Botox for MS symptoms? - news - multiple sclerosis

Inside MS, Jan-March, 2003

When the FDA approved Botulinum Toxin Type A (Botox Cosmetic) to temporarily improve the appearance of frown lines last April, it was the first time most Americans had ever heard the word "Botox". The drug, however, is anything but new: Botox was FDA-approved in December 1989 to treat two eye muscle disorders (blepharospasm and strabismus) and in December 2000 to treat cervical dystonia, a neurological movement disorder causing severe neck and shoulder contractions.

Botox and spasticity

Because Botox selectively paralyzes nerves, it also seemed a likely candidate for treating spasticity--a nerve-driven condition common among people with MS. A study published in the Annals of Neurology in 1990 detailed the results of a small double-blind, placebo-controlled trial in which investigators gave Botox injections to 10 non-ambulatory people with MS who had spastic contraction of the thigh muscles. It was a "crossover" trial, in which all participants received Botox or an inert injection. They had all had trouble sitting, cleaning, and catheterizing themselves, and they all experienced marked improvement--and no adverse effects--while taking Botox.

Botox and bladder dysfunction

Botox has also been studied in detrusor sphincter dyssynergia (DSD), which causes urinary urgency, frequency, incontinence, difficulties emptying the bladder, and urinary infections in people with MS. DSD is serious. It can sometimes lead to damage of the upper urinary tract (kidneys and ureters--the tubes connecting the kidneys with the bladder). In two case studies, each involving someone with MS who had DSD, Botox relieved symptoms for about three months after injection.

A study by University of Pittsburgh researchers presented at the American Urological Association's annual meeting last spring showed that 41 of 50 people with a variety of bladder problems, including MS-related ones, reported a decrease or absence of incontinence after a Botox injection. Symptom relief came within seven days of the injection and lasted for as long as six months. No one experienced longterm complications.

While it is unlikely that Botox will be resubmitted to the FDA for specific approval to relieve MS-related spasticity or bladder problems such as DSD, some MS doctors have begun to prescribe it. If you have questions about the use of Botox, ask your healthcare professional.