Botox®

For 25 years physicians at Atlanta Neurology have treated patients with varying diseases. Dr. Gwynn has expertise in the therapeutic use of Botox® and is is the chief of neurology at St. Joeseph's Hospital. Dr. Franco is a clinical neurologist and founding partner who has been in practice for 25 years. Dr. Sanders has a specialty interest in neuromuscular diseases-carpal tunnel syndrome, neuropathy, and others. Dr. Johnston's specialty is in sleep disorders. Sharon King, a certified nurse practitioner, treats many patients with headache, neck and lower back pain. Our doctors treat patients with disease ranging from strokes to headaches and migraines to Parkinson's disease.

What is Botox®?
Botox® is the brand name for purified and crystallized botulinum toxin type A. The toxin is produced by a bacterium called Clostridium botulinum, an organism that normally lives in soil. Although botulinum toxin is one of the most lethal biological chemicals on earth, when it is highly diluted and injected into muscles it is quite safe. Allergan Pharmaceuticals, the company that makes Botox®, packages the medication in doses that are far below quantities that would cause serious harmful effects.

How Does Botox® Help?
Botox® can help many disorders where excessive muscle contraction cause pain, disfigurement, or impairment of movement. The common denominator of all problems helped by Botox® is excessive muscle contraction. Thus, conditions that involve spasticity, excessive muscle movement, or excessive muscle tone may be improved by Botox®.

How Does Botox® Work?
Botox® is a protein molecule made of amino acids linked together in two chains that are connected. When the toxin is injected into muscles, the molecule is taken up by the nerve ending at the site that the nerve meets the muscle. The toxin then binds to part of the nerve ending, inactivating the nerve by preventing the nerve from releasing a chemical a (neurotransmitter) that normally travels over to the muscle causing the muscle to contract. Under normal conditions, an electrical impulse travels down the nerve to the nerve ending causing the neurotransmitter, acetylcholine, to be released by the nerve ending. The acetylcholine travels across a very small gap and binds to the surface of the muscle. When the binding occurs, certain changes take place in the muscle membrane which lead to the muscle's contraction. Because Botox® prevents acetylcholine release, the muscle cannot contract, and the cumulative effect is that the muscle belly relaxes.

What Are Some Conditions Treated With Botox®?

Many conditions may be helped by Botox®. Some of the more common ones include:

Spasmodic Torticollis - twisting and writhing movements of the neck
Writer's Cramp - difficulty writing because of excessive muscle contraction of the forearm
Spasticity from stroke - including painful contractions of the arm and leg
Spasticity from cerebral palsy, spinal cord injury, or traumatic brain injury
Hemifacial spasm - Repetitive twitching of one-half of the face
Tic disorders
Blepharospasm - forced eyelid closure
Facial wrinkles-associated with excessive muscle contraction, such as crows' feet around the eyes or frown lines of the forehead

Several conditions may also be helped by Botox® including:

Hyperhidrosis - excessive sweating of the palms, face, or arm pits

Anal fissures

Achalasia - an excessively tight stomach valve

Strabismus - crossed eyes

Headaches - especially those beginning at the base of the head

What About Pain Syndrones?
Because many types of neck and back pain re associated with excessive muscle contraction, the treatment of these disorders with Botox® is intuitively promising. In fact, recent studies and clinical trials suggest that Botox® may be an extremely useful treatment for some types of chronic musculoskeletal pain.

How Is Botox® Administered?
Botox® is injected through a thin needle directly into muscles or skin. After a few days the muscles relax. The injections are only mildly painful, and the pain can be minimized by the use of anesthetic sprays or pain medicines. The effects last for 10 to 20 weeks in most cases. The treatment can then be repeated as needed. What Are The Side Effects?
When they occur, the side effects are usually mild and may include excessive muscle weakness near the are of injection. Because the effects of Botox® always wear off, so do any side effects of muscle weakness. Bleeding and infection are always risks when the skin is punctured, but they are rare. No one has ever died from Botox®. Allergic reactions are rare.

Does Insurance Pay For Botox® Treatment?
From many of the disorders listed in the previous paragraphs, insurance companies cover the expense of the injection. Botox® is an extremely expensive medication costing the physician more than $500 per vial, and many disorders require two or three vials per injection series. However, because most insurance carriers recognize that many of the disorders listed above are only effectively treatable by Botox®, treatment is covered. Often the treatment must be precertified by the neurologist.

Who Injects Botox®?
Only a few physicians have a great deal of experience using Botox®. Though the technique is relatively uncomplicated, knowing which muscles to inject and how much Botox® to inject into each requires skill and training. In many regions of the country, university hospitals are the only locations where the treatment is available.

Dr. Gwynn of Atlanta Neurology has treated patients with Botox® for well over a decade, and has more experience than nearly any physician in the southeastern United States. Dr. Gwynn has participated in training courses through the American Academy of Neurology and the Medical College of Georgia, and he was the only participant from Georgia to the International Conference on Botulinum Toxin in Munich, Germany. He was the founder and is the medical advisor of the Georgia chapter of the National Spasmodic Torticollis Association.

You may read testimonials from patients Dr. Gwynn has treated with Botox®. If you would like more information or have a specific question about Botox® you can e-mail Dr. Gwynn.