AcuteCare Telemedicine Blog

Botox – The Poison that Heals

Ounce for ounce, a molecule made by the bacterium Clostridium botulinum is the most potent neurotoxin on earth. A tiny amount ingested or introduced to the body through wounds has been enough to paralyze all the muscles in a human for more than long enough to allow suffocation from respiratory failure. The structure and biology of this large molecule, primarily made of protein, was deciphered just in the last century, but its ability to quickly and easily get into humans made it of great interest to scientists and physicians around the world.

Over time after its discovery, physicians came to understand that there could actually be medicinal qualities to this poison. One such interesting properties of botulinum toxin was its mechanism to weaken muscles by being taken up by the nerve endings attached to those muscles. This shuts down the nerve endings and their communication with muscles which keeps the muscles from contracting. When exposure is due to a bacterial infection, the toxin is widely distributed, coming into contact with nerves throughout the body, including those of the chest and diaphragm, resulting in breathing paralysis.

But what would happen if a tiny amount of the toxin was isolated and injected right at a site of a muscle in doses that were too small to have any effect elsewhere? Using a small dose would preclude weakness developing throughout the body and produce effects just locally. In fact, this is exactly what happened; an ophthalmologist who was a previously involved with the Army project injected eye muscles of children with crossed eyes (strabismus), weakening the muscles that were pulling too far and straightening out the gaze. The results were very good with few or no side effects.

Ultimately, many other indications came along, all based on the theory that relaxation of muscles can have a desired effect. By far the most publicized application of Botox in particular has been for the treatment of wrinkles – popularized as a fountain of youth in a bottle. Shortly after, it was discovered that patients with chronic headaches, including migraine, who received Botox for wrinkle treatment in the foreign were alleviated, incurring fewer headaches.

The mechanism of action regarding headaches is unknown. Some scientists suggest that the relief results from the interaction of Botox with sensory nerves as well as its known effect on motor nerves. There is evidence of this, but it remains a mystery how it works. Studies clearly show that it does not get into the brain or spinal cord and so does not affect pain centers there. The muscle relaxation itself probably doesn’t play a huge role, though there are sensory receptors within muscle fibers that may be influenced.

The story of this poison that heals is truly fascinating and represents one of the most important medical advances in the last two decades. The future could be even more interesting, as it may be possible to use the properties of some parts of the botulinum toxin to bring other molecules into nerves and have effects on them. This may have implications in trying to restore function and vitality to weakened nerves from many diseases. But for now, millions of people have found that Botox is at least worth a shot.

Read a more detailed history and perspective on Botox here.

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