Patients with compromised respiratory status treated with BOTOX for spasticity should be monitored closely. In a double-blind, placebo-controlled, parallel group study in patients treated for upper limb spasticity with stable reduced pulmonary function (defined as FEV1 40-80% of predicted value and FEV1/FVC ≤0.75), the event rate in change of Forced Vital Capacity (FVC) ≥15% or ≥20% was generally greater in patients treated with BOTOX than in patients treated with placebo (see Table 5).

Other than that, there don’t seem to be any specific groups of people or health conditions that are contraindicated for Botox injections. As with all treatments, general health guidelines apply. People with a healthy body-mass index who are non-smokers, moderate or non-drinkers, and physically active will nearly always tolerate any type of medical treatment well.
Why Botox works isn’t completely clear. There’s some evidence that it may reduce the production of neurotransmitters related to pain in the areas where it’s injected. There’s also some evidence that it may have a broader effect on the brain’s pain centers, reducing the sensitivity that causes migraine sufferers to react to migraine triggers. While the exact mechanisms are poorly understood, the studies, as well as many of my patients’ experiences, do show a real benefit for many people.
A randomized, multi-center, double-blind, placebo-controlled study of the treatment of cervical dystonia was conducted. This study enrolled adult patients with cervical dystonia and a history of having received BOTOX in an open label manner with perceived good response and tolerable side effects. Patients were excluded if they had previously received surgical or other denervation tre atment for their symptoms or had a known history of neuromuscular disorder. Subjects participated in an open label enrichment period where they received their previously employed dose of BOTOX. Only patients who were again perceived as showing a response were advanced to the randomized evaluation period. The muscles in which the blinded study agent injections we re to be administered were determined on an individual patient basis.
The cosmetic benefits came to light in the 1990s by happy coincidence. “The aesthetic indications were purely happenstance,” says board-certified surgeon and clinical professor Seth L. Matarasso, MD, who has been treating his clients with Botox since the 1990s but is not affiliated with the brand. “Dr. [Jean] Carruthers was working with patients with strabismus...[and] with diplopia [double vision], and her patients were coming in and saying, ‘Gee, my wrinkles are better.'" Soon enough, doctors were using Botox for what it is most commonly associated with today — nixing lines.
Botox has not been approved for any pediatric use.[30] It has, however, been used off-label by physicians for several conditions. including spastic conditions in pediatric patients with cerebral palsy, a therapeutic course that has resulted in patient deaths.[30] In the case of treatment of infantile esotropia in patients younger than 12 years of age, several studies have yielded differing results.[21][better source needed]

In 1950, pharmacist Gavin S. Herbert established Allergan Pharmaceuticals, Inc. Allergan focused on the discovery and development of novel formulations for specialty markets, as well as intimate collaboration with physicians and the scientific community. In 1953, Allergan produced eye drops and formulated new products such as the first cortisone eye drop to treat allergic inflammation and the first ophthalmic steroid decongestant.
Alternatively, bruising could occur, though is less likely, says Rowe, especially in the hands of an experienced doctor. While he says it's "dumb luck" whether or not one bruises from an injection, he also notes that good technique helps reduce the chances. Sobel says that "if you inject [the needle with Botox] too deep, very often you can hit a blood vessel and bruise." What you do after the injection can also make a difference: Take care not to rub or massage the treated areas, as this can cause the toxin to migrate.
Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing.
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