Could I have been over injected with Botox? How can my degeneration since my injections get diagnosed properly?

Question

I had MRI's, nerve study, epidural injection, tested for MS lupus multiple blood tests, 1st ANA test positive & now negative. Diagnosed with hyper-reflexes. I have lost strength in my right arm/hand, brain fog, eyes blur at times, muscles twitch from nerve impulses, insomnia, loosing weight & causing anxiety I was tested for MS, Lupus, Lyme disease, seen neurosurgeon, orthopedic surgeon, physiatrist, PT, Rheumatologist, & PC Dr. I am degenerating since injections in 7/2018. What is the cause?

Jeffrey R. Raval, MD, FACS, MBA · Answer

Hello and thank you for your question. I am very sorry to hear about this deterioration in your health. Based on your symptoms, I do not think Botox is the cause of your health issues. I would seek out a neurologist to have them conduct a full evaluation and help pinpoint what might be happening. Good luck and take care!

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Mkijn. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam where the entire medical history is reviewed. However, I hope the information provided here is useful.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
  
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.Botox was originally obtained from the bacterium Clostridium botulinum, the bacteria that causes botulism. These bacteria can be found in certain foods that are not properly preserved. When it is ingested the bacteria multiplies and spreads through the bloodstream releasing a protein called botulinum toxin, the active ingredient in Botox. As the bacteria multiply more and more of the toxin is released. The botulinum toxin attaches to the nerves on large muscles such as those responsible for breathing or those in the limbs. This makes it difficult to breath and perform activities such as walking. The live bacteria are required to multiply and continue releasing large amounts of the toxin. In the absence of the bacteria, as when Botox is used for cosmetic purposes, more toxin is not produced. Also, the amount of toxin used for cosmetic treatments is miniscule compared to the amount required to produce effects such as difficulty breathing. Finally, the minute amount of Botox used in cosmetic treatments is not enough to pass into the bloodstream and spread to other muscles, as evidenced by the lack of systemic side effects.
If I had a patient with the concerns described here I would say that the symptoms described are not secondary to a Botox treatment and I would recommend consulting with a neurologist for further evaluation.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Drew Varano, MD · Answer

Botox is not the cause of your symptoms and you need further medical investigation. I would suggest seeing a neurologist as you have expressed signs of upper motor neuron issues ( Hyperreflexia ) as well as lower motor neuron issues ( muscle twitches are known as fasciculation's ) which ALS needs to be ruled out

Could I have been over injected with Botox? How can my degeneration since my injections get diagnosed properly?

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Could I have been over injected with Botox? How can my degeneration since my injections get diagnosed properly?

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