Multiple Sclerosis: Botox Treatment

Botox can treat many multiple sclerosis symptoms.

• Patients with spasticity in their arms or legs may receive botulinum toxin injections to relieve painful spasms and improve mobility for bathing or dressing.
• Botox may benefit patients who struggle with oral anti-spasticity medications due to side effects.
• Botox can also treat overactive bladder symptoms associated with multiple sclerosis.
• Small amounts of Botox injected into the vocal cords can treat dysphonia, a vocal cord problem some multiple sclerosis patients experience.
• It’s important to note that Botox decreases spasticity but doesn’t improve muscle strength.

What is Botox?

Botox is one brand of purified botulinum toxin, the toxin produced by the bacterium Clostridium botulinum. Medical uses of botulinum toxin began in 1980, when weakening eye muscles was identified as a potential treatment for strabismus, a condition where the eyes don’t align correctly.

While various types of botulinum toxin exist, types A and B are approved for treating muscle problems. In addition to Botox, other approved forms of botulinum toxin A include Dysport and Xeomin. Myobloc is the approved form of botulinum toxin B.

When used medically, botulinum toxin is injected in small amounts to weaken the injected muscles. This weakness can be beneficial for conditions characterized by too much muscle activity, such as dystonia or spasticity. This is different from botulism, a disease caused by ingesting the non-purified bacterium and experiencing widespread weakness due to dispersed toxin.

What is multiple sclerosis?

Multiple Sclerosis (MS) causes demyelination of the brain and spinal cord, leading to impaired axon function. As more areas lose myelin, patients develop symptoms.

• Specific symptoms depend on the location of injury in the brain or spinal cord.
• Patients may experience numbness, tingling, weakness, or even paralysis on one side of the body.
• In some cases, patients may develop incontinence or an inability to empty their bladder.
• As multiple sclerosis progresses, some patients experience muscle spasticity or involuntary painful muscle contractions.

QUESTION

What is spasticity?

Spasticity is a condition where muscles are almost constantly contracted, leading to decreased range of motion, reduced function, and pain.

• It occurs when an area of the brain or spinal cord is injured, resulting in weakness and increased muscle tone.
• Movement of an affected arm or leg often meets involuntary resistance.
• Speeding up the movement can worsen spasticity.
• Spasticity is commonly seen after a stroke, traumatic brain or spinal cord injury, or in cases of multiple sclerosis. In some instances, it can be associated with involuntary tremors.

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Who benefits from Botox injections?

• Patients with limited spasticity, like one arm or one leg, are good candidates for botulinum toxin treatments.
• Patients who struggle with oral medications due to side effects may also benefit from botulinum toxin injections for spasticity.
• Patients with certain neuromuscular diseases, like myasthenia gravis, or those undergoing neuromuscular junction-blocking medications shouldn’t receive botulinum toxin injections, as it can cause widespread or prolonged weakness.

How many Botox injections are needed? How do the injections work?

The number of injections required varies for each patient. Some respond to as few as two or three injections, while others may need more.

• Botox blocks the release of acetylcholine, a neurotransmitter necessary for muscle contraction. By preventing muscle contraction, it relaxes the muscles, reducing spasticity and tone.
• The effects of a botulinum toxin injection do not occur immediately. It takes a few days to start noticing a difference, and several weeks for the maximum benefit to become apparent.
• The effects of botulinum toxin injections are temporary. After a few months, typically three, the injections need to be repeated.

What are the potential risks and side effects of Botox injections?

Experienced injectors consider Botox injections safe and effective. However, there is a risk of weakness in the injected area, which may interfere with its function. As with any injection, pain, bleeding, or infection at the injection site is possible. Large injections can cause widespread dispersion of the toxin, potentially leading to breathing or swallowing problems.

How much do Botox injections cost? Does insurance cover them?

The cost of Botox injections depends on factors like the amount of toxin used, the number of injection sites, and whether guidance methods like electromyography (EMG) or ultrasound are employed. The FDA has approved Botox for treating upper limb spasticity caused by multiple sclerosis and other conditions, and insurance companies often cover most of the associated costs. Some insurance companies may even cover “off-label” uses of Botox, although this depends on the patient’s policy. Most companies can confirm coverage before the injections.

How can I expect to feel after getting Botox injections?

Immediately after the injections, you may not notice any specific changes besides slight soreness at the injection sites.

• Within a few days, you should notice a decrease in spasticity in the targeted area, along with reduced pain and improved function.
• Rarely, some patients experience flu-like symptoms or generalized achiness and fatigue, lasting a few days. Discuss such reactions with your physician.

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Medically reviewed by Joseph T. Palermo, DO; Board Certified Internal Medicine

Goldman, M. D., et al. “Multiple sclerosis: treating symptoms, and other general medical issues.” Cleveland Clinic Journal of Medicine 73.2 (2006): 177-186.

Graham, L. A. “Management of spasticity revisited.” Age Ageing 42.4 (2013): 435-441.

Jankovic, J. “Botulinum toxin in clinical practice.” Journal of Neurology, Neurosurgery, and Psychiatry 75.7 (2004): 951-957.