Gastric Botox Overdoses - Botulism Poisoning

You might have read in the press about cases of botulism, a poisoning caused by botulinum toxin, after gastric Botox treatments in Turkey. Here is a brief update for your information:
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Recently, there have been 12 cases reported in Germany, 1 each in Austria and Switzerland, and 57 cases in Turkey where patients experienced symptoms of botulism after gastric Botox treatments in Istanbul. These symptoms include muscular vision and speech impairments, swallowing difficulties, and generalized muscle weakness. In severe cases, paralysis of the respiratory muscles could occur, although fortunately, it seems that this has not happened in these cases.
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As a prominent practitioner of this method in Germany, affected individuals have contacted me directly seeking advice. I am aware of the treatment parameters used in Istanbul by these individuals and can contribute an assessment of the issue.
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There are four major manufacturers of botulinum toxin approved for medical use in Germany and the rest of the world, with a fifth one currently introducing another product to the market. The problem lies in the fact that the effectiveness of the product is determined and divided into units by the manufacturers themselves. The potency of one unit of the substance from Manufacturer A does not correspond to that of one unit from Manufacturer B.
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In my patients' treatments, I use 300 or 400 units of botulinum toxin from the company Allergan/Abbvie. These dosages have been used in various studies on the subject since around 2005, totaling nearly 40 studies. None of these studies reported similar side effects. Apart from mild nausea for a maximum of 3-5 days after the treatment, no other side effects have been described at all. Studies very clearly demonstrate that increasing the dosage does not yield any additional effect. Therefore, I strictly adhere to the dosages used in the gastric Botox studies, and accordingly, I have not observed any side effects in my patients.
In the cases I am aware of from Turkey, a different manufacturer's botulinum toxin was used. There is a conversion factor of approximately 1:2 between its units and Allergan units. Additionally, 1500 units of this substance were used, which led to the symptoms of poisoning.
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The described cases involve a significant overdose of the substance, explaining the side effects. Either the dosage was chosen out of ignorance or following the principle of 'more is better.' However, this principle does not apply to Botox treatments in general, and as Paracelsus already knew in the 16th century:
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"The dose makes the poison."
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In the correct dosage, the method remains safe to use. For example, in urology, the bladder is routinely treated endoscopically with 300 units of botulinum toxin. This procedure has been approved since 2013. If you have any questions or need consultation, we are here to assist.