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9/15/2016
Botox Gone Rogue
Researchers studying whether botulinum neurotoxin (BoNT) A, BoNT/D and tetanus toxin (TeNT) can spread within networks of neurons to have distal effects found that indeed they do.
Cosmetic Surgery Times: Botox Gone Rogue

Researchers studying whether botulinum neurotoxin (BoNT) A, BoNT/D and tetanus toxin (TeNT) can spread within networks of neurons to have distal effects found that indeed they do.

Specifically, they found that while the toxins act on the targeted neurons, they are also taken up, via an alternative pathway, where they are transported and released to exert effects on upstream neurons.

The result, at least in a lab dish, is long-distance effects, according to the study, epublished August 4 in Cell Reports.

According to a university press release on the study, the concern isnt new. In 2009, the FDA added a warning in prescribing information, noting that botulinum toxin may spread from the area of injection to produce symptoms consistent with botulism, such as unexpected loss of strength or muscle weakness, swallowing and breathing difficulties that can be life-threatening.

There are also those puzzling results from Botox and other treatments, according to study author Ewa Bomba-Warczak, a doctoral candidate in neuroscience.

In many cases, after an injection for a disabling spasm of neck muscles called cervical dystonia, there is no change in muscle tone but the patient finds relief and is perfectly happy. That result cant be explained by the local effects, Bomba-Warczak says in the release.

In the study, the researchers used mouse neurons in wells connected by tiny channels that allow growth of axons.

Every time one fraction of the toxin acts locally (on the first nerve cell it contacts), another fraction acts at a distance, says study author Edwin Chapman, Ph.D., investigator, Howard Hughes Medical Institute, and professor of neuroscience at the University of Wisconsin-Madison. Its unknown how far they travel, which likely depends on the dose of toxin and other factors.

Implications for the Cosmetic Practice

San Francisco-based plastic surgeon Larry Fan, M.D., says the study has no new implications for cosmetic practice.

It is well known that botulinum toxin can spread from an injection site via passive diffusion, intraneuronal transfer or through the bloodstream. This study provides direct evidence that botulinum neurotoxin can spread distally between nerve cells, Dr. Fan says. Botox injection for cosmetic use remains a safe treatment. However, all patients should keep in mind that there is a small possibility of undesired effects such as temporary eyelid or eyebrow drooping.

The studys findings underscore the importance of the injectors qualifications.

A qualified injector should possess extensive knowledge of facial anatomy, aging, injection technique, botulinum pharmacology and treatment of potential complications, Dr. Fan says. The only injectors who consistently possess these skills and knowledge, with a few exceptions, include board-certified plastic surgeons, facial plastic surgeons and dermatologic surgeons.

http://cosmeticsurgerytimes.modernmedicine.com/cos...

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