As a dermatologist, it thrills me to see how happy Botox makes my patients, whether I'm treating them medically for excessive sweating or cosmetically for wrinkles.

Excessive sweating is no laughing matter. To those whose personal and professional lives, and clothing, it ruins, Botox often seems like a miracle. Take Jodie*, who told me that my Botox treatment of her underarms made her wedding day, and saved her dress. Or Peter, who's 21 and told me that Botox treatment of his palms allowed him to hold hands with a girl for the first time in his life. We can certainly all live with wrinkles but, as I've written previously , cosmetic surgery is inspiring and uplifting if you use it to project a positive image and to balance how you look with how you feel. Anne, a recently widowed 53-year-old, was one of the first patients to visit me after I opened my private practice. The Botox and laser treatments that I gave her helped her to cope with the stress of her husband's death and the toll it had taken on her appearance and self-image.

A recent Los Angeles Times article about the petition provides insight into how much Botox can improve the life of children with cerebral palsy. It includes an interview with a pediatric orthopedic surgeon, Dr. Hank Chambers, who says that he's given 20,000 Botox injections to cerebral palsy sufferers and never had a complication. Dr. Chambers speaks with authority in describing Botox as "a spectacular treatment" and avowing that it has "changed lives", as his own son has cerebral palsy and has himself been treated with Botox.

Dr. Chambers comments that some doctors who are not expert in treating cerebral palsy might inject patients with doses of Botox that are much higher than recommended guidelines. Although this could cause problems with muscle control elsewhere in the body due to spread of Botox, Dr. Chambers also notes that children with cerebral palsy already have muscle control problems, so it's difficult to determine the role, if any, of Botox.

On February 8, the FDA announced that it will be reviewing the safety profile of Botox and Myobloc, with particular emphasis on their use in large doses for children with cerebral palsy and similar conditions. The FDA's statement that "reactions may be related to overdosing" and that "there is no evidence that these reactions are related to any defect in the products" seems to echo Dr. Chambers' thoughts.

During a public teleconference following its announcement, the FDA's neurology chief, Dr. Russell Katz, stated that this review involves "a relative handful of serious adverse events" in a patient population that is already "very sick" and confirmed that none of these is related to the cosmetic use of Botox.

The product labeling for Botox already warns that patients with pre-existing neuromuscular diseases may be at increased risk of significant side effects from regular Botox doses that would not cause problems in healthy patients. So what this seems to boil down to now is that the FDA and the drug manufacturers will discuss whether a warning should be added to the product labeling for Botox stating that some children with cerebral palsy could also experience significant side effects from Botox, especially if they are given high doses which might encourage spread of Botox to other parts of the body.