The power of Botox, a drug with many faces

For those of us who first learned of Botox from the frothy pages of People and Entertainment Weekly, it might come as a surprise that a drug that rose to fame in the 1990s as wrinkle-eraser to the stars now makes regular appearances in the venerable Annals of Neurology . But Botox is serious medicine, “one of the biggest breakthroughs of the last 50 years,” says Yale Medical Group (YMG) physician and Associate Professor of Neurology Jonathan M. Goldstein, M.D., a member of YMG’s Botulinum Program.

Botox is a trade name for botulinum toxin type A, the highly potent bacterial substance that causes botulism poisoning. Botulinum makes wrinkles less obvious by relaxing facial muscles, but the drug also eases symptoms in a number of serious medical conditions, including multiple sclerosis, cerebral palsy and chronic muscle spasms. Botulinum is also useful in treating migraines and excessive salivation or sweating.

More than 300 patients with a wide range of symptoms visited YMG’s Botulinum Program last year. One, H. Stuart Engar, suffered neck pain from an undiagnosed neurological disorder for 15 years before enrolling in a botulinum study conducted by Professor of Neurology Bahman Jabbari, M.D., who was one of the first re-searchers to establish the drug’s effectiveness in treating pain. Engar says the relief provided by botulinum has been “life-changing.” According to Jabbari, Engar’s enthusiasm is not unusual, because botulinum can dramatically relieve symptoms in chronic conditions that are otherwise difficult to treat. New uses for the drug continue to evolve at Yale, where Jabbari is testing its effectiveness in pain management and other applications.

Clinical interest in botulinum dates back to the 1960s, when Alan B. Scott, M.D., of the Smith-Kettlewell Eye Institute in San Francisco showed that the toxin could successfully treat disorders of eye muscles. In collaboration with biochemist Edward J. Schantz, Ph.D., of the University of Wisconsin, Scott developed a botulinum treatment for humans that was approved by the Food and Drug Administration in 1978.

Ten years later, Allergan purchased the rights to pursue other medical applications of botulinum from Scott, and gave the drug the now-famous Botox brand.