When people hear the word “Botox," many associate it with preventing facial wrinkles. However, botulinum toxin – a neurotoxin that paralyzes targeted muscles – actually has many other beneficial medical purposes. Botox, as we know it, is actually a brand name for a specific strain of botulinum toxin made by pharmaceutical company Allergan. Other brands also exist in the market.
Botulinum toxin has been enormously beneficial for treating certain patients with spasticity caused by neurological conditions. This is a breakthrough for people who have had less than optimal results with other treatments.
What is spasticity?
Spasticity is a condition that can occur in patients with certain diseases that affect the brain or the spinal cord. It is caused by an imbalance between signals that inhibit or stimulate the central nervous system, resulting in overactive muscle contractions, leading to painful muscle spasms and sometimes involuntary posturing.
Limb spasticity can interfere with mobility and performance of activities of daily living. Even changing clothes or maintaining hygiene can become a daunting task. Spasticity can be painful and, over time, may lead to permanently contracted muscles called contractures, which may result in further loss of range of joint motion. Limb joints can be contorted, sometimes severely. For example, the hands may become fisted — clenched so tightly that the fingernails dig into the palms of the hands. This can potential cause pain, skin breakdown, and prevent maintaining hygiene in the palms.
Who is affected by spasticity?
Limb spasticity can affect people with a variety of neurological disorders, including stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, cerebral palsy, brain or spinal cord tumors, and others. It can affect muscles of the neck, arm or leg.
How botulinum toxin can help
When someone has spasticity, the first line of treatment is usually oral muscle relaxers and/or physical therapy. However, sometimes these methods are not enough, and other things like injection with botulinum toxin and/or consideration for baclofen pump placement may have to be done, depending on the areas involved.
Botulinum toxin blocks nerve impulses. It interferes with transmission of nerve impulses in nerve endings and prevents the release of chemical transmitters that activate muscles. When the transmitters are blocked, it blocks the message from the brain that tells muscles to contract. Thus, the muscles cannot contract — the muscles do not spasm.
It is not a magic drug. It will not cure spasticity. It will make it better, until the effect wears off. The goal is to restore some motor function, decrease pain, enable maintenance of hygiene, and allow the caregiver to better take care of the patient.
Does botulinum toxin work for all spasticity?
Botulinum toxin can be effective for most patients. Occasionally, when a patient’s condition is severe, multiple treatment adjustments may have to be made before a desirable effect is achieved. If there is an underlying permanent contracture, it may not be possible to relax the muscles enough to improve joint mobility, and surgery may be recommended. However, in many cases, botulinum toxin is typically tried first.
How is botulinum toxin therapy administered?
- During the outpatient procedure, small electrodes are taped to the patient’s skin over the affected muscle area. The electrodes are attached to an electromyography machine (EMG), which is used to confirm the injection locations, ensuring the correct muscles are identified.
- Botulinum toxin is injected directly and locally into the affected muscles using a small needle and small syringe. The doctor may inject small amounts of the toxin into an area of the muscle, or into several different locations within the same muscle.
- The amount of medicine used will depend on a number of factors, including the severity of spasticity, the size of the muscle, etc. Adjustments in the toxin dosing may be made for subsequent injections depending on the outcome.
- Botulinum toxin usually takes effect within two to four weeks after injection, and can last from about 2-4 months in most cases.
- A follow-up appointment is usually done in a few weeks after injection to evaluate for potential side effects, and to potentially plan for adjustments in further treatment sessions.
- Patients should resume activity slowly and carefully after treatment. Physical or occupational therapy and mobilization of the joints affected after toxin injection is very important to achieve the best results.
- Treatment may be repeated as often as every three months, if the patient has had good results, and goals were met.
- Because every patient is different, the degree of relief will vary from person to person.
- Botulinum toxin is an effective, ongoing treatment for the relief of symptoms — it is not a cure.
Potential side effects*:
- Injection site pain, swelling, bruising
- Flu-like symptoms
- Difficulty breathing
- Overly weak muscles
- Distant spread of toxin effects is always a risk, but is usually minimal
*These side effects are temporary.
Wondering if botulinum toxin therapy is right for you or a loved one? Talk to your doctor.