For 25 years physicians at Atlanta Neurology have
treated patients with varying diseases. Dr. Gwynn has expertise in the
therapeutic use of Botox® and is
is the chief of neurology at St.
Joeseph's Hospital. Dr. Franco is a clinical neurologist and founding
partner who has been in practice for 25 years. Dr. Sanders has
a specialty interest in neuromuscular diseases-carpal tunnel syndrome,
neuropathy, and others. Dr. Johnston's specialty is in sleep disorders. Brandy Hughes, a certified nurse practitioner, treats many patients with headache, neck
and lower back pain. Our doctors treat patients with disease ranging from
strokes to headaches and migraines to Parkinson's disease.
Botox® is the brand name for purified and crystallized botulinum toxin type A.
The toxin is produced by a bacterium called Clostridium botulinum, an
organism that normally lives in soil. Although botulinum toxin is one of the
most lethal biological chemicals on earth, when it is highly diluted and
injected into muscles it is quite safe. Allergan Pharmaceuticals, the company
that makes Botox® packages the medication in doses that are far below
quantities that would cause serious harmful effects.
Botox® can help many disorders where excessive muscle contraction cause pain,
disfigurement, or impairment of movement. The common denominator of all problems
helped by Botox® is excessive muscle contraction. Thus, conditions that involve
spasticity, excessive muscle movement, or excessive muscle tone may be improved
Botox® is a protein molecule made of amino acids linked together in two chains
that are connected. When the toxin is injected into muscles, the molecule is
taken up by the nerve ending at the site that the nerve meets the muscle. The
toxin then binds to part of the nerve ending, inactivating the nerve by
preventing the nerve from releasing a chemical a (neurotransmitter) that normally
travels over to the muscle causing the muscle to contract. Under normal
conditions, an electrical impulse travels down the nerve to the nerve ending
causing the neurotransmitter, acetylcholine, to be released by the nerve ending.
The acetylcholine travels across a very small gap and binds to the surface of
the muscle. When the binding occurs, certain changes take place in the muscle
membrane which lead to the muscle's contraction. Because Botox® prevents
acetylcholine release, the muscle cannot contract, and the cumulative effect is
that the muscle belly relaxes.
What Are Some Conditions Treated With
Many conditions may be helped by Botox®. Some of the more common ones include:
Spasmodic Torticollis - twisting
and writhing movements of the neck
Writer's Cramp - difficulty
writing because of excessive muscle contraction of the forearm
Spasticity from stroke - including
painful contractions of the arm and leg
Spasticity from cerebral palsy, spinal
cord injury, or traumatic brain injury
Hemifacial spasm - Repetitive
twitching of one-half of the face
Blepharospasm - forced
with excessive muscle contraction, such as crows' feet around the eyes or
frown lines of the forehead
Several conditions may also be helped by
sweating of the palms, face, or arm pits
excessively tight stomach valve
Headaches - especially
those beginning at the base of the head
What About Pain
Because many types of neck and back pain re associated with excessive muscle
contraction, the treatment of these disorders with Botox® is intuitively
promising. In fact, recent studies and clinical trials suggest that Botox® may
be an extremely useful treatment for some types of chronic musculoskeletal pain.
Botox® is injected through a thin needle directly into muscles or skin. After a
few days the muscles relax. The injections are only mildly painful, and the pain
can be minimized by the use of anesthetic sprays or pain medicines. The effects
last for 10 to 20 weeks in most cases. The treatment can then be repeated as
|What Are The Side Effects?
When they occur, the side effects are usually mild and may include excessive
muscle weakness near the are of injection. Because the effects of Botox® always
wear off, so do any side effects of muscle weakness. Bleeding and infection are
always risks when the skin is punctured, but they are rare. No one has ever died
from Botox®. Allergic reactions are rare.
Does Insurance Pay For
From many of the disorders listed in the previous paragraphs, insurance
companies cover the expense of the injection. Botox® is an extremely expensive
medication costing the physician more than $500 per vial, and many disorders require
two or three vials per injection series. However, because most insurance
carriers recognize that many of the disorders listed above are only effectively
treatable by Botox®, treatment is covered. Often the treatment must be
precertified by the neurologist.
Who Injects Botox®?
Only a few physicians have a great deal of experience using Botox®. Though the
technique is relatively uncomplicated, knowing which muscles to inject and how
much Botox® to inject into each requires skill and training. In many regions of
the country, university hospitals are the only locations where the treatment is
Dr. Gwynn of Atlanta Neurology has treated patients with Botox® for well over a
decade, and has more experience than nearly any physician in the
southeastern United States. Dr. Gwynn has participated in
training courses through the American Academy of Neurology and the
College of Georgia, and he was the only participant from Georgia to the
International Conference on Botulinum Toxin in Munich, Germany. He was the
founder and is the medical advisor of the Georgia chapter of the National
Spasmodic Torticollis Association.
You may read testimonials from patients Dr. Gwynn has treated with Botox®. If you would like more information or
have a specific question about Botox® you can e-mail