Should I consider Botox therapy to manage my neurological disorder?
By Karen Hales, Neurology Solutions Contributing Writer
There are a variety of treatment options used in combination with medication and physical therapy to manage symptoms of debilitating neurological diseases such as dystonia and spasticity and provide patients greater independence. In these conditions, faulty connections between the brain and muscle cause parts of the body to spasm. Botulinum toxin injections, or Botox® therapy, can be one of the fist lines of treatment for many movement disorders. Less invasive than deep brain stimulation, Botox® injections can offer relief of symptoms for patients who have Parkinson’s disease, essential tremor, or dystonia.
In this article:
• What is Botox® Therapy (Therapeutic Botulinum toxin)?
• Conditions treated
• How is Botox® administered?
• What is the effectiveness of Botox® therapy?
• What are the side effects?
What is Botox® Therapy (Therapeutic Botulinum toxin)?
Therapeutic Botulinum toxin, commonly referred to as “Botox® therapy,” and other nerve blocks have been successfully used to treat neurological and musculoskeletal disorders such as dystonia, spasticity and cerebral palsy for the past 30+ years. Injectable Botulinum toxins are purified forms of Clostridium botulinum, the bacterial poison that causes botulism. Botulinum toxin is exceptionally toxic but, when purified and used in tiny, controlled doses, it can be used effectively to relax excessive muscle contraction. Used in this way, the drugs temporarily reduce or halt muscle activity by blocking the release of the chemical, or neurotransmitter, that transmits the signal telling muscles to contract.
There are seven types of Botulinum toxin produced by different types of Clostridium botulinum (types A through G). Of these, only two types are used to treat dystonia – A and B.
What conditions are treated with Botox® Therapy?
Botox®, the brand name for the first toxin produced using Botulinum toxin type A, was first approved by the Food and Drug Administration (FDA) in 1989 to treat two eye muscle disorders–uncontrollable blinking (blepharospasm) and misaligned eyes (strabismus). In 2000, the FDA approved Botulinum toxin type B, or Myobloc®, for treatment of patients with cervical dystonia, a condition that severely affects head, neck and shoulder muscles in 50,000 Americans. Dysport®, a pharmaceutical brand of Botulinum toxin type A similar to Botox® produced in the UK, was approved for use in the United States in 2009. (One unit of Botox® has a potency that is approximately equal to 4 units of Dysport®.)
In the last 10 years, Dysport® has been used in the treatment of children with cerebral palsy to reduce muscle stiffness and allow stretching of shortened muscles to increase range of motion and motor function. The use of Botox® therapy for cerebral palsy patients has not been approved by the FDA and is considered an off-label use.
Spasticity, or muscle stiffness, is a common problem for patients with cerebral palsy and one of the most common side effects of damage to the brain and spinal cord. Spasticity also affects nearly one in three patients who have suffered a stroke, with symptoms most commonly localized in the arm, wrist and hands. Botox® therapy used in combination with physical therapy can often reduce the stroke patient’s symptoms so he can regain mobility and function of the muscles.
This spring, the FDA upped the maximum regular tolerable dosage for Botox® from 360 units to 400 units for the treatment of upper limb spasticity. (Click here to read more.)
Botulinum toxin injections are the most common treatment used in treating focal dystonias in adults. Because the drug is injected directly into the affected muscle groups rather than passed through the entire body via oral medications, Botulinum toxin is more suitable for treating dystonias which are focal to one or two areas of the body, but it is also sometimes part of a treatment regime for more generalized dystonia.
Botulinum toxin has a number of medical applications other than treating dystonia and spasticity–including treating bladder problems, tremor and migraines. Most famously, it is used for cosmetic purposes, a use most closely associated with the brand name Botox®.
How is Botox® administered?
Dystonia is caused by the brain requesting an excess of muscle activity, so one method of treatment involves interfering with the chain in our nervous system that passes the request from the brain to our muscle fiber. Botox® is injected directly into muscles to block the connection between nerves and muscles in order to relieve spasms and other conditions associated with muscle overactivity. Eventually, new neurons will develop that will work to bypass the junction that was disrupted by the injection, which is when the toxin ceases to be effective.
Many factors affect the dose of Botulinum toxin and other nerve blocks. Administration of these therapies requires a thorough understanding of the substances used, preparation of various dilutions, and practical knowledge of the drugs’ strength and dosage. Manufacturers don’t recommend that one brand or type of Botulinum toxin be substituted for another.
Once the physician is ready to administer the appropriate toxin injection, he will identify which muscle groups need to be injected. Doctors will select the muscles either by observing the abnormal postures or movements and feeling for the muscle spasm or by using an ultrasound, flouroscopy or electromyography (EMG) machine, which measures muscle activity.
The areas are cleaned with alcohol, and an Ethyl Chloride “freeze spray” is applied to the sites targeted. The physician will administer the drug using a small needle with typically one to three injections placed in each muscle group. The number of injections will depend on the size of the muscle and the total number of muscles to be injected. A typical treatment consists of 5 to 10 injections.
The actual injection procedure will take just a few minutes. After the injections are completed you will be given specific instructions regarding follow up.
The treatments are typically repeated every 3 to 6 months and can be continued indefinitely as long as you continue to respond and do not have a serious allergic reaction. A very limited number of patients may develop antibodies that are believed to interfere with the process of the toxin binding with neuron membrane over time, preventing the effectiveness of Botulinum toxin treatment.
Botulinum toxin cannot be administered if you have any of the following:
• Fever, cough, cold or flu like symptoms
• Immunizations received within the last week or scheduled to receive immunizations within 7 days
• Are pregnant or breastfeeding
Patients with compromised respiratory status should be monitored carefully.
How effective is this treatment option?
Botox® therapy is not a cure, it is an ongoing treatment used to manage your symptoms. For best results, oral medications in combination with therapy such as stretching and strengthening exercises are best and are typically the first line of treatment.
Without daily physical activity, your muscles will remain contracted and joints will become immobile, making it difficult to manage everyday tasks such as sitting, walking and eating. Learn more about Neurology Solutions’ on-site physical therapy center, Austin Renewal Therapy.
Botox® therapy can significantly relieve muscle spasms and other conditions associated with muscle overactivity. Approximately 80% of patients treated with Botox® to manage their neuromuscular disorder experience a relief in their symptoms following their injection.
Botox® therapy treatment is effective within three days and is generally sustained for approximately 3 to 6 months. At the point the effects of the injection seem to diminish, you will return to your physician for additional evaluation and treatment.
Injections can be repeated no sooner than three months, and treatment can be repeated indefinitely as long as there is no allergic reaction.
What are potential side effects of Botulinum toxin?
As a general rule, patients should go home and rest immediately following the injection of Botox® and refrain from strenuous activity for 2 to 3 days.
Side effects of Botox® therapy are generally mild and wear off quickly. For example, because the drug makes the targeted muscles weaken, patients may notice a new pain which arises from shrinkage of the affected muscle or the other muscles trying to compensate.
According to the FDA warning on this class of drugs, the risk of symptoms is greatest in children with cerebral palsy treated for spasticity.
The most common side effects of Botulinum toxin are:
• temporary general weakness
• soreness at the injection site or affecting your whole body
• weakness in muscles that have been injected
• trouble swallowing, particularly for patients treated for cervical dystonia
• a red rash
• an infection at the injection site
Select your doctor carefully
Botox® therapy for treatment of dystonia and other movement disorders must be administered only under a doctor’s care. Ask for a referral from your primary care doctor or contact a doctor who specializes in your condition to help determine if Botox® therapy is a suitable option for managing your symptoms.
Because of the potential risks of improperly administered injections, it is important to seek the advice of a properly certified doctor with experience using Botox® injections to treat movement disorders.
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