Can an Injection that Smooths Wrinkles Also Treat Serious Childhood Conditions?

You may think that botulinum toxin, most commonly known by brand name Botox, is only used to smooth wrinkles and improve your appearance. But it also can treat some serious childhood conditions, such as cerebral palsy. And promising new therapies for children continue to be discovered.

What Is Botulinum Toxin?

Botulinum toxin is produced by the bacteria Clostridium botulinum in eight different types. Type A of the toxin is used the most often for medical and cosmetic treatments. When it is injected in tiny doses into targeted areas, it blocks signals between nerves and muscles so the muscle cannot contract. This causes the muscle to relax.

There are four brand-name neurotoxins: Botox, Dysport, Jeuveau and Xeomin.

Approved Uses for Botulinum Toxin

If your child has cerebral palsy, you may be familiar with some of the most effective uses for botulinum toxin. The U.S. Food and Drug Administration (FDA) has approved it to treat two related conditions: limb spasticity and excessive saliva. One of the hallmarks of cerebral palsy is overactive, tight muscles that interfere with a child’s daily functioning. For example, many children with cerebral palsy walk on their toes. If the muscles in the ankle are injected with the toxin, they relax, allowing the child to bring the heel down and have a better gait.

In the case of excessive saliva, injections guided by ultrasound in front of the ears and chin have been shown to prevent drooling and choking. Both uses of the drug have been approved for children ages 2 to 17.

The toxin also is approved in the United States for the treatment of blepharospasm, or the involuntary tight closing of the eyelids, in kids 12 years and older. The severity of this condition can vary between frequent repeated blinking and persistent vigorous shutting of the eyelids with functional blindness.

Off-Label Uses for Botulinum Toxin

Once a drug has been approved by the FDA for a condition, physicians legally are allowed to prescribe it for any medical issue they think it could help, regardless of whether it’s been proven to work for that condition. That has led to many exciting new uses for botulinum toxin.

For many teenagers with chronic migraines, the toxin has changed their lives. Chronic migraines are defined as more than 15 headache days a month for at least three months. This condition affects 7.7 percent of children in the United States, decreasing their quality of life, performance at school, exercise and sleep. Migraine pain can be so intense that sufferers often cannot function or think well during or immediately after the attack. Migraines can also increase anxiety and depression.

If your child is deemed a candidate for botulinum toxin treatments for migraines, the doctor will administer 31 injections in your child’s head and neck as often as every 12 weeks. The injection sites include your child’s forehead, temples, back of the head, upper neck and shoulders. The toxin blocks chemical signals that cause muscles to contract, making them less stiff and less sensitive to pain.

Is Botulinum Toxin Safe?

For most children, botulinum toxin is a safe treatment. However, the FDA requires manufacturers to label these products with black box warnings about the possible risk of serious side effects if the toxin spreads to other parts of the body. They can include:

• Trouble breathing or talking
• Blurry vision
• Muscle weakness
• Loss of bladder control
• Death

“The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults, particularly in those patients who have underlying conditions that would predispose them to these symptoms,” the warning states.