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How effective can be Botox injections for the reduction of synkinesis?

What is Botox?

Botox is short for Botulinum Toxin. Toxin in Latin is “poison”. Botulinum is “sausage”. Actually, Botulinum Toxin means “sausage poison”. It was discovered in rotten meat, in sausage, hence it was called that way.

How does Botox work?

What Botox does is it blocks a Neuromuscular junction. It is a place, the narrow gap where the nerve reaches the muscle and the signal from the nerve jumps over to the muscle. What Botulinum Toxin does, it blocks this junction. So the signals cannot pass from the nerve to the muscle any more.

That is the reason why the synkinetic involvement reduces.

How Botox affects synkinesis?

Because of Botox the signals of synkinetic contractions simply do not reach the muscles. The mimetic signals are still being formed in the brain and are sent to the muscles, but they cannot pass through the Neuromuscular junction and cannot reach the muscle. As the result, the muscle does not receive the signals and so, it will not contract. That also means, that any healthy, non-synkinetic signals, also cannot reach the muscle.

This process can be compared to a light bulb (muscle) and its switch (the brain). Let’s say your switch is damaged, and it is sending intermittent signals to your lamp. Instead of fixing the switch (correcting the synkinetic mimetic signals in your brain), to stop the light from flashing you simply break the bulb every time. The switch will remain broken, no matter how many times you break the bulb, it will still be sending intermittent signals until it is repaired. Botox is just “breaking the bulb”, but does not “fix the switch”.

So that’s the thing, that’s my opinion about Botox. Yes, it can be indicated in certain medical conditions, and we have to realize that Botulinum Toxin injections do provide certain improvement in manifestations of synkinesis. They reduce the manifestations of synkinesis, but it is a temporary phenomenon. After a certain time, you have to repeat it again.

Will synkinesis come back after Botox?

When the Botulinum Toxin is injected, the Neuromuscular junction dies. It is irreversible. So, the axon of the facial nerve has to grow a new, side branch to the same muscle to reconnect the nerve with the muscle.

That is why it takes three, four or five months before you see that the Botulin Toxin effect is gone. It takes that much time for that new side branch to reach your muscle. After that happens, your synkinesis will come back again.

Why? Because the source of synkinesis did not change. It is the wrong mimetic patterns of your brain. So, it is up to the patient to decide whether you want to do it or if you want to do something else to reduce your synkinesis.

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Alex Pashov

Co-founder of Crystal Touch clinic and Bell's palsy expert.

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