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Treating MS With Botulinum Toxin

What Is Botulinum Toxin?

Botulinum toxin is a muscle-relaxing medication used to decrease spasticity related to multiple sclerosis and other neurological conditions.

Botulinum toxin is derived from the bacterium Clostridium botulinum and is in a class of drugs called neurotoxins. There are four types of botulinum toxin available for therapeutic use:

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  • OnabotulinumtoxinA (Botox/Botox Cosmetic)
  • RimabotulinumtoxinB (Myobloc)
  • AbobotulinumtoxinA (Dysport)
  • IncobotulinumtoxinA (Xeomin)

Your doctor will decide which type of botulinum toxin is appropriate for you.

Despite the fact that the drugs are used for a variety of medical problems, the FDA, as of this date, has not yet approved the use of these treatments for MS-related spasticity. Botox, Myobloc, Xeomin, and Dysport are approved by the FDA for the treatment of a condition marked by repetitive contraction of the neck muscles (cervical dystonia), chronic migraine headaches, and uncontrollable blinking of the eyelids (blepharospasm). Botox is commonly used to treat wrinkles.


What Is Spasticity?

Spasticity refers to a wide range of involuntary muscle contractions that result in muscle spasms or stiffness. Spasticity interferes with voluntary muscle movement and usually involves the muscles of the legs and/or arms.

Spasticity is the result of an imbalance in the central nervous system, caused by a trauma or disease in the brain and/or spinal cord. This imbalance causes hyperactive muscle stretch reflexes, which result in involuntary contractions and increased muscle tone.

Some doctors believe that an increased sensitivity in the parts of the muscles that are responsible for contracting (tightening), relaxing and stretching the muscles contribute to spasticity.



How Does Botulinum Toxin Work?

Normally, the nerves in the body send electrical messages to the muscles so that they will  contract and move. This messages are  transmitted from the nerves to the muscles by a substance called acetylcholine. Botulinum toxin works to block the effect of acetylcholine on the muscle, resulting in weakness or paralysis.


How Are Botulinum Toxin Treatments Given?

Botulinum toxin is administered  as an intramuscular injection (into the muscle). Your doctor will determine which muscles need to be injected to reduce the degree of spasticity.

If the muscles to be injected are small or difficult to reach, it may be necessary to record electric signals from the muscles, to ensure that the appropriate muscles are receiving the injected medication.

A very fine needle is used for the injection. Although the  medication usually does not sting or cause irritation, some people report minor and temporary discomfort from the injection.

The effect of the medication begins to appear from one to two weeks after the injection. The muscles injected should start to  relax.


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