Botulinum Toxin Clinics

Dr Emma Blackwood is a consultant neurologist and neurophysiologist practising in Orange. She has commenced regular botulinum toxin clinics for patients with the following conditions:

• Cervical Dystonia  involuntary twitching or jerking of the neck
• Blepharospasm  involuntary blinking
• Hemifacial Spasm  facial twitching
• Axillary Hyperhidrosis excessive underarm sweating
• Chronic Migraine
• Post stroke Spasticity upper limb spasticity  stiffness in the arm after a stroke

All of these conditions are indicated and reimbursed for botulinum toxin type A (Botox and Dysport) treatment under the Pharmaceutical Benefits Scheme.

Botulinum toxin is extracted from bacteria under controlled laboratory conditions, in much the same way penicillin is produced from mould.  

If your doctor has made a diagnosis or you have a query about any of these conditions, please contact the rooms for more information or to make an appointment.

• Cervical Dystonia

Cervical dystonia is a condition whereby the muscles involuntarily contract in the head and neck.  These contractions result in abnormal posture (positioning of the neck) and pain.  Typically people develop worsening symptoms over a period of 5 years and then the symptoms tend to stabilise.  The most debilitating problem is neck pain which may be caused by the muscle contractions or due to the positioning of the neck.

For more information on cervical dystonia  https://www.dystonia.org.au/what-is-dystonia/forms-of-dystonia/cd-cervical-dystonia

• Blepharospasm

Blepharospasm is a form of facial dystonia and is the medical term used to describe involuntary blinking of the eye, and in severe cases, complete closure of the eye.  In the majority of cases, this is because the muscle responsible for closing the eye (the orbiculari oculi) goes into spasm.

For more information on blepharospasm  https://www.dystonia.org.au/what-is-dystonia/forms-of-dystonia/blepharospasm

• Hemifacial spasm

Hemifacial spasm is a form of facial dystonia and is the medical term used to describe involuntary contractions of the upper and lower facial muscles, resulting in twitching of the face.  This mainly happens when blood vessels are not working normally and compress the facial nerve.  

• Axillary Hyperhidrosis

Axillary Hyperhidrosis is the medical term for excessive sweating under the arms.  This occurs when overactive sweat glands release a volume of sweat that is significantly more than the body’s normal requirements for cooling.  Normally the brain sends messages to the sweat glands, via nerves, to make them produce sweat.  These messages are transmitted from the nerve to the sweat gland via a chemical messenger called acetylcholine.  When too much acetylcholine is released due to inappropriate messages from the brain, the glands become overactive and produce more sweat than is normally required.  Botulinum toxin temporarily blocks the nerve’s ability to release acetylcholine.  As a result the gland does not receive the message to produce sweat.  

To be eligible for botulinum toxin injections for axillary hyperhidrosis the patient must have severe symptoms interfering with daily activities and have failed or be intolerant of topical aluminium chloride hexahydrate (Driclor) after one or two months of treatment.

• Chronic Migraine

Chronic Migraine is similar to migraine as sufferers experience the same type of symptoms (intense, sometimes throbbing or pulsing headache pain, nausea and/or vomiting, sensitivity to light and/or sound , and aggravated by routine physical activity).  Chronic migraine sufferers experience 15 or more headaches per month, at least 8 of which have the above migraine features.  Because they have lived with severe headache for so long, many chronic migraine sufferers are affected socially, economically and may also deal with depression, anxiety and other chronic pain.   

Botulinum toxin blocks the release of the neurotransmitters that signal the start and progression of pain in the brain, thereby reducing the number and severity of migraines that patients experience each month.

To be eligible for botulinum toxin for chronic migraine the patient must have 15 or more days of headache per month and have failed 3 or more preventative medications.  Botulinum toxin is not effective for episodic migraine or tension headache.

• Post Stroke Spasticity

Post Stroke Spasticity is when there is increased muscle tone and stiffness occurring after a stroke.  This can cause pain and result in difficulty performing tasks such as getting dressed as well as hygiene problems.  Botulinum toxin can be injected into the muscles to weaken them.  This is most effective when combined with physiotherapy exercises and splinting.  Currently botulinum toxin injections are funded for the upper limb (arm) but not the lower limb (leg).  A maximum of four treatments are funded over a patient’s lifetime.