Neurology Department

Botulinum toxin, also known as Botox, is a neurotoxin derived from the bacterium Clostridium botulinum, and of which there are seven immunological forms, known as TbA to TbG. The most used sub-types for medical or cosmetic purposes are the botulinum toxin type A (TbA) and the botulinum toxin type B (TbB).

In the world of cosmetics it is used to reduce the appearance of the lines caused by the relaxation of the underlying muscles, giving a more youthful appearance.

In medicine, Botox has several uses in different specialist areas. In the field of neurology, Botox is a very useful drug in the following conditions:

• Chronic migraine.
• Trigeminal neuralgia.
• Blepharospasm.
• Torticollis.
• Focal dystonia.
• Hemifacial spasms.
• Spasticity.
• Hyperhidrosis (excessive sweating).
• Hypersalivation (excessive production of saliva).

The injection of Botox to treat these conditions is considered safe and effective. The most common side effect is excessive muscle weakness. In blepharospasm, this can cause a fall in the eyelid and difficulty in closing the eye. Cervical dystonia can result in swallowing difficulties. However, these side effects are slight and temporary, as they are dose-dependent and because the body breaks down the botulinum toxin in time resulting in the reappearance of the symptoms, thus requiring a further injection to treat the symptoms.

This treatment consists in the administration of a local anaesthetic with or without corticosteroids mainly to treat chronic headaches, for example occipital neuralgia, tension headaches and even chronic migraine. It is an injection administered in the back of the head the greater and lesser occipital nerves are, which is the pain comes from or which contributes to the pain in these conditions. The side effects are minimal and temporary. Pain and a small haematoma in the injection site are the most common complaints.

The carotid and transcranial Doppler study is an ultrasound test making it possible to visualise in real time the arterial and venous blood vessels at cervical and intracranial level.

It is an accessible and simple test that can be carried out in the consultation and which does not preparation on the part of the patient. It is safe and can be performed during pregnancy, and there is no contraindication for patients with pacemakers. No type of dye is used.

This test enables us to observe whether there is stenosis (narrowing) of the vessels, thrombi or cholesterol plaques, or artery occlusion. It is usually conducted in high cardiovascular risk individuals or those who have suffered a cerebral infarction or transient ischemic attack previously. It also allows us to see the walls of the vessels and their internal flow, and to measure the speed of the blood within them. In some patients it can be difficult to view the vessels, and so another imaging test will be requested to visualise the vessels (for example, a computerised tomography angiography).

The results will be assessed and explained by the neurologist, who will determine the most appropriate action in each case. If the flows and appearance are normal, no treatment will be necessary. However, it is possible that the findings will oblige the doctor to medication or even make a referral for surgical treatment.

This test is performed to visualise and measure the flows and the degree of stenosis (narrowing) of the temporal artery, which is located superficially on the temporal area of the skull. It is very useful to assess headaches due to or possibly due to temporal arteritis.

This nerve is located across the wrist and gives sensitivity and motility to a large part of the hand. This nerve is affected by carpal tunnel syndrome, the nerve is compressed, causing tingling and weakness in certain movements of the fingers. With this technique it is possible to measure the degree of compression and guide a better medical and surgical treatment.

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