Botulinum Toxin Therapy for Spasticity

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Botulinum toxin (Botox®, Myobloc®), is a medicine used to reduce unwanted spasticity in a muscle or a group of muscles. It is given by injection into the muscle. It only works to reduce spasticity in the injected muscle and occasionally those next to that muscle. It does not reduce spasticity in the rest of the body. The medicine works by stopping the impulse between the nerve endings and the muscle that would otherwise contract (tighten up). Botulinum toxin is the same toxin that can cause botulism, a form of food poisoning. However, when given in very small amounts, it can have a positive effect in decreasing muscle tone. It is placed directly into the muscle, so it affects only the area it has contact with. The medicine itself is painless.

Insurance Coverage and Consent

Some insurance plans may cover Botulinum toxin therapy. It is important to talk about the financial details before the procedure is done. For this reason, we will need a copy of your insurance card to pre-certify this procedure. If your insurance changes after the appointment is scheduled in the next few months, you must call our office.

This procedure requires a consent form to be signed by the parent or guardian. If you are  not planning to come with your child to this appointment, be sure to tell the clinic nurses 
so they can arrange to get the consent form signed.

Preparing Your Child

The treatment may involve several needle injections. This can make your child very anxious.  Your child’s comfort is important to us. We may use one or more of the following: 

  • Nasal Versed® (midazolam) – Nasal Versed (midazolam) is given as a nasal spray that provides light sedation to a patient.
    • Stop feeding your child for 6 hours before the appointment.  For your child this will be ________ o’clock.  You may give medicines with a sip of water if needed up to 2 hours before the procedure.
    • Tell the doctor and nurse if your child is allergic to any medicine. This is very important!
    • If nasal spray given, the nurse will hook your child up to monitors that will check blood pressure and oxygen level in the bloodstream. The monitors will be used until your child is no longer sleepy.
  • EMLA Cream (numbing cream) on the injection sites – The nurse may put numbing cream on the places where the shots will be given. A clear bandage is put on to hold the cream in place.
    • It takes an hour for the cream to work, so you must get to the hospital 1 hour before your child’s appointment.
  • DistractionEthyl chloride (numbing spray) – A cold numbing spray will be used on the sites right before the Botulinum toxin is given.
    • Arrive at your child’s scheduled appointment time.
    • It is helpful to do things to relax or distract your child. Please bring along music, a favorite toy or blanket or other items that normally comfort your child (Picture 1). Parents are welcome to stay with their child and offer comfort and support during the procedure.
    • Please note: If a patient thinks they might be pregnant, they should tell the doctor. Botulinum toxin injections cannot be given to anyone who is pregnant.

After the Procedure

Your child may return to normal activities afterward. Depending on the treatment goals, the doctor may order a series of casts to increase the range of a particular joint. Changes in your child’s physical or occupational therapy program may also be made.

Risks and Complications

  • Most serious side effects are rare. However, if your child has overall weakness or trouble with breathing or swallowing, get immediate medical attention.
  • Sometimes children get bruises or pain where the injections were given. This can usually be treated by putting ice bags on the site and giving Tylenol® (acetaminophen) 
    for pain.
  • If the numbing cream or spray was used, there may be redness or a rash. 

Expected Treatment Results

Every child is different, so outcomes will be different. You may start to see results 2 to 3 days after the injections. The greatest effect is seen between 2 and 3 weeks after the injection. It will probably last for several months. Examples of the changes you may see include:

  • Improved range of motion
  • Greater ease in stretching
  • Improved tolerance to wearing braces
  • Developmental gains such as crawling or standing
  • Changes in gait (the way the child walks)

Follow-up

You will need to schedule a follow-up clinic appointment 3 to 4 weeks after the procedure. The doctor can then check to see how the treatment is working. When the Botulinum toxin begins to wear off, ask your doctor if repeated injections are the right treatment for your child. 

Botulinum Toxin Therapy for Spasticity (PDF)

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