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BOTULISM: CAUSES AND TREATMENT
A botulism outbreak can terrify a city. Botulism is caused when food becomes contaminated by the bacteria that produce botulinum, a deadly toxin. It kills most of its victims. The symptoms – arriving in a rush – include muscular weakness, paralysis, and the impairment of vision, swallowing, and speech. Survivors often suffer from brain damage. Fortunately, botulism outbreaks are rare.
Now science is turning evil to good, using the botulinum toxin to relieve the muscle spasms triggered by conditions as severe as stroke or as simple as a furrowed forehead. Most of us have had brief spasms, maybe a painful “charley horse.” But for some, the agony is chronic. And it was untreatable – until now.
Muscles come in pairs. If equal in strength, they balance each other’s force. If one is stronger, it contracts and stays in spasm. Injection of a minute amount of the toxin equalizes the muscles. Botulinum toxin is being used for many conditions caused by muscle spasms, including several that affect vision.
Injection of the toxin brought back precious sight to Marjorie Daley of Yonkers, New York. She had been unable to function since 1982, when her eyelids began to squeeze shut intermittently. This condition is called blepharospasm (blepharo is Greek for eyelid).
“I couldn’t drive or read,” says Mrs. Daley. She found help in 1986 at Columbia-Presbyterian Medical Center in New York City, where a tiny amount of the poison was injected into the convulsed muscles that control eyelid movement. “Within 24 hours,” she recalls, “I could keep my eyes open and sleep at night. My eye wasn’t jumping all the time.”
“Botulinum toxin relieves the effects of muscle spasm, regardless of the underlying disease,” says Dr. Mitchell Brin, a neurologist at Columbia-Presbyterian. “Before, we had no way of relieving such horrible deformity, which could occur in any part of the body.”
The treatment was conceived by Dr. Alan Scott, a San Francisco ophthalmologist. He was seeking a non-surgical treatment of strabismus (strabos is Greek for squint-eyed), or weak eye, which can cause eyes to cross or a weak eye to look to the side; the stronger eye focuses as desired. Dr. Scott knew the weak eye wanders when its stronger muscle pulls it over too far, preventing it from working in tandem with its normal partner. His brainstorm: poison the weak eye’s strong muscle and make it equal in strength to its weak muscle.
After first working with animals, he tried the toxin on a human; the strabismus disappeared. Since then, the Food and Drug Administration has approved botulinum toxin for blepharospasm, strabismus, and related facial muscle spasms. It is sold as BOTOX by Allergan, a company in Irvine, California.
In 1981, soon after Dr. Scott published his findings, Dr. Howard Eggers of Columbia-Presbyterian injected the toxin into the right eye muscles of a patient suffering with strabismus for 22 years. Over 5 months of injections, the eye retained correct positioning.
Dr. Stanley Fahn, chief of the Movement Disorders Clinic at Columbia-Presbyterian, heard of the toxin’s effectiveness and had Dr. Brin work on other spasms. Dr. Brin and Dr. Andrzej Freidman, visiting from Poland, first treated torticollis, or “wry neck.”
Jack Newhall, 61, of Bethlehem, Pennsylvania, recalls the onset of wry neck in 1978. “My head started turning to the left. A pain began. My head started to pull down, nearly to my left shoulder. The pain was so bad! It never went away.” After 10 years of torture, he found Dr. Brin. “I got the shots,” he says. “In 9 days, the pain was gone. My head was up straight. It was a miracle.”
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