Despite being widely known for its use in cosmetics, botulinum toxin (BTX) - brand name Botox - has also been noted by the medical community for its benefits to those with chronic medical problems, including central nervous system conditions related to involuntary muscle movement and pain as well as migraines.
Now, the American Academy of Neurology has updated its official guidelines for using BTX to treat various neurological conditions, including stroke, spinal cord or other neurologic injury and, for the first time ever, include recommendations for patients with chronic and episodic migraines.
BTX, which is a neurotoxin produced by the bacterium Clostridium botulinum bacterium, works by temporarily paralyzing muscles, which stops contractions in the case of involuntary muscle movement disorders and blocks the nerve endings that trigger pain signals for pain disorders.
Although BTX use for migraines was previously considered an experimental treatment, data from recent placebo-controlled trials have continued to show its effectiveness for migraine management, even more so than current medications and with fewer side effects.
There are four different types of BTX on the market: onabotulinumtoxin A, abobotulinumtoxin A, incobotulinumtoxina and rimabotulinumtoxin B. Each one is more effective at specific doses and for certain conditions. For example, when treating upper limb spasticity, all of the listed formulations, except for rimabotulinumtoxin B, are recommended.
The therapeutic effects of BTX last four to six weeks, and patients typically require follow-up treatments. However, too much BTX can cause serious side effects and even death, making the guidelines essential to ensure physician awareness of these dangers and ensure proper treatment plans.
BTX is also used in a wide variety of other specialties beyond neurology and cosmetics, including urology and gastroenterology. However, due to its association with cosmetic use, many patients do not realize its benefits and coverage under their insurance plans, causing them to pass it up as a treatment option.
"This is not a last resort," said David Simpson, a professor of neurology and director of the clinical neurophysiology laboratories at the Icahn School of Medicine. "In some situations one might think it should come in very early in the treatment cycle."
The new guidelines were published in the April 18 issue of the journal Neurology.
