South Nassau Communities Hospital

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South Nassau in the Community

05/12/2008

Botox Injections Bring Relief to Victims of Stroke, Spine, Brain Injury


Best known for its use by individuals, celebrities and models to stave off “Father Time” and eliminate facial lines and wrinkles, the Botox injection is gaining increasing attention for its use in the treatment of a debilitating and painful condition known as spastic paralysis.

Also referred to as spasticity, spastic paralysis often occurs following a stroke, spinal cord injury, or brain injury. It is estimated that spasticity affects from 19 to 38 percent of stroke patients, often affecting the hands and wrists. Spastic paralysis results from the damage to the portion of the nervous system that controls and coordinates the movement of voluntary muscles (which are the muscles that allow us to walk, throw a ball, grip a pen, play the piano, sit in a chair, etc.) Spastic paralysis leads to stiffness and lack of mobility in these muscles, disrupting mobility, reclining as well as dressing, hygiene, washing, and other activities of daily living.

In the same way that Botox temporarily relaxes the muscles that contract to form lines and wrinkles, it can relax the muscles of patients with spastic paralysis.

"The patients we have treated with Botox injections have experienced good results," said Ernesto Capulong, M.D., Chief of the Department of Physical Medicine and Rehabilitation and Director of the SMART Center. "It’s an approved treatment for those patients who do not respond to other conservative therapies and rehabilitation. As long as the treatment is effective, patients can continue to receive injections, avoiding more complex and radical treatments, such as surgery."

Botox (Botulinum toxin) is a protein that is produced by the bacterium Clostridium botulinum, the culprit of the food poisoning, botulism. The bacterium relaxes muscles by blocking the release of the neurotransmitter, acetylcholine, which triggers muscles, prompts excitability, arousal, and reward, and activates learning and short-term memory. A small dose of Botox injected directly into the spastic muscle(s) blocks the acetylcholine so that the muscle can loosen and relax, resulting in increased flexibility and mobility and reduced pain.

Patients experience relief within three to seven days following an injection. Relief typically lasts three to six months, so repeat injections are usually required. Patients can receive the injections for several months or many years after their disability.

A recent study led by Indiana University neurologist Allison Brasher, MD, on the benefits of Botox in reducing spasticity, found that people who had severe spasticity in their hands and fingers after a stroke were twice as likely to get relief from Botox injections as compared to patients who did not receive them. In the study, which was published in The New England Journal of Medicine, half of 126 stroke patients received injections of 240 units of Botox and half received injections of a placebo. Over the next 12 weeks the patients were asked to rate their improvement on one of four self-selected criteria: improvement in personal hygiene, dressing, limb position or pain. Sixty-two percent of those who were given Botox injections found relief of their symptoms, while only 27 percent of the patients taking the placebo reported improvement.

Other than the relief, there are few if any noticeable side effects produced by Botox, said Dr. Capulong. “That fact, combined with its proven effectiveness, makes the injection a perfect antidote for patients who don’t respond to physical therapy and rehabilitation.”



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