[2] Botox, dubbed “medicine’s answer to duct tape”, has been found to be effective for muscle spasms and contractures, severe sweating and drooling, migraines, urinary incontinence, and many other disorders.
[3][4] In pursuit of new ways to help his patients, Scott made many basic scientific advances concerning eye muscles, their coordination, and their modifiability.
Finally, inspired by Daniel B. Drachman’s[13] work with chicks at Johns Hopkins, Dr Scott and colleagues injected botulinum toxin into monkey extraocular muscles.
Botox is formed by spores of the bacteria Clostridium botulinum, which is found naturally in sediments as well as the intestinal tracts of some animals and fish.
After working-out techniques for preparing the toxin and assuring its sterility, potency, and safety, Scott was granted FDA approval for investigational use, and began manufacturing it in his San Francisco lab.
Based on data from thousands of patients collected by 240 investigators, under the 1983 US Orphan Drug Act, Scott obtained FDA approval in 1989 to market Oculinum for clinical use in the United States to treat adult strabismus and blepharospasm.
[14] Scott also injected the first cases of the painful, spastic twisting of the neck known as torticollis,[17] but it was difficult to accept that the specificity and molecular tenacity that made ingested toxin so deadly also made it safe when injected into a target muscle, and no Bay Area physician would try Botox for the muscle contractures of stroke, dystonia, torticollis, or cerebral palsy, until L. Andrew Koman of Wake Forest University in North Carolina pioneered its use to treat pediatric leg spasm in cerebral palsy.
[18] Patient groups quickly spread the word that there were now effective treatments for previously untreatable motility disorders such as blepharospasm, which can result in functional blindness despite an otherwise normal visual system.
But, in 1986, Oculinum Inc, Scott's micromanufacturer and distributor of botulinum toxin, was unable to obtain product liability insurance, and could no longer supply the drug.
For 4 months, pending resolution of liability issues, American blepharospasm patients traveled to Canadian eye centers for their injections.
Scott and colleagues therefore developed EMG-guided injection, a system that uses a hypodermic needle that records the electrical activity of the muscle (the electromyogram or EMG) at its tip.
Dr Scott and his colleagues have therefore developed electrodes that are both safe and effective in animals tested with realistic, long-term stimulation regimens.
[4] The uniform patient populations and standardized treatments of controlled, so-called “explanatory” research are indeed essential for testing scientific hypotheses and finding small differences.