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The Rest Of The Botox Story: Therapy For Many Diseases Donna Halvorsen, Star Tribune Published January 27, 2004 Today is the day Kyle Stegner gets his pokes. The 7-year-old from Inver Grove Heights has cerebral palsy, and he has been treated with Botox since he was 3. Some kids might cry or scream, but Kyle only flinches as Dr. Mark Gormley injects 16 doses of the drug into his thigh muscles. As his mom, Cynthia Stamper, cradles Kyle's head in her arms, she knows that in a week or so, his leg muscles will relax, making his life and hers easier. When it wears off in four or five months, they will go back to Gormley for more pokes. These routine treatments for Kyle at Gillette Children's Specialty Healthcare in St. Paul illustrate how Botox, known as a glamour drug for smoothing wrinkles, quietly has become one of the workhorses of American medicine. It has been approved by the U.S. Food and Drug Administration for only a few conditions but is being used for dozens more, including stroke, facial tics, eyelid twitching, excessive sweating, stuttering, carpal tunnel syndrome, writer's cramp, tennis elbow, Parkinson's disease, multiple sclerosis, cerebral palsy, bladder problems and headaches. It also holds promise for treating arthritis. "It seems like every time we turn around there's a new use for it," said Gormley, who has injected Botox into 1,000 children with cerebral palsy to loosen their muscles and improve the quality of their lives. Botox is "the most potent poison known to man," Gormley said, but when it's used in a greatly diluted, purified version, it can loosen muscles by blocking nerve signals from the brain that tell the muscles to contract. It's the injured brain that's the problem, "but we're not able to do anything about it yet," Gormley said. Not a cure Botox is not a cure, and although it does wear off, it sometimes spells relief when nothing else does. Dee Mathias, 44, of Byron, Minn., suffered migraine headaches all of her adult life. She never knew when they would come: sometimes when the weather changed or when she was stressed out or wasn't sleeping well. At other times, they just came out of the blue. Her husband and two daughters tiptoed around the house as she huddled under the covers for hours in a cold, dark bedroom with as little sound, smell and light as possible, until the pain lifted. At times she had headaches daily and needed daily injections of pain-relieving drugs. There were spinal taps, emergency-room trips and, in one instance, hospitalization. One day her neurologist referred her to Dr. Ricky Clay, a plastic surgeon at the Mayo Clinic in Rochester who was injecting Botox for headaches on referral from Mayo neurologists. Mathias, who works as a secretary at the Mayo Clinic, was game for anything. After Clay first injected Botox into her scalp a year and a half ago, the migraines were gone for months. When the Botox wore off and the headaches returned, she was injected again. Although Clay later found a surgical solution for her headaches -- a brow lift that removed the muscles above her eyebrows -- Mathias is grateful for the pain relief that Botox offered. "It was a very good thing for me," she said. Botox is made from the botulinum Type A toxin, which in its raw form causes the food poisoning called botulism. In many cases, the drug is injected in muscles to relax them and keep them from becoming spastic. It usually wears off in three months, but can last longer with some conditions. Injections can be repeated "for as long as the patient can benefit from it," said Dr. Stephanie Boyle of Methodist Hospital in St. Louis Park. As researchers continue efforts to validate existing applications and to find new ones, Botox's usage continues to expand. Besides quelling the pain of migraine headaches, which often are unresponsive to traditional remedies, it is being used to loosen the knotted muscles of stroke victims. Boyle uses Botox to give stroke victims more movement for physical therapy and everyday activities and to ease their pain. One study found that the drug reduced spastic movements in stroke victims' wrist and finger muscles. Boyle, Gormley and others use an electronic device to find problem muscles. "If a muscle is at rest, is not moving, is not contracting, it should be electrically silent," Boyle said. "If we pick up a lot of static electricity, it lets us know that the muscle is spastic, and we inject the Botox into the muscle." Arthritis may give Botox its biggest chance to shine. An estimated 23 million Americans have arthritis, and prescriptions and treatments cost $140 billion a year nationwide. Arthritis is "a very, very new use of the toxin," said Dr. Dennis Dykstra, head of physical medicine and rehabilitation at the University of Minnesota Medical School in Minneapolis. Dykstra and other physicians used Botox for 15 arthritis patients and "got some very nice results that lasted a long time," he said. With Botox, the patients had less pain and "were able to do things they weren't able to do before," he added. Dykstra and others presented their arthritis findings at the annual meeting of the American Academy of Physical Medicine and Rehabilitation in Chicago last fall. He said that controlled, randomized trials are needed to determine whether Botox is an effective treatment for arthritis. Overactive bladders, which empty without control, affect 17 million people in the United States. Current treatments of drugs and surgery "are not always effective and may have intolerable side effects," Dykstra said. In a new, 30-minute procedure, Botox is injected into bladder muscles to keep them from going into spasms that cause urine leakage. Patients can expect results in a few days that can last six to nine months, Dykstra said. As with arthritis, he said, further research is warranted. A 'trouper' At Gillette and elsewhere, Botox is used successfully with cerebral palsy, which is caused by brain injury before, during or just after birth. One study found significantly better movement in 86 percent of 250 children with cerebral palsy who were given Botox, and minimal side effects with 2 percent of the children. Kyle is among the success stories. "He's a trouper, huh?" his mother said after he had endured the last of the 16 injections, four each in four thigh muscles, front and back. Botox "really has been helpful" for him, she said. "His muscles are more at ease, not so tight and restricted," and that makes his physical therapy and personal care easier, she said. "His quality of life has increased because of the injections," she added. Without it, "I think he would be a lot more crippled up than he is." The drug's potential for relieving headaches was discovered by plastic surgeons who had injected Botox into forehead muscles to remove wrinkles. Their patients told them their headaches were gone. Injecting Botox for migraines is a laborious process. "We use 20 injection sites all around the scalp and basically paralyze all the muscles in the scalp with 100 units of Botox," Clay said. If the headaches come back -- as they sometimes do after 4 1/2 to 5 months, he tries to localize the treatment -- injecting only the forehead, for example. The need for repeated treatments is a shortcoming of Botox for some patients. And there can be side effects, from drooping eyelids to difficulty in swallowing, depending on the condition being treated. Mathias, who initially was treated with Botox, said she didn't like the injections. She wanted a nondrug solution, if one was available. That's why she took Clay up on his offer to do a brow lift. She has been pleased with the results. Clay sees Botox use as a sign of the times. "A lot of the ills of modern life are caused by stress, and what stress causes is muscle tension," he said. "I think many of the ills that we modern Americans have picked up in our day-to-day lives are relieved or at least ameliorated by releasing some of that muscle tension. I think that's why Botox is finding such wide use." Donna Halvorsen is at [log in to unmask] SOURCE: Minneapolis Star Tribune, MN http://www.startribune.com/stories/1556/4335713.html * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn