Botox Treatments
Botulinum toxin is a muscle-relaxing medication that can be used to decrease spasticity related to neurological conditions when it affects only a few muscles.
What Is Spasticity?
Spasticity is a movement disorder that can sometimes occur from injuries to the brain or spinal cord, such as brachial plexus injury, trauma to the spinal cord, or neurological diseases such as multiple sclerosis and brain injury. Spasticity occurs when the signals traveling along the axons between the brain and muscle fibers are unbalanced. It is the result of an upper motor neuron injury.
This results in hyperexcitable stretch reflexes, increased muscle tone, and sudden jerky or involuntary movements that can’t be controlled. When spasticity is severe, contractures (fixed limitations of range of motion) may develop.
What Is Botulinum Toxin?
Botulinum toxin is a medication derived from a neurotoxin produced by bacteria (Clostridium Botulinum) and is used in millions of procedures around the world in cosmetic medicine. In its natural form, this toxin causes botulism, a severe condition that can be fatal. The botulinum toxin medication is designed to be used safely without causing botulism. Three formulations of botulinum toxin A are currently approved by the FDA for the treatment of spasticity: • Abobotulinum toxin A (Dysport®) • Incobotulinum toxin A (Xeomin®) • Onabotulinum toxin A (Botox®)
How Does Botulinum Toxin Work?
Normally, the brain sends messages to the muscles so they can contract and move. These messages are transmitted via the nerves to the muscles by a substance called acetylcholine. Botox blocks the release of acetylcholine from the nerve to the muscle, and the muscle relaxes. Typically, Botox injections last 6-12 weeks before the procedure needs to be repeated.
How Do I Know If I’m A Good Candidate For Botox To Treat My Spasticity?
Using Botox to treat spasticity is usually considered when the spasticity only affects a few muscle groups. It should be used combination with other treatments for spasticity, including bracing and therapy. Botox is often the right treatment earlier following an injury when you are still making progress, before consideration of a permanent intervention. Once recovery plateaus and you are no longer making additional functional gains (usually 1-2 years from your injury), we use Botox to demonstrate the effect of a selective peripheral neurotomy to ensure that you will be happy with the results of the procedure.
Your Paralysis Specialist can only decide if Botox therapy is right for you after they have completed a full assessment of the location and cause of your spasticity. For more severe cases of spasticity, Botox therapy may not be a suitable treatment and your Paralysis Specialist will be able to offer better treatment alternatives to help you.
Selective Peripheral Neurotomy (Precise Nerve Branch Cutting)
A selective peripheral neurotomy is a procedure used by our paralysis specialists at the Paralysis Center to restore hand and arm movement and improve walking.
This procedure is typically performed on patients who have experienced brain or spinal cord injury due to stroke, tumor, or trauma and suffer with spasticity as a result.
A selective peripheral neurotomy is used to relax overactive muscles and allow the other muscles that have better control to work without interference. In conditions of spasticity, fists become clenched, wrists flexed, and arms can be difficult to straighten. Similarly, feet can turn in and toes curl, making walking challenging.
Performed under a microscope, a selective peripheral neurotomy is a procedure where nerves that contribute to spastic and dysfunctional limbs are precisely "cut back" in such a way that reduces spasticity, but maintains control, allowing more normal functioning of that muscle.
Cutting a portion of the nerve reduces the “noise” being relayed back to the spinal cord, which causes the spasticity. However, during a selective peripheral neurotomy, enough remaining nerve is maintained in order to control the muscle and avoid paralyzing it. The muscle is preserved, and there is no need to cut or lengthen the tendon.
Is A Peripheral Neurotomy Right For You?
Depending on your medical history, a selective peripheral neurotomy may be appropriate for you if you have a brain or spinal cord injury as a result of stroke, tumor, or trauma. People with cerebral palsy or multiple sclerosis may also benefit from this procedure.
More Effective Than Botox
A selective peripheral neurotomy is a more precise, more effective, and longer lasting alternative to Botox injections. Anyone who receives some benefit from Botox treatments can get more effective and longer lasting relief of spasms with a selective peripheral neurotomy.
Quick Recovery
Selective peripheral neurotomy is a relatively simple procedure; no special post-operative care is required – that is, no braces or immobilization. Also the sutures are absorbable and with skin glue you can shower and won’t need to apply any particular dressing. Rehabilitation can begin 72 hours after the procedure.
Which Treatment Is Right To Treat My Spasticity?
Your surgeon at the Paralysis Center will select Botox, selective peripheral neurotomies, tendon transfer, nerve transfer, nerve graft or other treatment based on your condition and which techniques offer you the very best chance of recovery.
Schedule a Consult with the Paralysis Center today (844) 930-1001.
Tips to help you get the most from a visit to the Paralysis Center
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your Specialist tells you.
At the visit, write down the name of your diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your specialist gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your Paralysis Specialist if you have questions.