Relaxation of overactive muscles using botulinum toxin. Performed for neurological indications; this is not a cosmetic procedure.
Indication
- Cervical dystonia (involuntary neck rotation/tilting) and blepharospasm (eyelid contraction)
- Muscle spasticity following stroke or brain injury (especially wrist and ankle)
- Spasticity from cerebral palsy in children and adults
- Hemifacial spasm (involuntary twitching on one side of the face)
- Chronic migraine prophylaxis (≥15 headache days per month, ≥8 with migraine features)
- Excessive salivation (sialorrhea) and selected hyperhidrosis cases as supportive treatment
- Neurogenic overactive bladder (with specialist evaluation)
Preparation
- All medications used must be reported; physician approval is required for blood thinners
- Aminoglycoside antibiotics, myasthenia gravis, or similar neuromuscular conditions must be disclosed
- Pregnancy or breastfeeding status is reported in advance
- If previous botulinum toxin treatments have been given, the brand, dose, and response should be noted
- On the procedure day, avoid creams and makeup on the skin; come in comfortable clothing
How it's performed
- Target muscles are identified through examination, with EMG or ultrasound guidance if needed
- The skin is cleaned with antiseptic solution; injection is performed with a fine needle into the planned muscles
- Total dose and number of points are individualized based on region and indication
- For chronic migraine, a standard scheme is applied to head, forehead, temples, neck, and shoulders
- The procedure usually takes 15-30 minutes and does not require anesthesia
- Cold compresses may be applied afterward; the patient returns home after a brief observation period
Post-procedure
- Onset of effect: 3-7 days; full effect becomes evident within 2 weeks
- Effect duration is typically 3-4 months; treatment may be repeated every 12-16 weeks if needed
- Follow-up at weeks 4-6 after the first administration to assess response and side effects
- Maintaining a daily headache diary in migraine treatment
- Emergency consultation if rapidly progressing weakness, swallowing, or breathing difficulty develops
Risks
- Temporary pain, redness, and bruising at the injection site
- Transient weakness of off-target muscles (e.g., eyelid drooping, asymmetric smile)
- Temporary swallowing difficulty or neck weakness with neck injections
- Rarely flu-like symptoms or headache; very rarely allergic reaction
- Spread of effect and generalized weakness in patients with neuromuscular disease (warning indication)
FAQ
Is this the same as cosmetic 'Botox'?
Although the active ingredient is the same protein, the dose, target muscles, and administration scheme in neurological indications differ from cosmetic procedures and are planned by a neurologist.
How long does the effect last?
It typically lasts 3-4 months. Duration varies by patient and target muscle; treatment is repeated at the same intervals if needed.
How many sessions are needed for migraine?
At least 2 sessions (12 weeks apart) are recommended to assess response. If significant benefit is not seen, the treatment plan is reassessed.
Does it cause dependency or permanent harm?
The effect of the toxin is temporary and does not leave permanent damage to muscle or nerve. With repeated administration, the physician monitors dose and intervals.
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