Posted Sunday, January 14, 2007
The neurological disorder that plagues Art Kessler arches his spine painfully backward and swivels his neck sideways. Every three months for the past four years, the 39-year-old private-equity manager from Chicago has gotten injections in his neck and along his spine that relax his tightened muscles and allow him to work, play with his young son, and "live a normal life. It's been huge for me in terms of keeping me mobile," Kessler says. The shots responsible? Botox.
In the past decade, since its war on wrinkles began, Botox has gained a massive following, from soccer moms to movie stars, who refuse to accept the evidence that they're getting on in years. Sales for cosmetic use of the drug, which causes temporary muscle paralysis and prevents the grimacing that leads to crow's feet and frown lines, were $357 million in 2005, according to Allergan, the drug's manufacturer. Meantime, sales for far-less-publicized therapeutic uses reached $473 million, as doctors have wielded it against everything from cerebral palsy to headache to Parkinson's disease and crossed eyes. "I don't know of a single treatment that has more applications," says Joseph Jankovic, director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine in Texas and a pioneer in Botox research.
It was Jankovic's work that led the Food and Drug Administration to approve Botox back in 1989 as a treatment for blepharospasm, an eye-muscle disorder that causes abnormal blinking. Injecting the drug-diluted botulinum toxin, a poison-directly into an affected muscle inhibits the neurotransmitter acetylcholine from relaying messages from the brain, which relaxes the clenching and thereby eases pain. It's the overactive signaling from the brain that's common to the conditions the drug treats best. Botox paralyzes only at the site of the injection, but patients must endure needle jabs directly into the problem area-again and again, since the drug's effect wears off in a few months.
Off-label use. Besides brow-wrinkling and blepharospasm, Botox has been approved to treat crossed eyes, cervical dystonia (involuntary muscle contractions in the neck and shoulder), and-most recently-excessive underarm sweating. (Acetylcholine also stimulates sweat glands.) But the list of "off label" targets has been growing fast and now includes lower back pain, constipation, epilepsy, tennis elbow, and fibromyalgia, to name a few. Jankovic considers the injections to be quality-of-life-saving to a number of patients with disorders that cause uncontrollable movements, including Parkinson's disease, tremors, and Tourette's syndrome. (With research support from the drug companies, Jankovic has been studying the effectiveness of two competing drugs as well as Botox, in hopes of ultimately lowering the cost of treatment.)
"Without it, I would not be on the air," says National Public Radio talk show host Diane Rehm, who has spasmodic dysphonia. The condition clenches her vocal cords, causing her voice to quiver and crack. Shots into her vocal cords every four months have saved her career, she says. More than 50 clinical trials of botulinum toxin are currently underway, including Allergan-sponsored efforts to rack up FDA approvals for headache, overactive bladder, and spasticity caused by stroke.