Botulinum toxin is a medication and a neurotoxic protein produced by the bacterium Clostridium botulinum.

Botulinum toxin type A, is a therapeutic muscle-relaxing agent that reduces the rigidity of muscles or unwanted spasms in a specific muscle. Over the past ten years, the use of botox has shifted from wrinkle reduction to successfully treating muscle spasticity in children with cerebral palsy, making botox and cerebral palsy a hugely successful match.

How does Botulinum Toxin work?

Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum. It affects the neuromuscular synapse by inhibiting the release of acetylcholine. The action of Botulinum toxin lasts for 3-6 months. this is because new nerve ending sprout and in later stages the original neuromuscular junction recovers.

Clinical effect of Botulinum toxin starts in 1-3 days but maximal effect is evident at 1-2 weeks

Cerebral Palsy : what happens with the muscles?

In cerebral palsy, the brain los es the ability to moderate the activity of contracting muscles. Muscles that produce contraction are stronger than those that produce extension, Partially paralyzing the stronger muscles with botulinum toxin gives patients an opportunity to stretch and strengthen the weak muscles. The long-term goal of the two components of the treatment – injections and physical therapy – is to achieve b etter muscle strength balance which may lead to restoring normal function.

How does Botox help in Cerebral palsy ?

The marriage of botox and cerebral palsy may seem odd at first, but is actually quite practical. When prepared for therapeutic use, botox is injected in small amounts into the spastic or stiff muscles. It begins to take effect by blocking transmission between the nerves and the affected muscles. The injection stops the signal between the nerve and the muscle, relaxing the muscle and reducing stiffness. Botox only affects the muscles that are injected and once the muscles are relaxed, therapists are able to stretch the muscles and stimulate normal growth.

Botox injections can offer many benefits including ease in stretching, improvement in child’s range of motion, tolerance to wearing braces and developmental improve ments in crawling, standing, or gait changes.

Who respond the best to Botox?

Children under the age of six respond best to this type of cerebral palsy treatment, especially effective in children who have not developed fixed joint contractures. It is most effective when used in the early stages of spasticity while the child’s bones are still developing and before problems with bone development and deformity set in.

Precaution to be taken after Botox injection

Since this treatment changes muscle tone , your child may initially miss some of the support that they relied on from their increased tone. Therefore, until your child gets used to these changes, we recommend close supervision in situations where they may be at increased risk of falling. This might include going up and down stairs, walking in halls, or other busy areas. Other than this precaution, there are no restrictions following the injections and normal activities can be resumed...

What are the advantages of Botulinum toxin

· can be done without anesthesia

· easy to administer

· essentially painless

· effects wear off

· most side-effects are minor

· can be repeated in 6 months

Disadvantages of Botulinum toxin

· patient can develop resistance to BTX-A (antibodies, unknown) but it usually reverses itself over time

· expensive

· limited effect

· minor comp lications like headache, flu like symptoms

Role of physiotherapy

Physiotherapy, which involves the use of stretching, strengthening, casting,bracing, positioning and facilitation of movement, is an essential part of the treatment plan for children with cerebral palsy. These forms of treatments assist

children in developing muscular control, better balance and mobility.

Ability ofthe parent or carer to assist their child in becoming as physically independent as possible is enhanced by physiotherapy. A range of motion exercises, tailoredfor each child help improve strength, maintain muscle length and improve movement of joints. Exercises can help strengthen muscles and improve physical stamina, preventing the weakening and wasting of under used muscles. This further reduces the risk of developing fixed contractures.

Children who stand and walk may benefit from the provision of special foot splints and walking aids (called orthotic appliances or orthoses) which, as well as supporting joints to assist in walking, are also able to assist in avoiding fixed contractures by stretching overactive muscles.

For more information on role of Botulinum toxin in cerebral palsy email to doctor@ipodindia.org

Cerebral refers to the cerebrum, which is the affected area of the brain (although the disorder most likely involves connections between the cortex and other parts of the brain such as the cerebellum), and palsy refers to disorder of movement. CP is caused by damage to the motor control centers of the developing brain and can occur during pregnancy (about 75 percent), during childbirth (about 5 percent) or after birth (about 15 percent) up to about age three^. Further research is needed on adults with CP as the current literature is highly focused on the pediatric patient.

Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems.^[5]

There is no known cure for CP. Medical intervention is limited to the treatment and prevention of complications arising from CP’s effects. A 2003 study put the economic cost for CP sufferers in the US at $921,000 per case, including lost income.

In another study, the incidence in six countries surveyed was 2.12–2.45 per 1,000 live births^, indicating a slight rise in recent years. Improvements in neonatal nursing have helped reduce the number of babies who develop cerebral palsy, but the survival of babies with very low birth weights has increased, and these babies are more likely to have cerebral palsy.