Botox Therapy in Cerebral Palsy

Botox Therapy in Cerebral Palsy

Botox injections have become very popular and in fact this is treatment of choice for selected spastic muscles. It should be done after comprehensive evaluation including posture, gait and functional analysis. The goal is to decrease the spasticity, pain and increase the range of motion at a given joint. Once you have received the therapy, you should follow a disciplined physiotherapy program to achieve the maximum benefit of Botox injections.

How does it work?

Skeletal muscles tighten in response to the release from nerve endings of the neurotransmitter acetylcholine. When BTA is injected into the muscle, the release of acetylcholine is blocked, resulting in a relaxation of overactive muscles. The injections generally take effect within a few days and last for three to six months.

Can Botox cure cerebral palsy?

No, this cannot cure the disease and it is not the suitable treatment for all types of cerebral palsy. It only helps in management of spasticity (tight muscles) and dystonia (fluctuating muscle tone) with good results.

Children with Toe walking usually have tight gastrocnemius muscles; can be helped by injecting these muscles. When injected into the calf or lower leg muscles, it can relax these muscles, making walking easier and more comfortable, as well as generally improving balance and reducing the frequency of falls. Children with tight hamstrings and adductor muscles usually havescissoring gait, crouching, difficulty in sitting, standing, etc. These children need a comprehensive evaluation and proper planning for injections. In some children, the need for surgery should also be discussed and in liaison with orthopedic surgeon, we should be able to make the best plan in the best interest of the child.

What are the side effects of Botox?

In the main, reported side-effects are mild and short-lived.

They include:

  • Post-injection pain requiring simple analgesia
  • Increased frequency of falls within first 2 weeks of injection
  • Mild, cold or flu-like symptoms
  • Temporary incontinence
  • Difficulty with swallowing, especially where upper limb or neck injected
  • Mood swings/irritability
  • Fatigue
  • Anaphylaxis [severe allergic reaction], but this is rare.

Conclusion

In brief, botulinum injection (Botox) is good option in cerebral palsy, however, it should be administered by experts with good experience and needless to emphasis the importance of details evaluation before and after the therapy. One must remember that these injections are not beneficial if not combined with a good rehabilitation program.