Botox: How medicine uses the poison

When many people think of Botox, they think of injected wrinkles. But the poison can also help with health problems. What is possible – and where the limits are.

It is the strongest poison known and disables muscles, almost paralyzing them. We are talking about botolinum toxin, known in everyday language as Botox. Most people know that the poison can smooth wrinkles, at least indirectly. But Botox injections can also be used to treat different medical conditions.

This happens, for example, in the special outpatient clinic for botulinum toxin therapy, which is part of the Neurology Clinic at the University Hospital Frankfurt . Botox is injected there to treat spasticity.

These are strong tensions in the muscles that severely limit the motor skills of those affected. Spasticity can occur after a stroke , but also with multiple sclerosis or as a result of an accident or brain tumor.

With Botox for torticollis

Dystonia can also be treated with Botox. These are movement disorders in which certain muscle groups are overly active. An example: torticollis, in which the head involuntarily turns or tilts and the neck muscles tense.

“However, dystonia can occur in very different parts of the body, including the eyelids, so that some patients can no longer open their eyes,” describes Marcel Hildner, head of the special outpatient clinic for botulinum toxin therapy.

The neurotoxin can help with spasticity and dystonia because it paralyzes or relaxes the muscles that are too tense. Botox prevents the transfer of information from certain molecules from the nerve to the muscle or to another end organ.

Botox can prevent excessive sweating

Botox can also inhibit the work of sweat or salivary glands. In the case of excessive sweating , so-called hyperhidrosis , or excessive saliva production, injections are therefore a treatment option.

Botox is also used to treat chronic migraines . The mode of action has not yet been fully researched. According to Marcel Hildner, it seems to be the case: Botox relaxes the head and neck muscles, but may also inhibit the release of messenger substances that play a role in pain disorders.

A migraine attack: Botox is used for patients with chronic migraines.
A migraine attack: Botox is used for patients with chronic migraines. (Source: IMAGO/ Arcurs

Not always useful for teeth grinding

In cases of extreme teeth grinding or clenching, Botox can even “break a vicious circle,” says Prof. Alexander Schramm from the Center for Dentistry, Oral and Maxillofacial Medicine at Ulm University Hospital .

He also works at the Bundeswehr Hospital in Ulm, where he treats younger professional athletes whose physical activity is limited by straining. “But Botox is not suitable for the average person who grinds or bites,” says Alexander Schramm.

Or at least only to a limited extent: According to him, a Botox injection only makes sense if the grinding is purely muscular, i.e. the muscle can be switched off by the poison.

But grinding and clenching can also have other causes: a misalignment of the teeth or jaw, for example. In such a case, doctors tend to try to correct the misalignment or use splints to reduce wear on the teeth, as Schramm explains.

Botox for teeth grinding: In some cases, the neurotoxin can help.
Botox for teeth grinding: In some cases, the neurotoxin can help. (Source: Thinkstock by Getty Images)

Disadvantage of long-term treatment

Botox is by no means always the solution. And therapies with this also have their disadvantages: They are usually a long-term treatment, and the doctor and patient have to work out the dosage. The effect typically only occurs after days or a week, reaching its maximum after six to eight weeks.

“The toxin has to be injected again about every three months,” says Marcel Hildner. For some patients, a single injection is enough. The athletes treated by Alexander Schramm, for example, did not have to be injected again.

Not suitable for pregnant women

Other possible side effects, depending on the area of ​​use: The swallowing muscles can be affected, and weakness in holding the head can also occur.

But bleeding or infections are rare, says Marcel Hildner. “In itself, Botox is well tolerated with manageable side effects, a treatment that is suitable for many patients.” Unless, of course, you have a phobia of needles.

However, medical Botox treatment is not an option for pregnant women. “After a critical risk-benefit assessment, the toxin can be used under certain circumstances,” says Hildner.

Botox is also not suitable for people with myasthenia, a muscle weakness. Not even with certain forms of glaucoma, because Botox can increase intraocular pressure .

By the way: Blood thinners and Botox don’t mix either. For affected patients, doctors must carefully analyze which muscle or muscle groups should and can be treated. It might then be possible to stop taking the blood thinner for a while, says Hildner.


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