Botulinum Toxin for Spasticity

Botulinum toxin is a protein that helps stop muscle spasms by blocking chemical messages sent from the nerves to the muscles.

It may be used to treat muscle spasms associated with focal dystonias (cervical dystonia, blepharospasm) or spasticity that may result from cerebral palsy, spinal cord injury, or multiple sclerosis.

In general, botulinum toxin is not used to treat widespread severe spasticity because the amount of toxin required would be too great and increase the risk of side effects. High doses of botulinum toxin also increase the risk of developing antibodies that would make the treatment ineffective (see below). However, selected spastic muscle groups can be treated to provide improve function.

What types of botulinum toxin are available?

There are several branded formulations of botulinum toxin used to treat neurological disorders, including:

  • Botox® (onabotulinum toxin A)
  • Dysport® (abobotulinum toxin A)
  • Myobloc® (rimabotulinum toxin B)
  • Xeomin® (incobotulinum toxin A)

Each form of botulinum toxin is unique, with its own safety, and efficacy. Your doctor will choose a botulinum toxin based on several variables including the location of the injections, cost, and a person's individual response to past injections.

How long to the benefits of botulinum toxin injections last?

The benefits of botulinum toxin usually last for 3-6 months, with a maximal effect for 2-6 weeks after injection.

Botulinum toxin is usually not injected again into the same muscle until after 3 months have passed.

How are botulinum toxin injections given?

Botulinum toxin is mixed with saline (salt water) and injected into the muscle with a tiny needle.

The number of injections given varies depending on the size and location of the muscles being treated.

What are botulinum toxin antibodies?

After the body has been exposed to botulinum toxin, it's immune systme may start to identify the toxin as a foreign substance and develop antibodies against it. These "neutralizing antibodies" or "NABs" bind to the toxin and make it ineffective.

The presence of neutralizing antibodies may be suspected if the benefits of treatment start to fade after multiple use.

The creation of neutralizing antibodies is more likely to occur after multiple treatments or the use of large doses of botulinum toxin. It is therefore recommended that a person receive the small dose of botulinum toxin necessary to achieve the treatment goal and expand the interval between treatment sessions as long as possible.

If the presence of neutralzing antibodies are suspected or proven with blood tests, an alternative form of botulinum toxin may be used.

What are some side effects of botulinum toxin injections?

You might have soreness at the injection sites. If your injection sites get sore, you can take acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®). You can also put an ice pack on the painful area.

You might also experience dry mouth, blurred vision, mild flu-like symptoms, weakness in the muscles that were injected, or difficulty swallowing or a red rash that lasts several days after the injections. Call your doctor immediately if any of these symptoms develop are concerning to you.

Botulinum toxin should be used with extreme caution in people with neuromuscular diseases such as myasthenia gravis or amyotrophic lateral sclerosis (Lou Gehrig disease) or in those taking certain antibiotics (aminoglycosides).

Are botulinum toxin injections safe?

Botulinum toxin is made by the same bacterium that causes food poisoning. A high dose of botulinum toxin could be fatal, just as food poisoning can be fatal. However, the dose given in injections is so small that you probably won't have any harmful effects from the toxin.

Botulinum toxin has been used safely in thousands of people for more than 10 years.

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Last updated: 5/14/2020