BEBCRF Support Group Meeting – Fall 2006, Vancouver
As chairperson, Heather Brown welcomed all of the members to the meeting including first-time attendee, Matthew Lee, a Neuroscience Specialist with the Canadian Branch of Allergan.
Botulinum Toxin Type A
In the public's mind, botulinum toxin-type A or BOTOX® is mainly associated with cosmetic applications and, as a result, the public has no idea how many other medical applications it has; especially when it comes to ophthalmology.
What is BOTOX®?
It is the registered trademark for botulinum toxin-type A. In reality, there are seven different strains of botulinum toxin. It is created from a strain of bacteria that would in fact cause 'food poisoning' or botulism. In severe cases people actually die from food poisoning. However, it should be emphasized that the medical administration of botulinum toxin-type A is in no way remotely near the strength of the fatal version of this bacteria. Simply stated, the quantity is merely sufficient to paralyze facial muscles/nerves so that the involuntary spasm does not occur.
It should be noted that it is not a chemical but rather a biological substance so it does not interfere with other medications, for example, those prescribed for diabetes, that the patient may be taking at the time of injection. The toxin is 'local', that is, does not travel far from its point of application, nor is there any residue to prolonged use.
In British Columbia, payment for the injection is covered by PharmaCare and depends upon the family's net income. The injections are considered as a part of one's overall medication expenses and are affected by the plan's standard deductible. In the case of private or third-party insurance coverage the patient should ensure that the insurance company understands that the injections are for medical reasons rather than cosmetic. A major portion of insurance companies assume that the BOTOX® injections are for cosmetic reasons and will not initially cover the cost of the toxin.
The efficacy of BOTOX® and the possibility of side-effects
Botulinum toxin-type A, over the years, has shown itself to be very safe; that is, no major or lasting side-effects have been observed. Experience has shown that any manifestation of such side-effects as ptosis (droopy eyelid), bruising, or double-vision, are short-lived and often may be the result of an incorrect injection point or some variance of the dosage used.
Another question that may come to mind is "do ophthalmologists take some sort of course dealing with injection techniques, or, is this something that they develop on their own?" It is really a combination of the two. Most physicians that decide to work with BOTOX® will develop their own techniques as they use the toxin. Some American neurologists will learn about various techniques through their Association. Allergan, together with the American Neurologists Association, offers courses on how to best administer botulinum toxin Type A. However, one has to bear in mind that the results of administering botulinum toxin is 'subjective': that is, they will be different for each patient.
Then there are the questions of frequency, that is, the time between injections, and 'top-up'. It should be stressed that it depends upon the need of the individual patient and the dialogue with his or her physician. As far as Allergan is concerned they have no evidence to date that the frequency of use would be harmful in anyway.
Each doctor has his or her own starting points as far as injections are concerned. Each patient responds differently to the treatment and, as a consequence, what may be good for one patient may not be good for another. In addition, the dosage varies according to the need of each patient. The majority of physicians will take their time with the injections ensuring that possible side-effects are avoided. It should be noted that it is most advantageous if the patient gives his or her doctor accurate feedback concerning the injections.
What about the 'shelf-life' or stability of the toxin?
BOTOX®, over the years, has proven to be very stable and has a good shelf-life. Allergan recommends that the toxin be kept in a cool environment; preferably in a refrigerated unit. Stability tests have shown that toxin, which is four days old and, which has been kept at a constant temperature, is still effective when injected by the physician.
A general observation made by the members is that the efficacy of injections depends a lot on the experience and training of the persons performing this function coupled with the quality of patient feedback given.
BOTOX® is a registered trademark of Allergan Corporation