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The Story of Botox 

 

This is a lecture that Dr. Patrick Treacy gave at IMCAS (Paris) 2003 and FACE (London) 2004 when the use of botulinum toxin was still a novelty. It begins in the late 1960s, when Alan Scott, MD, (San Francisco) and Edward Schantz first began working on a standardized botulinum  preparation for therapeutic purposes. By 1973, Scott (Smith-Kettlewell Institute) used type A (BTX-A) in monkey experiments, and, in 1980, for the first time in humans to treat strabismus and "uncontrollable blinking" (blepharospasm). In 1993, Pasricha showed botulinum toxin could be used for the treatment of achalasia (spasm of the lower esophageal sphincter). In 1994, Bushara showed injections inhibit sweating. This was the first demonstration of non-muscular use of BTX-A in humans.

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The Effect on Botox on Sweating
 

While treating patients with hemifacial spasm at Southend Hospital in England in 1993, Khalaf Bushara and David Park were the first to show that botulinum toxin injections inhibit sweating. This was the first demonstration of nonmuscular use of BTX-A. Bushara further showed the efficacy of botulinum toxin in treating hyperhidrosis (excessive sweating). BTX-A was later approved for the treatment of excessive underarm sweating. This is technically known as severe primary axillary hyperhidrosis – excessive underarm sweating with an unknown cause which cannot be managed by topical agents (see focal hyperhidrosis). Dr Treacy started treating pateints in 1997 and was amongst the first docotors to do so. 

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Information on Botulinum Toxin 

Botulinum toxin is a protein and neurotoxin produced by the bacterium Clostridium botulinum. In the early 1980s, university-based ophthalmologists in the USA and Canada further refined the use of botulinum toxin as a therapeutic.  agent. In December 1989, Botox, manufactured by Allergan, Inc., was approved by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients over 12 years old. There are two kinds of botulinum in the Iirsh market Dysport (Azzalure) and Botox (Vistabel).

Dr. Patrick Treacy is KOL for Galderma and an advanced Botox trainer. He was one of hte first docotrs in the world to use this pharamceutical for sweating in 1997. He has published many papers on this compound and htese are some of his television and radio interviews used as an information source for pateints and not intended for advertisment purposes. 

The Cosmetic Effect 
 

The cosmetic effect of BTX-A on wrinkles was originally documented by a plastic surgeon from Sacramento, California, Richard Clark, and published in the journal Plastic and Reconstructive Surgery in 1989. Canadian husband and wife ophthalmologist and dermatologist physicians, JD and JA Carruthers, were the first to publish a study on BTX-A for the treatment of glabellar frown lines in 1992. After formal trials, on April 12, 2002, the FDA announced regulatory approval of botulinum toxin type A (Botox Cosmetic) to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). Subsequently, cosmetic use of botulinum toxin type A has become widespread. The results of Botox Cosmetic can last up to four months and may vary with each patient.

The Effect on Chronic Migraine

 

Onabotulinumtoxin A (Botox) received FDA approval for treatment of chronic migraines on October 15, 2010. The toxin is injected into the head and neck to treat these chronic headaches. Approval followed evidence presented to the agency from two studies funded by Allergan, Inc. showing a very slight improvement in incidence of chronic migraines for migraine sufferers undergoing the Botox treatment. Since then, several randomized control trials have shown botulinum toxin type A to improve headache symptoms and quality of life when used prophylactically for patients with chronic migraine. Dr. Patrick Treacy started experiments on this effect in 2003 and gave this lecture to the Migraine Association of Ireland in 2006 - four before its Irish Medicines Board official approval  

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Dr. Patrick Treacy explains about Botox® and its use in Chronic Migraine

 

Onabotulinumtoxin A (Botox®) received FDA approval for treatment of chronic migraines on October 15, 2010. The toxin is injected into the head and neck to treat these chronic headaches. Approval followed evidence presented to the agency from two studies funded by Allergan, Inc. showing a very slight improvement in incidence of chronic migraines for migraine sufferers undergoing the Botox® treatment. Since then, several randomized control trials have shown botulinum toxin type A to improve headache symptoms and quality of life when used prophylactically for patients with chronic migraine 

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The Cosmetic Effect 
 

TIn cosmetic applications, a Botox® injection, consisting of a small dose of botulinum toxin, can be used to prevent development of wrinkles by paralyzing facial muscles. As of 2013, it is the most common cosmetic operation, with 6.3 million procedures in the United States, according to the American Society of Plastic Surgeons. Qualifications for Botox injectors vary by county, state and country. Botox cosmetic providers include dermatologists, plastic surgeons, aesthetic spa physicians, dentists, nurse practitioners, nurses and physician assistants. The wrinkle-preventing effect of Botox normally lasts about three to four months, but can last up to six months.[41] Following treatment, visible results of Botox Cosmetic are usually seen within 3–5 days, however it can take up to 2 weeks to see full results. 

Dr. Patrick Treacy explains about the effect of Botox on the Brain 

 

Lecture by Dr. Patrick Treacy to the Royal Society of Medicine, London in 2012 and the Aesthetic World Congress in Paris in 2014. Lecture was also given at IACD Sao Paulo Brazil and AMEC Medillin, Colombia in 2014. He highlights the facial feedback hypothesis, which states that facial movement can influence emotional experience and how Charles Darwin was among the first to suggest that physiological changes caused by an emotion had a direct impact on, rather than being just the consequence of that emotion. During a functional MRI brain study done in 2011, Andreas Hennenlotter showed that Botox® decreased activation of brain regions implicated in emotional processing and emotional experience (namely, the amygdala and the brainstem). These studies suggest that botox can dampen the ability to understand another's emotions, and they lend considerable support to Darwin's original notion

The main conditions treated with botulinum toxin in medicine presently are:

  • Cervical dystonia (spasmodic torticollis) (a neuromuscular disorder involving the head and neck)

  • Blepharospasm (excessive blinking)

  • Severe primary axillary hyperhidrosis (excessive sweating / focal hyperhidrosis)

  • Strabismus (squints)

  • Achalasia (failure of the lower oesophageal sphincter to relax)

  • Local intradermal injection of BTX-A is helpful in chronic focal neuropathies. The analgesic effects are not dependent on changes in muscle tone.

  • Migraine and other headache disorders, although the evidence is conflicting in this indication

  • Bruxism: by injecting the toxin into the muscles of mastication, such as the masseter
The other main conditions treated with botulinum toxin in medicine presently are:
  • Idiopathic and neurogenic detrusor overactivity
  • Pediatric incontinence
  • Iincontinence due to overactive bladder and  neurogenic bladder
  • CNS trauma, stroke, multiple sclerosis 
  • Parkinson's disease, or cerebral palsy
  • Focal dystonias affecting the limbs, face, jaw, or vocal cords
  • Gastric cancer 
  • Temporomandibular joint pain disorders
  • Diabetic neuropathy
The other main conditions treated with botulinum toxin in medicine presently are:
  • Wound healing
  • Excessive salivation
  • Vocal cord dysfunction, including spasmodic dysphonia and tremor
  • Reduction of the masseter muscle for decreasing the apparent size of the lower jaw
  • Painful bladder syndrome
  • Detrusor sphincter dyssynergia and benign prostatic hyperplasia
  • Allergic rhinitis
  • ​Anal fissure
  • Vaginismus 
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