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Botox Treatments

Botox Treatments for Medical Conditions

November 1, 2012
12:00 p.m. – 1:00 p.m. (EST)

  • Tarannum Khan, MD

Cleveland_Clinic_Florida_Host: Today's Live Web Chat, "Botox Treatments for Medical Conditions" with Tarannum Khan, MD will begin very shortly, thank you for your patience. Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Florida_Host: We have already received some great questions! Dr. Khan will begin to answer your questions momentarily. Thank you in advance for your patience. We will get through as many questions as possible.

Cleveland_Clinic_Florida_Host: Welcome to our Online Health Chat "Botox Treatments for Medical Conditions" with Tarannum Khan, MD. We are thrilled to have her here today for this chat. Let’s begin with the questions.

goheat6: What’s the difference between Juvederm, Dysport and Botox?

Dr_Khan: Botox is the name of one type of Botulinum toxin. Botox is the so called "trade" name. Botulinum toxins are marketed by different names by different companies- Dysport is one of them. The indications for Dysport are similar to Botox. Juvederm is something, I think is used for cosmetic purposes- I haven't used it for medical purposes.

jdavidof: Do you give Botox shots to patients who have back spasms caused by a tear in the ligaments in the L4 & 5?

Dr_Khan: It can occasionally help but for the most part No. It doesn’t get approved for this indication by insurance companies.

caminante81: Hi Dr. Khan! I have a question about Botox as treatment for muscle spasms in multiple sclerosis patients. I am curious about the long term effects of Botox injections. What are the long term side effects of Botox injections? Do they eventually lose efficacy in patients who are treated on a regular basis? How often is Botox given for muscle spasms? Is it more effective for some muscles than others – for example, back muscles as opposed to muscles that control urinary function?

Dr_Khan: Definitely Botox or its other counterparts like Dysport, Myoblock etc. can be used for secondary spasticity caused by Multiple sclerosis or strokes. The Botox weakens the muscles and it has to be repeated every 3-5 months. I try to avoid it to be repeated in less than 3 months. So far no significant long term side effects of Botox have been seen. Definitely as we progress in time the issue of antibody formation comes up which is dealt with accordingly. They do use Botox for urinary symptoms also, which we haven't been doing in our Neurology department. You are right, each individual muscle group has to assessed individually and then a discussion with the injecting physician regarding the possible outcomes should be held prior to the treatments. Hope this answers your question.

Cleveland_Clinic_Florida_Host: We have already received some great questions! Dr. Khan is being as thorough as possible in her answers. Thank you in advance for your patience. We will get through as many questions as possible.

mkboogie: Hi Dr Khan.I have Hemi facial Spasm on my left side of the face. I have been receiving Botox injections since 2010. Are there any long term health risks? Botox injections are administered every 3 months.

Dr_Khan: No. I have treated patients with hemi facial spasm for years.

mkboogie: I am currently breastfeeding. I usually "pump and dump" my breast milk 24 hours after receiving the Botox.

Dr_Khan: I have had talks about the Botox and breast feeding with the BOTOX company representatives. They have no data. I have never treated someone with Botox when they are Breast feeding.

mkboogie: Does the dosage have to be increased after a while?

Dr_Khan: Very good question. No specific studies have been done. In my experience the dosage remains the same over the years. It does however take 2-3 injections to reach the best optimal dose sometimes.

DAuclair: How is Botox used to manage pain? I have FMD of the carotid arteries in the head and neck and suffer from chronic headaches.

Dr_Khan: Botox has been now FDA approved for certain types of chronic headaches. And depending on the type of headache it can help.

jodyraddy1: Hello Dr., I’m considering Botox injections for my son, he’s 13. Is he a candidate for injections for facial spasms?

Dr_Khan: It will all depend on what kind of facial spasm he has. It is beneficial in Blepherospasm (recurrent twitching of both eyes) and Hemi facial spasm (one sided spasm of half of the face).

RW1975: Can you list the side effects of getting Botox® for strabismus?

Dr_Khan: We do treat for strabismus at Cleveland Clinic Florida. However, possible side effects can include bleeding behind the eye- any blurred vision etc. after the injection should be immediately attended to.

gatormom: Who is the appropriate doctor to administer Botox injections, it seems like everyone is doing them. My ophthalmologist offers them too.

Dr_Khan: That is a very important question. Who should be doing it? In Neurology, for a lot of medical conditions Neurologists are trained during their fellowship (further training after Residency) to do the Botox. However I agree with you a lot of physicians are doing it. I have seen Ophthalmologists doing it for strabismus. Headaches are being done almost by everyone these days. I think one can get specific references through the Botox company too. It is an important question, with no easy answer. Personal recommendations from patients can be helpful too.

yolo: Where do you get injected for migraines?

Dr_Khan: There is a specific protocol of 31 sites around the head and neck, in the forehead, temples back of the head, neck and a few areas in the shoulders as well.

mkboogie: What are the ingredients in a Botox injection for hemi facial spasm? Are there any parabens or artificial ingredients or preservatives?

Dr_Khan: Botox comes in a powdered form, stuck in the bottom of the bottle. It is reconstituted in the desired concentration by your doctor by adding desired amount of saline. The concentration used for Hemi facial spasm is very mild. I am not sure about the preservatives.

gbh: Are there any major complications with recurrent Botox treatments? I get injections in my brow and upper lip every 4-5 months.

Dr_Khan: No.

honolulugirl: I have Lambert-Eatons, however my meds have been working to give more muscles strength, I want to get Botox for my eyelids. Can I be in any danger?

Dr_Khan: Yes. Muscle weakening diseases are one of the contraindications for the Botox injections. You will have to have a discussion with your injecting doctor about the dosage and also it will depend on your examination.

stephyc: Is Xeomin comparable to Botox?

Dr_Khan: Xeomin is another type of botulinum toxin type A- the generic is Incobotulinum toxin A. Similar effects can be expected as Botox however proven only for some conditions so far.

PADDY: My 56 year old aunt had Botox-A injections for headaches and after about a month she began to suffer from severe migraines. What can she do to relieve her of this pain?

Dr_Khan: Very difficult to answer without knowing full history, without examining. She should be evaluated by a neurologist for any specific weaknesses in any specific muscle groups etc.

PM187: Can Botox injections be used to prevent wrinkles?

Dr_Khan: I have no experience in cosmetic use. Please log on to clevelandclinicflorida.org to find out more information about cosmetic injections.

Rebecca: My father had a stroke a year ago and his arm muscles are very tight, can we consider Botox to get some spasticity back, thanks.

Dr_Khan: Absolutely. It can help relax the muscles to some degree for sure. While deciding for post stroke spasticity one has to be careful so that the Botox doesn’t make the already weak muscles further weak.

Cleveland_Clinic_Florida_Host: We have approximately 10 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

XNXX: is Botox® the same as botulinum toxin, please explain the difference?

Dr_Khan: "Botox" is a specific name for a kind of Botulinum toxin made by a specific company- Allergan. Its actually now renamed- Onabotulinum toxin A. This has been done because slightly different toxins have been found like Incobotulinum toxin A. And then there are botulinum toxin type B. These are all used in similar fashion but it depends on their marketing companies, who develop these ingredients to be able to be used for medical purposes- as to how do they make the final product. Some come premixed in a liquid form, and some have to be reconstituted from a powdered form. Their indications vary sometimes and so do the dosages. Some have been more used in UK as compared to USA. Some have been in the market longer than the others. In short though- Botox is a trade name while Botulinum toxin is generic like acetaminophen is generic and Tylenol a trade name.

mkboogie: What are the chances of Botox toxin spreading outside the area of administration or how much area does Botox injection cover?

Dr_Khan: It can happen however it’s difficult to predict in whom it will happen and in how much area. It happens more often when Botox is injected in and around the neck muscles- causing difficulty swallowing. Usually less likely to spread to the neck muscles for example, if injected in a leg.

Cleveland_Clinic_Florida_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

Vicky_belton: I had a bad reaction to Dysport, should I stay away from Botox as well?

Dr_Khan: For the most part, yes. But it also depends on the kind of side effects you had.

benjilopez: How does Botox injections work for underarm sweating? Is it possible to use in other locations of the body for excessive sweating?

Dr_Khan: It works very well for underarm sweating. Among sweating it works the best for underarm sweating because the pain is somewhat lesser when compared to other areas for excessive sweating like palms and soles. It can also be done for forehead and hairline area.

mkboogie: Or for example in a left hemi facial spasm, can the toxin go to the neck or breast (breastfeeding) area?

Dr_Khan: The official note from the company says it can spread to far away body areas too. So the answer will be yes.

Cleveland_Clinic_Florida_Host: I'm sorry to say that our time with Tarannum Khan, MD is now over. Thank you again, Dr. Khan, for taking the time to answer our questions today about Botox Treatments for Medical Conditions. To make an appointment with Dr.Khan, or any other specialist at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

Cleveland_Clinic_Florida_Host: If you would like to view the entire transcript of this chat after the event, it will be available on the Cleveland Clinic Florida website.If you have logged in during the middle of this chat and want to view what has already been discussed, click on the transcript button on this page.