Botulinum Toxin Service

Botulinum toxin is a protein that comes from the bacteria Clostridium botulinum. This is one of the most toxic substances in nature. However, when injected therapeutically in small doses, the toxin is a safe and effective treatment for a variety of medical conditions.

Botulinum toxin blocks the release of acetylcholine at the neuromuscular junction (where nerves meet muscles), thereby relieving the symptoms of dystonia, spasticity, and other disorders. However, evidence suggests that botulinum toxin also offers therapeutic potential for certain non-muscular disorders, such as hyperhidrosis (excessive sweating), overactive bladder, and chronic migraine headaches.

Botulinum toxin is FDA-approved for the treatment of several movement disorders, including blepharospasm, cervical dystonia, and spasticity. Physicians at Mount Sinai's Robert and John M. Bendheim Parkinson and Movement Disorders Center and Mount Sinai's Neuromuscular Division are highly skilled at performing botulinum toxin injections for these conditions.

The primary commercial formulations of botulinum toxin available in the United States for these conditions include Botox® (onabotulinumtoxinA), Dysport® (abobotulinumtoxinA), Xeomin® (incobotulinumtoxinA), and Myobloc® (rimabotulinumtoxinB). These formulations differ in potency, thereby requiring different dosages and injection strategies.

Because of the slight risk of bleeding associated with inserting a needle into muscle, patients should inform their physicians about bleeding disorders or prescribed "blood thinning" agents (anticoagulants), such as warfarin or aspirin.

What to Expect During Your Visit

Botulinum toxin injections are performed in an office setting during a visit usually lasting no more than 30 minutes. The actual injections themselves take only a few minutes. Physicians often use numbing medications (cream or spray) at the site of the injections to minimize discomfort.

The needles used for botulinum toxin injections are smaller in size than needles typically used to draw blood. For injection into some dystonic (overactive) muscles, an electrical stimulator (EMG) is used to more precisely identify injection sites. There is minimal discomfort or bleeding during the procedure.

Within one to three days, muscles begin to relax, significantly relieving your symptoms. This effect usually lasts at least three months, after which time the injecting clinician will reevaluate for further treatment.

Botulinum Toxin Injections for Spasticity

Spasticity is a debilitating condition caused by injury to the brain or spinal cord, in which the muscles continuously contract involuntarily. Botulinum toxin is an excellent, minimally invasive treatment option for spasticity with a low risk of side effects. The treatment is targeted, thereby avoiding potential complications associated with systemic medications or surgical interventions.

David M. Simpson, MD, Director of Mount Sinai's Clinical Neurophysiology Laboratories, has been a leader in the research and clinical use of targeted treatment for spasticity using botulinum toxin. Dr. Simpson and his colleagues provide a coordinated, multidisciplinary approach to spasticity, consulting with rehabilitation medicine, physiatry, physical and occupational therapy, and Surgery Department staff. Botulinum toxin injections for spasticity are performed in the Mount Sinai clinical neurophysiology area, located in the Annenberg Building, second floor (area 218).

Dr. Simpson led a research team that performed and published the first placebo-controlled study demonstrating the safety and effectiveness of botulinum toxin (Botox) in the treatment of post-stroke spasticity. Additional studies by Dr. Simpson's group demonstrated the superiority of botulinum toxin over oral anti-spasticity medications. Further, he has led several studies to enhance the technique of the botulinum toxin injection. Dr. Simpson has lectured and published extensively in this area and trained physicians in these injections throughout the world.

In addition to his spasticity studies, Dr. Simpson chaired a panel chartered by the American Academy of Neurology to develop evidence-based guidelines on the use of botulinum toxin for a wide range of neurological diseases, including movement disorders such as cervical dystonia and blepharospasm;  pain, including migraine; and autonomic disorders, such as hyperhidrosis (excessive sweating).

Botulinum Toxin Injections for Dystonia and Other Movement Disorders

Dystonia encompasses a range of neurological disorders characterized by involuntary movements. Dystonia can affect the neck, eyes, voice, or limbs. Botulinum toxin is the treatment of choice for most of these conditions. Botulinum toxin can be injected in select muscles affected by dystonia, thereby avoiding the potential systemic side effects of medications taken by mouth or complications related to surgical procedures.

Physicians in the Robert and John M. Bendheim Parkinson and Movement Disorders Center are specially trained in the use of botulinum toxin for dystonia and other movement disorders. The Movement Disorders Center is located at 5 East 98th Street on the first floor.

Botulinum Toxin Injections for Chronic Migraine Headaches

In 2010, the Food and Drug Administration (FDA) approved Botox, a commercial formulation of botulinum toxin, for the treatment of chronic migraine. Doctors affiliated with the Mount Sinai Center for Headache and Pain Medicine are experienced in this treatment. This facility is located at 5 East 98th Street on the 7th floor.

Mount Sinai doctors who perform botulinum toxin injections for chronic migraines include:

  • Mark W. Green, MD, is Director of Mount Sinai's Center for Headache and Pain Medicine. He was previously at Columbia University, where he served as Director of Headache Medicine at the College of Physicians and Surgeons and the College of Dental Medicine.

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Botox and Spasticity

In this New York Times article, Mount Sinai’s David M. Simpson, MD, discusses how Botox can relax the muscles of stroke survivors.  Read More