Beyond wrinkles, Botox treats crippling ailments

Toxin: Its ability to relax muscles makes the drug valuable in easing symptoms of multiple sclerosis and other disabling conditions.

Medicine & Science

March 22, 2004|By Erika Niedowski | Erika Niedowski,SUN STAFF

For Susie Hilfiger Clapp, Botox has nothing to do with ironing unwanted wrinkles.

The 51-year-old multiple sclerosis patient from Connecticut gets injections of the toxin every few months to help her relax her clenched hand and release the tension in her toes.

"I really had a hard time keeping my hand and arm from going into that cradled position," said the former nurse, who is the sister of clothing designer Tommy Hilfiger.

"Now I can clap my hands. I can turn pages. ... It helps me bend my knee and it keeps my toes from curling. And it keeps my foot flatter on the floor because it releases some of that spasticity."

Despite its pop culture status, Botox isn't just for Hollywood types who can't stand the visual manifestations of aging.

Though it became popular in recent years after the U.S. Food and Drug Administration approved its cosmetic use, botulinum toxin has played a pivotal role in the treatment of a range of disorders - including MS, stroke, cerebral palsy and eye and neck spasms.

Allergan, the company that manufactures it, is also studying the use of Botox for migraine relief, bladder problems and excessive sweating.

"It's just made a world of difference for patients," said Dr. Stephen G. Reich, co-director of the Maryland Parkinson's Disease and Movement Disorders Center.

"Long before it was used for wrinkles, it was used for pathological conditions. Wrinkles are a very new target for Botox."

The FDA first approved the use of the toxin in 1989 for two eye conditions: one that causes involuntary spasms of the muscles that control the eyelids, which can lead to uncontrollable blinking, and another responsible for "lazy eye," or crossed eyes.

In 2000, the FDA added cervical dystonia - a painful condition characterized by involuntary muscle contractions in the neck - to the list of approved uses.

The principle of treatment is the same regardless of whether the toxin is used to relax facial wrinkles or leg muscles. It works at the level of the neurotransmitters, chemical messengers between nerves and muscles.

When injected by needle into the affected area, Botox essentially blocks the release of the neurotransmitter acetylcholine, which means the muscle no longer gets the message to continually contract.

Reich compares the process to cutting the nerve - without making an actual split.

"These are muscles which are already working excessively," he said. "In this case, it just weakens the muscle." The effect wears off after about three months.

According to Allergan, Botox sales in the United States reached nearly $564 million last year - 40 percent of which was for cosmetic use.

Dr. Michael O'Dell, associate chief of rehabilitation medicine at NewYork-Presbyterian Hospital, estimates he has administered Botox therapeutically to 50 to 75 patients in the past few years.

Most have been diagnosed with multiple sclerosis - an often debilitating disease of the central nervous system - though some have had strokes or traumatic brain injuries.

Botox, often used in combination with other medications, is not a cure for those conditions. The toxin works best, O'Dell said, when there are a few specific muscles or muscle groups causing problems.

He works with physical and occupational therapists to determine which muscles are affected so the injection is made in the right place. But the ultimate goal, he said, isn't just to relieve uncontrollable spasms.

"We're not really treating muscle stiffness, we're treating someone's ability to walk ... and to care for themselves," he said.

O'Dell has been giving botulinum toxin injections to Clapp for more than two years. She gets one about every three months.

When O'Dell first mentioned Botox as a possible treatment, Clapp hadn't heard of it being used for anything other than temporarily erasing facial lines.

"I said to him, `So, you're going to make my foot flat on the floor, and you're going to make my face not wrinkled.'"

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