Children and Botox, WAS:Taniea's proposed treatment plan

August 2, 2011

Shamira wrote:

>

> ...Taniea's GI and he said that his treatment plan at the moment is

> that she have another dilation with Botox. ...

>

> Have any you heard of such research particularly directed towards

> children?

>

I am going to address the Botox issues separately from the rest of your

message. I hesitate to post some of this because even though I think

parents, and others, should know this I think the risk is not too large.

One of the main uses for Botox in children is not achalasia but cerebral

palsy patients being treated for spasticity in their legs. The idea here

is to relax spastic muscles in the legs instead of in the esophagus but

the way it works is the same. There have been problems reported with

this use, even some (I think four) deaths in children. There are also

reports of problems in adults. The product labels already contain a

warning about risks for patients with neuromuscular problems but the FDA

is now investigating similar reported problems in patients without that

risk factor. The number of cases being investigated is suppose to be

small so the risk may also be very small.

It is thought that some of the problems are from overdoses. The products

do not contain consistent instructions and one could confuse

instructions for one product or treatment with another and overdose.

Some other problems seem to come from the site of injection being close

to another tissue that should not be treated. In treating cervical

dystonia (spasms of neck muscles) there are reports of dysphagia

(difficulty swallowing). In fact the labels already contains a warning

about the cervical dystonia related dysphagia risk. The nerves that

control swallowing for the esophagus are close to the injection sites

for the nerves that control the neck muscles. Still in other cases the

problems seems to happen at larger distances, a problem called distant

spread.

The body of a child is smaller so it takes less to overdose. The

different tissues are smaller and closer together. Distances are smaller

so distant spread could be more of a problem.

There are not many studies of Botox for children with achalasia. Here

are two:

Botulinum toxin for achalasia in children

http://www.ncbi.nlm.nih.gov/pubmed/11106087

Evaluation of the use of botulinum toxin in children with achalasia

http://www.ncbi.nlm.nih.gov/pubmed/10817280

There isn't much there to know that you probably don't already know. It

works but not for long in most cases.

There are not many reports of serious complications from Botox for

achalasia. There is the issue of scarring but that is not part of this

discussion.

If I were interested in Botox I would understand these risks and then

find the most experienced doctor with achalasia and Botox. I would then

trust in the doctor and figure these risks are too small to worry about.

If the doctor I could get was not very experienced with achalasia and

Botox I would be more concerned.

notan

August 2, 2011

Thank you Notan.

________________________________

From: notan ostrich <notan_ostrich@...>

achalasia

Sent: Tuesday, August 2, 2011 4:20 PM

Subject: Children and Botox, WAS:Taniea's proposed treatment plan

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