Botox injections a mainstay treatment of dystonia

By Karen Hales, Neurology Solutions Contributing Writer

Therapeutic botulinum toxin, commonly referred to as Botox therapy, has been used to treat disorders such as dystonia, spasticity and cerebral palsy for over 30 years. Botox® injections can be used effectively to relax excessive muscle contraction in individuals with movement disorders. While exceptionally toxic in large doses, when purified and used in controlled doses botulinum toxin calms muscles and helps reduce or halt muscle activity and control motor symptoms.

Botox therapy applications

There are two serotypes of botulinum toxin that are FDA approved for human use, Botulinum toxin type A (Botox®, Dysport® and Xeomin®) and Botulinum toxin type B (Myobloc®).

Dystonia is a movement disorder caused by the brain requesting an excess of muscle activity. In cervical dystonia, muscles in the neck cause uncomfortable pulling and twisting in the neck area. Generalized dystonia affects multiple muscle groups throughout the body, including the torso, limbs and sometimes neck or face.

In Parkinson’s disease, and particularly young onset Parkinson’s Disease (YOPD), there is a tendency to develop motor fluctuations and dyskinesias related to the use of levodopa and a greater likelihood of developing dystonia of a limb when in medication “off” times. Botulinum toxin also has been reported to be helpful in treating tremor, constipation, drooling and bladder difficulties in PD.

Botox therapy used in combination with physical therapy also can help reduce the symptoms of stroke to help stroke patients regain mobility and function of the muscles.

What does Botox do?

Botulinum toxin works by blocking a neurotransmitter (acetylcholine) involved in muscle contraction. Botox calms the affected muscles and allows for a more natural and neutral positioning.

Botulinum toxin is injected by hypodermic EMG needle directly into the muscles blocking the connection between nerves and muscles. This relieves spasms and other conditions associated with muscle overactivity.

Once the physician is ready to administer the appropriate toxin injection, he will select the muscles either by observing the abnormal postures or movements and feeling for the muscle spasm or by using an ultrasound. The number of injections will depend on the size of the muscle, though a typical treatment consists of five to 10 injections.

The actual injection procedure will take just a few minutes and is typically repeated every three to six months. The treatment can be continued indefinitely as long as you continue to respond and do not have a serious allergic reaction.

How effective is Botox therapy?

Botox therapy for neurological disorders is not a cure, it is an ongoing treatment used to help manage symptoms. Approximately 80% of patients treated with Botox to manage their neuromuscular disorder experience a relief in their symptoms following their injection.

At the point the effects of the injection seem to diminish, you will return to your physician for additional evaluation and treatment.

Oral medications in combination with physical therapy, stretching and strengthening exercises are recommended 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. Complementary therapies can include occupational therapy, physical therapy, speech/voice therapy, yoga or tai chi, and other interventions, depending on a person’s symptoms.

Potential Side Effects of Botox injections

Side effects of Botox injections for movement disorders are generally mild and wear off quickly. Patients should go home and rest immediately following the injection and refrain from strenuous activity for two to three days.

The most common side effects of Botulinum toxin are temporary general weakness, soreness at the injection site or affecting your whole body, and weakness in muscles that have been injected. Difficulty swallowing, upper respiratory infection, neck pain and headache may be signs of an allergic reaction or rare but serious side effects and should be brought to the attention of your doctor immediately.

According to the FDA warning on this class of drugs, the risk of symptoms is greatest in children with cerebral palsy treated for spasticity.

STAY CONNECTED

Neurology Solutions is accepting new patients seeking a specialist in managing Parkinson’s disease, dystonia, essential tremor and age-related movement disorders. If you are looking to confirm a diagnosis and/or find possible different treatment choices for managing symptoms of a movement disorder, please contact Neurology Solutions or call 512-865-6310 to schedule an appointment.

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