What is it?

Botox is the brand name for botulinum toxin-A produced by the Clostridium botulinum bacteria. It is one of the most deadly proteins known to medical science, but it has also been harnessed for the medical industry. Although it is better known for its use in cosmetic and anti-aging procedures, it is also used for spastic muscle syndromes, chronic pain, and in stroke recovery. When injected into the bloodstream or absorbed through the mucous membranes, it can cause botulism, which is a deadly paralytic disease. However, when injected directly into muscles, it can stop muscles from spasm.

How does it work?

For use in decreasing spasticity, Botox works by blocking the release of acetylcholine from neurons in the area of the spastic muscle. It actually keeps the neuron from accessing the compartment that contains the neurotransmitter, and this lack of acetylcholine allows the muscle to relax. Unfortunately, the Botox only lasts for three to four months before the symptoms of spasticity returns. This means that those with chronic conditions will need to get injected three to four times per year.

What is it used for?

Botox is used for a wide variety of medical problems. It was first used for excessive blinking and eye squinting. It is now used for such conditions as cervical dystonia, migraines, and focal neuropathies located anywhere in the body. Excessive sweating is also treated by this medication. Some off-label uses of Botox include focal dystonias, TMJ, diabetic neuropathy, wound healing, and vocal cord dysfunction. It can also be used for painful bladder syndromes, and it is now gaining popularity in the use of post-stroke spasticity.

Research and Evidence

A study published in Clinical Medicine and Research in 2007 examined the use of Botox injections for focal spasticity post-stroke. It found that some functional improvements can be seen with the use of injections, but more profound and global resolutions of spasticity are elusive. The study recommends further research using a larger sample size and more intensive testing.

A further study published in the Journal of Toxicology in 2012 examined the use of Botox injections in stroke victims. It focused on choosing which muscles to target when using the injection, and it examined the relationship of Botox when used in conjunction with rehabilitation. The authors found that the medication was helpful, but more research should be pursued to determine how effective it is when compared with physical therapy.


Clinical Medicine and Research; Botulinum Toxin in Poststroke Spasticity; Suheda Ozcakir, MD and Koncuy Sivrioglu, MD; 2007

Journal of Toxicology; Therapeutic Use of Botulinum Toxin in Neurorehabilitation; Domenico Intiso; 2012