What is botulism

Botulism is an illness caused by a toxin produced by Clostridium botulinum bacteria (and sometimes Clostridium butyricum and Clostridium baratii bacteria) ¹⁾. The name comes from the latin word for sausage (‘botulus’) and comes from a German physician who described the poisoning after the ingestion of sausage. These Clostridium botulinum bacteria toxins are some of the most powerful known to science. They attack the nervous system (nerves, brain and spinal cord) and cause paralysis (muscle weakness). Most people will make a full recovery with treatment, but the paralysis can spread to the muscles that control breathing if it’s not treated quickly. This is fatal in around 5-10% of cases.

The Clostridium botulinum bacteria spores are naturally present in the environment, often living in garden soil and produces bacterial spores which can survive heating to 212° F (100° C). Although botulism is a serious condition that can cause difficulty breathing, muscle paralysis, and even death, fortunately it is very rare.

These bacteria make spores, which act like protective coatings. Spores help the bacteria survive in the environment, even in extreme conditions. The spores usually do not cause people to become sick, even when they’re eaten. But under certain conditions, these spores can grow and make one of the most lethal toxins known. The conditions in which the spores can grow and make toxin are:

• Low-oxygen or no oxygen (anaerobic) environment
• Low acid
• Low sugar
• Low salt
• A certain temperature range
• A certain amount of water

For example, improperly home-canned, preserved, or fermented foods can provide the right conditions for spores to grow and make botulinum toxin. When people eat these foods, they can become seriously ill, or even die, if they don’t get proper medical treatment quickly.

The clostridium botulinum anaerobic pathogenic micro-organism can multiply and produce a neurotoxin which inhibits nerve transmission by decreasing release of the neurotransmitter acetylcholine at nerve synapses.

• All types of botulism can be fatal and are considered medical emergencies. If you or someone you know has symptoms of botulism, see your doctor or go to the emergency room immediately.
  

Five forms of Botulism occur:

1. Wound botulism: Clostridium botulinum bacteria spores can get into a wound and make a toxin. People who inject drugs have a greater chance of getting wound botulism. Wound botulism has also occurred in people after a traumatic injury, such as a motorcycle accident, or surgery.
2. Foodborne botulism: The botulism bacterial can also survive in improperly homemade canned or preserved food which then causes intoxication after ingestion of the food. Though uncommon, store-bought foods also can be contaminated with botulinum toxin.
3. Infant botulism: Clostridium botulinum can colonize the gastrointestinal tract of young infants who ingest certain foods with subsequent production of the neurotoxin.
4. Adult intestinal toxemia (also known as adult intestinal toxemia) botulism is a very rare kind of botulism that can happen if the spores of the bacteria get into an adult’s intestines, grow, and produce the toxin (similar to infant botulism). Although doctors don’t know why people get this kind of botulism, people who have serious health conditions that affect the gut may be more likely to get sick.
5. Iatrogenic botulism can happen if too much botulinum toxin is injected for cosmetic reasons, such as for wrinkles, or medical reasons, such as for migraine headaches.

Food-borne botulism, the first form of the disease to be identified, is responsible for 963 annual cases worldwide.Home-processed foods are responsible for most botulism outbreaks.

Infant botulism occurs most commonly in those aged 1 week to 11 months, with peak susceptibility occurring at 2-4 months. Since infant botulism was identified in 1976, there have been 1134 recorded cases of infant botulism in the USA.

From 1992, only 1-3 cases of wound botulism have been reported in the US each year.

Progression of Botulism

The botulism toxin binds irreversibly to the presynaptic membranes of peripheral neuromuscular and autonomic nerve junctions blocking acetylcholine release.

The first symptoms of botulism, occurring 18-24 hours after ingestion of clostridium botulinum bacteria, are nausea and diarrhea. These are followed by cranial nerve weakness and then progressive symmetrical paralysis, leading to respiratory failure.

Recovery of function requires regeneration of the nerve endings, which can take a considerable period of time.

How do you get botulism

You can get botulism in two different ways:

• Through food – usually honey, home preserves, canned food, meat, seafood and soft cheeses.
• Through a wound – this is more common in people who work on the land or who use injecting drugs.

There is a type of botulism called infant botulism. In this situation, a child gets the Clostridium botulinum bacteria in their gut and it produces the toxin from there. Honey sometimes causes this – children under 12 months of age should not be given honey.

You can’t catch botulism from someone else.

Food-borne botulism

Food-borne botulism occurs when the bacteria grow in the food and produce toxins that are not destroyed by the cooking process. Eating these contaminated foods can cause botulism.

The bacterial growth happens most often in foods with low acidity such as:

• home-preserved fruits and vegetables e.g. asparagus, green beans, beets, corn, potatoes
• potato salad
• minced garlic in oil.

It is also associated with:

• canned foods
• meat
• fish
• soft cheeses
• canned cheese sauce
• canned tomatoes
• carrot juice
• baked potatoes wrapped in foil.

In Alaska, most cases of foodborne botulism are caused by fermented fish and other aquatic animals.

The symptoms are severe and usually develop 12 to 36 hours after eating contaminated food. This form of botulism can be fatal and about 5 to 10 per cent of adults who acquire food-borne botulism will die.

Wound botulism

This form of botulism is rare and occurs when bacterial spores in soil or gravel get into an open wound and reproduce, then release toxins. Symptoms typically develop between 4 days and 2 weeks after the bacterial spores enter the wound.

Intestinal botulism

Intestinal botulism occurs when spores from the bacteria are ingested and then multiply in your intestinal tract and produce toxins.

The spores are spherical structures produced by bacteria. These spores can survive boiling and extremes of cold and drying, and can develop into bacteria if in suitable growing conditions.

Children under 12 months are most susceptible to infection, but adults with gastrointestinal problems can also be at risk.

However, in most adults, even if the spores are ingested they do not make you ill because your body’s natural defences stop the bacteria from multiplying and producing toxins. Intestinal botulism is most commonly associated with eating raw honey.

Prognosis of Botulism

Prompt treatment for botulism significantly reduces the risk of death and those who survive botulism induced, acute paralysis usually make a full recovery.

The prognosis for infant botulism patients is excellent with anticipated full and complete recovery. Recovery results from regrowth of the nerve endings that then are able to signal the muscles to contract. Botulinum toxin does not penetrate into the brain, and so infant botulism patients retain all the intelligence, athletic ability, musical ability, sense of humor and orneriness with which they were born.

Botulism complications

Because it affects muscle control throughout your body, botulinum toxin can cause many complications. The most immediate danger is that you won’t be able to breathe, which is the most common cause of death in botulism. However, because of the development of antitoxin and modern medical care, people with botulism today have a much lower chance of dying than people did in the past. Fifty years ago, for every 100 people with botulism, 50 would die. Now, with antitoxin and proper medical treatment, fewer than 5 of every 100 people with botulism die.

Even with antitoxin and intensive medical and nursing care, some patients die from infections or other problems that are caused by being paralyzed for weeks or months. Patients who survive botulism may have fatigue and shortness of breath for years afterward, and may need long-term therapy to help them recover.

Other complications, which may require rehabilitation, may include:

• Difficulty speaking
• Trouble swallowing
• Long-lasting weakness
• Fatigue
• Shortness of breath

Infant botulism

Infant botulism is a rare but serious gastrointestinal condition caused by exposure to Clostridium botulinum (C. botulinum) spores. Bacteria from the spores can grow and multiply in a baby’s intestines, producing a dangerous toxin. The condition can occur in infants up to age 12 months.

Breastfeeding an infant can reduce risk of contracting botulism.

To protect your baby from infant botulism:

• Avoid exposure to potentially contaminated soil or dust. Soil can contain C. botulinum spores, which can circulate in the air and be inhaled into the lungs. In the United States, the risk is greatest in Pennsylvania, Utah and California — where soil botulinum spore counts are high. Exposure to contaminated soil is most likely near construction and agricultural sites or other areas where soil is disturbed.

• Don’t offer honey. Wild honey is a potential source of C. botulinum spores. Avoid giving honey — even a tiny taste — to babies under the age of 1 year.

• Be careful when canning food. Pressure-cook home-canned foods to reduce the risk of contamination with C. botulinum spores. Taking care when preserving food – the bacterial spores can survive at temperatures of 212 °F (100 °C), so make sure food is well cooked and containers are thoroughly sterilized. Sterilize home canned foods by pressure cooking at 248 °F (120 °C) for 30 minutes. Consider boiling home-canned foods for 10 minutes before serving them.

Constipation is often the first sign of infant botulism, typically accompanied by floppy movements, weakness, and difficulty sucking or feeding. If you suspect your baby might have infant botulism, seek medical help immediately. Prompt treatment with the botulism immune globulin — a substance given through the baby’s veins to work against the toxin — can help prevent life-threatening complications of infant botulism.

It is known that patients with infant botulism excrete both C. botulinum toxin and organism in their feces for periods ranging from weeks to months after symptom onset. Consequently, scrupulous handwashing should be practiced after each diaper change. Soiled diapers should be quickly disposed of in an area where no other person or animal can come into contact with them. Persons with open cuts or wounds on their hands should wear gloves when changing diapers.

Because the patient may be excreting the toxin and organism for weeks to months, it is advisable to limit close contact with other infants and children during this time. This is to ensure that other children do not come into contact with fecal material from a leaky diaper. Any contact the patient has with other infants and children during this time should be supervised by an adult.

C. botulinum is not part of the patient’s normal flora (normal, healthy bacteria that live in our bodies) and will eventually stop being excreted in the infant’s feces.

How can infant botulism be prevented?

The only known prevention measure for infant botulism is to avoid feeding honey to infants 12 months of age or less. Breastfeeding may slow the onset of illness if it develops.

How is infant botulism treated?

Infant botulism is treated with meticulous supportive care with special attention to feeding and breathing needs. In the United States the orphan drug BabyBIG® is also used to shorten hospital stay and reduce complications.

The orphan drug BabyBIG® is human-derived botulism antitoxin that was approved (licensed) by the U.S. Food and Drug Administration (FDA) for the treatment of infant botulism on October 23, 2003. Use of BabyBIG® significantly reduces the length of hospital stay and associated hospital costs in patients with infant botulism.

Can my baby get infant botulism again?

No. Infants treated with BabyBIG® will have a protective level of toxin-neutralizing antibody for at least six months following administration of the medicine. This feature allows sufficient time for elimination of C. botulinum, which has temporarily colonized the infant’s intestine causing disease.

Since the disease of infant botulism was first recognized more than 40 years ago, there have been no instances of an infant acquiring the disease more than once. During this time more than 4400 cases of infant botulism are known to have occurred worldwide.

However, a few reports of “relapsing” infant botulism have been published during this time. Careful review of these case reports by the CDC’s physicians indicates that these were cases in which the infant was discharged prematurely, before they had adequate recovery of strength needed to sustain feeding and breathing. For a further discussion of this topic please see the patient management section of their website here http://www.infantbotulism.org/physician/patient.php.

How soon after BabyBIG® treatment can my child be immunized?

The infant should have good to full recovery of muscle strength and tone before immunizations resume. In addition, most live-virus vaccines (i.e., measles, mumps, rubella and varicella) will need to be delayed until 5 months after BabyBIG® treatment because the antibodies in BabyBIG® may interfere with the effectiveness of the vaccine.

The live-virus vaccines for rotavirus, RotaTeq® and Rotatrix® should also be delayed until 5 months after BabyBIG® treatment ²⁾. Although current data suggest that administration of intravenous immunoglobulin products such as BabyBIG® will not interfere with the efficacy of oral rotavirus vaccines, patients with infant botulism should not receive the rotavirus vaccine because of the slowed intestinal motility that results from infant botulism.

Accordingly, any of the recommended doses of the rotavirus vaccine (RotaTeq® or Rotarix®) that were not given to the infant before treatment with BabyBIG® should be delayed. Because the other live-virus vaccines (i.e., measles, mumps, rubella and varicella) are normally first given at one year of age, only those infant botulism patients who were 7 months of age or older when they were treated with BabyBIG® will need delayed immunization with these vaccines.

What causes botulism

Infant botulism

Babies get infant botulism after consuming spores of the bacteria, which then grow and multiply in their intestinal tracts and make toxins. The source of infant botulism may be honey, but it’s more likely to be exposure to soil contaminated with the bacteria.

Foodborne botulism

The source of foodborne botulism is often home-canned foods that are low in acid, such as green beans, corn and beets. A common source of the illness in Alaska is fermented seafood. However, the disease has also occurred from chili peppers, foil-wrapped baked potatoes and oil infused with garlic.

When you eat food containing the toxin, it disrupts nerve function, causing paralysis.

Wound botulism

When C. botulinum bacteria get into a wound — possibly caused by an injury you might not notice — they can multiply and produce toxin. Wound botulism has increased in recent decades in people who inject heroin, which can contain spores of the bacteria. In fact, this type of botulism is most common in people who inject black tar heroin.

Risk Factors for Botulism

A very small amount of the botulism toxin can cause illness.

People come in contact with this botulism toxin in one of three ways:

• Eating food contaminated with botulism toxin. It is the toxin produced by the botulism bacteria – not the bacteria itself – which causes botulism in humans.Foods that may be contaminated with the botulism toxin include:
  • Home-canned goods
  • Sausage
  • Meat products
  • Seafood
  • Canned vegetables
• An infant can swallowing botulism bacterial spores, which then colonize the bowel and produce toxin. Honey is a common source of botulism spores. Other sources include soil and dust.
• A wound becomes contaminated with C. botulinum and via the wound the toxin reaches the bloodstream and may spread to other parts of the body.
• IV drug use (rare occurence).

Botulism prevention

Botulism is very rare, but you can reduce the risk further by:

• NOT feeding honey or corn syrup to infants who are younger than 1 year old.
• Breastfeeding. Breastfeeding can help prevent infant botulism.
• Taking care when preserving food – the bacterial spores can survive at temperatures of 212 °F (100 °C), so make sure food is well cooked and containers are thoroughly sterilized. Sterilize home canned foods by pressure cooking at 248 °F (120 °C) for 30 minutes.
• Throwing away canned food that is past its use-by date, damaged or spoiled. Always discard bulging cans or off-smelling preserved foods.
• Covering open wounds when gardening or in contact with soil.
• Don’t “TASTE TEST” uncooked foods.
• Keep cold food below 41 °F (5 °C) and hot food above 140 °F (60 °C).

Learn the proper home canning technique available at the U.S. Department of Agriculture in the USDA Complete Guide to Home Canning ³⁾

Botulism signs and symptoms

Signs and symptoms of foodborne botulism typically begin between 12 and 36 hours after the toxin gets into your body. But, the start of symptoms can range from 6 hours afters to up to 10 days later, depending on the amount of toxin ingested.

The main symptom of botulism is extreme weakness – weakness that is so severe it is hard to open your eyes, hard to speak and hard to have the strength to breathe. It is sometimes fatal.

Adults with botulism can also get diarrhea and vomiting, a dry mouth and blurred vision.

Babies with botulism can’t tell you how they feel. But it makes it hard for them to cry, to move, to eat and to drink.

Botulism doesn’t generally increase blood pressure or heart rate, or cause fever or confusion. However, sometimes, wound botulism may cause fever.

Symptoms in adults with foodborne botulism may include:

• an initial short period of diarrhea and vomiting, followed by constipation
• blurred vision
• difficulty in speaking, swallowing and breathing
• drooping eyelids
• facial weakness on both sides of the face
• dry mouth
• weakness, fatigue and ultimately paralysis of the muscles.

Wound botulism

Most people who develop wound botulism inject drugs several times a day, so it’s difficult to know for sure how long it takes for signs and symptoms to develop after the toxin enters the body. Wound botulism signs and symptoms include:

• Difficulty swallowing or speaking
• Facial weakness on both sides of the face
• Blurred or double vision
• Drooping eyelids
• Trouble breathing
• Paralysis

Infant botulism

If infant botulism is related to food, such as honey, problems generally begin within 18 to 36 hours after the toxin enters the baby’s body. Signs and symptoms include:

• constipation (often the first sign)
• weak cry
• loss of head control
• floppy movements due to muscle weakness and trouble controlling the head
• loss of appetite
• breathing difficulties
• reduced movement of limbs and weakness
• irritability
• drooling
• drooping eyelids
• tiredness
• difficulty sucking or feeding
• paralysis

Death may result from paralysis of the breathing muscles.

How is botulism diagnosed?

To diagnose botulism, your doctor will check you for signs of muscle weakness or paralysis, such as drooping eyelids and a weak voice. Your doctor will also ask about the foods you’ve eaten in the past few days, and ask if you may have been exposed to the bacteria through a wound.

In cases of possible infant botulism, the doctor may ask if the child has eaten honey recently and has had constipation or sluggishness.

Analysis of blood, stool or vomit for evidence of the toxin may help confirm an infant or foodborne botulism diagnosis, but because these tests may take days, your doctor’s clinical examination is the primary means of diagnosis.

However, these clues are usually not enough for your doctor to diagnose you because some diseases have symptoms similar to those of botulism, such as Guillain-Barré syndrome, stroke, myasthenia gravis, and opioid overdose. Your doctor may perform special tests to make a diagnosis. Some of these tests are:

• Brain scan
• Spinal fluid examination
• Nerve and muscle function tests (nerve conduction study [NCS] and electromyography [EMG])
• Tensilon test for myasthenia gravis

If these tests don’t determine what is making you sick, your doctor may order laboratory tests to look for the toxin and the bacteria that cause botulism. These laboratory tests are the only way to know for certain whether you have botulism. It may take several days to get the results of your tests from the laboratory. If your doctor suspects you have botulism, you may start treatment right away.

Botulism treatment

If you suspect that you or someone you know has botulism, see a doctor as soon as possible or go to your nearest emergency department.

If medical help is sought quickly, treatment can reduce the severity of the condition.

The treatment of botulism is mainly supportive.

• The goal of botulism treatment is to establish a clear airway, and provide ventilatory support while the nerve endings regenerate. If breathing difficulty develops, intubation (a tube inserted through the mouth into the trachea to provide an airway for oxygen) and mechanical ventilation can be used.
• Intravenous fluids can be given to maintain hydration while swallowing difficulties persist and nasogastric feeding (feeding through a tube inserted in the nose) may be initiated.
• Antibiotics for botulism treatment (metronidazole or penicillin) are often given but have not been shown to be beneficial in the treatment of Botulism.
• If you have botulism in a wound, a doctor may need to remove infected tissue surgically.
• Botulinum antitoxin is available, however the risk of anaphylaxis is relatively high so it should only be used in severe cases.
• Health care providers need to report cases of the botulism need to be reported to state health authorities so that contaminated food can be recalled and removed from stores.

Antitoxin

If you’re diagnosed early with foodborne or wound botulism, injected antitoxin reduces the risk of complications. The antitoxin attaches itself to toxin that’s still circulating in your bloodstream and keeps it from harming your nerves.

The antitoxin cannot, however, reverse the damage that’s been done. Fortunately, nerves do regenerate. Many people recover fully, but it may take months and extended rehabilitation therapy.

A different type of antitoxin, known as botulism immune globulin, is used to treat infants.

Breathing assistance

If you’re having trouble breathing, you will probably need a mechanical ventilator for up to several weeks as the effects of the toxin gradually lessen. The ventilator forces air into your lungs through a tube inserted in your airway through your nose or mouth.

Rehabilitation

As you recover, you may also need therapy to improve your speech, swallowing and other functions affected by the disease.

Botulism botox

Botulinum toxin is a neurotoxin that is produced by the bacterium responsible for botulism, Clostridium botulinum. The neurotoxin works by weakening the muscles and stopping them from contracting very well, which can lead to paralysis.

The commercial medical drug is a highly purified form of this toxin that can actually be very useful for lots of different medical conditions, not just the cosmetic ones for which it is better known. Some of these are neurological conditions due to muscles being too tight or over-contracted, while it can also be helpful in some other medical indications such as excessive sweating and drooling.

How does botulinum toxin work?

The therapeutic effects of the neurotoxin have been known for some time now with the first clinical use of the preparation in strabismus (lazy eye) or squint, in the 1970’s. There are two commercially available forms of the most common preparation, botulinum toxin type A. Botox was the first drug to use botulinum toxin. Other products now include Dysport, Myobloc and Xeomin. Each is a little different, particularly when it comes to dosage units, so they aren’t interchangeable. The term ‘botox’ is often used interchangeably with botulinum toxin, but this can be problematic given the very different equivalent doses available of these common preparations.

The preparations are purified forms of the toxin, and contain rather minute quantities of the toxin produced by the bacterium. Usually, the infection that produces this toxin, botulism, is quite serious and can cause weakness and even paralysis. The toxin does this by stopping the nerve fibers that control muscles from working the way they normally do. Usually, nerves release a chemical called acetylcholine from its endings which signals the muscle to contract. Botulinum toxin stops this substance from being released, and so the muscle does not contract. While this action is dangerous if released by infection, when purified and injected, it can be incredibly useful in diseases where the muscles are too tight/overcontracted, or where doctors want to stop the release of acetylcholine.

By making sure the injections are in just the right spot, botulinum toxin can provide very effective treatment for lots of conditions with very few side effects. Although the weakening of the muscle is felt to be important, some recent research suggests that some conditions like dystonia, which is an involuntary tightening of muscle, may be the result of abnormal incoming signals from nerves and muscle. This has led to recent thinking that the toxin may exert its beneficial effect by interrupting these incoming signals to the brain as well.

What is botulinum toxin used for?

While Botox may be better known as a tool for cosmetic surgeons to temporarily relax the facial muscles that underlie and cause wrinkles, such as:

• Frown lines between the eyebrows
• Crow’s-feet, the lines that fan out from the corners of the eyes
• Forehead furrows

There are other medical conditions that are treated very effectively by botulinum toxin.

Botulinum toxin injections are also used to treat conditions that affect how the body functions. Examples include:

• Hemifacial spasm;
• Blepharospasm;
• Cervical dystonia/torticollis;
• Spasticity: Cerebral palsy and stroke upper* and lower limb, other cerebral and spinal disorders (e.g. multiple sclerosis);
• Other focal dystonia (e.g. writer’s cramp, oromandibular dystonia);
• Tremor;
• Strabismus (lazy eye);
• Spasmodic dysphonia;
• Hypersecretory disorders: Primary (axillary) hyperhidrosis, hypersalivation (e.g. in Parkinson’s disease);
• Bladder: Detrusor-sphincter dyssynergy and detrusor instability;
• Headache: Tension and migraine;

Blepharospasm

Blepharospasm refers to a spasming eyelid or twitching of muscles around the eye (‘blephara’ being the eyelid and spasm meaning rapid movement). This can be a very unpleasant condition for a sufferer. Patients complain of repetitive blinking and sometimes, an inability to keep the eyes open.

To treat this, very small amounts of botulinum toxin can be injected through a very fine needle into the eyelids. This partially paralyses the muscle and provides great relief.

Hemifacial spasm

Hemifacial spasm is similar to blepharospasm, with an involuntary contraction of the muscles of the face on one side. The most frequently identified cause is a small loop of an arterial vessel just inside the base of the skull, which is pressing on the facial nerve which controls those facial muscles. Once again, injections around the eye and sometimes also the lower face can help.

Cervical dystonia

Cervical dystonia means abnormally high muscle tone (dystonia) in the neck (cervical) and can result in various positions of the head. Some of these may involve the neck being rotated and pulled in a certain direction or down towards the chest. This condition is also sometimes called torticollis or ‘wry neck’.

The injection partially paralyses the muscle and frees up movement of both the neck and also the shoulders. In this case, the toxin is usually injected with the help of an electromyography (EMG) machine that can sense the electrical currents of muscles to make sure that it is being injected in exactly the right spot.

Other dystonias

Like with cervical dystonia, other muscles can also have ‘abnormal tone’ and be too tight. This can limit the amount of movement that is possible. By injecting these muscles with botulinum toxin, they can be freed up and allowed to move more, providing effective treatment for dystonias.

Spasticity

Spasticity is a condition where there is excessive muscle tone, like dystonia, but follows injury to the brain or spinal cord. Often, very large doses of the injection are given into the ‘spastic’ muscles with a specific aim in mind e.g. comfort, mobility or hygiene. Other treatments such as physiotherapy and the use of plaster casts may be important.

Drooling in cerebral palsy and Parkinson’s disease

In children with cerebral palsy and in adults with Parkinson’s disease, there is often excessive drooling, and this can be helped by injecting botulinum toxin into the salivary glands beneath the jaw and on the side of the face that produce the saliva. Often, there is not actually an excess of saliva produced, but a lack of swallowing which normally clears saliva. Acetylcholine (the substance that botulinum toxin blocks) not only controls muscles but also controls the salivary glands and tells them to produce saliva. The toxin basically lowers the drive to create saliva and so can prevent drooling with few side effects.

Hyperhidrosis

Hyperhidrosis means there is an excessive production of sweat from the glands in the skin, which can be very troublesome for some. Acetylcholine is also produced by nerves and stimulates sweat production in the skin; therefore it can be blocked with toxin.

Lazy eye

The most common cause of lazy eye is an imbalance in the muscles responsible for positioning the eye.

Chronic migraine

If you experience migraines more than 15 days a month, botulinum toxin injections may help reduce headache frequency.

Other

Other conditions that can be treated with botulinum toxin include ‘spasmodic dysphonia’ (where the muscles that control speech in the voice box become too tight), tremor, some hyperactive bladder disorders, and occasionally even headache. Botulinum toxin injections can also help reduce urinary incontinence caused by an overactive bladder.

What is involved in having a botulinum toxin injection?

A botulinum toxin injection is usually a quick and relatively simple procedure that can be done in a doctor’s office. Firstly, the area for injection will be cleaned. There may be a little pain or pressure associated with the injection related to the needle and fluid itself, but a local anesthetic agent is usually not required. The actual injection is just like having a vaccination shot, with a smaller amount of liquid being injected into the desired area.

The effects (both the good and bad if present) can be variable but wear off in time (usually within 3-4 months) and so the injection will probably have to be repeated then.

No preparation is needed before you go to have an injection. If you are using a drug that thins the blood aside from aspirin, the clinician may wish to know.

What are the possible side effects of a botulinum toxin injection?

Botulinum toxin in the right hands in the commonly used doses is a relatively safe procedure and there are actually very few serious side-effects. The local side-effects of injection will be different depending on the area into which it is being injected. If injected to treat a spasming eyelid for example, some possible side-effects include drooping of the eyelid, blurred vision, and over production of tears and even some local bruising.

• Botulinum toxin is generally avoided during pregnancy, as is breastfeeding in the days following an injection.

Often after injection, there can be a little bit of excessive weakness in the muscles and if injected into an area like the neck can result in difficulties in swallowing, speaking and even cause noisy breathing. This is because the injection has found its way into some other areas which is sometimes difficult to avoid because of the anatomy.

More general side-effects can include some pain around the site of injection, a rash, some itchiness, headache, crooked smile or drooling and tiredness. There may also occasionally may be flu-like symptoms which are usually short-lived.

Aside from the above, there are some serious side effects of botulinum toxin injections but they are exceedingly rare.

Although very unlikely, it’s possible for the effect of botulinum toxin to spread to other parts of the body and cause botulism-like signs and symptoms. Call your doctor right away if you notice any of these effects hours to weeks after receiving Botox:

• Muscle weakness all over the body
• Vision problems
• Trouble speaking or swallowing
• Trouble breathing
• Loss of bladder control

Select your doctor carefully

Botox must be used only under a doctor’s care. It’s important that injections be placed precisely in order to avoid side effects. Botox therapy can be dangerous if it’s administered incorrectly. Ask for a referral from your primary care doctor or look for a doctor who specializes in your condition and who has experience in administering Botox treatments.

A skilled and properly certified doctor can advise you on the procedure and help determine if it best suits your needs and health.