Botox, the trademarked name for botulinum toxin, is sometimes used to treat muscle spasticity.
A child with spastic muscles (tightness) may find it hard to move. As the child gets older, contracture (permanent tightness) of the muscles can lead to deformities of the spine and limbs. Usually spasticity is treated with physiotherapy, bracing, and surgery. Botox® injections are another way to deal with muscle spasticity.
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 that blocks the chemical message before it can enter the muscle. In this way it prevents the muscle tightening which produces spasticity. The “block” is most effective one to two weeks after the injections. Three to six months later the spasticity usually returns. Botox does not cure spasticity.
Botox helps to relax muscles and decrease muscle tone. This helps to prevent contractures for improved function and ability to move the joint through the full range of motion. There are times when Botox is used to delay the need for surgery. Your child’s surgeon will make that decision.
Botox is also useful to improve the tolerance of wearing a brace or splint. Bracing a relaxed muscle helps prevent contractures.
Your child will be given Botox injections by your child’s orthopaedic surgeon in the Orthopaedic Clinic or operating room.
The area to be given Botox is covered with a cream called Emla, which numbs the skin. The orthopaedic surgeon injects Botox through the skin into the spastic muscle using a very fine needle.
Most children are afraid of needles so we do our best to make the injections easy. If needed, the orthopaedic surgeon will discuss giving the Botox injections in the operating room.
After the injections, your child can go back to their usual activities. Have them avoid bicycle riding or climbing for a few days: your child might be a little unsteady. Some children require a cast to help stretch out tendons and muscles. The cast is usually left on for three to four weeks after the injections.
Your child can continue with their therapy program while casted. After the cast is removed, the therapist can work to stretch the muscle that was injected, to strengthen other muscles and to encourage new skills.