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Sunday, February 21, 2016

Better Movement Through Botox

Posted By: Advancing Care

How one neurologist’s use of botulinum toxin is improving the quality of his patients’ lives.

By Melissa F. Pheterson

Since 2002, Melissa Wright of Kingston has had a standing appointment to receive injections of botulinum toxin (commonly known as Botox). In fact, the 39-year-old relies on the treatment — and her doctor — to set foot outside the house. “It’s the only way I can function,” she admits.

But Wright doesn’t suffer from excess vanity, and her doctor isn’t a dermatologist.

Instead, Fabio Danisi, MD, Neurologist at MidHudson Regional Hospital, a Member of the Westchester Medical Center Health Network, enlists botulinum toxin to treat Wright’s dystonia, a neurological condition of excessive muscle spasms and involuntary movement of, in Wright’s case, the neck and back. By blocking the nerve signals that feed these overactive muscles, botulinum toxin helps them relax and weaken.

With skilled injection technique, says Dr. Danisi, botulinum toxin can treat the involuntary motions of most kinds of dystonia, including that of the eyes, neck, jaw, limbs and vocal cords. (There are exceptions, one of which is tongue dystonia, as botulinum toxin can easily spread to and disable the swallowing muscles.)

“One of my pet peeves is that people automatically think of cosmetics when it comes to products like Botox,” says Dr. Danisi, a specialist in movement disorders whose office purchases the most botulinum toxin in the region — surpassing even plastic surgeons. “But this treatment is a big deal for patients with dystonia, as it significantly improves quality of life. With injections, people who were afraid to drive or even cross the street because their eyes would squeeze shut are no longer functionally blind. Patients with spasms of the neck muscles can keep their head straight and have much less pain. People can return to work.”

With a family history of neurological problems, Wright was diagnosed at age 16 with cervical dystonia, involuntary muscle contractions of her neck and head. While in college, muscle relaxants gave her relief, but the spasms returned forcefully as she was student-teaching for her master’s degree in the early 2000s, derailing her career. “I couldn’t move my head.”

Dr. Danisi started the botulinum toxin immediately, enabling Wright to return to work. Today, she receives the shots down the right side of her neck and sometimes along her spine, to treat the bulging discs that result from the way she holds her head. Together, she and Dr. Danisi are keeping an eye on some jitters that are presenting in her leg. If the dystonia moves down her body, says Wright, the injection sites can move along with it.

Wright sees Dr. Danisi every three to four months. “It’s the only way I can move around, drive, work — anything,” she says. “I’m stiff for the first couple of days — but then I get three months of relatively no pain.”

With new ultrasound guidance for more precise injections, botulinum toxin can effectively treat conditions from migraine headaches to overactive bladder syndrome, says Dr. Danisi, who has run several clinical studies examining the toxin’s use.

“There is still insufficient awareness of conditions like dystonia, and many patients go for years before getting the right diagnosis and treatment,” he says. “I had amazing mentors who pioneered use of these products, and when I relocated my practice to the Hudson Valley, I was one of the few with formal training in proper injection technique. I have been humbled by the eager participation in clinical research by members of this community.

“Over time,” he adds, “many more uses for Botox will be discovered — for spasms after strokes, multiple sclerosis or even traumatic brain/spinal cord injury.”

At this point, Wright feels comfortable enough in Dr. Danisi’s presence to “relax and let my head do what it wants,” she jokes, so he can fine-tune his course of action. “If there’s anything wrong, I call him first. If I’m worried about something, he’s always there for me.” •

For more information, call MidHudson Regional Hospital Neurology at 845-483-5951.

Photos By Michael Polito