Smith-Kettlewell and Botox
Smith-Kettlewell and Botox

A Useful Poison

Why would someone want a facial injection of one of the deadliest poisons on the planet? Especially if that neurotoxin was the botulinum toxin type A, the kind found in improperly canned foods, which can cause lethal food poisoning? In fact, more than 2.5 million people in 70 countries have voluntarily exposed themselves to this toxin. Botulinum toxin, otherwise known as Botox, is best known for its cosmetic application in combating facial wrinkles. It works by disrupting nerve impulses, relaxing or paralyzing muscles, depending on the dose. (The toxin, Botox, however, is found to be very safe in therapeutic amounts, one of the safest drugs we have; a fatal dose generally requires at least 35 vials of Botox.)

Botox Pioneered at Smith-Kettlewell

What isn't commonly known outside the ophthalmologic community is that the therapeutic usage of Botox, or botulinum toxin, was pioneered here at Smith-Kettlewell as a treatment for crossed eyes (strabismus), as well as for blepharospasm, facial muscle disorders, leg cramps, and wry neck (torticollis).

In 1980, ophthalmologist Dr. Alan Scott, a Senior Research member at the Smith-Kettlewell Eye Research Institute, first described the use of botulinum toxin in the treatment of strabismus and blepharospasm. He found that with the neurotoxin he could bring crossed eyes into parallel alignment by injecting the drug into eye muscles. Under the effect of the toxin, the muscles would relax enough for the eyes to uncross. Dr. Scott dubbed it Oculinum and later sold it to the pharmaceutical company, Allergan, where an energetic advertising campaign transformed the little known ophthalmologic drug into the well-known Botox of today (Newsweek, May,13, 2002).

The word itself has become such a part of our nation's lexicon that it was recently added to the Merriam Webster's Collegiate Dictionary.

The Tip of the Iceberg

What is exciting to us at Smith-Kettlewell is that strabismus treatment is just the tip of the iceberg concerning medical applications of Botox. While currently approved by the US Food and Drug Administration (FDA) for treating uncontrollable blinking (blepharospasm), crossed eyes, neck and facial spasms, and frown lines, researchers continue to discover new benefits of the botulinum toxin.

Sometimes compared to penicillin for its versatility against a wide range of ills (New York Times, March 2, 2003) and because it, too, is an organic product derived from a common bacterium, several hundred medical uses of Botox have already been determined. Botox is widely used as a treatment for stroke paralysis, facial tics, and stuttering. It is also being tested as a treatment for morbid obesity, ulcer prevention, muscle spasms, clubfeet, spastic vocal cords, lower back pain, incontinence, writer's cramp, carpal tunnel syndrome, and tennis elbow.

The Food and Drug Administration recently approved the use of Botox for treating excessive underarm perspiration. The treatment, which lasts an average of seven months, consists of having several injections of Botox in the armpit, which blocks the release of the neurotransmitter responsible for underarm sweating.

A recent news report in the San Francisco Chronicle (May 8, 2004) indicates that Botox has helped a concert pianist who suffered from a career-crippling case of focal dystonia, a disorder involving uncontrolled nerve signals which cause healthy muscles to spasm. Additionally, colon and rectal surgeons and pediatric orthopedic surgeons are trying Botox treatments as alternatives to some types of surgery.

A New, Selective Painkiller

One of its most promising potentials is the toxin's ability to relax muscles and relieve pain. It has advantages over other paralyzing and painkilling agents, especially in its specificity. Unlike most other painkillers, Botox works only where injected. It offers a range of selective muscle influences, from a small weakening of the muscles to full paralysis. The effect is long lasting but not permanent, so over effects are reversible as the toxin wears off.

There has even been work done with modified Botox that make it more effective against pain by affecting only pain nerves, ignoring all other nerve cells. The combination chemical was found to be as effective as morphine at killing pain and unlike morphine, which wears off in a few hours, it lasts longer than 9 days.

People suffering from migraine headaches have experienced Botox's power of pain relief. Discovered by accident, migraine sufferers who were being treated for frown lines noticed they stopped having migraines. A large clinical trial studying the toxin's use for migraines is in its final stages.

The Power of Science

The potential benefits of botulinum toxin have far surpassed its initial application for crossed eyes. We are proud of the fact that Botox's beginnings started at Smith-Kettlewell. This is a perfect example of why scientific research is so important. It shows how seemingly small advances can have such far-reaching effects.