Benefits and Risks of BOTOX Injections

Botox is shortened form of Botulinum toxin and this is a type of neurochemical agent that acts on axonal endings that inhibits the release of acetylcholinesterase.

So, this inhibition leads to neuromuscular blockade. This toxin was first isolated from bacteria known as Clostridium botulin.

Now, with the help of the recombinant method, this is extracted on a commercial basis. Its use has been approved for various medical conditions.

Though it has many benefits, one of the main risks of botox is its absorption from the injection site leading to systemic effects

Available Strengths of Botox Injections

This is available in form of a dried powder that has to be reconstituted with 0.9% Normal saline and it is available in the strength of 50, 100, and 200 units.

How to inject Botox?

This can be administered through various routes which include Intramuscular, Intra detrusor, and intradermal. The needle shall be inserted at least 2mm deep into the injection site. Lastly, reinjection time is between 42-48 weeks but shall not be earlier than 12 weeks.

Common Uses of Botox Injections:

Botox is being increasingly used in the treatment of various neuromuscular disorders. Primarily, it is used to relieve spasms as in patients with stroke and dystonia. However, it is more commonly used in cosmetic procedures nowadays than for true medical purposes.

Here are some of the medical uses of Botox injections:

Botox for Chronic migraine

Botox injections can be used as a preventative measure in cases of chronic migraine. It is usually indicated if the patient experiences more than 15 episodes per month lasting longer than four hours.

More studies are being carried out, however, it is currently recommended by FDA for Chronic migraine. Botox safety and efficacy apart from risks and benefits have not been established in episodic migraine.

Botox for Cervical dystonia

Another FDA-approved indication is its role in cervical dystonia. The dose depends on the area of involvement and on the position of the head and the hypertrophy of muscles.

As in cervical dystonia, there is a tilting of the head towards the spastic muscle. This continuous spasm eventually leads to hypertrophy of the muscles.

Botox for Upper limb spasticity

This is another muscular problem associated with hypertrophy and spasm of the upper limb muscle.

In this condition, the dosage is guided by the results of EMG studies and also size of the muscle is an essential determinant in dosage calculation. So, botox is also indicated to relieve muscle spasms in the limbs.

Botox for Blaphorism:

Blepharospasm is a condition when the eyes cannot close properly leading to incomplete and frequent blinking.

Incomplete closure of the affected eye results in dryness and corneal ulcerations. For this condition, 1.25U to 2.5 U are injected into 3 different sites of the affected eye.

Botox for Strabismus

Strabismus is a defect of the extraocular muscles. In this case, one of the external muscles of the eye goes into spasm leading to malalignment of the eyes.

The recommended dosage is 1.25 – 2.0 U in affected muscles.

Detrusor overactivity

The detrusor is a muscle of the bladder that when contracted causes urination. Overactivity of this muscle causes an inappropriate urge to urinate despite the fact that only a small amount of urine is present in the bladder.

Patients may complain of urinary incontinence and increased frequency. The overall bladder capacity is markedly reduced.

In cases of detrusor overactivity, almost 200 Units of Botox injection are administered. Dilution is made that each 1ml contains 6-7 units of drug and is injected at 30 different points.

Axillary Hyperhidrosis:

Axillary hyperhidrosis is excessive sweating in areas of the armpits. 50 units of botox injection per axilla in different locations are advised.

Side effects of Botox injections:

Two types of complications can develop after injecting Botox. These are:

Complications arising because of systemic absorption:

Systemic manifestations result because of absorption into the systemic circulation. These complications may be serious and require urgent emergency care:

• Upper respiratory tract infection
• Muscle paralysis
• Respiratory insufficiency
• Airway compromise.
• Dysphagia.

Local Complications:

Local complications are secondary to the effects of Botox injection in that specific muscle. These side effects may result from the medicine or the needle insertion.

• Pain at the injection site
• Cellulitis and infection at the site of injection
• Urinary retention
• Retrobulbar hemorrhage

Contraindications & Precautions to Botox injections:

Some of the contraindications to Botox injections are:

• Allergic reactions
• Infection at the site of injection
• Acute urinary tract infection or urinary retention.
• Concommitment neuromuscular disorder may exacerbate the clinical effects of treatment.
• Caution has to be exercised in patients with already compromised airways.

Patients with the above-mentioned conditions should be advised to delay the procedure until all the symptoms have resolved.

Prophylactic antibiotics except aminoglycosides shall be given 3 days prior to injection. [Ref]