Treatment of involuntary muscle spasms - botulinum toxin

Involuntary contraction of the muscles in different areas such as the neck and face (sometimes called spasms or dystonia), blinking eyes (blepharospasm), cerebral palsy (CP), certain kinds of headaches, excessive sweating and situations of chronic muscle cramps in the limbs are neurological problems that can be addressed. One of the effective treatments is by using Botlinum preparations.

What is botulinum toxin?
Botulinum is a type of toxin, produced from the Clostridium botulinum bacterium. It penetrates into the nerve cell and inhibits the release of acetylcholine, a substance that activates muscles and sweat glands. This leads to relaxation of the contracted muscle relaxant, and reduced secretion of sweat.

How is the treatment given?
In cases of muscle rigidity, spasms and dystonia: botulinum is administered via injections to several places in the contracted muscle. In the first injection the doctor injects a small amount of material. This is to ensure that there is botulinum sensitivity and to achieve benefit from the lowest possible dose. It may be that there is no immediate relief of the situation following the first treatment. In repeated treatments, it is possible to increase the dosage to achieve the best impact. The injection of botulinum toxin brings about muscle relaxation in a significant number of patients, reduces pain, reduces the risk of developing contractures and improves performance. In this respect, the best results are seen when treatment is begun early. It is possible to return and receive treatment every three months.

In cases of migraine type headaches and chronic tension headeches, injection of Botulinum Toxin (Botox) is made to the scalp muscles. The aim of treatment is to bring about a decrease in the number of headache attacks and their strength. Positive effects usually last 3-9 months. This treatment is not designed for everyone suffering from a headache, but only for cases of headaches of particularly high frequency, that have not responded to standard drug treatments. For more information click on the following link: Headaches

In a case of excessive armpit sweating: treatment with Botulinum toxin is given through subcutaneous injections to the armpit. Decreased sweating is usually noticeable starting three days after treatment, the effect is complete about 7-10 days after treatment, and usually lasts from 3-9 months.

Does the treatment involve pain?
The treatment involves the slightest pain caused by the injection. There is no need for painkilling drugs as we are talking about a small injection.

Does the treatment have side effects?
Yes, but most side effects are minor and occur infrequently. Possible side effects include: bleeding at the injection site, flu-like feeling, hypersensitivity and tears in the eyes. The side effects usually disappear after two days to three weeks of treatment. Another side effect is local weakness of the botulinum-injected muscle or the adjacent muscles. This can occur about 2-3 days after injection. It is a well known phenomenon that passes and does not cause permanent damage.

Are there any restrictions to the treatment?
There is only limited treatment in cases of hypersensitivity to botulinum.

What happens after the treatment?

After injecting Botulinum, the patient is monitored in the clinic for 30 minutes. This is to ensure that there are no unusual side effects to the drug. If everything is normal, the patient is released home.

When to call the Neurology clinic at Hadassah?
One to two weeks after receiving treatment, please call the clinic and report to the nurse whether the treatment helped. According to need, further treatment will be determined.

General Information
Treatment is given at the Neurology Clinic on the 6th floor with the assistance of a clinic nurse, by Dr Edward Linetsky who specializes in injecting botulinum. Before the first treatment you will sign a consent form for receiving treatment.

When you arrive for your treatment you should bring a detailed letter from the doctor who referred you for treatment.

How to contact us
Neurological clinic, Hadassah Ein Kerem
Clinic Phone: 02-6778437, 6776399
Days: Sunday - Thursday, hours: 8:00 to 15:00.
You can leave a message on the answerphone.

Literature:
Bhidayasiri R, Truong DD. (2005) Expanding use of botulinum toxin. J Neurol Sci. 235: 1-9.

Comella CL, Pullman SL. (2004) Botulinum toxins in neurological disease. Muscle Nerve. 29:628-44.

Costa J, Espirito-Santo C, Borges A, Ferreira JJ, Coelho M, Moore P, Sampaio C. (2005) Botulinum toxin type A therapy for cervical dystonia. Cochrane Database Syst Rev. 25;(1):CD003633.

Conway S, Delplanche C, Crowder J, Rothrock J.(2005) Botox therapy for refractory chronic migraine. Headache 45:355-7.

Dodick DW, Mauskop A, Elkind AH, DeGryse R, Brin MF, Silberstein SD; BOTOX CDH Study Group. (2005) Botulinum toxin type a for the prophylaxis of chronic daily headache: subgroup analysis of patients not receiving other prophylactic medications: a randomized double-blind, placebo-controlled study. Headache 45:315-24.

Fitzgerald E, Feeley TM, Tierney S. (2004) Current treatments for axillary hyperhidrosis. Surgeon 2:311-4, 360.

Lowe N, Campanati A, Bodokh I, Cliff S, Jaen P, Kreyden O, Naumann M, Offidani A, Vadoud J, Hamm H. (2004) The place of botulinum toxin type A in the treatment of focal hyperhidrosis. Br J Dermatol. 151:1115-22.