Botox® and Boosters

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(Ed. note:  The following is a resurrection of a previous article about Booster injections, in this case, botox.  Whether it’s botox or any of the other toxins, the same will apply for all of them.  We are re-running this article once again as, from what you read in “In Perspective”, this issue raised its ugly head once again.  We believed that all doctors knew about this.  Apparently not…and it could be very serious. You don’t want to build up antibodies).

Botox® and Boosters.

My first reaction to hearing that some patients were being given booster shots of Botox® were 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 Botox® 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 perhaps 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.

Recently, I was referred an unfortunate young lady who had been receiving Botox® injections for spasmodic dysphonia and oromandibular dystonia.  She had been injected every three (3) weeks for a period of about six months and the specific ENT doctor wasn’t sure why the Botox® had stopped working!  When antibody levels were tested, as one can assume, they were highly elevated.  This is one of those situations where we have probably lost the entire ability to work with Botox® completely due to this particular physician’s ignorance and arrogance.

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 Botox® and booster shots on the Pub Med National Library of Medicine database reveals several articles all in favor of avoiding booster shots entirely.

Botox® 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 the medication.  Both of these may stimulate the immune system well enough to produce the necessary antibodies and other immunological reactions to inactivate the botulinum toxins from helping our patients.

Of the handful of patients that I have been injecting with Botox® for the past 14-15 years, many have some factors in common.  We work very hard to keep the overall dose of medicine to an absolute minimum per series of injection.  Patients that we have injected over this time period (14-15 years) have ranged in the 200-300 Unit category.  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.

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

James AUBERLE, M.D.
ST/Dystonia Medical Advisor
Toledo, OH

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