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Botox influences emotional control in the brains of people with borderline personality disorder – Neuroscience News

Summary: Botulinum toxin, or Botox, can help reduce negative emotions in people with borderline personality disorder.

Source: MHH

The bacterial toxin Botulinum toxin (BTX) – colloquially known as Botox – is probably known to most people as a remedy for wrinkles. But botulinum toxin can do even more: if injected into the forehead, for example, it can relieve depression.

It also lessens negative emotions in people with borderline personality disorder, who suffer from extreme mood swings.

Professor Dr. Tillmann Krüger, senior physician and research group leader at the Clinic for Psychiatry, Social Psychiatry and Psychotherapy at the Medical Faculty Hanover (MHH), proved this years ago, together with his colleague Privatdozent (PD) Dr. Marc Axel Wollmer from Asklepios Hamburg Campus of Semmelweis University.

Now psychiatrists have discovered where and how BTX influences the negative program in the brain. Using magnetic resonance imaging (MRI), they visualized neuronal effects in borderline patients.

The result: Botulinum toxin influences what is known as the amygdala or almond nucleus in the temporal lobe of the brain, where fears arise and are processed.

The work was recently published in the journal Scientific reports.

Feedback between muscles and psyche

Negative moods are expressed on the face in the so-called glabellar region, the area of ​​the lower middle forehead. When we are angry or tense, two different types of muscles contract and cause frown lines or worry lines to appear above the root of the nose.

When botulinum toxin is injected into the glabellar region, it paralyzes these muscles between the eyebrows. Because facial expressions and psychological state are closely related, it also reduces the intensity of emotions.

“A relaxed forehead conveys a more positive feeling, so to speak,” says Professor Krüger.

In science, this feedback is discussed as facial feedback theory. In an earlier meta-analysis, Prof. Krüger and his team had already demonstrated that an injection of BTX into the glaballar region had a positive influence on mood and mood arousal.

Depressive symptoms improve considerably as a result. “The treatment has several advantages at once: since the paralyzing effect lasts for three months or more, an injection should also only be given at these intervals. Infrequent injections are also less expensive than some other treatment options and are very well tolerated and accepted by patients,” explains Professor Krüger.

Botulinum Toxin Curbs the Constant Emotional Fire in the Tonsil Core

And it works for both depression and borderline personality disorder. About three percent of Germans suffer from this disorder, and more than 62% of those affected are women. By interrupting the feedback loop between the forehead muscles and the brain, botulinum toxin also alters emotional feedback.

Has shown that botulinum toxin injections affect not only the muscles, but also the emotional control center in the brain: Professor Dr. Tillmann Krüger. Credit: Karin Kaiser / MHH

The researchers were able to prove this in the brains of borderline patients who had been treated with an injection of botulinum toxin in the glabellar region. Just four weeks later, the patients were showing significantly reduced symptoms, as the MRI images also show.

“We were able to see that botulinum toxin curbs the constant emotional fire in the nucleus of the tonsils, which accompanies the high-level inner tension of sufferers,” explains the psychiatrist. A comparison group treated with acupuncture also showed improvement in clinical symptoms, but not neural effects on MRI examination. However, the feedback between the muscles and the brain does not operate only in the glabellar region.

This is the result of a database study in which Prof. Krüger and his colleague Prof. Wollmer were involved and which has already been published in the journal Scientific reports end of 2021.

Working with the University of California, San Diego, they found that botulinum toxin can also alleviate anxiety disorders when injected into muscles in the head, upper and lower limb muscles, and neck muscles.

Until now, however, BTX treatment for mental illnesses has not been included in the services provided by health insurance companies. The psychiatrist hopes this will change when the mode of action has been better studied.

Botulinum toxin, colloquially known as Botox, is the most potent neurotoxin known. It is produced by the bacterium Clostridium botulinum in the absence of air and causes what is called botulism. Symptoms of poisoning are usually caused by eating poorly preserved foods in which the bacterial toxin has accumulated. This inhibits the transmission of excitation from nerve cells to other cells, especially at muscle and blood junctions.

See also

This shows someone adding a sugar cube to a black coffee

About this borderline personality disorder and current emotions research

Author: Stefan Zorn
Source: MHH
Contact: Stefan Zorn – MHH
Image: Image is credited to Karin Kaiser/MHH

Original research: Free access.
“Neural effects of glabellar botulinum toxin injections using a valent inhibition task in borderline personality disorder” by Tillmann H. C. Kruger et al. Scientific reports


Neural effects of glabellar botulinum toxin injections using a valent inhibition task in borderline personality disorder

Previous studies have indicated that glabellar botulinum toxin (BTX) injections can result in long-lasting relief from depression. This can be accomplished by disrupting a facial feedback loop, which potentially dampens the experience of negative emotions.

Accordingly, glabellar injection of BTX may attenuate amygdala activity in response to emotional stimuli. A prototypical condition with excess negative emotionality and impulsiveness accompanied by high amygdala reactivity to emotional stimuli is borderline personality disorder (BPD).

To improve understanding of how glabellar BTX may affect the processing of emotional stimuli and impulsivity, we conducted a functional magnetic resonance imaging (fMRI) study.

Our hypotheses were (1) that glabellar BTX results in increased activation in prefrontal areas during inhibitory performance and (2) that BTX decreases amygdala activity during processing of emotional stimuli in general. Using a go-/no-go emotional paradigm during fMRI, the interference of emotion processing and impulsivity in a sample of n = 45 women with BPD was assessed.

Subjects were randomly assigned to either BTX treatment or serial acupuncture (ACU) of the head. After 4 weeks, both treatments resulted in a reduction in symptoms of BPD.

However, BTX treatment was specifically associated with improved inhibition performance and increased activity in the motor cortex. In addition, the processing of negative emotional faces was accompanied by a reduction in the activity of the right amygdala.

This study provides the first evidence that glabellar injections of BTX can alter central neurobiological and behavioral aspects of borderline personality disorder. Since the control treatment produced similar clinical effects, these neurobiological findings may be specific to BTX and not a general correlate of symptom improvement.

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