Beyond Wrinkles

Botox provides Mary Greeley Medical Center patients benefits that go well beyond cosmetic.

Doreen Szopinski is in her eighties, but wrinkles weren't the reason her doctor suggested she should try Botox. Instead, Botox was seen as an option to relax severely contracted muscles in Szopinki's arm, which had been damaged by the effects of a stroke she suffered more than 30 years ago.

Botox is derived from botulinum toxin, which is a nerve poison. In large amounts, it can be deadly. But small, diluted doses can weaken certain muscles or glands. Its medical uses were discovered in the 1970s by an ophthalmologist who used it to treat lazy eye. While more commonly known as a cosmetic treatment, Botox now is used by many doctors to address neuromuscular issues. 

Stroke caused extensive muscle and nerve damage to Szopinski's right side. Over the years, the muscles in her right hand tightened to the point where the hand was in a permanent fist. Muscles in her right arm also contracted. As a result, the arm was bent at the elbow and moving in tighter and tighter against Szopinski's body.

Growing Awareness

Szopinksi was referred to Dr. David Moore, a board-certified neurologist with McFarland Clinic.

"A lot of people aren't aware of the uses of Botox or they have misinformation, including people in the medical professions," says Moore. "Most people hear about it by word of mouth."

Botox is injected into the junction where nerve and muscle meet. It is taken into the nerve, blocking it from releasing chemicals that make muscles contract. Botox treatments are usually administered every three to six months. The number of injections depends on the problem. It is effective 80 to 90 percent of the time, says Moore.

"Botox makes everything weak or loose," says Moore. "But the best thing about it is that it's 100 percent reversible. If you don't get any more treatments, you go back to the way you were."

Botox can ease pain and improve function, but there has to be function to improve. In Szopinski's case, her right arm was no longer functioning because of the effects of the stroke. But Botox treatments have relaxed her hand and arm, which is no longer pressed into her body. This has made her care, particularly dressing and showering, easier.

The treatments have also eased potential problems with her finger nails. When a stroke victim's hand contracts, it can drive the finger nails into the skin, causing pain and other problems.

A Variety of Uses

Moore, who started treating patients with Botox in 1990, is a consultant for Allergan, the producer of Botox. He often speaks on the benefits of the drug and trains medical professionals on its uses. He uses Botox as a treatment for a variety of neurological conditions, including:

  • Cervical dystonia, which involves the neck
  • Spasmodic dysphonia, which involves vocal muscles
  • Blepharospasm, which involves eyelids
  • Hemi-facial spasm, which involves muscle spasms on one side of the face
  • Oromandibular dystonia, which affects the muscles of the jaw, lips, tongue, and larynx
  • Hyperhydrosis, or excessive perspiration
  • Spasticity due to stroke, closed head-spinal injury, and cerebral palsy
  • Hypersialorrhea, or excessive saliva production

Specialized Care

There are only a few doctors in central Iowa who have extensive training with Botox. In addition to Moore, there is a neurologist at Methodist Hospital in Des Moines and another at Mercy Hospital who regularly use Botox for treatments other than cosmetic. Moore also treats children at the spasticity clinic at ChildServe in Johnston.

"Unfortunately, there are a lot of doctors who really don't know how to use it," says Moore. "I recently had a patient who had been given Botox by an inexperienced doctor and suffered from excessive weakness, which is an undesired side effect. There's definitely a learning curve. You have to know which muscles will be the primary cause of someone's problems."