Spasticity Management using Botulinum Toxin- A Injection Therapy (Botox™, Xeomin™, Dysport™)
Spasticity is increased muscle activity that occurs as a result of damage to the central nervous system (CNS) i.e. damage to the brain or spinal cord. Damage to the CNS can be caused by Stroke, Acquired Brain Injury (ABI) and Multiple Sclerosis (MS) to name the most common causes. Damage to the CNS often results in muscle weakness or paralysis, loss of voluntary movement, muscles spasms and tightness. It is this muscle spasm and tightness that is described as spasticity. If spasticity is not effectively managed then it can lead to muscle contractures and where there is underlying movement, loss of function.
Post injection aftercare is essential to optimise the effects of the Toxin. We can offer Physiotherapy, Occupational Therapy and a Neuro-Orthotist who can make bespoke Orthotics such as Soft and Scotch casts and fabricate thermoplastic splints.
Treatment goals may include:
- Reduce pain and spasms
- Afford better compliance with splints and casts
- Assist in improved alignment of muscles and limbs
- Allow improved hand function where there is underlying movements
- Assist with postural management and seating
Spasticity is complicated to treat and requires a team approach. At NPP we have a highly skilled team that includes a Consultant Physician that can prescribe and discuss oral antispasmodic medication which may include Baclofen, Dantrolene or Tizanidine. We also have a number of clinicians that can inject with Botulinum Toxin-A using Ultrasound, Electromyography (EMG) and E-stim, where necessary, to ensure accurate localisation of the muscles.
The indication for injections is where the spasticity is more focal; affecting a group of muscles such as the forearm flexors. This results in the fingers being pulled into a fist. In extreme cases this causes pain and the palm to sweat causing an offensive odour. Where there is underlying movement the Botulinum Toxin-A can reduce the spasticity sufficiently enough to allow underlying movements to emerge. Increasingly, using accurate localisation, it is possible to sculpture using BTX-A significantly improving hand function where there is already well demonstrated movements.
As testimony to our skill level, we have been asked by the pharmaceutical industry to teach doctors, physiotherapists and allied health professionals, the advanced skills which they require to inject patients, safely and competently.
Subsequently we have written a seminal text book on localisation techniques, which is widely used in clinical practice across UK and Europe.
Please see the images below for more photos of Botulinum Toxin-A injections;