Botox and other botulinum neurotoxin (BoNT) products are not just for the wrinkles on your face.
That's according to plastic surgeons in America who reckon they are just as successful at treating a wide range of non-cosmetic problems, such as headaches, excessive sweating and nerve-related pain.
Eight conditions with good evidence of effective treatment with BoNT are identified in a special review in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).
The international review analysed the research evidence on plastic surgery procedures using BoNT.
The reviews authors believe the use of botulinum neurotoxins has revolutionised the treatment of several different problems seen in the plastic surgeons surgery, from facial wrinkles (where it's most effective) to painful conditions with limited treatment options.
Two types of BoNT are available: BoNT-A (with brand names including Botox and Dysport) and BoNT-B (Myobloc), with BoNT-A approved in the States for treatment of forehead lines or wrinkles, and Botox specifically approved for treatment of 'crow's feet' at the corner of the eyes.
Botulinum neurotoxin is also effective for some types of facial movement disorders e.g. tics caused by benign essential blepharopasm. It can also be used to treat issues related to facial nerve palsy and abnormal facial nerve regeneration, which can cause problems such as abnormal tears or sweating.
Two studies have reported that Botox can reduce hand tremors in patients with essential tremor, although hand function may not improve.
Both BoNT-A and BoNT-B show evidence of effectiveness in patients with chronic, excessive sweating, especially of the hands (palmar hyperhidrosis).
Botulinum neurotoxin is a safe and effective treatment for upper limb spasticity of the arm and hand in adults. It also shows promise for treatment of muscle spasticity in children with cerebral palsy.
Neuromodulator therapy with BoNT has emerged as a useful new treatment for migraine headaches.
This benefit was discovered coincidentally when patients undergoing cosmetic BoNT injection for forehead wrinkles reported decreased migraines. Based on three large studies, Botox has been approved for treatment of chronic migraine headaches.
More recently, studies have supported BoNT for treatment of neuropathic (nerve-related) pain, a common problem with few effective treatments.
Injection is effective for the treatment of some important causes of neuropathic pain, including diabetes and surgical nerve damage.