Boosters II

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This article was previously published several years ago.  Some of the circumstances have changed but the message remains the same.  Boosters are a BAD idea!

When I first became aware of people receiving boosters, I began to hear those immortal words from the gizmo spinning robot in “Lost in Space”… Danger, Will Robinson, Danger!

Let us be frank discussing this here.  As the number of injectors of BotoxÒ increase without formal training requirements across multiple different specialties and disciplines, there are going to be problems.  I know of hard working physicians whose desire to help their patients cause them to be more aggressive than myself in those same circumstances.  However, there is a tremendous amount of ignorance when it comes to the techniques of injection with any of the botulinum toxins.

Previously, I was referred to an unfortunate young lady who had been receiving BotoxÒ injections for spasmodic dysphonia and oromandibular dystonia.  She had been injected every three (3) week for a period of about six months and the specific ENT doctor wasn’t sure why the BotoxÒ had stopped working!  When her antibody levels were tested, there was no surprise that they were highly elevated.  This is one of those situations where we have probably lost the entire ability to work with BotoxÒ completely.  It remains to be determined if the more pure forms of botulinum toxin will in any way benefit her.  You may need to become your own advocate, even to the extent of educating your doctor.

Booster shots of botulinum toxins, in general are a bad idea.  There is no scientific evidence to back up the claims that it improves control over a particular movement disorder.  In fact, a review of the literature search for BotoxÒ and booster on the Pub Med National Library of Medicine database reveals several articles all in favor of avoiding booster shots entirely.

BotoxÒ has done a world of good for many individuals. However, it is a foreign substance to the body and because of this it will stimulate an immune response from the body.  The best way to get this response, just like a vaccination, is to give large dosages of the medicine or to give frequent dosages of smaller amounts of the medication.  This is no different than the vaccinations that we receive for polio, hepatitis, measles, mumps and rubella.  All of these may stimulate the immune system well enough to produce the necessary antibodies to make sure that we do not become ill.  Frequent use of BotoxÒ and its other biologic cousins (Myobloc, Dysport, Xeomen, and Puretox) can cause immunological reactions to inactivate the botulinum toxins from helping our patients.  The only compound that does not seem to invoke this biologic response is phenol, likely due to its simple atomic structure.

For the last 15 years I have kept a database of injections that I have performed.  It took several years of performing the injections to realize that such a database is necessary.  Of the more than 800 movement disorder patients I have been injecting many have some factors in common.  We work very hard to keep the overall dose of medicine to an absolute minimum per each series of injections.  We will try to increase the time period between the injections occasionally stretching out the injection cycle to 14 – 26 weeks especially if the patient’s symptoms are better controlled.  These two factors alone may be responsible for the longevity that I have seen with some of my patients.

I think that there are several other factors that play into the success or failure of injections.  There is now enough numbers of different injectors of medications that if you are dissatisfied with your treatment you may seek out other physicians to help you.  In addition, if a particular physician wants to keep his patient, he may bend the rules and perform one of the dreaded evil booster injections.

Injections are being performed for other conditions than dystonia.  Some of these include myofascial pain syndromes, complex region pain syndromes or even fibromyalgia.  The concern here is if too frequent or too large amounts of botulinum toxins are used, then if and when the patient has a real problem that requires injections, then we may have lost our window of opportunity to treat because of sloppy treatment behaviors at a younger age.

There are also some misconceptions that suggest patients’ believe that the effectiveness of the botulinum toxins will only last for several years.  Then the effect will be gone and one would have to search for alternative treatment.  The patient’s who have been injected for nearly twenty years would argue against such thoughts.

Since no one person seems to know where healthcare is going to end up in the next several years, I sense that many patient’s and physicians feel that they might as well get in all the injections that they can before the government shuts them down!

Almost as an afterthought, let us not forget that physicians who provide booster shots are likely to get cash for those injections rather than running claims through insurance companies.  Willie Sutton, an outlaw from the old West, was reportedly asked why he robbed banks.  His classic reply “…that’s where the money is!”

Boosters may be fine for basketball and football teams but when it comes to BotoxÒ injections, a general rule of thumb is that they are not a good idea.


Dr. Jim Auberle, M.D.
August 2009

My mom and I wanted to thank you for hosting such a great symposium this year. This was our third year and we are looking forward to next years. E. Mathews