Botulinum Toxin Treatment Program

Botulinum toxin is a potent neurotoxin produced by the bacteria Clostridium botulinum.  The toxin blocks the release of acetylcholine, a neurotransmitter, into the space between the nerve and the muscle. This in effect causes muscle paralysis.  If the toxin becomes systemic, such as in the case of Clostridium bacterial infection or consuming large amounts of contaminated food, botulism can occur, causing difficulty moving and breathing.  However, the botulinum toxin used in medical injections has been carefully sterilized and diluted to prevent this from occurring. 

What types of botulinum toxin are available?

In nature there exists 8 types of botulinum toxin, named A-H, but only types A and B are available for use.  Though Botox is the most widely known, it is one of four brands approved in the United States for medical treatment, three being type A and one type B.  These are:

               Botox (Onabotulinumtoxin A)

               Xeomin (Incobotulinumtoxin A)

               Dysport (Abobotulinumtoxin A)

               Myobloc (Rimabotulinumtoxin B)

No generics are available.  All types have shown to be equally effective, though choice of brand may depend on pricing and current FDA approvals. This should be discussed with your physician.

Within movement disorders, botulinum toxin is used to treat dystonia (e.g. cervical dystonia, blepharospasm), hemifacial spasm, and in certain cases tremor and tics.  Additionally botulinum toxin injections can treat spasticity of muscles that can occur after a brain or spinal cord injury such as a stroke.  It temporarily reduces overactive muscle contractions allowing for more normal mobility and can even relieve pain. Botulinum toxin is also approved for the treatment of chronic migraine, overactive bladder, excessive drooling (sialorrhea), and excessive sweating (hyperhidrosis).

Botulinum toxin is injected intramuscularly using a fine needle.  Depending on the reason and area being treated multiple injections may be required.  Practitioners may use anatomical landmarks, electromyography (EMG) or ultrasound for guidance depending on what is being treated as well as where he/she was trained.  The injections are an outpatient procedure and take place in the office. 

Though it is a toxin, with proper administration and correct dosage, the injections can provide the desired benefit with minimal risk.  Sometimes patients may experience mild flu-like symptoms for the first few days to a week, but otherwise systemic complications are exceedingly rare.  Other side effects may stem from local spread depending on the area being injected, such as drooping eyelids from injections around the eye.  Your physician will discuss with you the possible complications based on your condition.  The side effects around the injection site may include pain, redness, bleeding and hematoma. 

Therapeutics effects start in about a week to 10 days and peak around 6 weeks post injections.  On average injections will last about 3-4 months and then need to be repeated.

For medical purposes, most commercial insurances and Medicare do cover botulinum toxin injections, although your co-pay may vary depending on your plan.  If your insurance does not cover or if you do not have insurance, most of the companies offer an assistance program.

At Rutgers - Robert Wood Johnson neurology clinics, you will first need a consultation with the appropriate specialist.  Afterwards your provider will send the prescription for pre-authorization which can take 6-8 weeks.  Once approved, you will be scheduled for your injection, and your pharmacy will ship the medication to the clinic.  Authorization typically will need to be repeated about once a year.

• Movement Disorders specialists
  • Jennifer Y. Chen: dystonia, including but not limited to cervical dystonia and blepharospasm, hemifacial spasm, focal tics, tremor, sialorrhea, spasticity
  • Marco Russo: dystonia, including but not limited to cervical dystonia and blepharospasm, hemifacial spasm, focal tics, tremor, sialorrhea
  • Gian Pal: dystonia, including but not limited to cervical dystonia and blepharospasm, hemifacial spasm, sialorrhea
• Neuro-ophthalmology:
  • Fred Lepore: Blepharospasm and hemifacial spasm
• Headache:
  • Pengfei Zhang: Migraine
  • Shelly Rishty (General Neurology and Epilepsy): Migraine
• Neuromuscular:
  • Shan Chen: Spasticity and sialorrhea