Botox puts new face on therapy
Posted Saturday, December 13, 2003 - 9:30 pm

By Liv Osby

Lawrence Acker can't feel the damaging spasms that keep him from straightening out his legs. Botox therapy helps to relax the muscles, allowing him to change position and prevent pressure sores. (Ken Osburn/Staff)
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Sitting in his wheelchair by a crackling fire, Lawrence "Duke" Acker gestures at his lifeless legs.
Deep inside, he says, uncontrollable spasms that he can't feel contract his muscles leaving him unable to straighten his legs.

For paraplegics such as Acker, 57, a retired Greenville attorney paralyzed in a fall from a tree, the inability to shift position can have serious health consequences, including pressure sores. But today doctors are helping these patients by injecting them with a poison best known for its ability to smooth wrinkles from aging faces.

Botox is made from Botulinum toxin, the same poison responsible for many a fatal picnic. The medicine is being used to treat a wide variety of painful and debilitating conditions. And the physical and emotional impact on patients' quality of life can't be overstated, says Dr. Rebecca E. Holdren, a physiatrist with Carolina Medical Rehabilitation.

Whether it's an adolescent suffering muscle spasms from a spinal cord injury or a senior citizen with clawed hands and arms from a stroke, patients are "overjoyed" with its effects, she says.

Stroke patients can walk better. People with spasms can dress or feed themselves. It helps many to live more independently, and makes life easier for caregivers, too.

"Sometimes patients will get spasms that shake their whole leg or whole body, throw them off balance, or throw them out of their chair," she says. "It makes a dramatic difference for those patients."

Botox can dramatically change the lives of children with cerebral palsy, too, says Dr. Pierrette "Mimi" Poinsett.

"It can get a kid from being in a wheelchair to walking," said the Modesto, Ca., pediatrician. "Even if children are not ambulatory, it makes it easier to transfer from one position to another."

Greenville ear, nose and throat specialist Dr. Sherman Stevenson uses Botox to treat spasmodic dysphonia, a condition of the vocal chords that leaves some sufferers unable to speak.

"It's an involuntary spasm of the vocal chord muscles," he said. "They can't start speaking...or they're talking and their voice just totally goes away."

And Dr. Tom McFadden, a Greenville plastic surgeon, uses Botox to treat facial tics, eye spasms, Bell's palsy - a condition marked by paralysis of one side of the face - and migraines.

"One lady tried 10 different medications," he said, "and she's headache-free for five to six months initially with Botox."

Botox works cosmetically by temporarily paralyzing and flattening facial muscles, reducing crow's feet, laugh lines, and brow furrows.

Therapeutically, it works much the same way, temporarily blocking the signal from the nerve to the muscle allowing the muscle to relax, Holdren says. On average, effects last about four months.

The Mayo Clinic calls Botox "an ongoing story," noting that it's being tested or used for Carpal tunnel syndrome, stuttering, tennis elbow, involuntary neck spasms and many other conditions.

"It's also for myofacial pain disorders, headaches, neck pain, back pain," says Holdren. "I'm really excited about recent studies coming out showing that it's very effective in those patient populations."

Side effects are temporary and can include flu-like symptoms and excessive weakness of the muscles treated. And while insurance doesn't pay for cosmetic uses of Botox, which can cost up to $500 per bottle, the therapeutic applications are typically covered, doctors say.

Acker says the Botox works and he wants to continue treatments to prevent further muscle damage and to help keep his dreams alive.

"When you're in my position, you need to be able to rotate ... to stay away from bed sores and I can't sleep on my belly any more," Acker says.

"And when I dream, I'm never in a wheelchair. I need my legs to straighten out because I might want to stand over a golf ball. It may happen. I don't know," he said.
Sunday, December 14