Botox should NOT be used in any neuromuscular diseases (disease that affects your muscles and nerves) such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease], myasthenia gravis or Lambert-Eaton syndrome. From the NIH website - "Guillain-Barré syndrome is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances, the weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until the muscles cannot be used at all and the patient is almost totally paralyzed. In these cases, the disorder is life-threatening and is considered a medical emergency. The patient is often put on a respirator to assist with breathing. Most patients, however, recover from even the most severe cases of Guillain-Barré syndrome, although some continue to have some degree of weakness. Guillain-Barré syndrome is rare. ...The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of those with Guillain-Barré still have a residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack. " Botox acts by irreversibly attaching and blocking the muscle receptors where the nerves send their impulses. For this reason people with disorders of the muscle receptors (myasthenia, ALS Lambert-Eaton) are much more susceptible to even small doses of Botox. In Guillan-Barre the nerves are injured (lose their ability to conduct) but the receptors are normal. As such the use of Botox in anyone with active or residual Guillan-Barre even tough it could logically be safe would be indefensible from a legal point of view, especially if done for a cosmetic reason. Other options would depend on what exactly was bothering your friend. Dr. P. Aldea