INCS: Impaired Neuronal Communication Syndrome – serious side effects from botulinum toxin

Impaired Neuronal Communication Syndrome (INCS) as Novel Neurological Side Effect to Botulinum Toxin Type A Therapy with 16 Case Reports 2016.

Dr. Hristova reported on 16 cases of people who experienced severe adverse events after botulinum toxin injections. She refers to their condition as Impaired Neuronal Communication Syndrome.  

One specific case involved a 38-year-old woman who received 20 Units of Botox at her first treatment for facial wrinkles. The first symptom appeared four hours after the injection and was reported as “burning in the brain, diarrhea, vomiting chest pain” (Hristova). She was at 100% functionality prior to the Botox injection, but has not recovered and remains disabled. Her other adverse events included small fiber polyneuropathy, hives on her face and hands, a sensitivity to certain foods and medicines, and relapses in recovery.

The toxin spreads to the brain via the lymphatic system, bloodstream, and retrograde axonal transport through both motor and sensory nerves. Boroff and Chen demonstrated that radio-labeled botulinum crosses the blood brain barrier. (Boroff, D. A., & Chen, G. S. (1975). On the question of permeability of the blood-brain barrier to botulinum toxin.International Archives of Allergy and Immunology, 48(4), 495-504.)

Once the spread of toxin is throughout the body, botulinum toxin prevents the release of acetylcholine. Acetylcholine is the neurotransmitter that acts at the neuromuscular junction (NMJ). The motor neurons of the nervous system release acetylcholine and this activates the muscle. In the brain, Hristova explains that acetylcholine plays a role in neural plasticity, word finding, concentration, attention, learning, abstract thinking, creativity, brain speed processing, noise/ signal ratio improvement and intra-cortical transfer of information. It is not a surprise, that the patients presented here frequently display cognitive deficiency” (Hristova).  

In 2004, Luvisetto and his fellow scientists discovered that mice produced dementia-like features after their brain ventricles where injected with botulinum toxin. (Luvisetto, Siro, S. Marinelli, O. Rossetto, C. Montecucco, and F. Pavone. “Central injection of botulinum neurotoxins: behavioural effects in mice.” Behavioural pharmacology 15, no. 3 (2004): 233-240.) “When there is a deficiency in acetylcholinergic pathways has been related to anxiety, bipolar behavior, and delirium” (Hristova).  

Hristova summaries the impact of botulinum toxin to the brain by summarizing “Patients often use the following expressions: “I am in a fog… …I am in a bubble…I feel detached…My body is not listening to my brain…I am disconnected…Somebody else is operating my body”. The most common symptoms are impaired concentration, word finding difficulties, impairment of memory, significant head pressure, phono- and photophobia and inability to multitask. Processing speed is decreased.” (Hristova)

The article can be read here. See also Hristova’s proposal for treating INCS inside the article:

The report can also be opened as a pdf. The Pfd file looks a bit different as there are schematics with notes.

Another report by Anna Hristova (3 studies on botulinum toxin), published in 2012. It doesn’t look like the full report can be downloaded from google, but you can see excerpts here:

and here: