There are still many imprecise concepts about what botulinum toxins are and what are the true scope of their uses beyond the aesthetic. For this reason, the virtual forum “The therapeutic benefits of botulinum toxins in chronic migraine, spasticity and abnormal movements”, held by EL TIEMPO and AbbVie on Wednesday, May 11, brought together several specialists who shed new light on doctors, patients and caregivers about this issue.
To start the day, Mónica Betancur, medical manager for AbbVie Colombia, began by saying that the objective of this meeting was “to realize that we have hope and we can improve the quality of life of patients, understanding that botulinum toxins are not just a treatment pharmacological, but they help, in a multidisciplinary way, so that these people have a better quality of life in their day to day”.
In this way they entered into participation, with the moderation of the journalist Ximena Bedoya, Dr. Paula Cavanzo, neurologist; Dr. Andrés Zuluaga, pharmacologist and toxicologist, and Dr. Diego Chaustre, physiatrist.
The first thing that Dr. Zuluaga highlighted was that behind botulinum toxins there is a long history that goes beyond aesthetics.
“The topic began with research in 1860 that identified toxins that produced a disease called botulism. From that moment on, a series of new investigations focused on treating this ailment and isolating the toxin was generated. But it was not until 1946 when it was finally possible to isolate the crystalline structure of what is now known as botulinum toxin and of which various types have been discovered”, reported the pharmacologist and toxicologist.
After these advances, the therapeutic implementation of the toxins could be promoted and, in 1989, their use in humans to treat strabismus was approved. Since then they have been used in various ailments.
“This makes it clear that the medical application of botulinum toxins is long before aesthetic use, although this is the best known,” said Dr. Andrés Zuluaga.
There are various types of botulinum toxins and some of these neurotoxins have been isolated, such as Type A and Type B, which are currently marketed. Some laboratories have even developed medications based on Type A neurotoxins, used to treat many ailments.
“Botulinum toxin is a biological drug,” the specialist explained. When we refer to this we mean a component that has a living origin. It is important to mention that, due to this characteristic, botulinum toxins are one of the largest available drugs on the planet and require very complex manufacturing processes. When a manufacturer makes one of these drugs, his particular process defines the type of product, equally effective in its action, but particular in its development and its effects”.
Therefore, the use of botulinum toxin is very broad in terms of treating diseases, with enormous potential that has allowed medical specialists to help improve the quality of life of thousands of patients. Even in the case of abnormal movements or postures caused by various discomforts.
Chronic migraine and botulinum toxins
Headaches can be conditions that are difficult to manage for many people, especially when it comes to migraines, an ailment of which there are two main types, episodic and chronic, which are defined based on the frequency with which they occur.
Dr. Paula Cavanzo explains that chronic migraine is a disease that is mainly characterized by presenting itself constantly for more than 15 days a month. “Some patients may even suffer from headaches every day for several years. Studies indicate that adequate diagnostic processes can occur after up to 20 years of suffering from it”, said the neurologist.
Its impact is such that this type of migraine has become the third most prevalent disease in the world and the second most disabling after cardiovascular disease, which translates into a total affectation of the work, personal and emotional life of patients. .
“In the case of chronic migraine, treatment with botulinum toxin is an option for individuals who have previously undergone other types of treatment, without significant improvement. The current indication given by national and international regulatory bodies such as the FDA and Invima is that botulinum toxin has a prophylactic use for this type of headaches, the one approved in our country being onabotulinum toxin Type A, or botox”, indicated the Cavanzo Dr.
Botulinum toxin is used in people with chronic migraine for, among other benefits, to space out the days of pain by reducing the inflammation processes typical of the disease and maintaining this relief over time.
It has been shown that, with the toxin, patients reduce the number of days of pain and its intensity, and there is an improvement in morbidities such as depression and anxiety.
However, the neurologist warned that the application of the toxin must be done by a specialist.
“There are many reasons: headache specialists are neurologists because we know the disease. In addition, it is a biological medicine that requires a special application. Also, there must be a prior assessment that allows determining the particular factors of the patient and thus consider the most appropriate treatment, “said Dr. Cavanzo.
The great objective is, then, to reduce disability and improve the quality of life of patients.
Use of botulinum toxins and spasticity
Dr. Diego Chaustre showed that spasticity is a disorder that occurs after an injury to the central nervous system, the brain or the spinal cord. “In our country it is associated with five causes: cerebrovascular event or stroke, multiple sclerosis, cerebral palsy, spinal cord injury and head injury,” he added.
Spasticity presents several particularities, which lead to an increase in muscle tone and joint stiffness, which generates abnormal postures and, therefore, a lot of pain. Likewise, it is variable over time in the same patient and depends on internal and external factors, such as the weather.
In the case of spasticity, botulinum toxin must be included in a patient treatment process.
“It is not the only intervention that should be done, but it has to be integrated into a program that includes physical, occupational and language therapy, psychiatry, physiatry and neurology. Due to its characteristics, the use of botulinum toxins is a good option within the process. The important thing is that the specialist can identify that the patient meets all the requirements so that this biological medicine can be applied to him,” said Dr. Chaustre.
In such cases, the impact on the patient’s quality of life is direct, from allowing them to reduce spasticity and recover basic movements, such as picking up a spoon or turning the light on and off, to managing their secondary pain. Also, it allows achieving a large number of objectives set together with the patient, with measurable results.
“Added to that, and in the case of patients with severe injuries, the application of botulinum toxins helps reduce the burden on their caregiver,” said the physiatrist.
There are several different brands of botulinum toxins on the market that can be used in spasticity, some approved by Invima, but each with a specific profile, as explained by Dr. Zuluaga, and that can be used according to the conditions individual of the patients.
In all cases, whether it be abnormal movements, chronic migraine, for safety and clarity, the patient should be shown the brand of toxin that is going to be applied and what the process to follow is. The medical task force must also know which brand was applied and where on the body.
This is critical in treatments with botulinum toxins because, when brands are changed without adequate medical indication, there is a risk, in the short and medium term, that the adequate result is not obtained by applying lower or higher doses. those indicated, with loss of the therapeutic effect of these biological drugs, seriously harming the health and well-being of patients.