Botulinum Toxin Medical Injection
What is Botulinum Toxin?
Botulinum toxin (BTX) is a protein produced by Clostridium botulinum bacteria. There are two main commercial types commonly used, type-A and type-B. Botulinum toxin A is marketed under the brand names Botox (marketed by Allergan), Dysport (marketed by Ipsen), and Xeomin (marketed by Merz Pharma). Botulinum toxin B is marketed under the brand name Myobloc (marketed by Solstice Neurosciences).
Mechanism of Action
Botulinum toxin binds to the nerve ending in the neuromuscular junction where the nerve joins a muscle, blocking the release of the chemical acetylcholine by the nerve. Acetylcholine, the principal neurotransmitter at the neuromuscular junction, is responsible to transmit impulses to the muscles causing them to contract. In inhibiting acetylcholine release, nerve impulses are blocked, therefore preventing the muscle from contracting, resulting in muscle relaxation.
Indication for Medical Injection
The medical indications to use botulinum toxin are diverse and include many neurological disorders and diseases such as chronic headache (migraine and tension), upper and lower limb spasticity, focal dystonia, axillary hyperhidrosis (excessive sweating), strabismus (misalignment of the eyes), hemifacial spasm, blepharospasm, and neurogenic detrusor overactivity.
The Injection Process
Botulinum toxin injections are administered by our neurologists Dr Kashouty and Dr Yono. The areas to be injected will be marked with a pen and then thoroughly cleaned with alcohol. A cold anesthetic spray may be used to numb the skin, and the botulinum toxin mixed with normal saline, will be injected. A thin needle will be used. The toxin will be injected through the skin into the targeted muscle. You will often need several injections in different locations. The number of injections will vary depending on your condition, and most people tolerate the procedure well with little discomfort.
Ultrasound-guided or EMG-guided techniques may be used to improve accuracy of the procedure. Each provides a clear advantage to guide botulinum toxin injections and to ensure that the needle is placed precisely in the desired location, avoiding the risk to damage the surrounding structures.
Post Procedure Care
There is no specific test preparation. The procedure is very short in duration, on average it takes about 15 to 20 minutes. Normal activities may be resumed after the procedure, however patient will be instructed to take it easy for the rest of the day, and to place an ice pack for a few minutes several times a day if pain persists at the injected site. A return office visit appointment will be made in few weeks for follow up. The patient is also encouraged to call at any time if any problems occur.
After the injection, you will start to see the benefit of the treatment within 4–7 days and sometimes longer. The positive effects of botulinum toxin injections can last up to 3 to 4 months.