Botulinum Toxin and Boosters

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My first reaction to hearing that some patients were being given booster shots of Botulinum Toxin 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 Botulinum Toxin 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 Botulinum Toxin 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 Botulinum Toxin 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 Botulinum Toxin 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 Botulinum Toxin and booster shots on the Pub Med National Library of Medicine database reveals several articles all in favor of avoiding booster shots entirely.

Botulinum Toxin 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 Botulinum Toxin 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 Botulinum Toxin 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