Botox Information Sheet
Frank S. Pidcock, M.D.
Botulinum toxin, BOTOX©, is a medicine that can be used to decrease tone or unwanted spasms in a specific muscle or muscles. It does this by stopping the impulse between the nerve endings and the muscle which would otherwise produce muscle contraction. Botulinum toxin is the same toxin that can cause botulism, a form of food poisoning. It is however, given in extremely small amounts and is placed directly into the muscle effecting only the area it has contacted with. The medication itself is painless and not known to leave any painful sensation after it is given.
The procedure involves multiple needle injections and is likely to be anxiety producing for your child. There are a number of things that can be done to lessen the discomfort of the procedure.
- A cream, EMLA, that will numb the skin surface can be placed on the anticipated injection sites. This cream needs to stay in contact with the skin for a minimum of one hour in order to be effective, therefore, it is covered with a clear adhesive bandage and then removed just prior to injection.
- Age appropriate toys and dolls that help explain the treatment and help distract the child are available. Music, a favorite blanket, or any item that is normally comforting to your child are welcome.
- We have found that the combination of EMLA with appropriate preparation is very successful in decreasing the level of anxiety and the amount of discomfort.
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. Depending on the goals after the injection, the physician may order serial casts or may ask for changes in the Physical Therapy Program.
We would, however, encourage you to call at any time if you have questions or concerns about your child’s response to the procedure. You will probably be asked to schedule a follow up clinic appointment after the injection so the results can be adequately evaluated.
You may begin to see results 24 hours after the injection, but usually not for two or three days. Maximum effects are seen between one and two weeks after the injection and will probably last for several months. Some examples of changes you might see in your child include improved range of motion, greater ease in stretching, improved tolerance to wearing braces, developmental gains e.g. crawling, standing, or specific gait changes. Every child is individual and outcomes will vary. When the BOTOX© begins to wear off, you should discuss with your doctor whether repeated injections are the appropriate treatment in achieving your child’s goals.
A video tape documenting your child’s functional ability or gait pattern will be taken just prior to injection and at the time of follow up for comparison.
Many medical plans are not yet familiar with this treatment option. If you are unsure about what your plan would cover, please contact them to see if prior approval is needed. There is also a Patient Services Representative available at Kennedy Krieger Institute to assist you in this area if needed.
Frank S. Pidcock, M.D. is a pediatric rehabilitation medicine specialist and Associate Director of Pediatric Rehabilitation at the Kennedy Krieger Institute. He is available for consultations regarding the use of BOTOX® and other treatments for the management of spasticity in children. He can be reached by calling 443-923-9440.