Neuromodulators: Botox, Dysport and Xeomin

What is a neuromodulator? Botox is the best known example of a class of drugs called neuromodulators. These are drugs that block the signal from a nerve to a muscle. When we move our muscles the signal to move starts in the brain, travels down our nerves, and then the nerve sends a signal to the muscle to move. Neuromodulators block the nerve from releasing that signal and it stays relaxed. Botox is the most well known brand, but there are several others that are in the same class. One is Dysport and another is Xeomin. Although they are very similar, there are slight differences that make patients prefer one over another. I personally prefer Dysport because I think it works faster and lasts a little longer than the others.

Cosmetic Uses

Neuromodulators are used for cosmetic reasons to smooth wrinkles caused by muscle contractions. The most common places they can be used is in the forehead, between the eyes (sometimes called 11 lines), and around the eyes to eliminate crows feet. An experienced injector may also use a neuromodulators in less well known applications. One is to reduce a “gummy smile” in patients whose upper lip raises too much when they smile. Another is to reduce “frown lines” due to the corners of the mouth being pulled down too much. For patients who have a square or side jaw, the lower face can be slimmed by relaxing the masseter muscles, one of the chewing muscles on the side of the jaw.

Chronic Migraine

Most people think cosmetics when they hear Botox, but now there are so many more uses approved by the FDA. As of now, only Botox is approved for uses that aren’t cosmetic. In my practice, I commonly use neuromodulators for migraine headaches and facial spasm. Patients who have severe migraine headaches that last more than 4 hours, occur more than 15 days per month, and have failed other medications can usually get approved to have insurance cover for Botox for migraines. In these cases, I inject Botox to multiple sites in the forehead, temples, back of the head and back of the neck. This can give patients a great relief from their headaches, especially if combined with trigger point injections, which are numbing shots injected into the areas that the headaches start.

Facial Spasm

Facial spasm is a condition that can occur in some patients who have had Bells Palsy. Bells palsy is a virus that causes one side of the face to be weak or paralyzed. It usually gets better on it’s own, but sometimes the nerve signals get mixed up during the healing. These patients often complain that their eyes close when they smile or move their mouth. They may also have tightness on one side of the face or neck that can be very uncomfortable. For these patients I also inject Botox, some into the areas that are in spasm, and often into the other (normal) side to help match the side that may be weak.

Other doctors use Botox to treat a range of problems from bladder dysfunction, excessive armpit sweat, cross eyes (strabismus) and abnormal movements in the neck and limbs. As we learn more, we are continuing to find more applications of neuromodulators to treat different problems all over the body. Botox; it’s not just for cosmetic anymore!