Botox a brand of botulinum toxin A is a therapeutic muscle relaxing agent. Botox belongs to a class of drugs called botulinum toxin  and has been used to treat tens of thousands of patients worldwide for more than 10 years. In the United States there currently are two brands of botulinum toxin type A (Botox) and type B( MYOBLOC).


Botox A

Is a formulation of  botulinum toxin A.  It is derived from the bacterium Clostridium botulinum.

This bacterium produces a toxin that blocks the release of acetylcholine and relaxes muscles.

Besides type A and Type B botulinum toxin there are five other types of botulinum toxin (A, B, C, D, E, F, and G properties  and each have different properties and actions.

No two botulinum toxins are alike.

Botulinum toxin  was first studied in the 1940’s in a search for a vaccine against botulinum .

In the 1960’s the muscle-relaxing properties of botulinum toxin A were tapped for  investigational use in realigning crossed eyes.  These early studies paved the way for treating other conditions caused by overactive muscles.


Toxin A and B is indicated for the treatment of cervical dystonia in adults to decrease the severity of abnormal head position and associated neck pain.

Botulinum is  indicated for the treatment of blepharospasm associated with dystonia, including benign essential blepharospasm or V11 nerve disorders in people  12 years of age  and above.

Is Botulinum Toxin a New Treatment?

No, botulinum toxin has been used for more then 10 years to treat patients worldwide, and is approved by health ministries of at least 70 countries.
Botulinum toxin is endorsed by the American Academy of Neurology and the National Institutes of Health.

How is Botulinum Toxin A and B Different?

The two toxins are different in several ways:

  • They are different serotypes
  • They have different manufacturing processes
  • They work differently
  • They require different doses

How Does Botulinum Toxins Work?

Normally your brain sends electrical messages to your muscles to make them move. The electrical message is transmitted from the nerve to muscle by substance called acetylcholine.  When muscles are overly active, they spasm or tense up

Botulinum toxin blocks the nerve from releasing acetylcholine. As a result, the muscle spasm stops or greatly reduced, providing relief from symptoms. Your doctor will know how much botulinum toxin is needed to treat your problem effectively.

It important to remember that botulinum toxin is not a cure.  For many people, however, its effect have been dramatic to allow them to be more functional and help with there activities of daily living.

The botulinum toxin will take about 3 months to recover and begin to release acetylcholine. And the muscles may become overactive again.

At that point, another injection will be needed to provide relief, as long as an allergic reaction has not occurred and clinical response was obtained.

How Long Can I Be Treated With Botulinum Toxin?

Each treatment usually has duration of 3 months and can be repeated for as long as your condition responds to the toxin and you do not have any serious allergic reactions.
Although most people continue to botulinum toxin injections, some people have experienced a diminished response over time.  Reasons can be:

Changes in your condition-
If the pattern of your muscle activity changes, your physician may need to inject different muscles or change dose.  This sometimes can be difficult to change muscle or muscle group, because of the different changing pattern of muscle involvement and progression of the disorder.

Setting Appropriate Expectations-
You may believe your first botulinum toxin injection was more helpful than subsequent injection. That’s because your condition was perhaps quite severe when you had your first injection.  Subsequent injections are usually given before your condition gets that severe again. Therefore, the relief you experienced with subsequent injections may not have been as dramatic as the first time.

Antibody Formation-
When foreign proteins, like botulinum toxins, enter the body, your body may form antibodies to them. If Antibodies to botulinum toxin develop, you may no longer respond to treatment. You may need to switch botulinum toxin medication.

The best way to prevent antibody formation is by minimizing the lowest effective dose given at the longest feasible intervals between injections.

How is Botulinum Toxin Given?

This is injected into the affected muscle groups. This will be discussed by you and your physician.

When Will The Botulinum Toxin Start To Work?

For cervical dystonia on will see effects from 7 days to 2 weeks of the injection, with maximum benefit reached by week 6 after injection.

How Long Will The Effects Last?

Because of the unique way botulinum toxin works it offers sustained relief, dose after dose.  The relief you’ll feel from one treatment of botulinum toxin will normally last about 12 week or 3 months. Treatments can be continued as long as your condition responds to the toxin, and you do not have any serious allergic reactions.  When the relief begins to fade, you’ll return to your treating physician for the next treatment.

Usually treatment is required approximately four times a year. Because symptoms can change over time, the amount and duration of relief you’ll experience can vary.

What Side Effects Have Been Seen With Botulinum Toxin?

Most frequent side effect or adverse reactions in patients receiving botulinum toxin for the treatment of cervical dystonia are dysphagia (difficult swallowing), upper respiratory infection, neck pain and headache.
Other common side affects can be dryness of the mouth, flu like symptoms, excessive weakness of the muscles, and bruise over the site of treatment.

How can I Find Out If My Insurance Covers Botulinum Toxin?

Before treatment is begun and with each treatment after your initial procedure prior authorization will be obtained because of changes in health care reimbursement programs.