Tuesday, March 04, 2008


Alex had his botox shots today. His physical therapist recommended 8 shots on the inner thighs to relax the tight muscles. This should help him stand more erect.

Botox Injections to Reduce Spasticity - from Boston Children's Hospital

A child with spastic muscles (tightness) finds it hard to move. As the child gets older, contracture (permanent tightness) of the joints, and deformities of the spine and limbs may develop. Usually spasticity is treated with physiotherapy, bracing, and surgery. Botox injections are another way to deal with muscle spasticity.

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. We do not usually recommend more than 2 Botox injections into the same muscle.

What are the Main Benefits of Botox? a) 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. b) 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 Orthopaedic 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 orthopaedic surgeon injects Botox through the skin into the spastic muscle fibres using a very fine needle. 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. Avoid bicycle riding or climbing --may be a little unsteady for a few 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.