SINGAPORE: There have been no local deaths associated with the use of botulinum toxin or botox, says Singapore's Health Sciences Authority.

Still, the agency is keeping a close watch for any severe reactions to the neurotoxin protein here.

This comes after watchdogs in Europe and the United States warned of dangerous side effects, including death.

A vial of about 100 units of botulinum toxin can be used to relax the spastic leg muscles of a child with cerebral palsy.

While Dr Ong Hian Tat said some young patients have stopped treatments since the warning from the US Food and Drug Administration, it generally has not affected the way he practises.

"What we have done is that we have re-explained to the parents again what the caution is all about, who these cases that had complications were - they were severe cases and non-ambulant - and the complications and general doses are much higher than what we have been using," said Dr Ong, a senior consultant paediatrician at NUH Children's Medical Institute.

In addition, Dr Ong now gives out a botox fact sheet to children's parents.

This describes the possible adverse side effects such as speech disorders, breathing problems and difficulties in swallowing or holding up the head.

He also records where the injection has been administered and parents are advised to seek immediate medical attention if any worrying symptoms occur.

Dr Ong pointed out that the complaints in the US were mainly severe cases of children suffering from cerebral palsy and were being treated for leg spasticity.

To treat a 15-kilogramme child with cerebral palsy for stiffness in the calf, a doctor would use one vial of botox of about 100 units.

However, if more sets of muscles need to be treated, doctors here would wait for three to six months to do the next injection, to avoid complications from a higher dose of botox in a single sitting.

In aesthetic procedures for adults, botox doses are small.

Only 12 units are used to treat frown lines, compared to about 100 for a young child's spastic leg muscle.

Dr Allan Kok, an aesthetic doctor, said: "Out of 17 million patients who have done botox since 2002....only 108 reported adverse effects and 16 deaths so far (according to the American Academy of facial aesthetics surgeons). And as far as the 16 deaths were concerned, all injected botox for medical reasons."

In the US, patients and their families have sued doctors and major botox-maker Allergan for allegedly causing them life-threatening injuries and deaths.

Dr Kok feels that while confidence in botox might have fallen in the US, it has not affected his practice here.

And that has not put Singapore patients off one bit.

Dr Kok is seeing more women asking for the procedure, with some returning for more.

- CNA/ir