Cerebral Stroke and Spasticity: Botulinum Toxin Treatment
What is spasticity?
Spasticity is a neurological symptom and sign that occurs when certain muscles become overactive, causing muscle stiffness, rigidity or spasms. Increased muscle activity presents as reduced relaxation of the muscle and successive contractions. If spasticity develops, it causes serious movement restriction, pain, poor posture and joint limitation, and leads to a decline in quality of life marked by the inability to perform many activities, weakened personal care and inadequate hygiene.
What conditions cause spasticity?
Stroke and other brain injuries (trauma, anoxic-hypoxic injury, etc.)
Spinal cord injury
Multiple sclerosis (MS)
Cerebral palsy (brain damage occurring for any reason before, during or after birth)
Other neurological disorders that damage the brain and spinal cord areas related to movement.
What is the approach to spasticity treatment?
Spasticity treatment involves a multidisciplinary approach. It consists of physiotherapy applied together with drug therapy.
Treatment is evaluated individually for each patient and treatment goals are determined.
Treatment options are reviewed considering the severity, distribution, duration and tissue damage caused by the underlying diseases.
Patients should be treated at centers where clinicians with adequate training, patience and experience work, and where adequate equipment and facilities are available.
When planning treatment, evaluating the patient together with their family and caregivers is very important for establishing realistic goals and outcome expectations.
Use of Type A Botulinum Toxin in Spasticity Treatment
Today, botulinum toxin application in spasticity treatment is an effective, safe treatment option with few side effects that improves the patient's functional capacity together with physiotherapy, and it is beneficial with long-term use.
What is Botulinum Toxin Type A and how is it administered?
It is the trade name of botulinum toxin obtained in a laboratory from the bacterium Clostridium botulinum. When injected into muscles in small amounts, it is an effective therapeutic agent for treating spastic muscles with excessive muscle activity.
Muscle and joint examination is performed for the injection site, and injection is made into the muscle body following anatomical assessment.
It is injected directly into the spastic muscle at several points close to the nerve endings. The drug acts at the nerve endings by blocking the release of the neurotransmitter called acetylcholine, and the muscle no longer contracts as it did before.
With repeated doses, prolonged effect is achieved and improvement in the condition is obtained. The decision to repeat injections and their frequency are determined according to the patient's response to treatment and the improvements observed.
When does the effect of Botulinum Toxin begin?
Its effect begins within 1-15 days after application and reaches its maximum level in 1-1,5 months. It lasts an average of 3-4 months. With repeated injections, an increasing effect emerges. It is recommended that at least 3 months pass between injections.
What Are the Side Effects of Botulinum Toxin?
As with all drugs, some side effects may occur. Most of them occur within the first week after application, are generally mild to moderate in severity, and are temporary. Pain and tenderness at the injection site and bruising may occur. In addition, rarely reported side effects include flu-like symptoms, joint pain, headache, skin rash, nausea and dizziness.
What Can Treatment Offer?
Taking into account the severity of spasticity, it is very important to be realistic about what is possible and to set goals accordingly. These goals include:
Better balance, mobility, sitting and positioning,
Less fatigue,
Becoming able to meet one's own needs (eating, dressing, cleaning oneself, etc.),
Preventing muscle and joint problems,
Fewer pressure sores (bedsores) developing,
Reducing problems caused by contractions,
Reducing pain and improving sleep by increasing comfort,
Correcting body image through cosmetic changes,
Increasing the effect of physical therapies.
Updated on 18.05.2015.
