You may know Botox as the go-to cosmetic treatment for smoothing out wrinkles, but did you also know it can provide relief for some people living with multiple sclerosis (MS)?
Botox, a brand name for the drug onabotulinumtoxin A, is a temporary muscle relaxant. Although Botox is made from a potentially deadly neurotoxin, in small amounts, it can safely relax muscles.
Botox is a form of botulinum toxin type A, which is taken by intramuscular injection. Two other types of botulinum type A also used to treat symptoms of MS are abobotulinum toxin A (sold as Dysport) and incobotulinum toxin A (sold as Xeomin).
Many MyMSTeam members have tried botulinum toxin treatments and have written about their experiences. “Well, here we go yet again. It’s time for my Botox treatment. I never knew that Botox was for things other than getting rid of crow’s feet,” wrote one member.
In MS, the immune system malfunctions and attacks the nerve fibers in the central nervous system. Botulinum toxin injections are sometimes used to treat symptoms of MS such as spasticity (muscle stiffness or tightness), problems with mobility, bladder control, migraine headaches, and vocal cord problems. Botox can help relax involuntary muscle contractions caused by nerve damage.
Note that although botulinum toxin therapies may provide temporary relief from some symptoms, only disease-modifying therapies have been shown to slow MS disease progression and disability.
Continue reading to learn about some ways therapies like Botox, Dysport, or Xeomin could ease MS symptoms. If you think botulinum toxin treatment might be helpful for your MS symptoms, talk to your neurologist.
Bladder problems can be a particularly uncomfortable symptom of MS. Muscle spasms in the bladder and urinary sphincter — the muscle that opens to release urine — can cause urinary incontinence or an overactive bladder. You might experience leaking of urine, frequent or weak urination, or an urge to urinate day or night, that comes on suddenly and is hard to control.
As cited in the journal Neurology, one study of 144 participants with MS found that onabotulinumtoxin A significantly reduced bladder dysfunction. More than half of the participants experienced a 100 percent reduction in urinary incontinence after six weeks.
“Botox has been a life changer for me. No more leaks or wet seats,” a MyMSTeam member wrote. Another member said, “I’ve gotten my second Botox to my bladder and must say it’s definitely an improvement.”
Botulinum toxin can be injected into the bladder muscle through a procedure called a cystoscopy. A very small camera and needle are inserted through the urethra (where urine comes out of the body). You may have local or general anesthesia during this procedure. Possible side effects include pain, bloody urine, or an inability to urinate after the procedure. This is a temporary treatment, so you will need to repeat this procedure after three to six months if you find it helpful.
Muscle spasticity in MS causes stiff, tight muscles and involuntary or jerky movements that can be painful and disruptive to daily life.
Botulinum toxin may be used to relieve muscle spasms when just a few areas of the body are affected. For instance, there have been several studies on botulinum toxin type A for cervical dystonia, a type of muscle contraction that can occur in the head, neck, and shoulder, causing abnormal and painful movement. A review of eight such studies found this treatment improved pain for most participants, but it also increased the risk of swallowing difficulties and fatigue.
Botulinum toxin can help improve mobility, which can be hindered by spasticity. In the journal Toxins, one observational study of 125 people with MS showed that botulinum toxin injections helped many participants achieve their goals of improved mobility and gait.
“I get Botox every three months in my left leg to help with walking,” a member wrote. Someone else wrote, “I have regular Botox to help with problems in my foot/big toe. It’s effective for a while but does wear off!”
A health care provider administers injections into the specific muscle groups that are targeted for treatment. It’s an outpatient procedure that typically lasts between 30 and 45 minutes. Common side effects include pain at the injection site and temporary muscle weakness.
MS can affect vocal cord muscles, making speaking difficult. According to MS Magazine, around 40 percent of people with MS experience speech issues. This complication can be due to muscle problems in the mouth, throat, jaw, or vocal cords.
Botulinum toxin treatments can help the vocal cord muscles relax and lengthen, so they function better. Several techniques are used for injections in the vocal cords, such as inserting a small camera and needle through the nasal cavity or inserting only a needle through the throat. The procedure is usually performed in a doctor’s office with local anesthesia. Possible side effects include difficulties in swallowing, breathiness, and breathing in fluids.
“Yes, the Botox does help,” wrote a MyMSTeam member. “I see an otolaryngologist for those treatments. It lasts about three or four months. Otherwise, I would also find myself trying to avoid conversations with people. It was extremely difficult when I was working because my job required me to talk to lots of people daily.”
“I finally went back to the doctor for another Botox treatment for the vocal cords,” another member said. “For the next couple of weeks, I will sound as if I am whispering, and then my vocal cords should ‘relax’ for a few months. Brief relief!!!!”
Botulinum toxin may be effective at treating chronic migraine headaches, which is a common symptom for people with (and without) MS. Although clinical trials have shown that botulinum toxin may help treat migraine, researchers do not fully understand how it works. Studies indicate that it may block pain pathways in the central nervous system.
One MyMSTeam member wrote, “My neurologist gives me Botox every 90 days for migraines, and I must confess I haven’t had a migraine for almost one year.”
“I’ve used Botox for migraines,” another member said. “When she was doing the shots, she noticed my neck was really stiff and did injections there, too. It really helped both issues a lot. I go every 90 days for Botox.”
Botulinum toxin treatments for migraines are administered by a clinician who injects it through a tiny needle into very small muscles in the head and neck. In some cases, injections may be targeted at “trigger points” where migraine headaches originate. Some people do not experience relief for several weeks. It may take a few treatments until migraines subside.
Although botulinum toxin is generally considered safe and may be an effective treatment for some MS symptoms, there is a risk of rare but serious side effects such as:
Botulinum toxin can be hazardous, and injections can potentially spread it beyond the intended muscle group. When this complication happens, botulism poisoning can occur within hours, days, or even months after an injection. Some individuals develop a resistance to botulinum toxin, usually because they built antibodies against it, especially after multiple treatments.
If you and your doctor determine botulinum toxin may be an appropriate treatment option for you, make sure to talk to your health insurance company before the treatment to find out if they will cover it. Botulinum toxin therapy has been approved by the U.S. Food and Drug Administration (FDA) for treatming spasticity. Keep in mind, however, that coverage can vary for botulinum toxin injections, depending on the health insurance provider.
You may qualify for savings programs offered by the drug companies that manufacture botulinum toxin treatments. If you meet certain requirements, these programs can help with out-of-pocket costs such as copays, deductibles, and coinsurance. You can learn more at:
Note that botulinum toxin therapy is not a cure for MS and should be used only as part of a treatment plan. These injections may have side effects, such as muscle weakness and difficulty swallowing. Make sure to discuss side effects with a health care professional before considering treatment. Your health care provider will carefully assess whether this treatment is appropriate for you, taking into account your medical history and any other medications you may be taking.
On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 197,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.
Have you tried Botox or another botulinum toxin treatment for your MS symptoms? Did you find this article helpful? Share your experiences in the comments below, or start a conversation by posting on your Activities page.