Botox-Enhanced Stellate Ganglion Blockade for the Treatment of Post-traumatic Stress Disorder

Emerging evidence promotes stellate ganglion blocks (SGB) as a treatment for post-traumatic stress disorder (PTSD) in individuals who have not fully responded to conventional therapies. Ongoing research aims to assess the reliability and sustainability of this intervention. A 36-year-old female presented to our clinic complaining of severe and persistent symptoms since childhood, consistent with a diagnosis of PTSD and trauma-induced anxiety. The patient tried traditional psychological therapies and psychotropic medications for multiple years without optimal symptom relief. The patient underwent two sets of bilateral SGB: one set of standard injections performed with 0.5% bupivacaine and one set performed with the addition of botulinum toxin (Botox) injected into the stellate ganglion. After the initial standard bilateral SGB procedures, the patient experienced a significant reduction in PTSD symptoms. Two months later, however, the somatic symptoms of PTSD and trauma-induced anxiety returned, including hypervigilance, nightmares, insomnia, hyperhidrosis, and muscle tension. The patient elected to proceed with a set of Botox-enhanced SGB, and the results demonstrated profound relief as quantified by a drop in PTSD Checklist Version 5 (PCL-5) scores from 57 to 2. At a six-month follow-up since the initial injections, the patient reported significant and sustained relief from her PTSD symptoms. We report that the addition of Botox in a selective blockade of the stellate ganglion reduced our patient's PTSD symptoms to below the PTSD diagnostic threshold for a sustained period while providing additional benefits of reduced anxiety, hyperhidrosis, and pain. We provide a reasonable explanation for our findings.