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Coma Recovery Association, Inc.
Botulinum Toxin (BOTOX) has been used for almost two decades in the management of strabismus and movement disorders. It is now primary therapy in the treatment of blepharospasm, hemifacial spasm, cervical dystonia, laryngeal dystonia and focal limb dystonias. In more recent years, its use has been extended to the treatment of spasticity associated with stroke and multiple sclerosis as well as brain and spinal cord injury. Botulinum Toxin is a potent neuromuscular paralyzing agent that exerts its effect at the neuromuscular junction by entering nerve terminals and preventing the release of the neurotransmitter acetylcholine. It is injected directly into muscles, inducing localized weakness in the offending overactive muscles thereby reducing the force of unwanted contraction. Side effects are few and primarily involve greater than desired weakness in injected muscles or weakness in nearby muscles due to diffusion. Effects last approximately three months with strength and spasms returning as new nerve terminals are generated. Because there are limits to the amount of Botulinum Toxin that can be injected in a given time period, treatment of spasticity tends to be focused on specific problem areas. Reducing spasticity in foot inversion and plantar flexion allows for improved fit and comfort of braces, improving ambulation. Reducing adductor spasm in the legs can improve comfort as well as facilitate catherization and hygiene. Relieving spasticity in finger flexors facilitates nail care and palmar skin care. More natural carriage of spastic upper extremity can be achieved. Relief of painful spasms in any given muscle can be an important indication for BOTOX treatments. BOTOX can be used alone or in conjunction with oral medications. It can also be used in patients with Intrathecal Baclofen pump to provide additional relief of spasticity when it may be undesirable to increase the pump dose. In patients with spasticity receiving Botulinum Toxin treatments, physical therapy is important before and after treatments to help optimize functional benefits. Written by: Melinda M. Morrissey, M.D. Copyright © 1999, 2000, * SOUTH SHORE NEUROLOGIC ASSOCIATES, P.C.
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