Botox

What is Botox & how does it work?

Botox, short for Botulinum toxin, is a neurotoxin  produced by the bacterium Clostridium botulinum. Botulinum toxin works by blocking the release of a specialist neurotransmitter called acetylcholine  at the neuromuscular junction. Acetylcholine is responsible for transmitting signals from nerves to muscles, leading to muscle contractions. By blocking this signal, Botox causes temporary muscle weakness or paralysis in the injected area.

What is it used for?

Botox is most commonly used as an extension of the clinical examination. It can be used as a "diagnostic test" to try and help doctors and healthcare professionals understand which muscles are causing the problem and to help target treatment. 

It can in some select cases be used as a therapeutic treatment. However it is important to understand that botox itself is not an effective treatment and it is only typically effective when used in combination with another treatment. 

Diagnostic

• Identify main spastic muscles
• Predict surgical outcome
• Unmask underlying fixed contractures

 Therapeutic

• Improve range of motion pre or post operatively 
• Delay surgery in very young children
• Facilitate splinting & therapy (when there progressive positive gains with each botox cycle) 
• Dystonia
• Child unsuitable Surgery

How are the injections performed?

A careful assessment by a medical professional will determine which specific muscles are contributing to the spasticity or muscle tightness. An individual "prescription" of muscles will be decided on.  Botox is then injected directly into these muscles using a fine needle. Depending on the child or adult the injections can be done awake in a clinic environment or less commonly under general anaesthetic. An ultrasound machine and/ or nerve stimulator is often used to ensure the Botox is injected into the correct muscles.

How long do the effects last?

The effects of the injection are localised and only the injected muscles are affected. The effect is also temporary. The duration of effect is variable between individuals but typically  the effects will last between 3-6months. As the effects wear off, the muscle spasticity often gradually returns. 

Are repeat injections helpful?

Repeat injections need to be carefully considered and should be undertaken only with a clear goal in mind. The main indications for repeat botox injections are in dystonic patients, to delay surgery in very young children or in children too sick to consider surgical treatment.

Whilst botox can have short term benefit. There is evidence that repeat botox injections can have a negative effect on the muscle quality and in most cases it does not prevent muscle shortening and contracture in the long term. 

If a child has had a significant improvement from botox but it has deteriorated once the effects have worn off, it is recommended that a review by an upper limb specialist is undertaken to assess whether your child is suitable for a more permanent treatment such as surgery.