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Thread: BOTOX experiences......HELP!

  1. #1

    BOTOX experiences......HELP!

    Well, I had a BOTOX procedure to my bladder done 3 weeks ago. I am absolutely LOVING what it has done for my bladder. I don't have to empty every 2 hours and I can now get some sleep at night!!!

    The bad thing is that I am experiencing some major muscle weakness in my arms. Being a c-6/7, this is not good at all. I push the limits of my disability--I drive a car and live pretty much independently. Losing some function is threatening my ability to do this safely because it is knocking out the already reduced tricep function I have. I am wondering if this loss of strength is something that is common, does it go away, how long does it stay, do I have to wait for the botox to completely run its course, etc? It seems like if the injections were into my bladder, that my arms could only be getting a fraction of the drug and would therefore be back to normal long before my bladder goes back to its pre-BOTOX state.

    Any insight or experience would be greatly appreciated!

  2. #2
    Bobby,

    To my knowledge, Botox is not supposed to weaken muscles so far from the injection site. So, I did a medline search and found the following information. Some people get a flu like syndome and general weakness. The incidence of the latter is supposed to be very low. Generally, if there weakness, if shold be mind and should be gone in two weeks.

    The Slawek paper is a general botox side-effects paper that mentions the possibility of generalized weakness. The rest are just some recent papers... I looked through most of them and was unable to find any that mentions the complication that you are describing.

    I think that you should call your doctor and find out what is going on.

    Wise.

    • Slawek J, Madalinski MH, Maciag-Tymecka I and Duzynski W (2005). [Frequency of side effects after botulinum toxin A injections in neurology, rehabilitation and gastroenterology]. Pol Merkuriusz Lek 18: 298-302. Botulinum toxin type A is one of the most potent biological toxins, recently used clinically (Botox, Dysport) for wide range of indications. THE AIM OF THE STUDY was to assess the frequency and severity of side effects during BTX-A therapy for different indications and underlying possible mechanisms. MATERIAL AND METHODS: Material consisted of 327 patients (F202, M125) who underwent 1043 sessions of BTX-A injections for: cervical dystonia--CD (n=58), blepharospasm--BLP (n=31), hemifacial spasm--HFS (n=39), spasticity due to cerebral palsy--CP (n=96), chronic anal fissure--CAF (n=96), esophageal achalasia--AE (n=7). RESULTS: In CD the following side effects were observed: dysphagia (27% of patients and 7% of sessions), weakness of neck muscles (6.7% and 1.3%), pain during swallowing (5.1% and 1%), flu-like syndrome (3.4%, 0.7%). Dysphagia appeared 8.2 days after injection and lasted 14.9 days on average. In BLP authors noticed: unilateral ptosis (22%, 6.3%), bilateral ptosis (3%, 1.9%), haematoma (3%, 0.6%) and in HFS: excessive weakness resulting in asymmetry of face--mild (28.2% and 20%) and moderate (46% and 26.7%). In spasticity due to CP authors noticed: excessive weakness of lower limbs which lasted 13.8 days on average (6.2% and 1.9%), pain (5.2% and 1.6%), flu-like syndrome (4.1% and 1.3%). In CAF: mild incontinence of the flatus and faeces (9% and 5% of sessions), haematoma (5%), flu-like syndrome (3%), inflammation of external anal varices (2%), epididymitis (1%). In AE: chest pain in 6 (at the day of injection and lasted 2-4 days) and reflux in 2 patients (4-8 weeks after injection, lasted 2-3 weeks) were observed. CONCLUSION: Therapy with BTX-A is a very safe procedure, especially when compared with high rate of effectiveness of injections. The side effects are transient, mostly local and completely reversible. Klinika Neurochirurgii, Oddzial Neurochirurgii Czynnosciowej i Chorob Ukladu Pozapiramidowego Akademii Medycznej w Gdansku. jaroslawek@amg.gda.pl http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15997637
    • Schulte-Baukloh H, Schobert J, Stolze T, Sturzebecher B, Weiss C and Knispel HH (2006). Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis. Neurourol Urodyn 25: 110-5. AIMS: We studied the use of botulinum-a toxin (BTX-A) injections into the bladder as an alternative approach in patients with neurogenic detrusor overactivity due to multiple sclerosis (MS) with drug-refractory overactive bladder (OAB) symptoms. METHODS: Sixteen MS patients--11 women, 5 men; mean age 48.6 years--with refractory OAB symptoms were included in a one-center prospective study. For outcome analysis, we used a bladder diary, a complete urodynamic study, and validated questionnaires for subjective assessment. We injected 300 U of BTX-A (Botox) into the bladder and into the external sphincter muscle to reduce the probability of posttreatment urine retention. RESULTS: There was an increase in residual volume from 81.3 +/- 23.8 to 126.3 +/- 32.9 ml after 4 weeks. In one woman, transient self-catheterization was unavoidable. Four weeks and 3 and 6 months after BTX-A injection, the significant results were as follows: daytime frequency was reduced by 29%, 44%, and 30%, respectively. Nocturia diminished by 33%, 72%, and 40%. Use of pads was be reduced by 38% after 4 weeks and by 64% after 3 months. Urodynamically, reflex volume and maximal cystometric bladder capacity increased by 73%, 77%, and 58% (at 6 months, the increase was not significant) and by 36%, 27%, and 36% (not significant). Maximal detrusor pressure decreased by 35%, 22%, and 57%. Subjective outcome indicated significant improvement of symptoms at 4 weeks and 3 months, but not at 6 months. Patient satisfaction with the therapy was very high. CONCLUSIONS: BTX-A detrusor injections are very effective in the treatment of drug-resistant OAB symptoms in MS patients as reflected in urodynamic measurements and in patient satisfaction. Build up of residual urine remains a problem of which patients must be informed. Department of Urology, St. Hedwig Hospital, Academic Teaching Hospital of Charite University Hospital, Berlin, Germany. hschultebaukloh@hotmail.com http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16470519
    • Grise P, Daoudi Y, Tanneau Y and Sibert L (2005). [Use and mechanism of botulinum toxin in overactive bladder treatment]. Ann Urol (Paris) 39: 105-15. Overactive bladder is very frequent in central neurogenic patients; it is a major cause of refractory incontinence despite anticholinergic treatment. In non-neurogenic patients it results in very distressing symptoms that associate urgency with or without incontinence and frequency. Botulinum toxin A is a well known agent used previously in the treatment of striated muscle spasmodism, which blocks the release of acetylcholine from nerve endings and neuro-muscular transmission. Its recent use in urology revealed a dramatic improvement in clinical and urodynamic parameters of the overactive bladder, associated with a long lasting effect over 6 to 9 months and an excellent tolerance. In neurogenic patients, the efficacy of botulinum injection was demonstrated over a placebo control group. Toxin was injected at 20 to 30 different sites in the detrusor muscle, with cystoscopy guidance. Recent studies showed a sub-epithelial mechanism of action on neuropeptides, which could explain an inhibitory effect of both efferent and afferent arms of the micturition reflex. Further studies remain necessary regarding the respective doses of Dysport and Botox toxin, selection of patients, combination with anticholinergic treatment, effects of repeated injections. Service d'urologie, Centre hospitalier universitaire Charles Nicolle, Rouen, France. philippe.grise@chu-rouen.fr http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16302703
    • Guzman S, Honeck P, Weiss J, Katrin Badawi J, Alken P and Bross S (2005). [Botulinum toxin injection for neurogenic and no neurogenic bladder dysfunction]. Arch Esp Urol 58: 651-5. OBJECTIVES: Botulinum toxin A (BT A) has gained popularity among urologists in the treatment of detrusor muscle dysfunctions. The aim of this article is to review our experience with this therapy METHODS: From 2001 we used BT A in 28 patients. It was injected in the bladder wall under cystoscopical vision. We analyze the indication of treatment, clinical data and urodynamics before and after treatment. RESULTS: We treated 28 patients. 71 percent had neurogenic hyperreflexic bladder, 18% idiopathic unstable bladder and 11% other diseases. No direct complications were observed. Neurogenic hyperreflexic bladder (n = 20): Mean preoperative bladder capacity was 220 cc, improving to 430 cc after treatment. Non inhibited contractions disappeared. All patients except one with multiple sclerosis, who had spontaneous voiding, required self catheterization after injection. Average time interval between injections was 8.6 months. Idiopathic unstable bladder (n = 5): a lower dose was used, with an average of 100 U. Non inhibited contractions disappeared and all patients were able to maintain spontaneous voiding with post void residuals under 50 ml. No patients required self catheterization. Bladder capacity improved from 128 ml to 370 ml. Average number of voidings per day diminished from 16 to 7 times. Other diseases (n = 3): results were poor in these patients. There were no changes in either bladder function studies or average voiding frequency (15 times per day). These patients required surgery for bladder augmentation in 2 cases and continent diversion in 1 case. CONCLUSIONS: BT A has a role in the treatment of neurogenic hyperreflexic bladder diminishing incontinence and improving bladder capacity. In cases of idiopathic unstable bladder without anatomical changes its results are promising, but a limited number of patients does not allow a definitive conclusion. In other bladder diseases with anatomical changes results are poor and its use should not be routinely recommended. Departamento de Urologia, Universitatsklinikum Mannheim, Alemania. sergio.guzman@uni.ma.uni-heidelberg.de http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16294787
    • Klaphajone J, Kitisomprayoonkul W and Sriplakit S (2005). Botulinum toxin type A injections for treating neurogenic detrusor overactivity combined with low-compliance bladder in patients with spinal cord lesions. Arch Phys Med Rehabil 86: 2114-8. OBJECTIVE: To evaluate botulinum toxin type A (BTX-A) for treating neurogenic detrusor overactivity in patients with spinal cord lesions, including those with abnormally low bladder compliance. DESIGN: Nonrandomized, before-after trial (9-mo follow-up). SETTING: Hospitalized care. PARTICIPANTS: Ten patients with high detrusor contraction pressure and/or poor response to oxyphencyclimine with incontinence selected as a consecutive sample. INTERVENTION: BTX-A (Botox; 300U) was injected into the detrusor muscle. MAIN OUTCOME MEASURES: Urinary continence, functional bladder capacity, bladder compliance, detrusor contraction pressure, and volume at first reflex voiding. Measurements were taken before and 6, 16, and 36 weeks posttreatment. RESULTS: Six weeks after treatment, complete continence was restored in 7 patients without oxyphencyclimine. Mean functional bladder capacity (P=.008), compliance (P=.012), and reflex volume (P=.045) significantly increased, whereas maximal detrusor contraction pressure significantly decreased (P<.001). Urodynamic variables remained significantly improved at 16 weeks, but values were returning toward baseline levels by 36 weeks. The procedure was generally uneventful, without any serious side effects. CONCLUSIONS: BTX-A injections are an effective, well-tolerated treatment for neurogenic detrusor overactivity in patients with spinal cord lesions, even in patients with abnormally low bladder compliance. Patients may require repeat injections after 16 weeks to remain continent. Department of Rehabilitation Medicine, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand. jklaphaj@mail.med.cmu.ac.th http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16271557

    Quote Originally Posted by BOBBY_BOUCHET
    Well, I had a BOTOX procedure to my bladder done 3 weeks ago. I am absolutely LOVING what it has done for my bladder. I don't have to empty every 2 hours and I can now get some sleep at night!!!

    The bad thing is that I am experiencing some major muscle weakness in my arms. Being a c-6/7, this is not good at all. I push the limits of my disability--I drive a car and live pretty much independently. Losing some function is threatening my ability to do this safely because it is knocking out the already reduced tricep function I have. I am wondering if this loss of strength is something that is common, does it go away, how long does it stay, do I have to wait for the botox to completely run its course, etc? It seems like if the injections were into my bladder, that my arms could only be getting a fraction of the drug and would therefore be back to normal long before my bladder goes back to its pre-BOTOX state.

    Any insight or experience would be greatly appreciated!

  3. #3
    Hi Bobby,

    I've had the botox injections too. And for me too the effect on the bladder is wonderful. First time I didn't have the muscle weakness, but the second time I had. It lasted for about 3 months but the effect on my bladder is already lasting 16 months now!!
    Those first months after the injections I went back to my urologist and SCI doctor. Both had no idea what caused the weakness and claimed it wasn't caused by botox.
    Months later my SCI doctor sent me the following article (full article on paper):
    http://www.nature.com/sc/journal/v43...C97303A206CA7A
    So we're not the only ones experiencing this loss of strength and loss of independency but it will come back; hopefully soon!

    Bieke

  4. #4
    Senior Member pavel's Avatar
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    Dr. Wise,
    Hello
    Doctor in delhi from indian spinal injury centre also suggest me about botex
    From today i have start CIC, but leckage problem after 3-4 hours be started , taken some medicine what u say dr. wise, rt for me botex or not,dr. told me high pressure inmy bladder cause of my leckage,
    guide me Dr. Wise,

    pavel
    Last edited by pavel; 03-28-2006 at 12:52 PM.

  5. #5
    BKE, thank you for the reply! do you have access to that article? i would LOVE to read it.

    so you had weakness too? man, i'm getting worried this is permanent. what level injury are you and what sort of weakness did you experience? i guess we're in that rare category of people that suffered adverse effects. i think i'd still do it because of how much i love not having to cath so often, and being able to get a full night sleep.

    thanks for your response!

  6. #6
    Quote Originally Posted by Bke
    Hi Bobby,

    I've had the botox injections too. And for me too the effect on the bladder is wonderful. First time I didn't have the muscle weakness, but the second time I had. It lasted for about 3 months but the effect on my bladder is already lasting 16 months now!!
    Those first months after the injections I went back to my urologist and SCI doctor. Both had no idea what caused the weakness and claimed it wasn't caused by botox.
    Months later my SCI doctor sent me the following article (full article on paper):
    http://www.nature.com/sc/journal/v43...C97303A206CA7A
    So we're not the only ones experiencing this loss of strength and loss of independency but it will come back; hopefully soon!

    Bieke
    Bieke, thanks very much for the citation. Wise.

  7. #7
    Hi,
    My injury level is C4-5-6 but incomplete. I can move my left leg. The first 3 months after the injections the weakness was in my whole body (could hardly move my leg) but the loss of strength in my arms was the most frustrating. I already have weak arms and those months I was really considering buying an electrical wheelchair.
    I do have the full article (2 1/2 pages) but I'm not a very good typist. Any idea how to do this another way?

    Bieke

    Dr Young, you're welcome.

  8. #8
    if it's on your computer, can you copy and paste it into a message? or do you only have a printed copy?

    thanks!

  9. #9
    Sorry Bobby, I only have a printed copy.

  10. #10
    The article says it is a lit review of 4 articles. Probably include the ones Dr. Wise cited. I have asked our librarian to get the article for me if she can.
    If she can, I will post it if I can.

    CWO

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