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How should we advise on Botox injections?

Q - How can GPs advise on Botox injections?

A - Following a botulinum toxin type A (BTX-A) injection, a toxin, produced by Clostridium botulinum, is internalised within the neuron where it binds to the membrane surface of the acetylcholine-containing vesicle stopping the pre-synaptic release of acetylcholine. The neuronal impulse no longer causes transmitter release and the muscle is therefore temporarily paralysed.

BTX-A has been used for more than 20 years in children with cerebral palsy.

The reported clinical studies and trials of BTX-A have been examined in Cochrane reviews and these should be read by any

doctor wanting further information on the clinical effectiveness and safety of BTX-A.

They conclude that:

 · In limb spasticity BTX-A gives significant improvement in functional activity with very few side-effects

 · In chronic pain management BTX-A provides significant improvement in symptoms, with no side-effects reported

 · In oesophageal achalasia there was a significant reduction in symptoms with no reported side-effects

 · In hyperhidrosis BTX-A was safe and effective

 · For glabellar lines, there was a significant improvement in cosmetic appearance. In one study 5.4 per cent developed mild, temporary blepharoptosis.

Improvement was persistent for up to six months.

It has also been used in focal dystonia, idiopathic torticollis, strabismus, blepharospasm and hemi facial spasm. An internal sphincter block can work in anal fissure.

In expert hands the use of BTX-A to induce areas of focal paresis is associated with improved signs and symptoms in a number of conditions involving muscle hypertonicity.

Dr David Baxter is lecturer in public health medicine at the Evidence for Population Health Unit, University of Manchester Medical School

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