Botox not just for beauty
Neurotoxin has many medical applications Eases debilitating pain and relaxes rigid muscles


In what may be one of the 21st century's great ironies, marketing extravaganzas extolling the "miracles" of today's hottest anti-wrinkle treatment may be masking the real beauty of one of the world's most promising medical breakthroughs.

Botulinum toxin, a poisonous bacterium capable of attacking every muscle of the body, including the heart, is one of many potential agents of biological warfare. But it is as Botox, a vastly diluted concoction immobilizing frown lines, that it is best known in North America.

In fact, sales of Botox as a beauty booster have been so hot, they've swept aside growing respect for a third use for the neurotoxin - as an important medical tool in treating everything from migraines to club feet.

Ultimately, this use may surpass all others in sales. But these days, with the beauty tie-in uppermost in the public consciousness, those who rely on Botox to take away excruciating pain or release rigid muscles too often find themselves met with skepticism, particularly from the insurance industry.

"My friends and relatives were dead set against Botox," says 28-year-old Stephanie Card, who suffered from a chronic excruciating headache for two and a half years after receiving a severe concussion in a car accident.

The headache was relentless, 24 hours a day, seven days a week.

Card says she tried just about every painkiller on the planet. Anything that managed to take the edge off the pain rendered her incapable functioning, let alone working.

Finally, at her wit's end two years ago, she went to see a respected headache specialist at Sunnybrook and Women's College Health Sciences Centre.

"His first words were not encouraging," Card recalls. "He told me that the headaches might last 10 or 20 years or never go away at all." But Dr. Marek Gewal also mentioned he'd had some success using Botox.

Card, who works for a news wire service, did some research on the risks and decided to go for it.

"I can't even begin to explain the difference it has made in my life," she says. "After the first injections in May, 2001, I felt like myself for the first time since the accident.

"I was able to get married that summer. (We had talked about cancelling due to the headaches.) And I was able to work, to get back to living a normal life."

Eventually, seeing what the treatments had done for her, friends and family became huge fans. But not her insurance company.

"The treatments are expensive, about $500 every three or four months," Card says. "Financially, I can't really afford them but for my mental and physical well-being, I can't afford not to have them.

"My insurance company won't cover them because they say the treatment is experimental. We're appealing"

In fact, the use of Botox as a medical treatment started back in 1968 at the University of Wisconsin's food research institute, where researcher Ed Schantz was cultivating the bacterium that takes its name from botulus, the Latin word for the sausage deemed to be the culprit making certain people deathly ill.

Schantz was studying whether it could be used as an agent of germ warfare when he joined forces with Dr. Alan Scott, who started injecting it in a much weakened form to relax the overactive muscles that pulled the eyes of some monkeys into a squint. The treatment worked so long as it was repeated every three or four months when the effect wore off.

Twenty years later, Vancouver ophthalmologist Jean Carruthers noticed the foreheads of patients she treated with Botox seemed particularly youthful and wrinkle-free. She persuaded her dermatologist husband, Alastair, to inject the frown lines of his office receptionist. And the rest, as they say, is history.

From then on, Botox became inextricably linked in the public consciousness with the vanity of non-essential cosmetic procedures. But behind the scenes, significant medical advances in uses of the neurotoxin have been expanding.

Doctors have found Botox can ease the paralysed muscles that disable after brain injuries and strokes. It has proved effective against back spasms and the debilitating pain of migraines. It cuts down the neck spasms of cervical dystonia, can reduce the excessive sweating known as hyperhidrosis and blocks the bladder spasms that cause some forms of incontinence.

Injected into the club foot of a newborn, it allows the muscles to relax so that the foot can be turned and placed in a splint. Eventually the correction allows the child to learn to walk the same way other children walk.

And it can free the stiffened muscles of children with cerebral palsy. That allows them to exercise, helping their muscles to grow while the neurotoxin keeps things flexible.

Some children with cerebral palsy have taken their first steps with the help of Botox, says Dr. Darcy Fehlings, a developmental pediatrician who treats many children with cerebral palsy at her busy Botox clinic at the Bloorview MacMillan Children's Centre.

Even the Ontario Health Insurance Plan (OHIP) recognizes the medical jobs Botox does.

While it states clearly that "cosmetic procedures do not improve or restore the health of Ontarians and should not be financed by the public purse," it put out a bulletin last month specifically adding Botox injections to its schedule of benefits for doctors' services and therapeutic procedures in treating the spasticity associated with "upper motor neuron disorders," such as cerebral palsy, multiple sclerosis, stroke, and spinal cord or traumatic brain injury.

Prior to that, Botox treatments for children with cerebral palsy were covered as neuromuscular blockades.

"We have to state why we have to go to Botox, that it's because nothing else works," says Fehlings. "But basically they've been excellent about coverage. And there's a huge body of evidence building up."

When it comes to treating chronic pain and headaches, the evidence is building, too, says Gewal. Sunnybrook has completed two good studies and a third is ongoing, he says.

Researchers think Botox works as a major inflammatory modulator, he says. "They don't know exactly how it works, but they do know it works."

A laboratory rat confronted with a hot surface will remove its forepaw after making contact, Gewal says. "But if the paw has been injected with Botox, it won't be removed. It's not paralysed; it simply doesn't feel the heat."

Botox is an important tool, he says. "It allows us to begin to help groups that haven't been helped by anything else."

For Card, there is no doubt. For her, Botox is no cosmetic vanity.

Before Botox, she says she was so exhausted from the pain she could barely function. She couldn't drive, couldn't participate in activities with friends, became completely isolated.

As the effect of one shot wears off after a few months, the headache comes back with a vengeance. "I let the Botox wear off on purpose," she says, "so I know if I still need it.

"I know Botox isn't a cure, but it sure is an excellent Band-aid that lets me function like a normal human being."
Additional articles by Helen Henderson