Botulinum Toxin Therapy
Senior Physician Imke Galazky
Offers of the botulinum toxin therapy
Botulinum toxin is a neurotoxic protein occurring worldwide produced by the anaerobic bacterium Cloareisium botulinum. If this bacterium occurs in food, it can cause botulism, a life-threatening food poisoning.
Botulinum toxin blocks the release of the neurotransmitter acetylcholine, which links nerves to the muscles at the neuromuscular junction, and thus to an inhibition of nerve impulse from the nerves to the muscles. Paralysis of the skeletal and smooth musculature results. Local injections of the toxin into abnormal, overactive muscles can be used to specifically immobilize these muscles. In addition, botulinum toxin causes an inhibition of the secretion of tears, sweat and saliva glands, and, for example, can be used in the treatment of pathological excessive sweating (Hyperhidrosis).
Botulinum toxin for therapeutic use in humans is obtained from bacterial cultures and packaged in glass vials under complex and strictly controlled technical conditions that insure precise dosage specifications. As a result, in the hands of qualified users, this compound is a safe medicine.
Duration of Effectiveness
The effect of botulinum toxin begins within a few days (depending on the dose and size of the muscles) and averages 3 to 4 months (with individual variations). After this period, further injection is required, with the dose to be adjusted depending on the effectiveness of the preceding injection. This therapy, is, therefore, not a cure, but serves to alleviate symptoms, which will occur again as the drug’s effectiveness weakens. Any unintended side effect of the treatment will also weaken and then vanish completely. Consequently, botulinum toxin can provide a long-lasting, problem-free treatment that can, if required, be continued for decades.
Therapy may not take place when illnesses of neuromuscular transmission (Myasthenia, Lambert-Eaton syndrome) are present, during pregnancy and lactation, in hemophiliacs taking anticoagulants (Marcumar, Falithrom), or when there are severe infections or severe myopathies in the area of the injection.
Treatment Prioities in our Outpatient Clinic
Dystonias are sustained, involuntary muscle contractions, which through a malfunctioning interaction of the musculature frequently cause bizarre twisting and repetitive movements or abnormal postures.
These include, for example:
- Cervical dystonia (wry neck, spasmodic torticollis),
- Blepharospasm (eyelid spasm),
- Meige syndrome (a combination of Blepharospasm, eyelid spasm) and Oromandibular dystonia (mouth and jaw), a combination of upper and lower facial motor dysfunction),
- Hand dystonia (writer’s cramp) and Foot dystonia.
For these focal dystonia, botulinum toxin is the treatment of first choice.
Hemifacial Spasm (half-sided face spasm)
This is causued by a peripheral damage of the facial motor nucleus and/or central areas. Treatment with botulinum toxin may be indicated by this condition.
Spastic Movement Disorder
Spasticity is a neurogenically related muscular hyperactivity which is produced by a central injury to the descending motor pathways (for example, apoplexy) Clinical symptoms are increased muscle tone, spastic paralysis, and impaired muscle coordination.
Secondary complications include muscle contractions, abnormal positions of the joints and frequently severe pain. Treatment of spasticity requires a multimodal thereapeutic approach (drug therapy, physiotherapy and occupational therapy, orthopedic aids, etc.). Treatment with botulinum toxin is possible but only for focal spasticity. In Germany, approval is granted for the use of botulinum toxin treatment for arm spasticity in adults after stroke and for the treatment of pointed foot spasticity in infantile cerebral palsy.
Treatment Goals of a local botulinum toxin treatment for spasticity are, in particular:
- The avoidance of muscle contracture
- The facilitation of care and hygiene
- The alleviation of pain
- If necessary, an improvement of motor skills
In addition to the diagnosis and treatment of dystonias and the treatment of spasticity with botulinum toxin, the botulinum treatment program seems to advance scientific knowledge. For this reason, we participate in studies concerned with the quality of life in patients undergoing chronic botulinum toxin treatment,and the tolerability of botulinum toxin in these patients. We also participate in studies of the tolerability and effi cacy of newly developed
botulinum toxin preparations, and the use of botulinim toxin for„off -label“ indications (those not as yet recognized for treatment with botulinum toxin).
The formation of Spasticity Competence Center in collaboration with the Magdeburg Neurological Treatment Center is in the planning stages.
University Department of Neurology
And University Department of Stereotactic Neurosurgery
University Medical Center Magdeburg A.ö.R
Leipziger Str. 44
Phone: +49 0391 6713484