UCSF doctors using botox to treat pain


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A UCSF team is currently engaged in a study measuring the effectiveness of mapping Distonia with multiple EMG needles.

For Sonoma winemaker Dan Schoenfeld, life had deteriorated into one agonizing pain in the neck.

"Basically my head wanted to go to the right all the time and it was getting worse and worse all the time," he said describing the pain.

Doctors at UCSF determined that an involuntary muscle movement known as Distonia was causing his neck to twist. The syndrome can trigger involuntary movement in almost any muscle group and can be caused by conditions ranging from stroke to Parkinson's disease.

"They may have a lot pain associated with that, decreased range of motion, it may be difficult to drive or read do the things they need to do," explained Dr. Jill Ostrem.

To counteract that doctors Jill Ostrem and Alec Glass have helped refine a treatment that involves listening to Schoenfeld's muscles, not with a stethoscope, but with needles.

"What we're able to do is listen for, in that unique patient, the loudest or most active muscle, which we pick up through EMG," explained Dr. Glass.

EMG is short for electromyogram" The needles, which are hooked up to a monitor, are sensitive to the electronic impulses involved in muscle movement. During monitoring they create a scratching noise represented by sound waves on a screen.

During an initial diagnosis, the UCSF team often takes multiple readings.

"What we were doing was using eight EMG needles simultaneously, just to map out the Distonia. And, in doing so were able to see which muscles were the most active and target those," explained Dr. Glass.

Ultimately, the same needles that locate the troubled muscle are then used to treat it. They are filled with Botulum toxin, Botox, the same substance that relaxes wrinkles in cosmetic patients. Using the electronic read-out like a GPS, the doctors will place the injection deep into Schoenfeld's neck, allowing the toxin to paralyze the precise area of muscle that is causing it to twist.

"Over time, the therapy may be tailored to know exactly how much toxin to inject into the muscle," said Dr. Ostrem.

The relief is only temporary and patients do have to return for another round of Botox injections, usually every three months. But, patients like Schoenfeld think it is a small price to pay to regain control of their bodies.

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