botox is injected into the bladder to curtail the organ's excessive squeezing.
ENLARGED PROSTATE
Botox is injected through an ultrasound probe into the prostate to help prevent frequent urinating in men.
ALOPECIA
Doctors believe Botox may be effective in helping some forms of balding. A study that began in January is assessing Botox use for preventing follicle damage.
CEREBRAL PALSY
A new study shows Botox may be effective as a treatment for muscle stiffness in children with cerebral palsy.

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For years, Margaret Fassio's head shook so badly, it appeared she was constantly saying, "No."

Doctors believed the Warren woman had a nerve problem and gave her muscle relaxers, but Fassio's body remained tilted to the right. The excruciatingly painful muscle condition had her body so contorted her head was nearly lying on her shoulder.

"It was horrible," she says. "The only way I can describe it is a stiff neck, only 10 times worse. People would stare at me and say, 'Oh, my God.' Women in stores with babies would run away from me, like I had some kind of dreaded disease."

Relief arrived when her doctor diagnosed the disorder as spasmodic torticollis, a form of dystonia, and prescribed Botox injections.

"It's my wonder drug," she says of Botox. "My life-saver."

Botox, commonly used for relaxing fine facial lines and wrinkles, is becoming a popular treatment for conditions ranging from migraine headaches, bladder control and excessive sweating to multiple sclerosis and even cerebral palsy in children.

"We should be every excited," says Dr. Paul Cullis, chief of neurology at St. John Hospital and Medical Center in Detroit. "It treats diseases that nothing else will treat."

Botox therapy initially was approved by the Federal Drug Administration in 1989 for treatment of crossed eyes and uncontrollable eye blinking associated with dystonia for patients age 12 and older. It was used for cosmetic purposes when patients with spastic eye disorder discovered the wrinkles near their eyes disappeared. By 2000, Botox was approved to treat cervical dystonia in adults to decrease the severity of abnormal head positions and neck pain. And in 2004, the drug received approval for hyperhidrosis, excessive underarm and palm sweating.

Since then, studies also indicate Botox successfully treats depression, bladder control problems, enlarged prostate and headaches.

To administer the drug, doctors inject patients in the affected area of the body. Typically, improvement can be seen in about five days, with results lasting from three to nine months, depending on the individual and the condition. Costs range from $500 to $2,000; insurance companies pay for some therapeutic treatment.

Dr. John Hramiec, a Southfield-based thoracic surgeon who specializes in sweating diseases, says he uses Botox to treat hyperhidrosis. He has patients who perspire so severely they change clothes several times daily, and avoid shaking hands and touching in relationships.

"It's very effective," he says. "After treatment, patients don't call us back for seven months."

Dr. Cheryl Perlis, a nationally-recognized women's health and aesthetic specialist in Chicago, says she discovered that Botox even works for people who have "hypergums," gums that extend below the lip line when smiling. She injects the drug near the nose to drop the lip. She uses the drug for her own issue with teeth grinding.

Perlis says she believes the drug is becoming popular for therapeutic uses because people are aware of it.

"Patients ask for it," she says. "Maybe the fear factor is gone."

Cullis of St. John Hospital says these therapeutic uses aren't new, but the public wouldn't accept it as a treatment.

"We tried to get people interested in this in the early 1990s, but most people really weren't that interested because these were fairly rare diseases," Cullis says. "Then people found out that stars in Hollywood were using it for their wrinkles. Now, they know their favorite movie actresses are using it and millions of Americans are getting cosmetic Botox. They are interested because they know what it is now."

You can reach Kimberly Hayes Taylor at (313) 222-2058 or ktaylor@detnews.com.

Plastic surgery going 'natural'

2007-07-19T13:45:00.000-07:00

AUSTRALIANS undergoing cosmetic surgery are shying away from the frozen look and trying to hide their beauty enhancements, according to a top visiting cosmetic surgeon.

While US patients are happy to be recognised as having had help to achieve their desired look, Dr Alina Fratila said Australians were following European trends and opting for a more natural look.

"In Europe and Australia the patients do not want to look like they have been frozen, like they have been treated where they don't have any movement," she said.

"They still want to have a natural look and keep some movement such as a little bit in the eyebrow.

"In the US they are not so worried about the fact they are looking frozen

because the American patients are more open to cosmetic surgery and it doesn't matter if it is recognised that they have had treatment."

Dr Fratila is in Melbourne to instruct cosmetic surgeons on the use of Dysport, a brand of botulinum toxin similar to Botox.

Grant McArthur

Researchers Discover How Botox Can Alleviate Bell's Palsy

2007-06-02T08:11:00.000-07:00

Main Category: Neurology / Neuroscience NewsArticle Date: 30 May 2007 - 1:00 PDT email to a friend printer friendly view or write opinions
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Cosmetic Medicine / Plastic Surgery
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Bell's Palsy which is a form of paralysis caused by a malfunction of a facial nerve can be helped by the injection of botox according to researchers of Melbourne's Brain Research Institute (BRI). Using state of the art technology to monitor the brain in real time, the scientists have discovered that certain areas of the brain, including damaged areas responsible for facial movements, may reorganise after injections of botox combined with facial exercises. This functional study provides the first insight into the mechanisms of action that allows for the treatment and long recovery from bell's palsy. Bells palsy is a condition that causes the facial muscles to weaken or become paralyzed. It's caused by trauma to the cranial nerve, and is sometimes associated with pregnancy or a virus infection. However, it is not permanent but can strike anyone at any age. The condition is named after Sir Charles Bell, a Scottish surgeon who first described it 200 years ago. Bells palsy is more prevelant than generally believed. Worldwide statistics set the incidence at approximately .02% of the population (with geographical variations). In human terms this is 1 in every 5000 people, and 40,000 Americans every year. Older people are more likely to be afflicted, but children are not immune though they tend to recover well from it. Until recently, its cause was unknown in most cases, but it has now been related to both Lyme disease and Herpes simplex. Researchers at the Murdoch Research Institute studied 20 sufferers before, immediately after and up to six months following their treatment with botox injections and facial exercise training. The researchers found that there was a significantly greater reduction in facial drooping accompanied by a greater improvement in control functions for those that had received the botox injections. These changes were associated with changes in brain activity in the affected motor cortex and in some cases brain reorganisation to adapt the portion of the brain controlling the facial movements. This unique project has involved collaboration between three Melbourne research institutes:--

The Brain Research Institute--
The La Trobe University, Faculty of Health Sciences --
The Murdoch Children's Research Institute
Further information on Bell's Palsy and Cerebral Palsy is available at: www.cerebral-palsey.info

Other applications for Botox and Dysport

Botox Is More Than Cosmetic: Presented at AUA

2007-06-02T08:06:00.000-07:00

ANAHEIM, CA -- May 30, 2007 -- Injecting botulinum toxin A, or Botox, into the prostate gland of men with enlarged prostate, eased symptoms and improved quality of life up to a year after the procedure, according to a study by researchers at the Chang Gung University Medical College, Taiwan, and the University of Pittsburgh School of Medicine.The study, based on 37 men with benign prostatic hyperplasia (BPH), was presented here at the annual meeting of the American Urological Association (AUA)."Millions of men in the United States suffer from enlarged prostate," said Michael B. Chancellor, MD, senior author of the study and professor of urology and gynecology at the University of Pittsburgh School of Medicine. "It's a challenging disease to live with because it causes frequent and difficult urination. Unfortunately, common treatments also are problematic because they carry some risk of serious side effects, such as impotence. Our results are encouraging because they indicate that Botox could represent a simple, safe and effective treatment for enlarged prostate that has long-term benefits."The study participants, previously diagnosed with symptomatic BPH that did not respond to standard medical treatment, received injections of Botox directly into their prostate glands. Up to one year post injection, 27 of these patients, or 73%, experienced a 30% improvement in urinary tract symptoms and quality of life. Patients did not experience any significant side effects, including stress urinary incontinence or erectile dysfunction.According to Yao-Chi Chuang, MD, principal investigator of the study from Chang Gung University Medical College, Taiwan, Botox reduces the size of the prostate gland through a cellular process called apoptosis, in which the prostate cells die in a programmed manner. This reduction in size can improve urine flow and decrease residual urine left in the bladder.BPH is one of the most common diseases affecting men as they age. More than half of all men over the age of 60 and 80% by age 80, will have enlarged prostates. Forty to 50% will develop symptoms, which include more frequent urination, urinary tract infections, the inability to completely empty the bladder and, in severe cases, eventual damage to the bladder and kidneys.

SOURCE: University of Pittsburgh Schools of the Health Sciences

More information on Botox

Botox uses go far beyond cosmetic

2007-05-25T04:46:00.000-07:00

Dr. Theodore Nukes, a neurologist and partner at Heartland Neurology, discusses alternative uses for Botox.
Question: Botox is now synonymous with wrinkle-remover. Why do you see it in another light?
Answer: Botox is not all about beauty. The reason it first became a medical product was to treat disorders of muscle hyperactivity, such as involuntary closure of eyes, or a disorder that causes a fluttering of the eyelid. Before the advent of Botox, there was no good treatment for this. People would take seizure medicine. Then there's a class of disorder called dystonias, where people have twisted motions. This includes writer's cramp.
Q: How can Botox help people with these conditions?
A: What Botox really does is, it weakens muscles. If I have four muscles in a row, I can inject it into one muscle and leave the other muscles strong.
Q: Are there other non-cosmetic uses for Botox?
A: Another great example is people who have spasticity from a stroke, multiple sclerosis or cerebral palsy. If we get patients that have those conditions early, as soon as they start showing signs of stiffness, we may be able to weaken the spasticity.
People who have multiple sclerosis and spasticity often experience a scissoring gait, in which the muscles on the inside of the thighs pull the legs inward, making it difficult to walk. I can go and weaken those muscles. Their gait isn't normal, but it certainly isn't as unsteady as it was before. They're able to walk a lot better.
Even if patients have developed more permanent stiffening, the Botox may be helpful in conjunction with physical and occupational therapy. The great thing about this is you can inject it into a muscle that shows abnormality, whereas the medicines for spasticity affect every muscle in your body because you take it as a pill.
Q. How often will people need injections?
A. I cannot give Botox any more frequently than every three months. The doses for medical reasons are a lot higher than the cosmetic doses. It usually involves more than one muscle. I would say on average, if it's a facial issue, we do between one and three muscles on one side of the face. If it's an arm, we probably do about four or five muscles.
Another thing we use Botox for is headaches and pain. Some people have chronic pain and chronic headaches, and nothing makes it better; however, Botox injections can really help.
Q: Will giving Botox for these uses then have cosmetic effects?
A: I can give somebody Botox for headaches, but even if it doesn't help headaches, they'll look 10 years younger.

Uses for Botox

Allergan sees Botox role for urinary problems

2007-05-25T04:42:00.000-07:00

NEW YORK, May 18 (Reuters) - The head of research for Allergan Inc. (AGN.N: Quote, Profile, Research said on Friday the company's anti-wrinkle Botox drug could transform the care of urinary incontinence and overactive bladder and garner annual sales of $500 million for the hard-to-treat conditions.
Although the company's official Botox sales forecast for the urinary problems remains $150 million to $300 million a year, Scott Whitcup said actual sales could prove far higher if the injectable drug's impressive effectiveness and safety in recent small trials is also seen in planned Phase III studies.
"If everything works perfectly, I think we can reach $500 million," Whitcup said in an interview.
He expressed confidence U.S. regulators may approve the use of the popular anti-wrinkle drug as a treatment for urinary problems by 2011.
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Allergan is also testing the drug, whose active ingredient is a toxin that paralyzes muscles, as a treatment for migraine headaches. It has forecast annual Botox sales of $300 million to $500 million a year for that condition.
"My guess is that (sales for) overactive bladder has the potential to be a little bigger" than those for migraine treatment, Whitcup said.

Wholesale Botox

Botox Decreases Pain And Intensity Of Post-Stroke Spasticity

2007-05-06T09:17:00.000-07:00

Main Category: Stroke / Neuroprotection News
Article Date: 06 May 2007 - 0:00 PDT
Article Also Appears In
Neurology / Neuroscience
Clinical Trials / Drug Trials

Final results from a multi-center study shows that repeated treatments of botulinum toxin type A (BoNTA or Botox®) over one year is well tolerated and results in a significant decrease in spasticity, pain frequency and average pain intensity in upper limbs following stroke, according to research from a neurologist at Wake Forest University Baptist Medical Center.Significant improvements in these outcome measures indicate a better quality of life for post-stroke patients suffering from spasticity-related pain, according to the researchers who presented their findings today at the annual meeting of the American Academy of Neurology in Boston. Spasticity is a disabling condition that leaves the muscles and tendons permanently shortened and inhibits movement."In the clinical setting, limb stiffness and pain are the most commonly reported symptoms of spasticity following a stroke, and relief of spasticity-related pain is a priority treatment goal for many patients," said Allison Brashear, M.D., professor and chairman of neurology at Wake Forest University Baptist Medical Center and head of the spasticity clinic at Wake Forest Baptist."Our study shows that treatment with botulinum toxin type A can lessen these disabling symptoms without treatment-limiting side effects, which in turn improves the ability of stroke patients to perform such essential activities of daily living as dressing themselves, maintaining good personal hygiene, and reaching for and grasping everyday objects."This is the largest long-term study to evaluate repeated treatment with BoNTA for post-stroke spasticity. Brashear and colleagues had reported in 2002 that one-time injections of BoNTA are safe and effective in people with wrist and finger spasticity after a stroke.About 58 percent of stroke survivors experience post-stroke spasticity, and only 51 percent of those are receiving treatment for that condition, according to the National Stroke Association.A total of 279 patients were enrolled in the 12-month study of BoNTA to evaluate the efficacy and safety of repeated BoNTA treatments. All study participants received up to five treatments of BoNTA. For the study, the BoNTA injections were given at the elbow, wrist and fingers and/or thumbs flexor of the affected limb to block overactive nerve impulses that trigger excessive muscle contractions. Patients were assessed every six weeks for one year. Patients demonstrated a significant reduction in pain and excessive muscle tone at each follow-up. In addition, average pain intensity was significantly reduced."Early intervention with effective therapies is absolutely vital to prevent the profound disability that afflicts many stroke patients," said Brashear. "Having data to support a safe and effective profile for long-term treatment with BoNTA is significant for patients and caregivers. Many oral anti-spasticity medications are associated with systemic side effects such as sedation, mental confusion, dizziness and muscle weakness, all of which can seriously hinder rehabilitation after a stroke."The study was funded by Allergan Inc., the pharmaceutical company that developed BoNTA or Botox®. Brashear's co-researchers were Elie Elovic, M.D., of Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ; Darryl Kaelin, M.D., of the Shepherd Center, Atlanta, Ga., Robin McIntosh, B.S., Amanda VanDenburgh, Ph.D., Catherine Turkel, PharmD, M.B.A. and Frederick Beddingfield III, M.D., Ph.D., all with Allergan Inc.About Wake Forest University Baptist Medical Center: Wake Forest Baptist is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The system comprises 1,298 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report.Wake Forest University Baptist Medical CenterMedical Center Blvd.Winston-Salem, NC 27157-1015United States
http://www1.wfubmc.edu/

Botox shots pinpoint migraine culprits

2007-04-16T06:38:00.000-07:00

Plastic surgeons, neuros team up for injection-guided surgery
By Giancarlo La Giorgia
Plastic surgeons in the US are using Botox to treat migraine headaches — a debilitating neurological condition that, according to the Migraine Association of Canada, affects over three million Canadians and costs our economy around $500 million annually in absenteeism and lost productivity.
By injecting the neurotoxin into different muscles of the face and head, surgeons can assess whether any are compressing or irritating the surrounding nerves, thus causing migraine. If the paralysis of one of the muscles prevents or improves migraine symptoms, the targeted muscle is surgically removed.
"We're seeing improvement in a substantial number of patients — about 80% in those treated with Botox and 90% who receive surgery," says Dr Jeffrey E Janis, co-director of the plastic surgery residency program at the University of Texas Southwestern Medical Center, and one of the technique's co-developers. "There's improvement across the board in the frequency, duration and intensity of their headaches." In some rare but encouraging cases, he adds, patients are cured entirely.
TO BE PRECISEThe idea of using Botox to treat migraines is not a new one: many neurologists use it as an alternative to traditional medications, injecting it in a headband-like fashion around the skull. But with this method — what Dr Janis refers to as a "shotgun" approach — patients only get about three months of relief before having to come back for a second round of shots. In contrast, a pinpointed, diagnostic use of Botox followed by surgery provides a longer-lasting, if not permanent solution, he says.
Despite the deliberate precision of the methodology, Dr Janis admits the basis for the combined chemical and surgical technique was discovered quite by accident by a colleague, eminent plastic surgeon Dr Bahman Guyuron.
"Five years ago or so, [Dr Guyuron] noticed that, after doing cosmetic brow lifts, a couple of patients reported very excitedly that their migraines were gone The only explanation seemed to be that, during the procedure, he had removed the corrugator muscles, which might have relieved compression or irritation of the nerves around them," he explains.
He and Dr Guyuron began collaborating on cadaver head studies, closely analysing nerve and muscle anatomy to determine which would likely be involved in migraines. "We couldn't go and operate on everybody, but we could perform a sort of chemical surgery — that is, use Botox to paralyze a given muscle so that it can't contract against these nerves. It's like removing it, but with a needle instead of a knife," he said. After testing several injection points, they ended up with a sort of roadmap, which could guide them towards a focused surgical procedure.
MEETING OF MINDSTreating headaches is clearly outside the normal scope of a plastic surgeon's practice, so Dr Janis requires that all patients be referred from a neurologist with an official diagnosis of migraine headache. Typically, he sees those for whom traditional treatment hasn't worked.
"I treat a lot of 'kitchen sink' patients — people who have been to many neurologists, tried an assortment of medications, modified their lifestyle and diet. They live in the dark, don't go out of their house, don't like strong smells. Basically, people who no longer enjoy life because they're dominated by migraine headaches," explains Dr Janis. "By the time I see them, they're looking for anything that can help them, because they've tried everything else medicine has to offer."
Such collaboration between plastic surgeons and neurologists isn't obvious. But Dr Janis insists the alternative he's offering should be seen as an adjunct to traditional treatment. "We're working with neurologists, not against them," he says.
Of course, his colleagues weren't always so gung-ho. "At first, people thought what we were doing was crazy. No neurologist wanted anything to do with me," he recalls. It took a lot of personal phone calls, but Dr Janis eventually forged an alliance. "This really is a collaborative effort that demands the expertise of both neurologists and plastic surgeons," he says, adding that the results, fortunately, speak for themselves.
FRINGE FACTORDr Guyuron has published several studies over the course of ongoing clinical trials, showing significant improvement in a substantial number of patients. But despite its promise, the technique remains on the medical fringe, being practiced by only about 10 doctors in all of the US.
Dr Donald Lalonde, president of the Canadian Society of Plastic Surgeons, is unaware of any Canadian physicians using the technique. "Some plastic surgeons in Canada may have heard of it, but 99% probably haven't. Dr Guyuron is finishing his clinical trials of the procedure, so hopefully, once his findings are published, it will be more well known," he says.
To that end, Dr Guyuron has begun organizing annual migraine headache symposia, the first of which was held in October 2006 at Case Western Reserve University, Cleveland, where he serves as chairman. But Dr Lalonde suspects it'll take more than physician awareness to gain the interest of Canadian migraine sufferers. "I've discussed this treatment with some patients, and though several expressed interest initially, it ended once they found out that it wouldn't be covered by Medicare. Canadians aren't used to having to pay [out-of-pocket] for medical procedures," he says.

Botox transforms girl's life; Treatments effective in dealing with her spastic cerebral palsy

2007-04-16T06:31:00.000-07:00

Sara Gauthier / For The Sudbury Star Local News - Thursday, April 12, 2007 @ 09:00 With wide, curious eyes, Jenna Fournier looks around at all the people gathered in the gymnasium at St. Jerome School. The cameras in particular seem to grab her attention. Jenna, 5, is an example of what Botox can do for children with spastic cerebral palsy. "Botox, for us, is a miracle drug," says her mom, Jennifer Collin. "So, we're hoping it lasts a long, long time." The little girl turns her head toward her mother and leans in. Her forehead rests on her mom's and their noses touch. A slight smile appears on Jenna's face. "If it wasn't for the Botox, she'd probably be in a wheelchair right now," says Collin. "She would not be independent the way she is.
And she's walking with canes now, too. In the past two years, she went from not walking with a walker, to running with a walker, to walking." Jenna started getting the Botox injections when she was just 18 months. "They're very fine needles injected right into the muscle," says Mary Sabo, a physiotherapist with the Children's Treatment Centre. "It's very localized. It's not a systemic drug at all." Sabo says that though the needles are small, the medicine penetrating the muscles can be quite painful. "Before," says Sabo, "if (Jenna) heard my voice in the hallway, she'd ball - she'd cry and cry and cry. And now, 2 1/2 years later, she'll say 'Mary, my legs are sore. When do I come for my needle?' " Children's Treatment Centre clinic manager Sally Spence says that when she was a practising physiotherapist, a child like Jenna would have already had at least one surgery to lengthen her tendons. Spence says Botox helps relax the muscle fibres, which reduces spasticity. After the injections, Jenna goes through casting to get the range of motion back, and then her parents and physiotherapists do exercises with her. "She may only need one in her lifetime now instead of four," says Spence. "It's not a cure - cerebral palsy is not curable per se - but it is another approach. It's a less invasive approach and less scary for the families." Jenna is not the only child in the Sudbury area to benefit from the Botox treatments. Spence says 90 local children received the injections last year and hundreds have received treatment since the clinic launched four years ago. The Rameses Shriners have paid for the Botox Clinic and this year is no exception. Robert Whitmarsh, the Potentate of the Rameses Shriners in Toronto, presented a cheque for $39,210.36 to Spence. "Being afforded the opportunity to actually see how the children improve with the care that we help provide is truly the most rewarding part of being a Shriner," says Whitmarsh. "They're great guys," gushes Spence.

Believing in BOTOX

2007-04-04T06:56:00.000-07:00

Local women are getting in line for cosmetic treatments to attain a more youthful appearance
LISA SOKOLOWSKI lsokolowski@timesleader.com

Dr. Patrick Conaboy injects Botox into the forehead of Lisa Stuppino of Pittston. Bumps are visible at the points of insertion, and blood trickles from some of the injections. The bumps eventually fade. Conaboy said it usually takes 15 minutes, but for Stuppino it took more than an hour.
PLAINS TWP. -- Some women at a “Botox Party” were talking about plumping up their upper lips when all eyes turned to Lisa Stuppino.
She had just walked out of a room at the RejuvenEssence Wellness Spa, where she had Botox done, and everyone stared at her forehead.
Across it, where the Botox was injected, the 38-year-old Pittston resident had more than 10 large circles resembling bubble wrap.
“Lisa looks like a Klingon,” someone whispered, referring to the “Star Trek” characters with notably ridged foreheads.
Not exactly the youthful look Stuppino was anticipating.
“There was nervousness, like, ‘What are they looking at?’ ” she said.
Botox raises the skin at the injection points for about 15 minutes, said Dr. Patrick Conaboy, a board-certified family physician who works at RejuvenEssence in both Plains Township and Scranton.
Conaboy is one of many practitioners in the area who might be the Northeastern Pennsylvania version of Juan Ponce de León. The Fountain of Youth is only a myth and “Tuck Everlasting” is only a story, but that doesn’t stop people from yearning for eternal youth.
There’s a reason Bob Dylan and Rod Stewart both had hits with the song “Forever Young.”
But, while preserving youth indefinitely is an unrealistic goal, a temporary solution comes in the form of Botox.
Botox was the No. 1 minimally invasive procedure in 2006, with nearly 4.1 million treatments administered, according to the American Society of Plastic Surgery.
And, though the organization didn’t release state-specific information, Pennsylvania is in a region with six New England states and two other Middle Atlantic states and accounted for just 13 percent of the total Botox patients in the country.
But that doesn’t mean Northeastern Pennsylvanians aren’t turning to Botox.
In fact, Dr. Francis Collini, who practices in Shavertown, said he did more than 400 treatments last year.
Botox Cosmetic (also known as Botulinum Toxin Type A) is created from Clostridium botulinum bacterium, which contains the toxin that creates food poisoning.
“They take a tiny piece of the poison molecule, much as penicillin is made from mold,” Conaboy explained. It is mixed with a saline dilute, similar to contact fluid, put into a single-use syringe and injected into a patient. The single-patient product must be used within four hours of preparation.
In the late ’80s, the Food and Drug Administration approved it to treat uncontrolled blinking and lazy eye. In April 2002, the FDA also approved Botox to treat frown lines.
“It keeps the muscles from getting the signal to squeeze,” Conaboy said. “It lasts three to four months until it breaks down and goes away.”
Stuppino said she started feeling her muscles contract immediately, but for most it’s a more gradual process, taking three to seven days.
People with faster metabolisms will process the Botox more quickly, and the treatment, which can cost $250 to $350, won’t last as long.
Nothing, really, is permanent.
“It’s not like the comics or funny movies where faces are frozen,” said Dr. Christine Cabell, a dermatologist at Geisinger Wyoming Valley Medical Center in Plains Township, who has been administering Botox for five years. “It’s not like that when it’s done properly. People say, ‘Oh, you look well-rested,’ or ‘You look good, you look awake,’ instead of, ‘Did you have something done?’ ”
Botox can be used for medical reasons, too. Neurologists can use it to alleviate tension and migraine headaches or other doctors can use it to reduce sweating in the armpits and hands.
But mostly it’s used for cosmetic purposes.
“This is all about vanity,” admitted Stuppino, who said the injections didn’t hurt. “It’s to feel good about yourself and project an image. I think it’s OK to be a little vain.”
Of course, nothing is perfect. Someone who isn’t well-versed in Botox may put too much of the solution in an area, causing elevated or depressed brows or unevenness. But once the body rids itself of the Botox, the problem is gone.
MedicineNet.com says the negative side effects could be temporary bruising or headaches (which are rare), or a small percentage of people can develop eyelid drooping, which can be resolved in three weeks.
The Web site explains, “This development is usually caused by migration of the Botox, and for this reason, you shouldn’t rub the treated area for 12 hours after injection or (lie) down for three to four hours. There have been no allergies associated with Botox to date.”
Botox isn’t the only service offered at the medi-spa at RejuvenEssence, which also specializes in laser hair surgery. At $200 to $250 for 15 minutes of treatment, the surgery can remove unwanted hair -- almost for good – after six to eight treatments.
After two to three treatments with a 532 nanometer laser, a patient also can remove sunspots and moles. Conaboy did note that the spots would get darker before fading.
And a Glycolic and Alpha-Hydroxy peel makes a patient’s face hot for five hours, eventually looks like sunburn, then peels in patches for about five days.
“I tell people they’re going to be shocked,” Conaboy said. He pulls out a mirror and assures them “they’re supposed to look like that.”
After three to four days, he said, patients start crying, and “think they’re never going to look right,” he said. After a week, though, the face looks normal.
Chemical peels can be for those suffering from acne, skin discoloration or wrinkles.
“I think all of it is good if the patient has the proper expectations,” Cabell said. “Some people feel strange about starting down the road and getting cosmetic procedures done. They don’t want people to perceive them as being vain. At the same time, there are great effects of this. You can go to cosmetic counters and buy makeup and creams that don’t do anything.
“Reluctance is a hump to get over.”
Botox was the No. 1 minimally invasive procedure in 2006, with nearly 4.1 million treatments administered, according to the American Society of Plastic Surgery.
“This is all about vanity. It’s to feel good about yourself and project an image. I think it’s OK to be a little vain.”

Licensed practioners can purchase Botox here.

Botox Prevents Migraines

2007-04-04T06:53:00.000-07:00

An innovative new surgical technique drastically reduces the frequency and intensity of migraines in people whose daily lives are regularly disrupted by severe headaches.
One in six people in the UK suffer from migraines, according to the Migraine Trust, with over 17% of sufferers living through more than forty attacks a year. Every day, as many as 90,000 people are forced to stay home from work or school due to a migraine.
Now, relief could be on hand for suffers from an unusual source: the anti-wrinkle cosmetic procedure Botox.
Performed by a handful of plastic surgeons in the US, the technique uses the anti-wrinkle drug Botox to pinpoint which specific muscles in the forehead, back of the head or temple areas may be serving as "trigger points" to compress, irritate or entrap nerves, causing the migraine.
Because Botox temporarily paralyzes muscles, usually for about three months, it can be used as a "litmus test" or "marker" to see if headaches go away or become less intense while the Botox's effects last, said Dr. Jeffrey Janis, assistant professor of plastic surgery.
If the Botox is successful in preventing migraines or lessening their severity, then surgery to remove the targeted muscle is likely to accomplish the same result, but on a more long-term and possibly permanent basis, he said.
For Sharon Schafer Bennett, who five years ago suffered from migraines so severe that the headaches disrupted her life, kept her from seeking a job and interfered with participation in her children's daily activities, the surgery proved to be life-altering.
"I can't even begin to tell you what a change this has made in my life," said Mrs. Bennett, 45, a Houston-area resident. "For the first time in years, I can live like a normal human being and do all the normal 'mom' and 'wife' things that the migraines physically prevented me from doing. My family thinks it's great because they don't have to put their lives on hold numerous times a week because of my migraines. I'm also going back to school to get a second degree, something I could never have considered before."
But Dr. Janis was quick to point out that while patients may get temporary relief; after the Botox wears off they will have to go back and get more injections or continue with medication for migraines.
"Many neurologists are using Botox to treat migraines, but they are making the injections in a 'headband-like' circle around the forehead, temple and skull,” he said. “They are not looking at finding the specific location of the headache's trigger point.”
Instead, Dr Janis injects Botox into one trigger point at a time to determine what trigger point is causing the problem. He helped pioneer the procedure with Dr. Bahman Guyuron, following the revelation by several of his patients that their migraines had disappeared after they had cosmetic brow lifts.
They only see patients who have been diagnosed with recurring migraines by a neurologist and have tried other treatments that have failed.
Botox is the most popular type of cosmetic surgery in the UK, with over 100,000 treatments taking place each year. A study in September, 2006 by the Association of Aesthetic Plastic Surgeons claimed that 40% of patients using Botox expressed a compulsive desire for further treatments, hinting that Botox treatment may actually be addictive.

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Botox might relieve pain in child surgery

2007-03-26T07:54:00.000-07:00

By Helen Altonn

A popular drug used cosmetically to fight wrinkles is being tested as a pain medicine for children undergoing limb lengthening or orthopedic corrections at Shriners Hospitals for Children.
"The project is very exciting because Botox (Botulinum toxin type A) relaxes muscles," said Dr. Ellen Raney, orthopedic surgeon and principal investigator of the study at Shriners' Honolulu hospital.
"A lot of what we're doing is about stretching the muscles, and since Botox relaxes the muscles, patients have less pain and faster return to recovery."
Ramona Fillman, research coordinator, said a two-year pilot phase began in 2004 for 16 patients and the Honolulu hospital was approved for 32 children in an expanded study that began in January.
The patients' quality of life, amount of pain, physical function and how fast they're up and back to normal activities is being evaluated, she said.
The Montreal Shriners Hospital launched the study to see whether Botox is helpful because physicians around the world had reported using it for pain management, Fillman said.
Besides Honolulu and Montreal Shriners hospitals, those in Portland and Philadelphia, the Hospital for Sick Children in Toronto and DuPont Institute in Delaware are participating in the study.
Patients ages 5 to 21 years old undergoing any limb lengthening or surgery for lower-extremity orthopedic deformities are eligible for the study.
Patients are assigned randomly to Botox or a placebo (saline water), which is injected into their muscles at the time of surgery, Raney said.
All patients are offered pain medications, and they can push a button to get medicine the first few days after surgery, she said. "We will chart the level of pain in a diary and how much pain medicine they ask for."
The study is being done independently of the company that sells the drug, Raney said. It will involve a total of about 150 children and is targeted for completion in December 2009.
"If it becomes clear that it's (Botox) a big advantage, we can actually stop the study and begin using it."
Botox has been used for many years to treat muscle spasticity in children with cerebral palsy. It also has been injected into muscles around the skull to relieve headaches, Raney said.
Only the one injection at surgery is given and only the Shriners pharmacist and statistician know whether it is Botox or a placebo, Fillman said.
Patients receive standard care and physical therapy and are followed for three months after the corrective procedure, she said.
Families are asked to complete questionnaires about the child's pain, quality of life and other aspects.
Results of the pilot study haven't been released, but "some indicators are looking very positive," Fillman said.

SUFU 2007 - Urinary Frequency and Urge Urinary Incontinence in Botox™ Repeated Injections: Outcome Data Using Voiding Diaries and UDI-6 Correlation

2007-03-21T13:08:00.000-07:00

Wednesday, 21 March 2007
Angelo Gousse, MD, Paholo Barboglio, MD, Brian Cohen, MD, and Dinorah Rodríguez, RN
Miller School of Medicine, University of Miami, FL
Introduction and Objective: Intradetrusor Botulinum toxin type A (BTX-A) injection has emerged as a novel therapeutic option for the treatment of idiopathic overactive bladder (I-OAB) refractory to oral antimuscarinic agents. We designed an IRB approved prospective trial to evaluate the improvement in urinary frequency (UF) and urge urinary incontinence (UUI) using voiding diaries (VD), urodynamic findings, validated symptomatic improvement, and quality of life in I-OAB patients submitted to a scheduled re-injection BTX-A protocol.
Methods: 34 Patients with I-OAB refractory to antimuscarinics were randomized to receive intradetrusor BTX-A (100 U or 150 U) as 10 U/ml /injection “trigone and dome sparing” (10-15 injections) with a 14 Fr. flexible cystoscopy. We used Botox ® for BTX-A, which was funded by Allergan. Prior to injection, the patients were evaluated by: history, physical examination, Urogenital Distress Inventory-6 (UDI6), multichannel videourodynamics (UDS), and urine culture. Repeat UDS were obtained at 6 weeks and prior every injection. The above mentioned questionnaires, 3 consecutive days VD, urinalysis, post-void residual volume were taken at every visit: 2wks, 6wks, 3mon and 6mon after every injection. Patients were re-injected using the same randomized dose and technique every 6 months regardless of response.
Results: Mean age was 56 years (22-80) at the beginning of the study. 29 Female and 5 male subjects were evaluated. 21 Patients had UUI (OAB-Wet) and 13 (OAB-Dry). Of the 34 patients who received baseline injection, 20 received a second injection, 12 a third injection, 8 a fourth injection, 5 a fifth injection and 3 a sixth injection. We analyzed the improvement in UF and UUI during the period of 6-12 weeks, comparing the outcome with the baseline status (T-test). The data was calculated from the voiding diaries and UDI-6. We took the answers from domains 1 and 2 from the UDI-6 in order to obtain the UF (UDI6-Q1) and UUI (UDI6-Q2) data. Patients who changed their baseline response from greatly or moderate to little or none after having received the BTX-A were correlated with (Spearman Correlation) the improvement on VD (Table 1-2).
Conclusions: There was a very strong correlation between VD and UDI6/Q1 on urinary frequency. The correlation was only strong after the first injection between VD and UDI6/Q2 on urge urinary incontinence. The improvement was greater in urge urinary incontinence than in urinary frequency when the outcome at 6-12 weeks was compared with baseline. VD correlated better with UDI-6 when evaluating UF rather than UUI.
UroToday.com Coverage of SUFU 2007

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Botox to help youngsters

2007-03-08T08:38:00.000-08:00

YOUNGSTERS with muscle problems are having botox treatment at Sheffield Children's Hospital
Botox - or Botulinum Toxin - is best known for being injected into the face to reduce frowning patterns and wrinkles in middle-age patients.But it is now being used to help children with cerebral palsy who have unusual muscle movements.Injections in muscles around the hip joints is making a 'remarkable' difference by helping children to walk normally and help prevent them needing operations to correct joint problems later on.Michael Bell, paediatric orthopaedic consultant at Sheffield Children's Hospital, said: "Botox has been used for a number of years in the treatment of inappropriate muscle activity amongst children with cerebral palsy, with remarkable results."What we aim to do for this group of patients at Sheffield Children's Hospital, is to carry out muscle treatments in children aged three to four years. This has shown to be much more effective than waiting until children are nine or ten years old."The treatment prevents some muscles moving inappropriately which can lead to joint problems, while encouraging other muscles to do more work.
"The botox treatments are administered directly into the muscle tissue and work by reducing muscle activity in specific areas injected, and encouraging muscle development in others," added Mr Bell.
Last Updated: 07 March 2007