THE ALTERNATIVE USES OF BOTOX

By Chloe Palumbo Riley Hurr

Often accompanied by the glitz and glam of the red carpet, Botox has emerged as a staple of the cosmetic world with its powerful skin wrinkling reduction formula. Produced from a protein generated by Botulinum toxin which is generated from the bacterium Clostridium botulinum, Botox is a type of injectable neurotoxin that weakens muscles by inhibiting nerve signals responsible for muscle contraction. While small doses of Botox are most commonly reserved for cosmetic purposes, in the past decade Botox has recently made a breakthrough in its wide array of medicinal applications.

One of the most groundbreaking medicinal applications of Botox is treating chronic migraines. This breakthrough was first discovered when Dr. William Binder noticed that his patients reported fewer migraines after receiving Botox injections. Following this observation, the pharmaceutical company Allergan explored these findings by conducting further studies which yielded promising empirical results, eventually leading to FDA approval of Botox in treating chronic migraines in 2010. While the mechanism through which Botox reduces chronic migraines is still unknown, it has been speculated that the injection of Botulinum neurotoxin inhibits the release of neurotransmitters, specifically those involved in pain production, including substance P and calcitonin gene-related peptides (CGRP). By inhibiting neurotransmitter release, neurotransmitters involved in pain production are prevented from traveling to the nerve endings to generate a pain response. Specific Botulinum toxin treatment consists of several injections once every three months in the head and neck area where pain fibers responsible for headache production are located. While serious side effects outside of mild neck pain and headaches are rare, standard treatments are typically considered before Botox injections due to the high frequency of Botox injections required. Nevertheless, Botox has proven to be a beneficial, safe, and effective treatment for chronic migraines and is being administered across a plethora of headache centers across the United States.

In addition to treating chronic migraines, Botox has been proven to be effective in combating excessive sweating, a condition known as hyperhidrosis. Once Allergan observed that patients who received Botox injections for facial spasms were sweating less, scientists began to study whether patients with severe primary axillary hyperhidrosis–a rare disorder characterized by

excessive sweating of the hands, feet, armpits, palms, and other areas–exhibited decreased sweat activity after Botox injections. The promising findings of the study led to FDA approval of Botox in treating underarm sweating in 2004. Such treatment typically consists of injections at the specific site of excessive sweating, where the overactive nerves responsible for sweat gland activation are paralyzed, leading to an overall decrease in sweating at the injection site. In fact, the International Hyperhidrosis Society, reports that underarm sweating was reduced by 82-87%, lasting anywhere up to a year. Although Botox has only been approved to treat underarm sweating, it is often administered by doctors as an off-label treatment for other areas of the body such as the forehead and palms. In fact, studies have found that Botox injections were successful in reducing palm sweating in as much as 80-90% of cases and forehead sweating by 75% for up to five months.

Additionally, Botox has been administered to treat forms of overactive bladder activity from urinary incontinence (the involuntary leakage of urine) to urinary urgency (the sudden urge to urinate). Botox bladder injections can help alleviate and even eliminate urinary incontinence and urinary urgency by preventing muscular contractions through the relaxation of the thick muscle bands of the bladder. In fact, as much as 70- 75% of patients reported a decrease in urinary incontinence after Botox injections. Injections typically last up to six months and possible side effects of Botox bladder injections include bleeding in urine, increased urine retention, and urinary tract infections.

The applications of Botox even extend into the realm of mental health, with numerous studies backing the efficacy of Botox as an antidepressant. In fact, one study conducted by the FDA found that those who received Botox injections to treat excessive sweating, spasms, migraines, and wrinkles reported up to 40-88% less depression than those who received alternative treatments for the same conditions–results independent from the medical condition and site of Botox injection. While precise mechanisms underlying how Botox works to combat depression are still largely ambiguous, scientists have speculated that Botox can travel to and impact parts of the central nervous system that are largely responsible for the regulation of moods and emotions. Such speculation is corroborated by the observation that depression is often associated with increased muscle tone–a phenomenon that Botox can help to target by weakening the muscles. While there is still much more testing to be done, the empirical data offers promising potential for Botox as an antidepressant, especially in cases where patients suffer from both depression and chronic conditions.

From treating depression to overactive bladder activity, Botox has emerged as more than a mere anti-wrinkle cosmetic injection, proving itself to be an incredibly versatile toxin with seemingly limitless potential. That being said, such a toxin is not to be administered without caution. In fact, in 2009 the FDA required that Botox carry the black box warning label due to its serious long-term potential effects. Although rare, Botox has the potential to spread beyond the injection site, causing muscle weakness, paralysis, difficulty breathing and swallowing, and even vision problems. The off-label administration of Botox to treat a wide array of medical conditions has even given rise to a number of high-profile lawsuits concerning the off-label uses of Botox in causing detrimental long-term effects. While the alternative applications of Botox come with some risk, loads of empirical data on the alternative applications of Botox back its efficacy and safety as a treatment for a widespread range of medical conditions.

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