Talking Again

 

• Recommended Reading
• Electrolarynx
• Esophageal Speech
• TEP/Prosthesis
• Hands-Free Devices
• Alternative Communications
• Speech Difficulties

 

 

Speech Difficulties

 

 

BOTOX - for overactive muscle activity

 

Let's dispel some misconceptions about this drug. You know, the old "Law of the Hammer"? Once you acquire a hammer, everything starts to look like a nail. That has been happening with Botox, and it is important to understand how this drug works to prevent its misuse and overuse. If not administered properly, it can cause very serious consequences. It is also quite expensive.

Most of you have heard of botulism poisoning, which is often fatal, usually acquired through consumption of improperly canned foods or processed meats. A toxin, produced by the bacteria Clostridium botulinum is the cause but this bacteria can easily be destroyed at high temperatures, This is why canned foods must be heated thoroughly as part of their processing.

For a muscle to contract, a signal is sent from the brain through a nerve towards the muscle. At the neuromuscular junction, where the nerve meets the muscle, the signal passes by a chemical called acetylcholine. Then the muscle will contract and movement occurs. The botulinum toxin blocks the release of acetylcholine, which will cause a partial paralysis of the muscle which lasts about 3-4 months.

In the 1950's, researchers realized that you could prevent overactive muscles from contracting by injecting VERY small amounts of the toxin into the muscles. The injectable drug Botox was developed by the company Allergen to treat muscle spasm and overactivity, initially to treat excessive blinking (blepharospasm). It has since been used to control muscle spasms throughout the body in the dystonias, and also has gained considerable popularity because of its cosmetic uses for treating wrinkles.

For laryngectomees, Botox has been used to reduce the hypertonicity and spasm of the vibrating segment, resulting in a less effortful esophageal (E) or tracheoesophageal (TE) voice. But it is only effective for conditions that are due to overactive muscle activity, and may require relatively large doses (when compared to the amounts used cosmetically), administered precisely at the location of the hyperactive muscles. It is helpful to do the injections into the pharyngeoesophagus under fluoroscopy in radiology so that the precise point of hyperactivity can be pinpointed. Other voice and/or swallowing problems that are the result of scar tissue, diverticula, or stricture aren't helped by Botox. These are structural problems, not movement problems caused by overactive muscles.

Ideally, before Botox is attempted, the clinician will do a thorough investigation to determine the cause of the voice or swallowing problem. That will prevent the needless use of this drug. The typical side effects include soreness at the site of injection, allergic reaction, and injection of the wrong muscle group, which could result in very undesirable weakness of some muscles, on a temporary basis. Injectable Botox is also known to travel to areas of the body distant to the site of injection. Between 1989 and 2003, there were 28 deaths attributed to its non-cosmetic use in a variety of medical conditions. Not a huge risk overall in 14 years, but one that you should be aware of.

As always, I suggest that anyone considering a new treatment have a thorough understanding of what it is all about, and be certain that your clinician has a clear rationale for recommending it.

Carla DeLassus Gress, ScD, CCC-SLP Charlottesville, VA