Botox Nation: How One Drug Fixes So Many Problems

Overactive bladder, diabetic nerve pain, excessive sweating, migraine headaches, voice tremors -- these are just a few of the conditions that the drug Botox can treat.

This week came the news that yet another condition might be alleviated by Botox -- benign prostatic hypertrophy, or prostate enlargement.

Botox's manufacturer, Allergan, says that it is one of the most used medications worldwide, approved for 20 problems in more than 75 nations. This list will likely grow as new discoveries are made.

How did one drug -- which was originally approved to treat excessive blinking back in 1989 -- become so useful? The answer lies in how Botox can be injected directly to the source of the problem -- usually an overactive muscle, gland or nerve connection -- with few lingering side effects, making it easy for scientists to experiment with it on different problems.

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"Every group of physicians that have taken on botulism A have found innovative uses for it," said Dr. Alastair Carruthers, a clinical professor of dermatology at the University of British Columbia. Carruthers is also half of the husband-and-wife team that first reported Botox's cosmetic use in the 1990s.

Botox comes from the botulinum toxin produced by the Clostridium botulinum bacteria. If ingested in large amounts, such as from eating infected food, it can cause a deadly infection that works by paralyzing muscles -- including the heart.

But, in very small doses, the toxin has a therapeutic effect by preventing nerves and muscles from "talking" to each other, relaxing the muscle for a period of time.

Initially, the Food and Drug Administration approved Botox to treat excessive blinking, known as blepharospasm, and strabismus, or crossed eyes. It didn't take long for Carruthers' wife, ophthalmologist Jean Carruthers, to notice Botox's most well-known potential -- a "wrinkle eraser."

That's because one of Carruthers' patients asked to continue treatment even after her eye tremors had stopped -- because it relaxed a wrinkle on her brow. Word got out, and by 2002, the FDA had approved Botox for wrinkles, initiating the plastic surgery craze for it.

Prostate Enlargement

The latest news about Botox is that it might help men with enlarged prostates. This discovery was made by yet another observant doctor, urologist Michael Chancellor, of the University of Pittsburgh.

Knowing that the drug was being used to help excessive perspiration caused by overactive sweat glands, Chancellor wondered whether Botox might help his patients suffering from an enlarged prostate, which also is a gland.

The results were promising: After one injection, 80 percent of patients were able to urinate normally. It appeared that Botox relaxed and shrunk the prostate, relieving pressure on the urethra.

"This could be a potential option for men who don't want surgery," said Chancellor, who presented his findings this week at the American Urological Association meeting in Atlanta.

What the Future Holds

Allergan, the company that makes Botox, also is conducting clinical trials for the drug's ability to treat enlarged prostates, not to mention headaches, poststroke muscle tightness, and overactive bladders.

"No other product has applications over such a wide range of medical conditions. It's like the penicillin of the 21st century," said Caroline Van Hove, Allergan's director of communications. "The demand for Botox has fueled funding for other medical uses. That is the beauty of this product."

Botox has its limitations. Some doctors feel that many conditions are complex and that Botox only solves part of the problem. It treats the symptoms but doesn't necessarily reverse them permanently. Botox for wrinkles must be re-injected every few months.

Also, according to Chancellor, the high cost and demand for cosmetic Botox has made it unsafe in some cases. In 2005, black-market Botox led to paralysis in some cosmetic patients.

But, as dermatologist Dr. Rhoda Narins notes, "at recommended doses, Botox is not in the realm of being dangerous."

Narins would know -- like Chancellor and Carruthers, she too helped find a new use for Botox: migraine headaches.

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