Botox Injections & Neurogenic Bladder

Hi -- I am hoping someone in this network is able to share experiences with Botox Injections and Neurogenic Bladder.

My husband age 37 had a massive hemorraghic stroke due to a Grade 5 AVM rupture on August 4th. He is recovering nicely (thank G-d). His left leg is coming along faster than his left arm. So we are planning to do botox injections next Monday. Also his bladder issues are persisting -- his problem is urinary retention so he has to be catherized every 3-4 hours (basically he can't pee because his bladder is still paralyzed from the shock of the brain bleed).

1. Re Botox - the doctor is planning to do approx. 30 injections with approx. 500 units of Botox in his left arm. Has anyone had any positive or negative experiences with anything like this?

2. Re neurogenic bladder -- did anyone have a paralyzed bladder post-brain bleed? We are now almost 5 months from the bleed and the urologist thinks that we just need to give it more time, but my husband is frustrated by not being able to pee and it would be helpful to know if others had this problem and what, if anything, we should be doing about it.

Thank you for your help!

After my stroke I had Botox done on my leg. It did relax it but wore off after a couple of months. I had it done three times and then stopped. The botox did help me. Doctor said people reacted diff so it was dificult to tell whether it would be effective beforehand. Nonetheless, , i suggest you do give it a go. if ur doc is recommending it is because he saw a need (your husband probably has tightness in his left arm) and he decided that the pros out weight the cons. In my case the Botox was used because i was in therapy and they wanted me to be able to make the most out of it.

One of the neurologist I specialized in movement disorders. She gave me Boton (a type of Botox)injections for my cervical dystonia. It helped me for a while. I can't remember exactly what it does.... I think it relaxes the muscles but, I'm not sure(?).

This is gloria. I received 33 botox injections for migraines. The did work, the ins co. Balled but finally approved. It took approximately 1 month for the migraines and anxiety to diasipate. I now unserstand it should be done every 3 months for full affect. To make matters lighthearted I complained he forgot one wrinkle which his wife wld have complained. Laughlingly he said she’s only 40 jokingly saying I am 20 yrs older. Said he wld do btr next time, but I understand Botox is very beneficial. I gave it a chance and it did work. I have tried other injections whose results were not as effective. Go with your instincts, they work if only quarterly and you keep up the treatment. Very good luck!

Hello,

I am sorry to hear about your husbands stroke and I hope the recovery continues to be rapid. I have a lot of clinical scientific knowledge about BOTOX in neurosciences, so I felt compelled to reply to your email.

Your questions:
1) You did not indicate the diagnosis for your husbands arm. I am assuming that your husband is being treated for arm or upper limb spasticity. There is a nice review article published in 2013 by L. Nalysnyk (BMC Neurology 2013, 13:118) titled: OnabotulinumtoxinA muscle injection patterns in adult spasticity: a systematic literature review. In this review, there is a chart for BOTOX Injections for Stroke. I have cut and pasted it below.

BOTOX Injections for Stroke

Forearm:
Extensor carpi radialis 10
Extensor carpi ulnaris 10
Pronator quadratus 25
Pronator teres 10–75
Elbow Flexors
Biceps brachii* 25–200
Brachialis 50
Brachioradialis 20–200

Wrist Flexors:
Flexor carpi radialis* 5–96.75
Flexor carpi ulnaris* 10–93.33
Palmaris longus 20–25
Wrist flexors‡ 50–120

Finger Flexors:
Finger flexors§ 30–160
Flexor digitorum profundus* 5–120
Flexor digitorum superficialis* 5–77.89
Interossei volares 10–15

Thumb:

Adductor pollicis 10–20
Flexor pollicis longus 10–35
Lumbricals NR
Opponens 10
Opponens pollicis NR

More BOTOX is not always the best solution. It is a delicate balance between muscle relaxation and functionality. Make sure to indicate to the physician what your husband would like to use his arm for.

2) I did not have incontinence after my stroke, but I understand his frustration. BOTOX injections into the bladder an give great relief and dryness, and it tends to last longer than BOTOX injected into skeletal muscle (9 months versus 3-4 months). However, there were a high percentage of patients in the clinical trials that encountered urinary retention post-injections, hence, they had to self-catheterize for a few months after injections. If your husband already has to self-cath, then perhaps he may want to try this.

I hope this helped. Good luck and Happy Holidays!

my son had an AVM at age 13 he is now 16 and is still having Botox shots in him right arm it helps loosen the muscles so he can strengthen the hand muscles that work his fingers it only last 3 months or so. I suggest you give it a try.

Hi - I’m five-plus years post-bleed; although I’ve never had Botox, I had to be cathed for a few months after. I had some other paralysis that most came back as mostly-full-functioning without Botox, but I’m not sure if I did anything special to recover this functioning. I would suggest that your husband drink plenty of water still and still get some exercise and/or move.

I had botox done on my left leg. They did about 6 or so shots. It was OK and loosened up my stiff leg. Your insurance should cover it as well. Best of Luck!

I had a massive rupture in 2012 weve done botox a few times this year the first three mixtures we tried failed and didnt eliminate symptoms in my left arm, it was still very tight, we tried two different kinds those three times i went in, none worked finally a couple weeks ago my physiatrist tried a different strain of botulinum and it worked! Wat finally worked for me is myoblock and its been helping alot its kinda weird going from my extreme tone to having it so greatly reduced im still gettin used to it but its much better it makes electrical stimulation in my arm alot more comfortable and i can manage to wear a full arm air splint for acfew hours keeping my arm completely straight which i couldnt before i wouldnt say ive ganed much movement given it basically paralyzes the nerves but i definitely feel i can move a very small amount more with the tone reduced so much. Pi doubt youll have any problems with the botox but if he reacts or should i say doesnt react to it like me ask your doctor about trying different strains of botulinum, it took us a couple tries but its definitely good for stretching and getting the muscles at full length while its working hopefully allowing for more movement once paralyzation starts to wear off. While its active get a lot of stretching e stim and occupational therapy, the e stim also helps to work the into the muscles

Hi I am Jennifer I had a avm in 2004 and I had botox ever since because I am so tight. I get it every 3 months. It does work for me it makes me not as tight.

All I Know is they work on the outer nerves of my head and remove my headaches. Never had them on an extremity. However. It is not as scary as everyone makes it out to be. I will say this.