New uses for Botox by Dr. Patrick Treacy

PR Log (Press Release) – Jun 21, 2009 – Botulinum neurotoxin, once called the 'most poisonous poison on the planet' and a ‘potential bioterrorist weapon’ has recently seen a surge in the number of medical conditons that this controversial, elegant and specific toxin can treat. In Ireland, botulinum toxin it comes in two forms, Botox ® and Dysport ® and the original word patented by Allergan has now crept into the common use for both as Botox. Within the first few months of 2006 the application of this novel pharmaceutical was extended to use in voice tremors and then came news that it could be used to treat depression. And if that was not enough, last month came the news that Botox could be used in the future treatment of benign prostatic hypertrophy. I thought it was now time to review this new penicillin of the 21st centurys uses outside of cosmetic medicine. I must initially say that I am skeptical about the study of the treatment of depression with Botox, which was published in the May 2006 issue of the Journal of Dermatologic Surgery. I was glad to see in an accompanying commentary, the editor Alastair Carruthers, cited a series of flaws with the study and concluded that its finding must be considered anecdotal. I had similar concerns with the study of Botox and depression by Dr. Eric Finzi, MD, from the Chevy Chase Cosmetic Center in Maryland. This doctor used a very small number of patients, lacked a control group, had no psychiatrist assessing the patients and even allowed the patients to assess themselves. It is of more than passing interest that this doctor has now filed a patent concerning this treatment.

Benign Prostatic Hypertrophy

The more intriguing study regarding the use of Botox for patients with benign prostatic enlargement (BPH) comes from a better academic pedigree. It was presented at the 2006 meeting of the American Urological Association in Atlanta at the end of May this year. Benign Prostatic Hypertrophy is one of the most common diseases affecting men as they age. During the condition an overgrowth of prostate cells constricts the urethra so the flow of urine is reduced, making it increasingly difficult to empty the bladder. More than 50% of men over the age of 60, and 80% by age 80, will develop have enlarged prostates. This means 50% will develop symptoms of BPH, which include more frequent urination, urinary tract infections and in severe cases, eventual damage to the bladder and kidneys.
During the study, researchers, Dr Michael B. Chancellor, (Professor of Urology, University Of Pittsburgh) and Kaohsiung Hsien, M.D., (Chang Gung University Medical College in Taiwan) injected Botox into the prostate gland of men with BPH and found that it eased symptoms and improved their quality of life. The patients had prostatic symptoms that were unresponsive to standard medical treatment. The study revealed that 75% of the patients had improvement in their quality of life, which apparently remained over one year after being injected. Of interest, was the fact that 80% of the patients were able to completely empty their bladders within a week to one month after the injection. The study showed that the botulinum toxin caused the prostate gland to relax, putting less pressure on their urinary system. It was important to note that none of the patients experienced any significant side effects. It appears that Botox reduces the size of the prostate gland through a process called apoptosis, in which the prostate cells die in a programmed manner. This reduction in size can improve urine flow and decrease residual urine left in the bladder.


The research teams demonstrated that injection of Botox (botulinum toxin A) into the prostrate gland produced improvement in symptoms such as the frequent urge to urinate, incomplete emptying of the bladder and low urine flow rate in men with bladder outlet obstruction due to BPH. This fact has actually been known for some time. In 2003, Giorgio Maria, MD, (University Hospital Agostino Gemelli in Rome), treated 30 men with severe symptoms of enlarged prostate with Bootx and showed that after two months, the pateints had reduced their symptoms significantly.
Prostates also reduced in size
Of interest was the fact that the men's prostates also reduced in size as most of them became half as large, and their PSA levels -- a measure of cancer risk -- also dropped. This meant that BTX-A injected into the prostate seems to be a promising approach for the treatment of benign prostatic hyperplasia. In an editorial comment accompanying the study, Alexis E. Te, MD, of Weill Cornell Medical College in New York, said the results of the Italian study were very promising. He also noted that not all urinary problems result from enlarged prostates -- nor do all enlarged prostates cause urinary problems. Another study was published in Prostate in 1998 by the joint researchers of the above paper to investigate the mechanism of action by which BTX-A might work to reduce the symptoms of prostatic hypertrophy. It was known that surgical denervation is known to produce profound reduction of the rat prostate. Because Botulinum toxin type A (Botox) produces a long-term chemical denervation, the potential to induce reduction of the rat prostate cells was explored. For this study, researchers injected varying doses of Botox into the enlarged prostates of adult male rats. One week after injection, researchers noted an increase in cell death, a contraction of the prostate and a relaxation of the bladder muscles, thereby allowing urine to flow more freely.

Treating Lumbar pain

There is growing evidence that Botox may also be effective for lumbar pain secondary to spasm. Researchers from the Walter Reed Army Medical Center in Washington, D.C., studied 31 patients with lower back pain. (Bahman Jabbari: Neurology, 2001). All of the patients had experienced pain for at least six months, with an average of six years, and were taking standard medications, which they continued to take during the study. Patients received either Botox injections or injections of a saline solution. Three weeks after the injections, 73% of those who received Botox injections said the amount of pain they experienced had gone down by 50% or more. Two months later, 60% of those who received Botox said their pain was still decreased by 50% or more.

Migraines

Botox has already been shown to help prevent and treat migraines and doctors usually inject it into various trigger points that can differ from patient to patient. The duration of action of BTX-A in migraine prevention varies from about 10 to 13 weeks and the onset of effect may take a few weeks. Ideally, the medication should not be administered more frequently than every 3-4 months. I was interested to see a recent paper by Brazilian dermatologists Dr Bertha Miyuki Tamura and Dr Bobby Chang (Dermatol Surg 2003) who used known acupuncture points to achieve temporary relief of pain in acute migraine. They gave the treatment to 10 women who regularly suffered from severe and prolonged migraines and after 2 weeks, 9 were pain free and one had minimal pain. The results lasted between 4-6 months.

Chronic Pain control

One of the most innovative pieces of research for the use of Botox in the treatment of chronic pain is presently being undertaken at the Centre for Applied Microbiology and Research in Porton Down. A recent article in New Scientist states that scientist Keith Foster is using botulinum toxin in conjunction with a protein from the Mediterranean coral tree, Erythrina cristagalli, to develop a new drug that can paralyze the nerves that transmit pain signals. It appears that this team discovered that the Mediterranean coral tree has a protein that binds to the surface of pain neurons and no other cells. By altering a key chemical segment of the toxin, scientists have made it home in on the nerve cells that transmit pain signals to the brain. The altered toxin stopped pain without affecting sensation.