What is botulinum toxin?
Botulinum toxin is produced naturally by bacteria. When purified, it can be used in small, controlled doses to reduce muscle stiffness and pain. For approximately 15 years it has been used in the treatment of several conditions including cerebral palsy.
How does it work?
When botulinum toxin is injected into a muscle it blocks the messages between the nerve endings and muscle fibres at the injection site. This block causes local muscle relaxation around the injection site, within two to three days, with peak relaxation at two to six weeks. The chemical effect may last for three months. However, some benefits may last longer.
Are there any side effects?
Like other prescription medications, botulinum toxin has some associated side effects. However serious side effects are rare. The dose injected will be carefully calculated according to your child’s weight to reduce the chance of these happening.
The most common side effects reported are:
- Weakness of nearby muscles. In the short term some young people find walking or functional activity more difficult, this usually quickly resolves.
- Soreness and bruising at the injections site.
- Mild flu-like symptoms in the days after the injections.
- In children receiving injections around the hip, temporary difficulty with bladder control.
What are the benefits?
Research has shown that botulinum toxin is an effective treatment for children with muscle stiffness. Studies have reported improvements in walking, range of movement and pain.
These improvements are maximised when botulinum toxin is used in conjunction with advice from your local physiotherapist regarding stretching and strengthening, a short-period of casting (usually two weeks) and using recommended splints.
Assessment for treatment
To select which muscles require treatment the team will review your child’s current progress with local services and perform a detailed clinical examination. A video assessment may be needed.
Receiving injections
The injections can be uncomfortable and your child needs to stay still. So pain relief and sedation is usually prescribed. There are three types of sedation:
- Oral sedation with midazolam – this will make your child drowsy and forget the procedure. They will need to stop eating at 10.00am and have no clear fluids after 12.00pm (midday) on the day of their procedure.
- Entonox® (gas and air) – this is most suitable for older children.
- A general anaesthetic is very occasionally required.
Approximately one hour before receiving sedation the team will apply numbing at the site of injection to reduce discomfort. In older children, a local anaesthetic spray may be used.
Following Injections
- There is no need for any restriction of activity following injection but children who have received oral sedation may be sleepier than usual and should not return home on public transport.
- Children should be able to return to school the next day as long as they have recovered from the sedation.
- If your child takes any regular medication, this should be continued as normal.
- Your child’s local therapists will be informed by the team of your child’s treatment.
- Please contact your local physiotherapist to arrange an appointment, if possible try let them know you are coming to clinic for assessment or treatment.
- If your child is unduly sleepy or difficult to rouse seek further medical support.
Follow Up
Following the injections you will be invited to attend an appointment to assess your child’s response to treatment; approximately two months. It is important to attend this assessment to maximise the benefits of treatment for your child.
Posture and Gait Assessment Team
If you have any questions please contact a member of the team.
Dr Anita Devlin 0191 2821385 Consultant Paediatric Neurologist
Dr Yasmin de Alwis 0191 2821385 Consultant Neurologist in Paediatric Neurodisability
Dr Ki Pang 0191 2821385 Consultant Paediatric Neurologist
Mrs Helen Rowland 0191 2823452 Clinical Lead Physiotherapist
Mrs Amy Tears 0191 2823452 Senior Paediatric Physiotherapist
Contact
Child Development Centre: 0191 2824751 (Monday – Friday 8.30am – 4.30pm)
The Patient Advice and Liaison Service (PALS) can offer on-the-spot advice and information about the NHS. You can contact them on freephone 0800 032 0202
