What the treatment helps with
In neurology, botulinum toxin is used for conditions in which individual muscles are involuntarily and persistently contracted:
- Cervical dystonia — an involuntary turning or tilting of the head, often with neck pain
- Blepharospasm — forceful closing of the eyelids, which can amount to functional blindness
- Hemifacial spasm — twitching of the facial muscles on one side
- Spasticity — increased muscle tone after a stroke, in multiple sclerosis or after spinal cord injury
- Excessive salivation — for instance in the course of Parkinson's disease
- Chronic migraine — under certain conditions and once other treatments have been exhausted
Whether the treatment is an option in an individual case only becomes clear after a neurological examination. The symptoms must be clearly attributed, because the treatment is always directed at specific muscles.
How the treatment works
Botulinum toxin interrupts signal transmission from nerve to muscle. The treated muscle relaxes as a result, without any loss of sensation in the area.
The effect is not immediate: something is usually noticeable after a few days, with the full effect after one to two weeks. It then typically lasts around three months before gradually wearing off. Treatment is therefore repeated at intervals.
The effect is thus temporary and reversible. That is not a drawback: it allows the dose and the choice of muscles to be matched more precisely to the symptoms each time.
What happens
A thorough examination precedes the first treatment, establishing which muscles are actually involved — with a turned head these are often not the ones one would assume.
The treatment itself takes only a few minutes. The substance is introduced into the affected muscles with a very fine needle. For deeper muscles, or those that are hard to palpate, I guide the needle under ultrasound — often this is not necessary.
A review after about two weeks can be useful to assess the effect. What emerges then informs the next treatment.
What you should know
Used appropriately, botulinum toxin is well tolerated. Like any effective treatment it nonetheless has possible side effects, which you will be informed about beforehand.
The most common is temporary weakness of neighbouring muscles. Treatment in the neck area can temporarily cause difficulty swallowing; treatment in the face can cause a drooping eyelid. These effects recede as the substance wears off.
Botulinum toxin must not be used in certain disorders of neuromuscular transmission, where there is an infection at the injection site, or during pregnancy and breastfeeding. Whether any of these applies to you is something we clarify in consultation.
For the recognised neurological indications, health insurers usually cover the cost in full or in part. As this is a private practice, you settle the fee yourself first and then submit the invoice.
Certification
I am certified for botulinum toxin therapy by the Austrian Dystonia and Botulinum Toxin Working Group (ÖDBAG), which maintains a public register of certified physicians.
Frequently asked
- Is this the same as a cosmetic treatment?
- No. The substance is the same, the application is not. In neurology the aim is to reduce the pathological overactivity of particular muscles — not to alter appearance. I do not offer cosmetic treatments.
- Does the treatment hurt?
- The needles are very fine. Most people feel a brief sting, comparable to having blood taken. Anaesthesia is not usually required.
- How often does treatment need repeating?
- Usually every three months. The exact interval depends on how long the effect lasts for you.
- Can the effect diminish over time?
- In a small proportion of those treated, the effect lessens over the years. In that case there are other preparations and approaches, which we would then discuss.