Botox Injections
From Holoprosencephaly
Botox Injections
Spasticity resulting from cerebral palsy can reduce the quality of life in affected children and can eventually cause more severe impairments, such as joint dislocation and scoliosis.
Botulinum toxin type A (Botox) is widely used to temporarily alleviate the increased muscle tone associated with spasticity, and when combined with a comprehensive physical therapy regimen can result in permanent improvement.
How does Botox Work?
The "tone" of a muscle -- how floppy or tight it is -- depends on the nerve impulses (messages) which reach the muscle from the brain. These messages are carried by chemicals in the nerves to that muscle. Botox is a substance which blocks the chemical message before it can enter the muscle. In this way it prevents the muscle tightening which results in spasticity. Botox does not cure spasticity. The "block" is most effective 1-2 weeks after the injections. Three to six months later the spasticity usually returns. More than 2 Botox injections into the same muscle are not usually recommended.
What are the Main Benefits of Botox?
Botox injections offer a chance to see whether reducing spasticity in a muscle makes a big difference for your child. If it does, you may want to consider the more permanent solutions which surgery offers.
Botox is also useful before a new treatment like a brace or splint. Bracing a relaxed muscle helps prevent contractures. This is easier than trying to "undo a contracture, therefore, younger children benefit more than older children.
How is Botox Given?
Botox injections are given in a room in the Orthopedic Clinic. The place where the Botox will be injected into the muscle is marked, by your doctor, with a pen. This area is covered with a cream called "Emla" which numbs the skin. The orthopedic surgeon injects Botox through the skin into the spastic muscle fibres using a very fine needle. Most children are afraid of needles so physicians do their best to make the injections easy. If necessary, your child is given a mild sedative. This makes him/her drowsy in about 20 minutes. As a result, most children do not feel pain or even remember the injections. A nurse will stay with you and your child until the procedure is finished. The procedure takes about 2 hours to complete.
What Happens after Botox Injections?
Your child can go back to his/her normal activities. Weight bearing activities may be discouraged for 1-2 days. Some children require a cast to help stretchout tendons and muscles. This is usually put on 1-2 weeks after the injections. Your child will return to his/her therapy program. The therapist will work on the particular muscle injected, as well as, encourage new skills.
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